Suppressed TSH

[Greybeard]

I'm sure I read somewhere that there is an official measure for the term suppressed. I had in mind it is less than 0.1. Can anyone help with a link to a relavant document. Thanks.

[SeasideSusie Remembering]

Greybeard Yes, <0.1 is suppressed.

I don't have a link to a document but it is mentioned in GP Notebook

A serum TSH level of less than 0.1 mU/l (fully suppressed) should always be avoided.

gpnotebook.co.uk/simplepage...

I don't agree with any of it, mine is <0.01 and has been <0.005, I'm in the 'older' age group and I'm still alive and not suffering atrial fibrilation, osteoporosis, or anything else they like to scare us with.

[Greybeard in reply to SeasideSusie]

Thank you seasidesusie thats just what I need. I am seeing gp about a dose increase tomorrow, poor dear thinks the lower end of the reference range counts as suppressed so a bit of documentation may oil the wheels. Gb.

[SeasideSusie Remembering in reply to Greybeard]

Greybeard Just don't let her read the rest of the page!!!

Obviously I don't agree that a suppressed TSH should be avoided, I've had this with my own GP. She was banging on about suppressed TSH but my FT4 and FT3 were within range, but she wasn't interested. You just can't seem to be able to get through to them that TSH is irrelevant when on replacement hormone.

Just in case this helps, and might educate your GP -

TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

Sorry I don't have a reference for that. If I can find something I'll come back and add a link.

Also, a bit more evidence from Dr Toft, leading endocrinologist and past president of the British Thyroid Association (also the Queen's doctor when she's in Scotland!):

Dr Toft states in Pulse Magazine, "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)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

[Greybeard in reply to SeasideSusie]

Thanks again. Ps I wasn't being sexist gp is male, but still out of his depth.

[SeasideSusie Remembering in reply to Greybeard]

I don't think any of them understand hypothyroidism and how to treat it Gb! Rather sad really, and devastating for the patients they keep permanently unwell

[Zephyrbear in reply to SeasideSusie]

Ditto Susie! Mine has been 'suppressed' for years now and yet I'm feeling fine without an atrial fibrillation or weak bone in sight! These are just stories made up by the so-called 'professionals' in the medical industry to scare us 'ignorant' post-menopausal women into going along with their pet- treatments... I've lost count of the number of times I have told them that, as I'm taking T3, my pituitary gland doesn't detect any need for my thyroid to produce its hormones and therefore doesn't stimulate it to do so...

[diogenes Remembering]

This i s another "shoehorn" categorisation. Choosing 0.1 is simply arbitrary. It has no scientific hard evidence to support it - only a clutch out of thin air! The apparent thinking is: we have to designate a number which is a boundary between thinking in one way and in another. Suppression is merely a word covering many things. It could be "below the lower limit of the reference range - about 0.5"; it could be "undetectable - that is 0.01 or less"; and all points in between. Suppressed has no real meaning - it depends on who is talking and their agenda for the particular patient.

[Greybeard]

Just a quick update. I saw the gp this morning armed with 2 folders of paperwork and my partner looking prickly. I came away with a dose increase and the promise of further increases till tsh is reduced to lower limit if needed. Gunboat diplomacy still has its uses.

[SeasideSusie Remembering in reply to Greybeard]

Oh well done GB! And a prickly partner to boot! Probably scared the pants off your GP