Can someone point me at evidence of suppressed TSH being OK when on T4/T3 therapy?

Hi, I'm trying to get evidence together to convince my Endo that my suppressed TSH of 0.02 doesn't indicate that I am borderline hyper and need to reduce my meds. My fT4 is 15.2 (11-24) my fT3 is 5.2 (3.9-6.8) which says to me that there might be room for negotiation to alleviate some of my symptoms that the endo says are not thyroid related. Just added plantar fasciitis to heart ahhrythmia, joints and muscle aches and pains, weight gain, tinnitus, sinusitis etc etc etc, and it's pretty miserable. Endo says he is open minded, so with the right 'evidence' I might be able to convince him to change/increase meds. Thank you

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  • Below are two pubmed abstracts of papers that are questioning the value of TSH when on replacement thyroid hormone:

    TSH may not be a good marker for adequate thyroid hormone replacement therapy.

    ncbi.nlm.nih.gov/pubmed/164...

    Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?

    ncbi.nlm.nih.gov/pubmed/231...

    Also, here is an extract from the BMA book by Dr Toft (Understanding Thyroid Disorders):

    ---

    I feel better when I am taking a higher dose of thyroxine than recommended by my doctor. Is this safe?

    There is considerable debate about the correct dose of thyroxine. The consensus is that enough should be given to ensure that levels of T4 in the blood are at the upper limit of normal or slightly elevated and those of TSH at the lower limit of normal, or in some patients undetectable.

    ----

  • Thank you Red Apple, that is very helpful. Lisa

  • This article is of UK origin & very specific to this issue:

    endocrine-abstracts.org/ea/...

    Good luck with trying to educate an Endo, I personally haven't had much success in making one believe that night follows day, let alone something that requires a bit of research or thinking about! :-(

  • Ah yes, I knew there was another useful one but couldn't for the life of me recall it!

  • thanks very much for finding this. I think I may be able to have a dialogue with him. i have already sent him a summary of a study about Armour vs Thyroxine and he knew the authors and was impressed. Lisa

  • Hi Isabiz, please would you add the author and title here so I can research for my GP. Thanks

  • press.endocrine.org/doi/abs... this is the one. I hope you can access it. There is a more recent but less robust study, jscimedcentral.com/Endocrin...

  • Thank you

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