Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

Get Accurate Lab Tests While on Thyroid Medication

How To Get Accurate Lab Tests When Taking Thyroid Medications

Medically reviewed and written by Izabella Wentz, PharmD, FASCP on September 29, 2017

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I’ve been getting a lot of messages from people who began to feel hypothyroid after having their thyroid medications reduced based on a faulty lab interpretation.

One lady began to lose her hair in clumps, and another became nearly bedridden!

What all of these people had in common was that they were feeling great on a regimen of T4 and T3 medications, then found to have a low TSH (suggestive of hyperthyroidism or overdosing) on a monitoring test, which prompted their doctor to reduce their medications. Severe hyperthyroidism can be a life-threatening situation, and doctors worry about even slight hyperthyroidism due to its effects on the heart and bones.

Thyroid hormones are “Goldilocks” hormones, meaning the dose has to be “just right” for us to feel optimal. Doses that are too high or too low can result in symptoms.

Whenever I see a low TSH number in someone who is taking thyroid medications, my first question is always: “Did you take your thyroid medications before you had your thyroid labs drawn?”

Depending on the type and timing of medication, a person’s TSH number may be inaccurate.

Recommended Lab Tests

When first initiating treatment with thyroid medications for hypothyroidism, guidelines recommend testing thyroid function about 4-6 weeks after the start of the treatment to determine if the dose of medication is correct. It may be prudent to run these tests sooner and more often if the person was severely hypothyroid, hyperthyroid, or experiencing symptoms of either.

In addition to looking out for symptoms of hypothyroidism or hyperthyroidism, I also recommend lab testing to monitor. There are three main thyroid tests I recommend to measure your response to medications:

  • TSH – This is a pituitary hormone that responds to low/high amounts of circulating thyroid hormone. In advanced cases of Hashimoto’s and primary hypothyroidism, this lab test will be elevated, (read a post about interpreting this thyroid TSH test). In the case of Graves’ disease, the TSH will be low. People with Hashimoto’s and central hypothyroidism may have a normal reading on this test.
  • Free T3 & Free T4 – These tests measure the levels of active thyroid hormone circulating in the body. When these levels are low, but your TSH tests in the normal range, this may lead your physician to suspect a rare type of hypothyroidism, known as central hypothyroidism.

If your doctor does not order these tests for you, you can pay out of pocket and order them yourself through a company like Ulta Labs.

Slightly different rules apply to the timing of the lab draw based on the type of thyroid medication you are taking…

T4-Only Medications like Synthroid, Levoxyl, Tirosint, and Levothyroxine

T4 has a five to nine-day long half-life, which means that once you have become stable on it, it will take as many as nine days for 50% of the dose to clear the body. T4 has a slow and steady release and won’t produce many peaks or valleys that can make a person feel like they are on a thyroid roller coaster.

Whether you take T4 right before your lab tests or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test.

Same goes for free T3 levels when you take a T4 medication. The free T3 level will also be relatively constant.

Levels of free T4, however, will show a peak two hours after your T4 medication is given.

So let’s say you take your T4 medication at 8 am and have your blood test at 10 am – your thyroid labs may show that your T4 is falsely elevated, and this may result in your doctor lowering your medication, when in reality, your T4 levels may be within range for the rest of the day, with the exception of that 2 hour, post dose peak.

In most cases, taking a T4 medication the morning before your lab test will not be an issue, as most doctors adjust the dosages according to the TSH, which stays stable after T4 dosing. However, to get a reading of your T4 levels that is reflective of most of the day, you would want to postpone your T4 medication until after the lab test.

Combination Medication

If you’re taking a combination medication that contains T3, like Armour, Nature-Throid, WP Thyroid, compounded T4/T3, or the medication Cytomel (liothyronine), the timing of your tests does matter and may make a huge difference in getting you on an appropriate medication dose. This is because T3 has a half-life of only 18 hours to three days, depending on the person. In some, that’s less than a day for it to start rapidly declining in your body.

When scientists monitored the levels of TSH, free T3, and free T4 in people with hypothyroidism who were taking combination thyroid medications over a 24 hour period, they found that TSH levels may be falsely suppressed for 5 hours after taking a T3 containing medication. Right after taking a T3 containing medication, the TSH level begins to drop and stays suppressed for five hours. The TSH level then begins to increase again five hours after the dose and continues to rise until 13 hours after the last dose, after which point it stays stable. So in order to get an accurate representation of your stable TSH on a T3 containing medication, you would need to postpone your T3 containing medications until after your test—or wait 13 hours before testing!

Free T3 levels are also affected by a recent dose of T3 containing medications. T3 levels increase after the dose is given, and hit a peak at four hours after the dose.

This means that if you were to take your thyroid medication before getting your thyroid function tests done, your lab results might show that you are overdosed, even when you may be accurately dosed, or they may show your labs to be within normal limits when you may be truly under-dosed.

Thus, it is usually best to postpone your combination medication until after you get your lab tests done. I recommend getting your thyroid function tests done first thing in the morning, bringing your medications with you, and taking them right after you have your thyroid function tests to ensure that you get accurate test results.

**Please note, the half-life of the medications may vary per person, so some people may have a falsely suppressed TSH, even at the euthyroid state, when taking T3 containing medications.

This is when free T3 and T4 testing will come in handy, as well as of course, looking out for symptoms of hypo- or hyperthyroidism.

For even more help with your medications, download my Optimizing Thyroid Medications eBook for FREE below!

P.S. Be sure to sign up to my email list to get a free book chapter, recipes, the Thyroid Diet start guide and notifications about upcoming events and my weekly newsletter.  You may also want to become a part of our Facebook community to interact with us and other Root Cause Rebels!

References

  1. Saravanan P, Siddique H, Simmons D, Greenwood R, Dayan C. Twenty-four Hour Hormone Profiles of TSH, Free T3 and Free T4 in Hypothyroid Patients on Combined T3/T4 Therapy. Experimental and Clinical Endocrinology & Diabetes. 2007;115(04):261-267. doi:10.1055/s-2007-973071.

Note: Originally published in August 2015, this article has been revised and updated for accuracy and thoroughness.

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Comments

  1. My tsh is .110. My t3 is 1.93. My free t3 is 5.06. And t4 is 5..93 do do i need increase or decrease. I am on armour thyroid but going to switch to combination different. Feeling slugish sleepy tired and hot
    Reply

    • Brenda- I’m afraid I can’t comment on your lab results due to liability. I can tell you that while reference ranges of what’s “normal” may vary depending on the lab that produces the test reports, most thyroid patients feel best with a TSH between 0.5-2, and with Free T3 and Free T4 in the top half of the reference range. There are quite a few options for thyroid medications. In my experience, what works for one person may not work for another. If your doctor will not prescribe the medication you are looking for, ask your local pharmacist for doctors in your area who prescribe the medication you are looking to try. Have you read these articles?

      WHICH THYROID MEDICATION IS BEST?
      https://thyroidphramacist.com/blog/which-thyroid-medication-is-best

      TOP 11 THINGS YOU NEED TO KNOW ABOUT THYROID MEDICATIONS
      https://thyroidphramacist.com/blog/top-11-things-you-need-to-know-about-thyroid-medications

      Reply

      • I’m pregnant and when I took my thyroid test I was sick and hadn’t eaten breakfast yet. My TSH was 0.07 which seems pretty low. My free T4 came back at 1.5.
        Should I be worried?

        Reply

        • Monique – Thank you for following this page. Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. Every six weeks is usually a good schedule for testing your thyroid hormones.

          These are the recommended labs from my book, page 32.

          RECOMMENDED THYROID FUNCTION TESTS

          * TSH
          * TPO Antibodies
          * Thyroglobulin Antibodies
          * Free T4
          * Free T3
          * Reverse T3 (Optional)

          Have you read my book, Hashimoto’s The Root Cause? Here’s the link in case you’re interested:
          http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

          Hashimoto’s Protocol:
          thyroidpharmacist.com/protocol

          Reply

  2. Not a doctor, but that freeT3 is REALLY high. Sounds to me like you need to decrease. Especially if this test was done before taking your dose.
    Reply

  3. Question: My 6 year old does experience the peak on Synthroid. What would that indicate to you? She is taking very low doses (alternating days 6.25 and 12.5 mcg) and it is controlling her tsh, t3 and t4 are great and prolactin is now in normal range as well. (She has already tried natural Erfa and it caused her t3 to elevate and her liver enzymes as well.)
    Reply

  4. Question: Have you written any articles addressing the issue of natural thyroid meds and their effective suppression of TSH? It would be very helpful to have some credible sources supporting the idea that it is not always dangerous to have a very low TSH. I ask because my doctor has reduced my dose of Nature-throid several times over this last year, trying to bring my TSH into the “normal’ range. The problem is she is ignoring symptoms in pursuit of this number. I know there are thousands of patients out there like me, being kept sick because the AACE/ATA have decided that we all must fit into their arbitrarily constructed limits, without regard to real need. And many doctors are facing legal repercussion for thinking outside those limits. It would help all of us to have resources we can use in construction of the argument for health.
    Reply

  6. I was just wondering why I get anxiety so bad when I take levothyroxine. I’m wondering if it’s too much medicine but now I’m down to cutting 50 mgs into four pieces and taking it 4x a day but still having heart palpitations and anxiety! I Started 20 years ago with hyperthyroid and now hypo it’s so frustrating!!
    Reply

  7. It is likely your adrenals are in great need of support. Low adrenal output is common with low thyroid and visa versa. It is important to take the necessary vitamin, minerals and herbs and sometimes it is necessary to have either DHEA, Pregnenolone or Cortisol too but these should be taken under medical advise. Cortisol at physiological doses only. Once the adrenals receive appropriate support you will tolerate better the thyroid hormone and the anxiety will improve. Look up Adrenal Fatigue…..a book Adrenal Fatigue A Desk Reference by Dr Salmaan Dalvi is an excellent resource providing detail about the necessary vitamins and minerals, herbs etc. Dr Barry Durrant-Peatfields book will describe detail of adrenal support using physiological Cortisol. Start by having a 4x diurnal salivary test which tests Cortisol and DHEA. This problem happens to many of us with low thyroid hormone – physical, emotional and psychological stress including illness will impact the Adrenal glands. Furthermore, The adrenal glands need thyroid hormone to function and with low thyroid hormone as well as greater pressure due to body stress the adrenal glands cannot cope and suffer fatigue. Best of luck
    Reply

  8. This is very interesting. I am taking T4 meds. I have had T3, T4, and TSH tested by my endocrinologist. She would not test my rT3, so I got that ordered by my naturopath who told me not to take my meds the morning of testing. Is she correct? What I understand from your article is that it shouldn’t make a difference b/c it is only T4, not a combination. I have always taken my meds on the day of the draw b/c no one has ever suggested otherwise. Thank you.
    Reply

    • Diane- Whether you take T4 right before your lab tests, or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test. 🙂

      Reply

  10. i was diagnosed with pvc premature ventricular contraction ,i been on 112 mg of levothyroxine for years never had this but i feel as if i get upset or nervious or eat something i get these so called palpitations …any recommendations ?
    Reply

  11. I’m interested in your thoughts on taking Nature-Throid at night, as well. My APRN wanted me to try switching from Synthroid 100mg to Nature-Throid. I have Hashimoto. My previous Dr. kept my TSH suppressed in order to prevent the growth of two nodules in between the butterflies of my thyroid. In fact, my latest ultra-sound this spring showed they were completely gone. My first dose of Nature-Throid was 65mg. My first six week test results showed my TSH jumping from .861 to 3.840. My T3 (L-010389) went up to 4.7. She then dropped my NT to 48.75. This is a little scary to me. I’ve been doing this dose for about three weeks. I’m afraid I may end up a mess. I would like to know your opinion, as well. Thank you.
    Reply

  12. I’m interested in your thoughts regarding my thyroid issues. Has anyone else experienced this problem? I have been feeling more depressed every month and just didn’t feel normal for the last few months. I’m just miserable with myself! I recently had labs drawn and was in total shock when I saw my numbers on the report! T3 levels should be between 71-180… mine is 48. T4 levels should be between 0.82-1.77….mine is 0.77. TSH levels should be between 0.450-4.500.. mine is 13.230!! My doctor feels that I’m not absorbing my Synthroid now. I’ve been taking Synthroid for 23 years. Have you ever heard of this and what can I do to try to help my body to absorb the meds??
    Reply

  13. How long should one wait to recheck labs between dose adjustment. On WP Thyroid. ALL levels were low: T3, T4, TSH high, Free T3 low, etc. Dr wants to wait 3 months???
    Reply

    • Karla- Usually the person is started on a low-dose thyroid medication and
      the dose is increased gradually to normalize TSH, Free T4, and Free
      T3. This is to avoid a shock to the body of a huge, dramatic change
      and to determine the appropriate amount needed. After the initial
      starting dose, the TSH and Free T4/T3 are measured again in four to
      six weeks to see if they have improved. Testing TSH, Free T3 and Free T4 will help determine if you will need to have your dosage of medication adjusted. Testing TPO antibodies every 1-3 months may be helpful in determining progress from interventions. I hope you also check out my book! Here’s the link in case you’re interested.

      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  14. I’m so confused. I found out a little over a month ago that I have Hashimoto. I’ve been on Levothyroxine 112 MCG for about 5 years. My hair is coming out, weight gain and no energy. Luckily all my labs are online so I keep a record of all changes. My sister is the one that said she thought I had Hashimoto and I asked my doctor to run labs. Also very swollen face. So now I’m on Armour Thyroid. First month 60MG and now increased to 120MG. My labs seem very strange after the first month. Ferritin went up some 26.90 ng/mL. TSH ultra sen dropped some 0.959 mIU/L. Free T4 drooped 0.64 ng/dL Free Triiodothyronine pg/dL 4.6. Reverse T3 10.5. And before starting on Armour my antibodies 276 IU/mL. I’ve read Root Cause too. Great book!! I just don’t really understand all my labs. I’ve researched for hours. I’m just starting gluten free and dairy free. I just want to feel better, get this weight off, hair back and enjoy life! Yes, depressed too. The more I try to figure out all this, with not much results, the more upset I get. My GP is the only dr I’ve been to so far. I need to find an endocrinologist but I have no idea who to go see either. Any help would be greatly appreciated!
    Reply

  16. I take my medication at night, because it makes me nauseous in the morning. Should I not take them the night before my annual test?
    Reply

    • Melanie- Whether you take T4 right before your lab tests, or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test. Or if you take a combination…if you were to take your thyroid medication within 5 hours of getting your thyroid function tests done, your lab results may show that you are overdosed, even when you may be accurately dosed, or they may show your labs to be within normal limits, when you may actually be under-dosed. Thus, it is usually best to postpone your combination medication until after you get your lab test done. I recommend getting your thyroid function tests done first thing in the morning, bringing your medications with you, and taking them right after you have your thyroid function tests to ensure that you get accurate test results.

      Reply

  17. My PCP told me I had the highest hashimoto lab value he had ever seen! Due to biopsy of abnormal cells I had a total thyroidectomy. I recently was told by a different physician that if my thyroid was out I do not have hashimoto anymore. Very confused! Wouldn’t I still have symptoms!?! I am talking Nature throid.
    Reply

    • Sheila- Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.

      HASHIMOTO’S ROOT CAUSE BOOK
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  18. I am so glad I came across this web .I have been hypothyroid for over 20 years . About a year and a half ago I really start to have problems with my thyroid after being on oral and inhaled steroids for bronchitis it seems to have thrown my thyroid for a loop and we can’t get it back under control. I started to loose weight very rapidly , hair falling out ,I dropped 15 lbs in 2 weeks sure enough my TSH was way off then they started changing my doses and It has been a roller coaster ride since . They cannot get my thyroid doses under control .I started to get bald patches on my head ,my skin is so dry and now I have been having bouts of awful fatigue .My weight came back to where it was an then I gain 10 lbs more. One other symptom I start feeling pressure almost in my chest kind of anxiety like symptom I guess.( Docs tested for heart issues all came back negative) It only happens once in a while but this symptom is the pits really feel physically awful and can flair up off and on for days then go away for many ,many months I feel like I am having symptoms of hyper and hypo at the same time .

    Reply

    • Mary- Did you know that if you live in the United States, the UK, Australia, Europe and most developed countries that add iodine to the salt supply and take thyroid medications, there’s a higher probability that you do have Hashimoto’s?

      Depending on the source, estimates are that between 90-95% of those with hypothyroidism have Hashimoto’s.

      But most doctors will never tell people that they have Hashimoto’s, or that their own immune system is attacking their thyroid. People are told that their “thyroid is sluggish”, and that these things happen with age and “Just take this pill, you’ll be fine.” Hair loss is a distressing symptom experienced by women with Hashimoto’s. For women, our hair represents our femininity, and losing our hair is a constant reminder that something is off and that we are not well. Have you read these articles?

      HAIR LOSS AND YOUR THYROID
      https://thyroidpharmacist.com/articles/hair-loss-and-thyroid
      10 MOST HELPFUL DIY INTERVENTIONS FOR HASHIMOTO’S
      https://thyroidpharmacist.com/articles/10-most-helpful-diy-interventions-for-hashimotosaccording-to-my-clients

      Reply

  19. Have you ever heard of this I went from 1 grain all the way up to 3 grains of ndt over the course of 2 years. The only thing that went down was my tsh the t3 and t4 stayed the same! I was tested for rt3 and antibodies both came back negative. No one has a clue

    Reply

  20. Hi, I am on 150mg of Thyroxin for my Hashimoto’s. I am overdue for my yearly blood test but forgot to take my medication for two days recently, I then took 200mg on two consecutive days. how long should I wait for the blood test to ensure my levels have stabilised. I see you mention 4-6 weeks after starting medication the levels will have stabilised, is this a good guide for me to wait before my blood test? Any advise would be appreciated? Andy

    Reply

  21. I have only been on Nature Thyroid 48.75 for 2 days only, How long does it take to effect my levels, I had another blood test did this morning, I did not take a pill this morning before I had another series of blood work done for a second opinion to see if I was hypothyroid.will it effect the results?

    Reply

  22. I have only been on Nature Thyroid 48.75 for 2 days only, How long does it take to effect my levels, I had another blood test did this morning, I did not take a pill this morning before I had another series of blood work done for a second opinion to see if I was hypothyroid.Will it effect the results? Also I am suppose to have an ultra sound did Monday which is 4 days away, If I continue with meds will that effect outcome of scan ?

    Reply

  23. Thank you I only recent found out I have hypothyroid at 57. Just increased to 125 MG of generic senothyroid misspelled forgot to take my labs the morning of the blood test doctor said we needed to up the mess to 125 MG based on what you wrote missing the one dose wouldn’T change anything . Thank you.

    Reply

  24. Hi,

    May I ask please, I wanted to know, it takes TSH test six weeks to converge to it’s true value after changing the dose of T4 medications, from the first week of changing the dose of Levo till the end of the sixth week, how does TSH behave in this interval?

    If I am slightly hyperthyroid with only 50mcg per week more than what I need and reduce the dose, by how much does the TSH increase each week until the six weeks interval?

    If there is no exact answer to this question, can give something close to exact!?

    Thank you very much,

    Reply

  25. My question is I think my thyroid tests have increased over the years. At what point even though they say your results are good do you push the issue of the them climbing? My T4 was 1.17, my TSH 3rdGen results have been 4/2003 2.080, 5/2005 2.693, 6/2007 1.844, 6/2008 1.600, 10/2012 .964, 5/2013 2.030, 9/2013 2.096, 3/2015 1.005 (was diagnosed with AIH at this time), 3/2016 2.375, 1/2017 3.382
    On 1/2017 was diagnosed with Fibromyalgia but I don’t believe thats whats going on here. Cant thyroid issues have the same symptoms of fibromyalgia? I also was diagnosed March of 2015 with Autoimmune Hepatitis.

    Reply

  26. What about us persons with thyroid cancer. I often wonder how accurate our labs are being we had a thyroidectomy.?.
    I’m on tirosint and low dose cytomel. Recently my endo (whom I’ve now fired), lowered my tirosint because “you’re too high.” Her words. I understand thyroid cancer patients are kept suppressed as part of cancer tx. And fully disagree with my med reduction. I lost my job now, am not functioning 80%. And getting worse as the weeks go by.
    My pcp agreed to take over my meds but wants to wait the 6-8 weeks to get an accurate reading. Feb 22nd is in that time frame. I fear I cannot wait that long as my thoughts are getting darker….but, I am going to skip my meds that morning and take after my labs. Do you have any “suggestions” (I’m not ok with NDT, Armour etc…not yet)

    Reply

  27. Hi.
    I am on 112,5 mg of Levothyroxin for my Hashimoto’s.
    Please help me how to interpret this lab results?
    TSH 0,9330 mUI/L
    FT4 1,20 ng/dL
    FT3 2,87 pg/mL
    ATPO 750,0 UI/mL

    Thank you!

    Reply

  28. I am taking Cytomel (T3) only at midnight, no T4 at all. Since I’m not a morning person, I don’t see myself having blood drawn before noon. Should I skip my Cytomel dose the midnight before my test to get an accurate free T3 lab test? Or will taking Cytomel at midnight be OK since the test will be at least 12 hours since my last dose? Will taking a midnight dose of Cytomel affect a TSH level drawn at least 12 hours later? Thanks for your reply.

    Reply

  29. I live in a very small town without access to a functional medicine doctor. I have the Thyroid Secret Gold, Love it! and I’m committed to healing. I’m allergic to most foods, have multiple chemical sensitivity, Sjogrens and Raynaud’s with Hashi’s, at the end of the line. Can’t afford to lose more foods. My GP is happy to run tests for me but admits he can’t interpret them (he likes your book!) What do you suggest? Oregano oil, bone broth, lemon and ACV, essential oils, proteins, even the capsules from Seeking Health supplements give me a reaction (pine cross reactive with peanuts I’m told.) At this point my husband doesn’t believe tests are worth the finances or stress, with no one to interpret them and nothing I try helps. Considering working with a doctor from “The Thyroid Secret” but who to choose? Clearly the typical diets and treatments don’t work for me. Do you think you could help me heal, are you taking patients one-on-one, is there someone else you can direct me to? Thanks.

    Reply

  30. I just started WP thyroid less than 1 month ago prescribed by my primary care physician (based on TPO antibodies confirming Hashimoto’s & TSH being 3.88 – I’ve had Hashi’s since 2012 but never been prescribed thyroid medication). I felt GREAT the first week (lost 4 lbs doing same eating plan/exercise plan I’d been doing for previous 3 months), energy back, joint pain almost gone & swelling/puffiness down. But within 1 week, all symptoms back. I thought maybe a dose increase was warranted, but the PCP won’t increase the dose so I started seeing a Naturopath who is requesting full panel of blood work and specifically said she wanted me to take WP the morning of my blood work. I told her what I’ve read online (your article, Dr. Alan Christiansen & others) – who all say test before taking the thyroid medicine. The NP said that’s normally true but in this case they wants to see what the medication is doing to my body (they didn’t say what specifically they are looking for). Is there ever a time when you would test labs within 3-4 hours of taking the medication or does this NP sound like they may be mis-informed and/or just trying to run a bunch of labs to make money?

    Reply

    • Kathy – Please, understand that due to liability issues, I am unable to answer specific medical questions.

      A couple of years after my diagnosis, I found Hashimoto’s 411, a closed Facebook group run by Alice Berry McDonnell. This group is amazing! It is comprised of an army of highly motivated, smart, supportive women and men (now 45,000+ strong), and each of them sharing ideas of what worked for them, things they were planning to try, and offering support to one another. The comfort I received from knowing that there were others going through the same challenges as I, was enormous.

      https://www.facebook.com/groups/hashimotos411/

      Ask questions. Post your thoughts. Scan the files. It is an absolutely amazing resource. Best of all it’s kept private from spammers.

      Reply

  31. I had been stable on naturethroid for the last 4 years. This past November my doc suggested I try a compounded t4/t3 formula. I felt great on it but my TSH wouldn’t stabilize and was at 5 last time we checked even tho we had previously increased the dose. We switched me back to naturethroid as I’m trying to conceive and TSH needs to be at 2 or lower. I’m feeling absolutely terrible after switching back. It’s been about 7 days sinced I switched. Would appreciate any insight into why my TSH wouldn’t stabilize on the compound and why I feel so bad after switching back. Many thanks for any thoughts.

    Reply

    • Emily – thank you for following this page.

      Please, understand that due to liability issues, I am unable to answer specific medical questions.

      In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  32. Hello,

    Thanks for the helpful information. I am currently prescribed Nature Throid and I am scheduled to have my thyroid levels re-tested. The previous tests showed suppressed TSH (0.14 and 0.02). My doctor was mildly concerned but didn’t change my dosage. I have begun experiencing hypo symptoms again, and I think my dosage might need to be increased. However, I am afraid she won’t increase it if my TSH is suppressed. Do you think skipping my dose on the morning I get tested will help it not be so suppressed? Or would I need to skip it for a couple days leading up to the test for it to not be as suppressed?

    Thank you!

    Reply

    • Megan – thank you for following this page.

      Please, understand that due to liability issues, I am unable to answer specific medical questions.

      In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  33. What about patients who have/had thyroid cancer and do not have a thyroid? How do we know we are properly medicated for optimal living if doctors (I’ve been to over 15 now in 2 years because they are focused on tsh only) are tsh only focused? Do we take our meds before tests?

    Reply

  34. I am going for a physical in a few weeks & I am wondering exactly which tests I need to request that my doctor have done for an accurate account on my thyroid. I have been taking medication for hypothyroidism for over 25 years. I did go to an endocrinologist until 2 years ago-he retired. I’ve always had my TSH & T3 & T4 tests run. What else should my doctor be testing? Thank you.
    Carlotta

    Reply

  35. In your book, you mentioned that you’ve suggested to some of your patients taking thyroid meds at bedtime. I have started doing this with great results. I even sleep better. Thanks for the tip!
    Is it okay to take the nighttime dose prior to a blood test the following am? I am on Nature-Throi.

    Reply

  36. Wait, Cytomel may be cross-contaminated with gluten, is this currently still the case? I seem to have issues with conversion (relatively high in free T4 and low in free T3) and just started with Cytomel. First days I felt great! But than this horrible pain in my belly started (including problematic stools) with fatigue, which I associate with gluten contamination. I thought that I was contaminated on a birthday party, but could it relate to the intake of Cytomel?

    Reply

  37. “People with Hashimoto’s and central hypothyroidism may have a normal reading on this test.”

    One of the biggest risks for those of us with Central Hypothyroidism is most doctors’ obsession with TSH levels. When my free T3 and free T4 are at the bottom of the normal range, my TSH will still be close to zero. The TSH test simply isn’t a reliable indicator of thyroid function for us. But in 25 years of being hypothyroid, I’ve never been able to get an endocrinologist to order a thyroid panel.

    Reply

  38. I missed 3 days in a row of my Levothyroxin 175mg that I have been on for over 10 years. I need to get blood work done soon, but I was wondering how long I needed to wait after missing those doses. Thank you for your help!

    Reply

  39. Is there an optimal time to test thyroid function in relation to a woman’s menstrual cycle? I know that the optimal time to test for other female hormones is usually around the 19th or 20th day of a woman’s cycle. I have read that progesterone can affect thyroid sensitivity at the cellular/receptor level, so one would think that the fluctuations in progesterone during the menstrual cycle could influence thyroid function?

    Reply

  40. Hello,

    I just finished reading your article about accurate thyroid testing. My hubby skipped his NDT dose the day before and the morning of his thyroid blood test. He takes it in the mornings usually. Normally, he just misses the dose the day of testing and takes it after the blood is drawn. However, I have seen it said that because of NDT’s combined T3 and T4, that skipping the day before and day of testing is more accurate? His results are back and they are much lower all around. Actually, more relating to how he feels. Which is leading him to increase his meds. Thoughts on this?

    Reply

  41. Hello,

    I wae dx last September with hashis and hypothyroidism. I was put on NP thyroid for hypo, and I still have not hit a maintance dose. I split my dose daily at 7 am and then at 3 pm. I normally do my labs at 7:30 am, and hold my meds until after my lab. My last set of labs was done 8 hrs after my am dose because the nurse practioner said me.waiting till Am would give faulty readings. What is the appropriate time to do my labs for the most accurate reading, since I split my dose.

    Thank you,
    Jen

    Reply

  42. Hi
    Thank you for all the useful information you send.
    In the article above I am confused by this sentence:”So in order to get an accurate representation of your stable TSH on a T3 containing medication, you would need to postpone your T3 containing medications until after your test—or wait 13 hours after testing!”
    Should it be “wait 13 hours “before” testing!” ? Or am I misreading here?
    Thanks.

    Reply

  43. Hi, I m Anne. I m having hypopituitarism. Recently my hypothyroid became hyper. My cortisol went up to 729. At the moment having second test after redused lower dosage for both meds.

    My

    Reply

    • Anne – thank you for following this page. Unfortunately, I don’t have any current information available on this topic. However, I recommend working with a functional medicine doctor for Hypopituitarism. I also suggest talking with your practitioner about pituitary glandulars – like Cytozyme PT/HPT by Biotics. Graves and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto’s, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people)-Hashimoto’s results in hypothyroidism and is usually treated with Synthroid and replacement hormone.

      The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves have hyperthyroidism, and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on Synthroid as well.

      Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.

      We need to rebalance the immune system to prevent this (sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      You may also find this article helpful.
      ARE YOUR ADRENALS SABOTAGING YOUR HEALTH?
      https://thyroidpharmacist.com/articles/are-your-adrenals-sabotaging-your-health

      Reply

  44. Hello,

    I do not have access to Armour or any other T3, so I am using compounding T3 but having problems with it. It gives me stomachaches. Is it a common side effect from this medication? What might be happening?

    Reply

  45. Dr. Wentz,
    I was diagnosed with subclinical hypothyroidism and given NDT. The first time I tried the NDT I took 1/4 grain a day and felt hyper so I stopped completely for over a year. I finally decided to try again because my labs got worse. So we started very slowly. Half a 1/4 grain every other day, then moved up to half a 1/4 grain a day. The goal was to move up to a whole pill. I felt pretty wound up a couple weeks ago and started working out really hard. After a really hard workout I got a migraine and basically crashed for several days. I then started feeling better again and attempted to take a whole pill. It was too much so I went back down but still feeling a little wound up. So I went to get labs again. My TSH has gone UP! From 3.05 to 3.9. My T3 and T4 have also gone slightly down. What the heck?? I’m so confused and frustrated. My practitioner said it sounds adrenal related and maybe I should take an adrenal supplement and don’t increase my dose due to the hyper symptoms. I’m so lost. Thoughts?
    Thank you!

    Reply

  47. hello Thank you so much for this worth full info.

    Can you please tell me if want to see the level of :
    Vitamin A , E
    bacteria level (e.g. for which i should use Probiootics 50B) and selenium, which tests i should do or ask in Lab.

    Regards
    Momna

    Reply

  48. Interesting article that I just found! So much useful information!
    I am on NDT, and my latest labs showed FT3 levels of 3.6 (ref 1.7-3.7) 24 hours after taking any meds. Although that’s in range (just below upper normal limit), I have read that you should assume that FT3 levels were ca 20% higher on the previous day, meaning they were out of range…does that mean that I am currently overmedicated, although I feel absolutely fine and show now signs of hyperthyroidism? FT4 levels came back midrange and TSH suppressed.

    Reply

  49. Hi,
    I have been hypothyroid for 17 years and taken desiccated thyroid. At present I am on N.P. Thyroid since they first came out. For many years now even when my TSH and FT3 are in normal range my FT4 runs consistently at the lowest number in the range or 1 point lower. The only time it is in the normal range is when my TSH is high. My dr. tried to raise my meds to increase it but with disastrous results. So happy I found your website! Thank you.

    Reply

  50. Dr. Wentz,
    I’ve been struggling for several years to get to the bottom of my fatigue. Started with ferritin and B12 and then tried a tiny dose of NDT with a functional doc who doesn’t like to give T4. I tried many times to do the NDT even after a year of Ashwaghanda and I still get too amped up on it. I went to a regular endocrinologist and they gave me Synthroid and then Levothyroxine. The Synthroid made me so exhausted I was practically dead and the Levo is just so so (surprisingly). I don’t know what the heck is going on. I haven’t been able to get pregnant for 2 years with no known fertility issues. My TSH fluctuates between 2.5 and 3.1 and went up to 3.9 after 3 weeks on NDT. I’m thinking about doing a salivary cortisol test to see if that can give any insight. I’ve had cortisol and DHEA blood tests and they’re normal. Will a salivary cortisol test be accurate after I’ve been messing around with all these thyroid meds?

    Reply

  51. What about taking iodine before a TSH test? I have been taking a supplement that I found out has a high level of iodine and I am suppose to have my TSH tested this week. Will that affect the TSH test?

    Reply

  52. Very interesting article, thanks!
    I am doing well on Erfa Thyroid after suffering for years on T4 only drugs…it turned out I’m a poor converter, leaving me with insufficient T3 levels despite high-in-range FT4 levels.
    However, I only see my thyroid doctor once a year, and my family doctor is constantly telling me I need to go back on T4 only without delay to normalize my TSH (suppressed since starting NDT).
    Does what you say in this article mean that if I go to the lab more than 13 hours after taking medication containing T3, and the TSH is still very low (below 0), then I am in fact overmedicated (I take 5 grains daily and feel well on that, no signs of being overmedicated)?
    If, just to calm my family doctor down, I went off Erfa long enough for my TSH to rise to above 0.4 (ref ranges for my lab 0.4-4.0), how many days – or weeks – would that approximately take? I realize that, when you’ve had a suppressed TSH for a long time, it can take time for the TSH to rise…
    Also, if I decide to go down this road, would the best thing be not to take any thyroid hormone at all for a week or so (I guess FT4 levels would remain more or less stable during that time, or at least not decline dramatically?), or go back to T4 only? In both scenarios, how long do you estimate it would take for the TSH to rise above the lower normal limit? Sorry if this question sounds stupid, but I cannot take much more of this from my family doctor who keeps telling me I’m at risk for osteoporosis and heart disease…I just want him off my back!!!

    Reply

  53. My TSH is at 16.16 now, down from 97 in June. My G.P. Doesn’t test for T3 or anything other than TSH and in Aug. TPO which was 427. I was started on Synthroid 50, upped every 3 months to 100 by Nov. And yesterday to 125. I told him the near constant muscle pain and weakness, worse after waking and standing and when walking was getting me down. I fell into a closet the other day at work bruising my arm after standing up and taking a few shuffling paces until my legs entirely ‘stopped working’. He is not as concerned as I am about this, or about my weight still being 251lb. despite my best efforts, after ballooning to 266lbs. between Jan and June when diagnosed. He said I list more weight than he has following Weight Watchers since Apr. and to feel proud as it is so hard to lose when hypo. I think a lot was water, I’m not as puffy, and I’m not happy it feels like forever to lose an oz. I fluctuate from 254-248 up and down since Nov. Dry skin, hair loss back too. If I’m doing so well as per the Dr. Why do I feel so much worse and struggle so hard?

    Reply

    • Char – thank you for reaching out. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.

      We need to rebalance the immune system to prevent this (sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:

      Hashimoto’s Root Cause
      https://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Reply

  54. Also, I read that t4 meds have. 5-7 day half life, and you shouldn’t notice a missed dose or two. My Dr says it shouldn’t matter if you miss a dose. I haven’t but I have been late on taking it. I work 4 nights 11pm-9am (since Nov. I had been on 5 – 11pm-7ams for past 5 yrs) and am on call otherwise. I usually must have coffee when I get up, so I take my med 2 hours after I finish it, 1-2am, and eat 2 hrs later from then around 3-4am. Occasionally I am late if it is really busy, and swear I ‘know’ if I have forgotten to take it by how I feel physically. Is this because I still have a high TSH (16.16 down from 97) or is this all in my head? I swear it can’t be because sometimes the only way I know I didn’t take it is how ‘off’ I feel, which is different than the brain fog induced ‘did I take my med yet’ where I need to check the bottle.. I put 4 pills in the bottle when I work, 3 when on days off to keep track easily, with the remainder in a dark closet until needed. I originally would take the med @ 7:30am at home after work, as I was told to take it in the morning, but by 4:30am at work was almost non-functional from brain fog, muscle pain, and fatigue. My coworker with Graves reminded me my morning starts at 9:45pm. Through trial and error and worry about brain fog, coffee or food affecting the med the above works for me albeit a bit different than the norm. I don’t know if this is why I still feel as bad and sometimes worse than before I was diagnosed. I really seem to need coffee to get myself going, I have tried the med on waking up, coffee later, but don’t seem to function as well and have cut back drastically from 8+ cups a day before Dx to 2 when working, 0-1 when not. There is no difference in the way it feels if I have coffee or not if I am late taking my med. I sure can tell, usually after 2 hours I know it, but the Dr doesn’t believe this is possible.

    Reply

  55. Hi there,

    I´m taking Erfa since a couple of years.( I have Hashimotos and PCO/ lack of Progesteron and a low function of my adrenal gland) My former doctor always did the blood test in the morning before I took medication. The results were always fine to a bit to low regarding the T3. after pushing my adrenal gland it has been perfect.
    So far…

    As I´m now pregnant I was at the hospital recently. They took my blood 4 hours after I took my thyroid medications. The T3 was way to high. 10 Point something!! It doesn´t worried me that much as two weeks before at my doctors clinic my T3 levels were a bit to low 24 hous after my last medication. It seems that after taking medication I have too much T3, after 24 Hours I have a bit too less of it…

    it raised following question:
    This peak or overdose in the morning can´t be that good/healthy, right? I don´t feel any overdose symptoms but I´m pretty sure a healthy thyroid would not produce such peaks – so it can´t be that good? I think normally you should have a stable amount of it in your blood or is there a pattern regarding the time of day?
    Wouldn´t it be better if I split my medication in two portions? One for the morning, One for evening or bedtime? That could perhaps avoid peaks and low points?

    Second question:
    My TSH has always been supressed since I´m on medication. 0.1 or even lower. But my doctor said that´s fine while being on medication because he thyroid just has nothing to do when it gets the hormones from outside. Why should it produce stimulating hormones?
    Would you agree?

    thanks for your comments

    best

    Anita

    Reply

    • Anita – thank you for following this page. When you take your thyroid medication on the morning of your thyroid blood work and you are taking T3 medication, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning). It’s always best to speak to your functional medicine practitioner to evaluate your specific case, and whether you need more testing. Here is a research article which might help further:
      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  56. I normally take my NDT at 7 am. If my labs are usually at 9 am, is that too long of a wait (26 hours) if I wait to take my NDT after labs? Or should I take them the night before (13 hours prior)? Sorry, I’m a little confused.

    Reply

    • Lisa – thank you for reaching out. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      TOP 10 THYROID TESTS AND HOW TO INTERPRET THEM
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  57. When taking a combination medication T4/T3 what is the appropriate amount of time between last dose and blood draw? I’m really looking for a concrete time frame not just “don’t take medication morning of the lab draw”. Because that could be different person to person. Some may take meds once in the morning and some may take meds several times throughout the day. Someone who takes meds throughout the day will have t3 in their system closer to the next morning lab draw than the person who took a single dose the morning before. I hope I’m making sense. Thank you.

    Reply

    • Morgan – thank you for following this page. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      Reply

  58. I have recently started taking armour. I have an appointment to get my levels re-checked, it will be 6 weeks after beginning armour. However the only time they could see me to re-test was 4pm!! It seems from this article you are saying I should not take my armour that day? Even though the test is not until 4pm? Thanks so much for the clarification. I just want to make sure I do the right things to get the right dosage.

    Reply

    • Amanda – thank you for following this page. When you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning). This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  59. can I ask about doing the glucose tolerance test in patients taking thyroid hormone replacement, I mean should he/ she stop taking medications or just fasting but continue their medication even if the morning dose is 1 hr before the start of the test?

    Reply

  60. Hi,
    I have a question regarding t3 medication, cytomel. I have been on it for about 5 months now and have felt so much better on it along with tirosint. My question is: can taking a t3 medication make your tsh number not show up correctly even when your free t4 and free t3 are in normal range? I didn’t take my t3 medication before bloodwork and my tsh number was still 0.02.

    Thank you!

    Reply

  61. I have seen in some articles that being on thyroid medications can raise the cholesterol levels. By how much can it raise it? Is there a range?

    Reply

  62. Hi, I have been having symptoms for over three years and not knowing it could be my thyroid. First time was when I went to a gastroenterologist with severe stomach issues and after a colonoscopy and endoscopy finding ‘nothing wrong’ because I tested positive for celiac and crohns. My sister is celiac and my other sister has lupus. So he specifically said not to go gluten free, I did. I felt better Lost much needed weight and had energy for days! Then about 8-12 months later, started feeling tired again, thinning hair, irregular periods, very moody and hot flashes and night sweats. Went to my gyno and she put me a low dose birth control and again felt great! Energy for days again, everything seemed to be back to normal. Well after about the same time as before I started to have the same issues, tired, cold hands and feet(also this time episodes of shivering), migraines, forgetfulness, dry skin, irregular periods, bloating, weight gain, just to name a few. I have had my blood taken every year for three years. The last two tests show only my tsh and it was 2.114 uIU/mL then went to 1.640 uIU/mL and tested nothing else associated to my thyroid. Should I just ask for a referral to see an endocrinologist? I know this is a lot of information, but I am seriously just tired! I am a mother of 6 kids and I know when I am tired, this tired is just different and can’t catch a break and I don’t think I can handle my doctor telling it’s my age again! Thank you in advance.

    Reply

  64. Does it make a difference if you are on a T3/T4 medication as to whether you are fasting or not fasting? First time I did fast although they did not require it.

    Thank you.

    Reply

    • Cheryl – thank you for reaching out. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      Reply

  65. Hi
    I had thyroidectomy 17 months ago (pap cancer) and everytime I have labs my TSH drops to near non-existent and my FT4 and FT3 never change both sit in lower end of lab ranges. Everytime my TSH drops my Endocrinologist gets fruity telling im going to die from heart disease or have crumbling bones …. this freakish behavior comes from a Dexa Scan I had showing mild osteopenia….in fairness I had hysterectomy 15 yrs ago cancer and I was a heavy steroid user for autoimmune disease. This whole time I’ve felt fine no issues with hyper or hypo symptoms….Endo keeps lowering Synthyroid and I get more Hypo….Sick and tired of this any idea what or Why TSH keeps dropping?

    Reply

    • Grace – thank you for reaching out. Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications. However, this test can often times be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto’s, where the person affected may fluctuate between highs and lows. Additionally, when scientists first set the “normal” ranges of TSH for healthy individuals, they inadvertently included elderly patients and others with compromised thyroid function in the calculations, leading to an overly lax reference range. This resulted in people with underactive thyroid hormones being told that their thyroid tests were “normal,” based on this skewed reference range.

      WHAT TO DO IF YOUR TSH IS NORMAL AND YOU ARE ANYTHING BUT
      https://thyroidpharmacist.com/articles/what-to-do-if-your-tsh-is-normal-and-you-are-anything-but/

      Here are the tests you need for diagnosis. Most endocrinologists don’t run them all so you will have to request them. Make sure to request a copy of your labs as well.

      TOP 10 THYROID TESTS AND HOW TO INTERPRET THEM
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  66. Thank you for the article. From now on o will schedule my bldwrk for the morning as the bldwrk being correct is so important. My next apt is in two days as I’ll be out of meds and it’s at 330 Pm. I’m on a np, my dr said to take it but after reading this I’m thinking maybe I would get more accurate results if I didn’t.
    Also I’m wondering if my bldwrk was possibly interpreted wrong previously. I was previously put on cytomel and my hair starting falling out by the handful and I thought it was the medication but maybe it was actually the dose. Unfortunatley It’s also the first time I’ve been able to drop a couple of pounds since my hashimotos diagnosis 5 years ago. I had the Mrs switched because I didn’t think my poor hair could handle it.

    Reply

  67. Thank-you so much for all the information that you share. I do have a question though . . . what effect, if any, does Cytomel meds have on a FT4 lab? Just curious.

    Reply

    • Jamie – you are very welcome! Cytomel is T3 so it will read as Free T3 on your thyroid labs, it does not really have any direct effect on your Free T4 lab work. Taking T3 hormone replacement therapy will suppress your TSH. There is information about this available from the medication manufacturer. I hope that helps.

      Reply

  68. Wondering what would cause a free T 4 to always be low in the lab ranges while the TSH is normal or in a better range and the free T 3 is either above the mid point or in the higher ranges. My free T 4 always seems low. Yes have hashimotos. I am on NP thyroid. Will increasing the dose increase the T 4 or no?
    I have not had any iron tests done nor any saliva tests for cortisol issues.

    Thank you.

    Reply

    • Cheryl – thank you for sharing your journey. I don’t know your health history so, I cannot advise you. This is a great conversation for you to have with your healthcare provider. <3

      Reply

  69. Am currently on 90mg ERFA thyroid. I understand normal thyroid lab values will be different while on any NDT. Comments?
    RAI 39 years ago resulting in 38 years of Synthroid. Have not felt well for years. Nobody believed me until I started researching last year. When I went on NDT, it seemed to exacerbate latent illnesses. At a loss.
    btw – also have low saliva cortisol 4 out of 4 amongst many other symptoms Insomnia, Hypothyroidism, AFS, CFS, EBV reactivation, Essential Tremors, bacterial vaginosis, GA granuloma anulaire, muscle aches, arthritis, extreme fatigue, brain fog, anxiety, incapable of handling stress. Very proactive and self advocating in my illnesses but I am exhausted and desperately want to move forward to healing.

    Reply

    • Ingrid – thank you for reaching out and sharing your journey. I understand how hard this all is. <3 Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. How much thyroid replacement therapy is needed is unique and different for each person, so it's important to work with a functional medicine practitioner or a doctor, who can closely monitor your dosage and your progress. Every six weeks is usually a good schedule for testing your thyroid hormones. Here is a research article which might help further:

      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Without going into too much detail, the first of the crucial defining moments in my disease development may have started during my undergraduate studies at the University of Illinois. Due to the communal living setting of dormitories (and less than stellar hygiene habits of most college students), I had recurrent strep throat infections and even contracted mononucleosis, a viral infection caused by the Epstein-Barr Virus (EBV), which is implicated in triggering many autoimmune conditions. I received multiple courses of antibiotics as well as flu shots (which may be associated with EBV infections) and started birth control for menstrual cramps.

      Animal fats, broths, soups, and stews support the body’s ability to suppress the viruses. Monolaurin or lauric acid, one of the components of coconut oil, has been found to be active against the Epstein-Barr virus. Replication of many viruses including Epstein Barr is inhibited by glycyrrhizic acid, an active component of licorice root. Quercetin, Co-Enzyme Q10, N-Acetylcysteine, and glutathione were also reported to be helpful in chronic fatigue syndrome because of their anti-viral properties. It is my belief that this combination had a profound impact on my gut flora, and thus my immune system.
      I have an entire protocol dedicated to eradicating EBV in my new book, Hashimoto’s Protocol, starting on page 329, that you may want to check out!

      HASHIMOTO’S PROTOCOL
      http://amzn.to/2B5J1mq

      Reply

  70. hello I have small doubt about when to give blood test done before taking or after taking medication
    on fasting or with out fasting
    please kindly reply me by today I completed 6 wk medication as I recently diagnosed with slight raise in tsh

    Reply

  71. After years on tirosint for Hashimoto s, I started on Armour thyroid 3 months ago. My T 3 has always been low and the TSH most recently around .1. My doctor has ordered a tsh test to monitor me now. When I asked about a t3 she said she doesn’t monitor t3 for Armour patients. Does this sound right, it doesn’t make sense to me. I thought we whold want to see if the Armour improved my conversion of t4 to t3 and check those levels.

    Reply

    • Jody – thank you for reaching out. <3 I understand how frustrating this can be. Here are the tests I recommend for diagnosis. Most endocrinologists don't run them all so you will have to request them.

      ¨ TSH
      ¨ TPO Antibodies
      ¨ Thyroglobulin Antibodies
      ¨ Free T4
      ¨ Free T3
      ¨ Reverse T3 (optional)
      ¨ Thyroid Ultrasound (optional)

      I highly recommend that you work with a functional medicine clinician to be a part of your own health care team. It’s an entire medical specialty dedicated to finding and treating underlying root causes and prevent serious chronic disease rather than treating individual disease symptoms. I believe that everyone needs to find a practitioner that will let him/her be a part of the healthcare team. You want someone that can guide you, that will also listen to you and your concerns. You want someone that’s open to thinking outside of the box and who understands that you may not fit in with the standard of care. It's a good idea to ask some standard questions when contacting a new doctor for the first time. Something else to consider is you can work with a functional doctor remotely, via Skype. You could also contact your local pharmacist or compounding pharmacy, who may be able to point you to a local doctor who has a natural functional approach. But I encourage you to keep looking for the right one for you! Here are some resources you might find helpful.

      CLINICIAN DATABASE
      https://thyroidpharmacist.com/database-recommended-clinicians/

      FIND A FUNCTIONAL MEDICINE CLINICIAN
      https://ifm.org/find-a-practitioner/

      COMPOUNDING PHARMACIES
      https://thyroidpharmacist.com/database-recommended-compounding-pharmacies/

      Reply

  72. My T-3 levels were a a little low a couple of years ago. I am now on Cytomel. At the time my levels were initially low, I was not in good health with multiple injuries. I have osteoporosis and hence and concerned about taking too much T-3, if my “natural” T-3 levels have gone up since I am now in good health and without injuries. With my doctor’s permission, the last time I took my blood test I skipped my Cytomel for 48 hours, and my T-3 was normal. My doctor felt that meant all was well and that I should keep taking the Cytomel. I have on my own started taking 75% of my prescribed dose due to my concerns, and I feel fine.

    Would it be better for me just to skip Cytomel for only 24 hours and focus more on the TSH levels? Is it possible to have high normal TSH levels and still be causing bone density harm with T-3? What do you recommend to make sure I am not taking too much Cytomel for my osteoporosis?

    Thank you

    Thank you

    Reply

    • Tessa – thank you for reaching out and sharing your journey. <3 Please understand, I am not able to advise on what would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor.

      Reply

  73. Dr. Izabella,
    I am getting thyroid labs in 4 weeks to see if I need to remain on Cytomel. My naturopathic doctor says I should not take my Cytomel the morning of the test. However, my general practitioner says I need to be off of Cytomel for 4 weeks to get accurate labs. Who is correct?
    Thank you,
    Lily

    Reply

    • Lily – thank you for following! ❤️ If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication (such as Cytomel) on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3 or T3/T4 medication until after you do the test (try to schedule the test in the morning).

      Reply

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