What to make of this?

[Greybeard]

Does this make sense?

ncbi.nlm.nih.gov/pubmed/289...

[shaws Administrator]

Someone may have a more expert response than I and keep in mind I'm not medically qualified.

For me it means that if our TSH is not kept low and hormones high (FT3 and FT4) we may well develop cardiovascular disease.

I don't think this is knowledgeable by the 'thyroid experts' as many doctors believe that a TSH towards the higher end of the range is 'fine'. The experts also advise us that a low or suppressed TSH will cause heart problems but I think that 'low' will protect heart in some ways.

Two excerpts:

Conclusions and Relevance:

1) "Design, Setting, and Participants:

The Rotterdam Study, a population-based, prospective cohort study. We included participants without known thyroid disease and with thyrotropin and free thyroxine (FT4) levels within the reference ranges.

2) At the age of 50 years, participants with low-normal thyroid function live up to 3.5 years longer overall and up to 3.1 years longer without CVD than participants with high-normal thyroid function. These findings provide supporting evidence for a reevaluation of the current reference ranges of thyroid function and can help inform preventive and clinical care"

T3 is required in all of our receptor cells, the brain and heart contain the most and it the only Active Hormone. I note they only refer to the Free T4 tested and not Free T3!

[diogenes Remembering in reply to shaws]

All this may well be true for "healthy" people. The problem is that, after the thyroid fails, and therapy is given, you cannot then extend the findings in health to therapy. This because the whole balance between TSH, FT4 and FT3 is changed in therapy, and solutions have to be found that are the best compromises. It's likely they cannot fully restore sufferers back entirely to the health they had - and I'm sorry to have to say that! Its just that one is substituting a rapidly acting, automatically balanced system in health, for an arbitrary unbalanced one subject to rises and falls according to time of dosing and based on human perception of what dose of what hormone gives the optimum result for the individual. Given this, projections of life expectancy become blurred. The best position is to be hopeful for the best outcome for the rest of whatever ones life is going to be.

[cwill in reply to diogenes]

Thanks diogenes . I take the call for a review of the range to be hopeful. The diagnosed thyroid group may be a difficult one to manage but a narrowing of the reference range would be helpful in alerting our docotrs to the harmful effects of high TSH levels. And the ghastly ‘no diagnosis of hypo until TSH reaches 10’.

[SlowDragon Administrator]

Brilliant bit of research to back up need for TSH to be low in range. Not just anywhere in what is already too wide a range

I will keep that link. Thanks

Here's a graph of a TSH distribution

healthunlocked.com/thyroidu...

[helvella Administrator Thyroid UK in reply to SlowDragon]

SlowDragon,

It doesn't say that, does it?

Isn't the ones with higher TSH that lived longer?

[SlowDragon Administrator in reply to helvella]

Well it’s obviously unclear

Shaws, like myself read it the other way, but you may be correct.

But as I said to my endo

Would I want to live a long time stuck in a wheelchair, which is where I was with TSH at their preferred level

He did agree with my viewpoint

Now same endo is in full support of T3 (and low TSH almost inevitable) BUT FT4 and FT3 in range

[helvella Administrator Thyroid UK in reply to SlowDragon]

SlowDragon,

The issue of what you (or any other patient) wants is very much the point in my response a bit further down.

[SlowDragon Administrator in reply to helvella]

Obviously if you had very low TSH NOT on Thyroid hormone replacement but due to hyperthyroidism then that’s entirely different to regular steady replacement dose that lowers TSH

[helvella Administrator Thyroid UK in reply to SlowDragon]

SlowDragon,

Absolutely. A very different situation.

[Hennerton]

I ám struggling to make sense of it, as it simply is not clear, or the other members who have replied, seem to read it differently. For me it seems to be bad news for my suppressed TSH and high T4. Am I reading it wrongly?

[Greybeard in reply to Hennerton]

That was my point. Quote "At the age of 50 years, participants with low-normal thyroid function live up to 3.5 years longer overall and up to 3.1 years longer without CVD than participants with high-normal thyroid function. " . I take thyroid function to include T4 and T3 which we believe should be in the high normal range. TSH which Is a pituitary hormone needs to be low normal. It may be semantics but could be used as a reason to reduce dosage.

[helvella Administrator Thyroid UK in reply to Greybeard]

Greybeard63,

Looks to me like the inference that lower thyroid function/higher TSH is "better" is simply not valid. We could question whether some genetic contribution that ends up with higher blood TSH and lower FT4 also confers an advantage with respect to CVD/longevity but not in any way mediated by the thyroid hormones.

However, I absolutely agree that some are likely to jump on it as proof that we should all be kept under-dosed (in our opinions).

What is almost universal in thyroid medicine is the removal of informed consent - we have the right to choose to feel well potentially at the "cost" of a shorter life, or vice versa. Doctors have no right to make that decision on our behalf. They just have a duty to fully and properly explain and then let us make our choices.

[Hennerton]

From my understanding TSH needs to be high in this study to confer benefit. Have I got that wrong?

[Greybeard in reply to Hennerton]

I cannot believe that was what they ment, it is far from clear.

[Hennerton]

But why have other members read it differently?

[Greybeard in reply to Hennerton]

I would prefer to be wrong.

[Hennerton in reply to Greybeard]

And I!

[Greybeard]

I've not read the full text, (has anybody got access) but it does say healthy subjects with no thyroid disease, so not medicated. I think it just muddies the waters.

[Hennerton]

Yes, it seems thyroid waters are always muddy. I guess we just have to continue doing what seems right to us at the time - never easy but ridiculous studies like this are no help at all.