Suppressed TSH and peripheral neuropathy

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This topic contains 30 replies, has 12 voices, and was last updated by  Ileanaswibe 1 month ago.

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    I am 56, post-menopausal and was diagnosed with Hashimoto’s in Feb. ’11. I am free of most symptoms; however, I continue to have problems with both legs that I believe are consistent with peripheral neuropathy (tingling, pinprick pains, pulsing, weakness). I do have an appt with a neurologist in 2 months, but I want to increase my TH dosages now and see if my legs improve. My endo is young and open to my involvement with my treatment, but of the TSH school so I know there will be some resistance. I am osteopenic, so we are concerned about that. (However, a recent bone scan showed improvement from -2.1 to -1.6.) My Nov. ’11 labs were TSH .118, free T4 1.6 and free T3 2.8. I have never had reverse T3 done. Since I began treatment 10 months ago, the only time I had NO leg problems was when my T3 was 3.5. When I changed from taking one to taking two T3 pills 2 weeks ago and my Synthroid was lowered from 88 to 75, I had two days of bliss–no leg symptoms. They’re back now, though.

    I’m seeing my endo in a few days. I am taking copies of your online articles. Could one of the physicians please advise me on what to ask him to prescribe? I currently take Synthroid 75 and 5 mcg generic T3 2X day. Should we increase the T4 or T3? How much? How long do you think it might take to see long-term improvement? Thank you!


    Kent Holtorf M.D.

    In general, a higher T3 to T4 ratio is more optimal for replacement, especially with any chronic inflammation, insulin resistance, diabetes or autoimmune disease. I would also try low dose naltrexone (LDN). High dose antioxidants, bioidentical estrogen, progesterone and testosterone can also be beneficial PN,. I assume you have insulin resistance and leptin resistance, as well. Would check a fasting insulin, glucose, hga1c, leptin level (should be less than 12) and SHBG (should be greater than 70.



    Thanks for your suggestions, Dr. Holtorf. Another question, please.
    Have you seen Hashi’s patients with peripheral neuropathy, specifically of the legs, and if so have the symptoms improved with increased T3?



    Hi Diana,

    Yes that is not an uncommon symptom that can see improvement with T3.



    This question from Diana was ineresting for me because I also have peripheral neuropathy, it especially keeps me awake at night. Before my total thyroidectomy I had it all the time before knowing I had Graves disease. My Dr doesn’t think my thyroid levels and the neuropathy are related but I thought otherwise. He as so many other Dr’s keeps lowering my meds due to my surpressed TSH. When he lowerd my meds last time he decreased my cytomel only. I take 75mg of synthroid and a 5 of the cytomel 2X a day. I was wondering if it might have been better to have lowered the synhroid and increased the cytomel as I still have hypothyroid symptoms. His answer was to offer me Zoloft, which I refused. He was the only Dr in my area that was open to trying the combination of the two drugs because I was doing much worse on synthroid alone. And the suggestion of low dose LDN would that lessen the hypothyroid symptoms or help with the neuropathy in my feet?


    Dr. Evans

    LDN helps with lowering antibodies in Hashimoto’s or other autoimmune conditions. It sounds like you’re still hypothyroid, so see if you can find another doctor who would be willing to raise your dose, rather than lower it.



    Dr Evans thank you for your reply. I have an appt at the Philadelphia office of Holtorf Medical Group on July 11th. It will be a six hour drive for me one way but I am so hoping to get some help with my thyroid levels. I had already tried a Dr in VA who did the saliva test for my cortisol levels and testing for hormone levels along with thyroid, selenium, Vitamin D, the B vitamins etc. I had high hopes when I went there after not feeling well on the synthroid protocol the endo wanted to continue me on. But I got feeling some better on the Armour but never could get feeling really all well. So a couple thousand dollars later here I am searching again. I really feel hopeful after reading all the information and talking to one of your new patient coordinators.
    My last labs were on 3-20-2012 TSH 0.0015 (0.200-3.0)
    Free T4 1.25 (0.70-1.50)
    Free T3 3.2 ( 2.0 – 4.4 )

    Thank you for your time.


    Dr. Evans

    That’s great you’re going to see Dr. Garabedian. It will definitely be worth your time. You’ll be able to do some of your follow-ups by phone, and once you’re feeling well, you will be on a maintenance plan. Your labs are looking better, but a reverse T3 level would help properly diagnose you, your dosage is probably not quite optimal yet.



    Diana, I had tingling, pinprick pains, pulsing, weakness in my legs with low FT3 , High RT3 & suppressed TSH. Once my FT3 came up the leg symptoms have completely gone away. TSH is useless for me and does not correlate with symptoms. I have now switched to armour thyroid from synthroid/cytomel and have seen much improvement on other hypo symptoms! Good Luck.



    People with thyroid problems show up in these forums, typically misdiagnosed (with TSH) or mis-medicated (with Levothyroxine monotherapy). Seldom if ever will you hear from people who take natural dried thyroid (ERFA, Armour, NPthyroid, and NatureThroid). Why is that?
    Most people who try this will not switch back to synthetics.

    When the phones stop ringing at the doctors offices there is a problem, having people coming back is a “good thing” depending on who’s point of view you hold.
    There are not patents in natural dried thyroid medications, no drug reps with glitzy brochures and lavish entertainment budgets.
    The symptoms of “sub clinical” (i.e. sub TSH-) hypothyroidism are manifold, as the hormone affect every cell in the body, this is not surprising.

    We are brainwashed to believe that for every ailment there is a corresponding pill, and nobody is doing root cause analyzes. Bad eating habits causing problems, great, you need this pill! The largest impact on our health are the TONS of food going thru our gut, and thus the most likely cause of most ailments, but other unnatural substances new to the human experience are also highly suspect, and the level of proof for harmlessness is very low. Commercial interests owns us.
    Beware, everything is suspect.



    I had thyroid ablation and for 2 years afterwards synthroid(150mcg) was not doing the job. I am a 34 year old with very healthy eating and exercise habits, but was gaining weight and feeling awful. I went to many drs and wanted to try Armour, but none would prescribe it. One would prescribe Cytomel with synthroid. This did help, but I was still having symptoms. And as my TSH drropped, my dr wanted me to reduce the T3 meds. I finally decided to pay out of pocket to see a holistic MD who would prescribe Armour. After just 8 weeks on my current dose, I am feeling SO much better and am almost symptom free. Armour is much cheaper too. I think the pharmaceutical companies can’t make as much money on dessicated thyroid, so they tell the drs it’s hard to regulate.
    It’s interesting because I am not getting much more thyroid hormone, just less T4 and more T3.
    The new Armour dose is about 97.5mcg T4 & 22.5mcg T3 = 187.5 total.
    Old dose 125mcg T4(synthroid) & 15mcg T3(cytomel)= 185 total.

    I am on another forum and it’s crazy how many drs would rather throw anti-depressants at patients with thyroid problems, rather than try dessicated thyroid.




    I’m glad you found the answer. As I’ve stated before, if you add two and two together you will find that it is highly probable that doctors needs office visits and pharmaceutical companies needs to sell patented ( expensive) drugs.
    Sick people generate income, healthy ones, who needs them?
    Pharmaceutical companies and their reps are no different than vacuum cleaner- and used car salesmen. Who would you rather set your confidence in for making health case decisions; a peer reviewed medical researcher or a money-counter?
    (stupid question b.t.w)

    “Sub-clinical” hypothyroidism is a profitable epidemic. Don’t expect it to go away anytime soon.



    Can I ask if anyone is on SRT3 and doing well. I just was put on this to clear my ReverseT3 but all the thyroid forums I read post and everyone says it does not work well for them? And taking the multiple doses of T3 works so much better? I would appreciate some feed back on this issue from anyone with experience.

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    Dr. Evans

    EricaS–It doesn’t really work to simply T4 + T3 numbers to come up with a total for comparison. However a pretty good way to estimate is to take the T4 number and divide it in half (indicating about a 50% conversion rate of T4 to T3), then add that number to the T3 number to get a total approximate T3 dosage. In your example:
    Synthroid 125 mcg + Cytomel 15 mcg = approx 62.5 mcg + 15 mcg = 77.5 mcg T3
    Armour 97.5 mcg T4 + 22.5 mcg T3 = approx 49.75 mcg + 22.5 mcg = 72..25 mcg T3
    As you mentioned, these approximate dosages are pretty close, but you probably do have fairly high levels of RT3 (meaning that less T4 is converted to T3) so increasing your T3 dosage and lowering your T4 dosage allows more T3 to enter the cells.



    I know this is an old post, but I’ve had both feet numb since last year (Nov 2011). My neurologist chalks it up to my M.S., now going on the 23 year, BUTI just feel like it COULD be something else. Especially since I found out my thyroid numbers are not quite right and my new doctor has be on liothyronine, but only 2.5 mcg, plus testosterone gel, and 5mg DHEA, plus Adrenamin by Prothera.

    A good friend suggested I should be on progesterone, too, but the new doc seems resistant, though the ZRT saliva test results show I am low there, too, besides DHEA.

    Here are my thyroid panel results:
    TSH: 1.78 uIU/mL (.45-4.5)
    Triiodothyronine, Free, Serum: 2.3 pg/mL (2.0-4.4)
    T4, Free (Direct): 1.2 ng/dL (.82-1.77)
    Reverse T3, Serum: 25.5 ng/dL (13.5-34.2)

    Side note: Vitamin D, 25-Hydroxy: 80.1 ng/mL (30.0-100.0)
    ZRT–which classified me as Pre-Menopausal:
    Estradiol: 1.4 (1.3-3.3)
    Progesterone: 135 (75-270)
    Ratio of Pg/E2: 96 (optimal is 100=500 when E2 1.3-3.3) — marked as L
    Testosterone: 25 (16-55)
    DHEAS: 3.1 (2-23)
    Cortisol morning: 10.3 (3.7-9.5) — marked as H

    Should I be on more than 2.5 mcg of liothyronine? It’s only been 20 days now and I am seeing some positive benefits. Next labs are not until January per htis new doc.

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