My TSH is normal but I still feel terrible — the T4-only vs combination therapy war
So I’ve been on levothyroxine for like 3 years now and my TSH is always “perfect” according to my endo (around 2.5). But I still have brain fog, I’m cold all the time, my hair is thinning, and I can barely drag myself out of bed most mornings. I mentioned adding T3 to my doctor and she basically laughed me out of the office saying TSH is all that matters.
I’ve been doing my own research and it seems like some people just don’t convert T4 to T3 very well? And that’s why combination therapy or even NDT works better for them? My doctor refuses to even test my Free T3 levels saying it’s unnecessary.
Has anyone here had success switching from T4-only to combination therapy? Did you have to doctor shop to find someone who would prescribe it? I’m so tired of being told I’m fine when I feel absolutely terrible. Starting to think about just ordering some cytomel online at this point tbh but that seems risky.
Any experiences or advice would be appreciated. I’m 38F if that matters, been hypothyroid since my second pregnancy.
Girl I could have written this post myself. Took me 4 different endos before I found one who would actually test my Free T3 and Free T4, not just TSH. Turns out my T3 was in the toilet even though TSH looked great. Been on combination therapy for 8 months now and it’s night and day. My current doc explained that some people have issues with the deiodinase enzymes that convert T4 to T3, can be genetic or related to inflammation, nutrient deficiencies, etc. Definitely worth getting the full panel done before you make any decisions though.
TSH-only testing is so outdated but unfortunately still the standard. I’d push for Free T3, Free T4, and reverse T3 at minimum. Some functional medicine docs are more willing to look at the complete picture rather than just TSH. That said, don’t order prescription meds online without proper testing and monitoring – you could swing hyper really easily and that’s dangerous for your heart. Maybe look into whether selenium or zinc deficiency could be affecting your conversion? My naturopath had me supplement those and it actually helped a bit.
I switched to Armour about 2 years ago after being on synthroid for forever. My TSH actually went slightly above range (like 4.2) but I feel SO much better. My doctor monitors me closely with full thyroid panels every 3 months. The thing is, TSH is a pituitary hormone, not a thyroid hormone – it’s measuring what your pituitary thinks is happening, not what’s actually happening at the cellular level. Some docs get this, most don’t. MitochondrialEve is right that you prob need a new doctor who will at least TEST the other markers before dismissing you.
Just want to add that if you do find a doctor willing to try combination therapy, start LOW on the T3. It’s way more potent than T4 and hits fast. I started with just 5mcg twice daily added to my existing levo dose and my doctor adjusted from there based on how I felt and my labs. Also worth mentioning that time of day you take it matters – some people split their T3 dose, some take it all at once. It’s very individual. Definitely don’t give up though, there ARE doctors out there who treat the patient not just the lab values.