TSH, FT4, FT3 and Nature Thyroid

[KornishPiskie]

Hi guys,

Can anyone give me any scientific articles that It is perfectly ok to have a suppressed TSH and low FT4 while on NDT? I am seeing the doc on monday due to blood results.

TSH: <0.05 (0.50-4.4)

FT4: 11.5 (10-20)

FT3: 4.5 (3.5-6.5)

(I posted earlier but realised I need more info)

Thanks guys

[Aurealis]

I don’t sorry, but your results are a bit like mine. Your tsh is higher, and fT3 a bit lower though.

[KornishPiskie]

This is great. Thanks. But do you have the citation for it from any medical community? I really want to ensure she trusts what i say

[stockman27]

In my long experience with thyroid problems. I have seen many DRs and the outcome is always the same. The NHS and private endos will always come on the side of having a TSH that that is in the limits. There is a prof in Scotland that use to be the chair of the Royal collage pf physicians , I cannot think of his name. He has written numerous papers on supplementing with T3 but it did not get anywhere. Its a bit like Brexit there was a vote but the establishment did not like the out come and ignored it.

[KornishPiskie]

Reallyfedup you dont haooen to know how they diagnose hyperthyroidism? Im thinking suppressed TSH, above range FT4 and FT3 (if fT3 is done). So i can say to the doc that FT4/FT3 are in range so im not hyperthyroid (putting it in simple terms). Both antibodies were high also so I think that has compounded it for her. But again that does not mean graves does it (to them)? It indicates Hashimotos

Thanks

[Kell-E]

This paper does not address low fT4 levels on NDT, but it does address suppressed TSH and cardiac/osteoporosis risks.

frontiersin.org/articles/10...

From page 5:

Many studies reported increased risks associated with suppressed TSH such as atrial fibrillation and osteoporosis but failed to properly classify the hormone status of patients into euthyroid versus hyperthyroid, and frequently did not even distinguish between treatment-induced TSH suppression and endogenous hyperthyroidism (94). Importantly, thyroid hormones, while suppressing pituitary TSH, have been reported to upregulate the locally produced osteoprotective TSHβv variant (95). Statistical associations with TSH cannot establish causality, as the opposing effects of low-TSH and low-FT3/TSHβv frequently occur together in LT4- treated patients.

[healthymarge in reply to Kell-E]

Thanks for the information link.

[mischa]

Kell-E this is just what I am looking for. You are a gem! Don't suppose you have any other nuggets like this. My meds have been reduced because I have suppressed TSH despite FTs well within range. I am writing to Endo and GP. I am well on my current dose.

When I write to them I want to enclose some research papers too.

[Kell-E in reply to mischa]

Here is another one for you...

ncbi.nlm.nih.gov/pmc/articl...

The other difficulty in interpreting serum TSH concentrations is to decide what value should be aimed for in patients taking thyroxine replacement. It is not sufficient to satisfy the recommendations of the American Thyroid Association11 by simply restoring both serum T4 and TSH concentrations to normal, as in our experience most patients feel well only with a dose resulting in a high normal free T4 and low normal TSH concentration, and those patients with continuing symptoms despite “adequate” doses of thyroxine12 may be slightly under-replaced. Some patients achieve a sense of wellbeing only if free T4 is slightly elevated and TSH low or undetectable.13 The evidence that this exogenous form of subclinical hyperthyroidism is harmful is lacking in comparison to the endogenous variety associated with nodular goitre,3 and it is not unreasonable to allow these patients to take a higher dose if T3 is unequivocally normal.

[Kell-E in reply to mischa]

And another

researchgate.net/profile/He...

[mischa in reply to Kell-E]

Kell-E Thank you for the information - it is much appreciated. Really interesting papers. I think I can use these and send copies to my GP. Thank you.

[Catseyes235]

My TSH is according to one doctor almost imperceptible at 0.01. He asked me to decrease thyroxine from 150 to 125 mcg despite feeling fine and TSH is now 0.03 and wants me to decrease meds again. However my old regular doctor knows me well and is happy for me to stay on whatever makes me feel fine. If I was really having too much thyroxine I would surely have hyper symptoms but there are none . . no shakes, sweating, restlessness and certainly -and sadly -no weight loss and endless drive to get things done!