Thyroid UK
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TSH repressed? Is it important to be nearer 1.0 than zero?

My question is whether or not a suppressed TSH should be of any concern, if indeed it is suppressed at 0.05 mU/L .

I have read around and am struggling to see whether this is of any matter at all if I feel largely better and my FT4 is still good.

I was diagnsed Atrophic Thyroiditis back in May 2017 when my TSH was 146. Severe/profound hypothyroidism and no palpable thyroid. A lot of water has flowed under the bridge since then! My endocrinologist recommended my GP get my TSH to around 1mU/L .

A brief history.

Month --------------------TSH-mU/L--------------------FT4-pmol/L--------- Levothyroxine

Mar - 17 154.00 negligible

May -17 146.00 0.14 50mcg up to 75

Jul -17 26.57 10.30 up to 125

Aug -17 0.09 16.50 remain at 125

Oct - 17 0.03 16.50 remain at 125

Nov -17 down to 117.9

Jan-18 0.05 15.70 up to 119.0??

I have a constant weight of 80-82kg (down from 95kg in May 2017).

In October 2017 my GP suggested I was over-medicated. At first I did not agree, but soon had to admit I was. Symptoms: tremor, too hot, blood pumping strongly, jumpy, startled, irritable, aggressive, darting attention, hunger pangs, bursting energy, thirsty, loose stool.

Mid Nov 2017, I reduced my dosage from 125mcg Levothyroxine to 100mcg for two days in every 7 days = 117.9mcg per day. After 2 to 3 weeks I changed dramatically. Calmer. By Christmas I believe I was experiencing some hypo symptoms - aches in leg/hip/back, drier skin/hair, fatigue, breathlessness, voice change, constipation. Less so now. Otherwise, my ongoing challenges are slightly improving. Brain fog, the same memory loss and the very strange and difficult realisation of the path of my mental health over the last 5 years or so.

I agreed this week with the GP to adjust slightly up by skipping 25mcg every 4th day =119mcg. However, my TSH is still low and I don't know whether this should be of any real concern. All Liver, Kidney and other blood results are ok. I think I feel slightly under still, but quite okay.

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The way you've listed then is not the easiest way to try and understand your results, too hard for my struggling brain at the moment.

But for anyone who can, they will need the reference ranges as well as the results otherwise it's not possible to see if you are high or low in range or over range.

My TSH is always below range, has been <0.005, <0.01 is the one I get most. Highest was in 2002 when it was 0.4 which is when the endo insisted I come into range and reduced my Levo to achieve that result, unfortunately my FT4 plummeted to very low in range and FT3 achieved 2.8 with a range of 2.8-7.1 As you can imagine the endo was ecstatic and I was a zombie and had to give up working in my own business and be looked after for 2 years.

As far as my TSH is concerned now, if the doctors don't like where it is they can kiss my rear end, I won't be made so ill by them again.

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Thanks. Yes, the "table" of results didn't look like that before I hit submit! I'll try again. I agree with you for the rest and will go by what I feel and keep an eye on my heart.

TSH range (0.3>5.0)

FT4 range (7.9>16.0)

Month ------------------TSH-mU/L--------------FT4-pmol/L------Levothyroxine

Mar -17 *********154.00 ***********negligible***** 0

May -17 *********146.00 ***********00.14 ********50mcg up to 75

Jul -17 ***********26.57 ***********10.30 *********up to 125

Aug -17 ***********0.09 ***********16.50 *********remain at 125

Oct -17************0.03 ***********16.50 *********remain at 125

Nov -17 ****************************************down to 117.9

Jan-18 ************0.05 ***********15.70 *********up to 119.0??

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That's better :) Formatting gets lost on this forum!

Your January results look good. With a top of range at 16 I think you might push your FT4 over the top if you increase. However, it is such a tiny increase is it even worth considering? If your FT4 goes higher then you risk making reverse T3 rather than FT3. Why not get FT4 and FT3 tested at the same time, see where your FT3 lies in range and you'll know if you are converting T4 to T3 well enough.

If GP won't or can't get FT3 tested (even when requested, it's the lab who makes the decision) then if you are in the UK you can do a home fingerprick test with Medichecks or Blue Horizon.

Have you had vitamins and minerals tested?

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You're probably right. It's just that I felt under again over Christmas, but this last couple of weeks have been fine again. Maybe it was the booze! I will hold off of making the slight adjustment. Vitamins and minerals - I know I had ferretin and B12 checked. I don't have my results here but they were fine. Thanks again.

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Never accept that results are "fine". You need to see them, and get the reference ranges as well, then you can decide.

If you have three patients A, B and C who all get their ferritin tested, imagine the results are as follows :

Ref range (13 - 150)

A : Result = 13

B : Result = 85 (i.e. approx mid-range)

C : Result = 150

Doctors would tell all these patients their ferritin results are fine because they are all in range. But the likelihood is that patient B would feel best and patient A would feel worst. The aim for any patient is always to feel as well as possible, but low nutrient levels is the kind of information that doctors ignore.

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This is the battle I am fighting at the moment with GP. Tsh is 0.07 and they want to reduce my levo, but b my T4 and T3 are low witihin the range and I am still symptomatic. Have just started to add in 6.25mcg T3 with my T4.They will like my next bloods results even less!

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Doctors in primary care in general don't have access to t3 readings which is the one you really need to tell if you are under or over medicated, so they use tsh and t4 instead. Unfortunately they don't give an proper indication of what your t3 is. You could get a private test done from medicheck or bluehorizon so at least YOU know what is going on.

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Cmmagee,

Most doctors will tell you that suppressed TSH increases your risks of developing atrial fibrillation and osteoporosis. I think the risk of osteoporosis is less in men than women. There's been some research into osteoporosis in men on Levothyroxine which should simplify things by taking female menopause out of the equation. I'm not sure when it will be published.

I'm not sure I agree that exogenous suppressed TSH is so risky but my endo would like my TSH less suppress than the <0.01 it's been since 2012 and would prefer it to be around 0.05. 3 dose reductions over 2 years didn't budge TSH but caused a significant drop in FT4 and FT3 and I began to feel less well so I declined further reductions. I've informed my endo that I prefer to feel well today even if that means I have adverse health outcomes in the future.

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Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne:
tukadmin@thyroiduk.org

Prof Toft - article just published now saying T3 is likely essential for many

See point 2 in the summing up re osteoporosis

rcpe.ac.uk/sites/default/fi...

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I can't work out what you've typed as it's too hard to read and tere are no ranges, but I think it is more important to keep Free t4 and free t3 in the top quarters of their ranges and TSH wherever it needs to be to maintain those levels.

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Thanks, I agree.

TSH range (0.3>5.0)

I'm now at 0.05, up from 0.03 in October.

FT4 range (7.9>16.0)

I'm now at 15.7 down from 16.5 in October.

I was definitely over medicated in October at 125mcg per day so I adjusted to 119mcg per day mid November and stopped being so loopy. I was surprised to see the TSH not rise more than this. Now I just want to be sure that, if I feel under yet with such a low TSH, I can adjust upwards without worrying too much about TSH provided I don't start feeling over again which was quite alarming!

Thanks again.

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