TSH levels

[Bradleyeb]

I've been to my Endo today and he was concerned about my suppressed TSH levels - they are currently 0.3 (range 0.4-4.0) and that it can cause oestoporesis when I am older if it sustained. I am currently on 100 t4 and split dose of t3 (2 x 10mg). I always better in myself when my TSH is fully suppressed, when it's in the doctors normal range I'm overtired and suffering with aches and pains. Endo is trying to change my dose again but I know it's going to make me feel bad .... Unsure what to do .... HELP

[shaws Administrator]

Follow your instinct and I wish these Endos would stop believing in fairy tales. We are most likely to get problems with too low a dose and it's not true what he says.

If you email [e-mail] and ask for a copy of the Pulse Online article by Dr Toft, who was President of the British Thyroid Association and question 6 will give you the answer you need to give to your Endo/doctor. This is the extract and ignore the last sentence as that's what most of them appear to think, I believe.

Why would he want to you feel unwell when a particular dose makes you feel well. It is confusing to me. Excerpt:

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

*****

Dr Toft's advice re T3 is now out of date according to new research.

[shaws Administrator]

This is a link for info:

web.archive.org/web/2010103...

[Bradleyeb]

Thanks Shaw, I cant access the link so will request from Louise.

I must admit, all this thyroid stuff is confusing as hell

[greygoose]

Bradleyeb, just ask him for proof that low TSH is going to cause osteoporosis. Ask him to explain how that is possible. Ask him the role of TSH in the body. If he can answer all those questions, I'll eat my hat! (Fortunately, I Don't wear one! hi hi hi) But he won't be able to because it's a load of cod's wallop. Continual over-range FT3 might do so, but that's got nothing to do with the TSH unless you have Graves. I think he's got his wires all in a tangle, and you have to help him straighten them out.

[Treepie]

Quoting Dr Toft got me nowhere with arrogant endo.

[Bradleyeb]

Thanks Greygoose, I did have Graves' disease before I had my TT in August 2013, have obviously been hypothyroid since. So what causes oestoporesis in thyroid patients?

[Clutter in reply to Bradleyeb]

Bradeleyb, Your TSH is low, not suppressed. This research says low but not suppressed TSH doesn't affect bone.

Suppressed TSH <0.03 and high FT3 in hyperthyroid patients increases the risk of atrial fibrillation and osteoporosis. I think the research into suppressed TSH in hypothyroid patients is often extrapolated from hyperthyroid research. I don't believe the risk is significantly increased by suppressed TSH unless FT3 is over range.

My TSH is <0.01 for three years. I do have mild osteopenia but I believe it pre-dates me taking thyroid replacement. Endo is monitoring me for both and although TSH could be less suppressed is happy that I feel well on my current dose.

[Muffy]

T3 Will suppress your FT3 levels and your endo should know this. Also, as others have said, quote Dr. Toft (former physician to the Queen when she was in Scotland).

Slight suppression of TSH will not cause osteoporosis. Sorry, I can't access my references at the moment, but there are plenty of references that support this.

[eeng in reply to Muffy]

Muffy, I think there's a typo - you mean that taking T3 will suppress your TSH levels. It may also lower your FT4 levels. Certainly the endo should know this!

[Muffy in reply to eeng]

Ooops, sorry, yes meant suppress your FT3 levels and yes it may also lower FT4 levels.

[Glynisrose]

No, its actually being on an insufficient dose that causes the trouble not taking meds that help!

[Maryh1]

I have weened myself off cytomel. Plus I was taking too much progesterone (400 mg) I was taking that much for another problem. Also on an AIG diet. All in all feeling much better.