Why measure TSH when you have no thyroid.

[LAHs]

Does anyone know what is the point of measuring TSH if you have no thyroid? (As a result of a thyroidectomy because of Th Cancer). TSH is the feedback loop between the thyroid gland and the pituitary but if you have no thyroid to respond to it, why measure it? T4 is usually measured at the same time as TSH and it should be that value which tells you if you need more T4. (Not to mention a measurement of T3 which should be routinely done since this is directly proportional to the patient's well being - but we can't expect miracles can we.)

[Clutter]

LAHs, the point of measuring TSH in thyroidectomised thyCa patients is to make sure TSH remains suppressed in order to avoid remnant thyroid cells in the thyroid bed or released into the body during surgery being stimulated which increases the risk of cancer recurrence.

Pituitary produces TSH in response to low thyroid hormone. It doesn't *know* the thyroid is no longer part of the feedback loop and will spew out TSH until sufficient replacement is detected. TSH will rise faster than FT4 drops in thyroidectomised and ablated patients and demonstrate the patient isn't adequately medicated.

My endo's lab measures FT3 only when TSH is suppressed. The labs are looking for indications of hyperthyroidism ie suppressed TSH with elevated FT3, not low FT3 in hypothyroid patients.

[LAHs in reply to Clutter]

Thanks Clutter

[shaws Administrator]

Regarding the TSH which varies throughout the day is only a problem if the doctors adjust patients' doses to keep it 'somewhere within the range' when most feel better with a low or very low TSH. Clinical symptoms are ignored and the patient is usually given another diagnosis for the symptom rather than a decent dose of hormones.

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

P.S I hope you have T3 in addition to T4.

[LAHs in reply to shaws]

Yes, I do, I am on NDT and what do you know? My endo is trying to reduce my dose because my TSH is too low even though I feel great! I told her I feel great, normal, so let's not argue with success but Nooooooo my TSH has to be increased (read "dose decreased"). Well, no it isn't, I am not going through that again. If she forces me by not prescribing a combination of pills which allows me to (easily) continue my current dosage well I will just buy them off the internet: Google "Buy Armour Thyroid" or "Buy NDT".

I wish doctors would read current papers, research and these blogs on this subject, I think there are enough people now who are not doing well that doctors should start thinking outside the box.

[shaws Administrator in reply to LAHs]

Dr Toft who was President of the BTA wrote an article in Pulse online (doctors magazine) and he says:

6 What is the correct dose of thyroxine and is there any rationale for adding triiodothyronine?

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.

While taking both hormones it is important serum TSH is normal and not suppressed.

******

Unfortunately he spoils this by the final comment:-

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.

While taking both hormones it is important serum TSH is normal and not suppressed. If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed."

[Gismo333]

Hi the TSH is the thyroid stimulating hormone test so normally when you have a gland the pituitary will stimulate the gland to release more thyroid hormone if needed, however, if no gland is present then the medication present will adjust the reading. I don't believe it to be a very good test at all as the FT4 and the FT3 test will show how much free circulating thyroid hormone in the blood, however, no test will actually show how much T3 is entering the receptor sites on the cells, only symptoms, pulse, body temperature, heart beat, reflex tests will show this so the whole picture has to be look at and never just the tests alone. I have a result of 0.01 on my recent tests and so did my husband. Our doctor in Belgium examined both of us, I was a little overstimulated so I cut the T3 down but my husband wasn't. The tests are a guide and not the true picture of what is going on.

[LAHs in reply to Gismo333]

Excellent points raised here. Thanks Gismo333

[Glynisrose]

I have asked my endo this as I too have no thyroid but I never get an answer!

[shaws Administrator in reply to Glynisrose]

He may not know the answer!

hormonerestoration.com/

[nightingale-56]

Hi LAHs, we can't even expect correct treatment, let alone miracles. I only have part of my thyroid, so goodness knows what messages get through after almost 40 years of being without it.