Low TSH because of Armour - Osteoporosis risk?

[mushumouse]

Hello all. Has anybody bumped into some reliable info on this?

My TSH is always suppressed which I understand is because I take Armour Thyroid, but I’ve been told that a low TSH can lead to osteoporosis but my Endo doesn’t seem concerned. I had a total thyroidectomy in case that changes anything?

(My TSH ranges from 0.03-0.1)

Thanks for your advice!

[diogenes Remembering]

No problem. For patients on therapy the "healthy" TSH range doesn't apply. Best estimate for a sensible TSH range on therapy is 0.03-0.5. You are right on the money.

[jimh111]

A suppressed TSH does lead to increased osteoporosis risks. It's difficult to assess because some studies included patients with thyroid cancer or patients who might have had parathyroid damage. However, this is a very good paper that shows the risks academic.oup.com/jcem/artic... .

So there are risks with a suppressed TSH (< 0.04), no point being in denial. Do what you can to minimise risks with exercise and good vitamin D, calcium etc and get on with life. All treatments have risks, we have to weigh benefits against risk and try to be on the lowest effective dose.

I've just come across this paper ncbi.nlm.nih.gov/pmc/articl... which I'm sure will be good - but I haven't read it yet! The authors are competent doctors with a lot of knowledge so it should be a useful paper.

[diogenes Remembering in reply to jimh111]

Trouble is that all the papers you quote, including this one, have severe statistical problems which render their conclusins doubtful. No doubt over treatment with T4 to give high T3 and suppressed TSH is wrong, but treatment with T4 that gives normal FT3 and just above normal FT4 + suppressed TSH is permissible. The problem is that all studies mix up the truly overdosed with the mere TSH-suppressed because virtually none measure FT3.

[Kell-E in reply to diogenes]

So, is it fair to say in general that all hyperthyroid people will have a low TSH, but not all people with a low TSH are hyperthyroid?

[diogenes Remembering in reply to Kell-E]

I don't like "all" as there always will be a "Martian" that defies everyone. But in general, yes.

[Kell-E in reply to diogenes]

That's why I said, 'in general'. Let's excluded the Martians on the front end

[jimh111 in reply to diogenes]

I've expressed this in different terms with my comment lower down. The term 'suppressed' is used to define a very low TSH without establishing whether TSH is truly suppressed by above average hormone (T3 and T4) or whether TSH is insufficient due to central hypothyroidism or more frequently a down-regulated axis. TSH is a poor marker but nonetheless there is an association between a very low TSH (< 0.04) and osteoporosis. Even so a truly suppressed TSH is needed in many cases, it has risks but every treatment carries risks, it's about time the endocrine establishment set about finding why suppressed TSH's are needed and found better alternative treatments.

[SeasideSusie Remembering]

Listen to diogenes - Dr John Midgeley, advisor to ThyroidUK - see here

thyroiduk.org.uk/tuk/About_...

I have had suppressed TSH for 20+ years since I've been keeping a record of my results (on Levo 43 years). I don't have osteoporosis.

[jimh111 in reply to SeasideSusie]

It's a relative risk not a certainty. mushumouse's TSH hovers in the range 0.03-0.1 which is more or less above the 0.04 risk cutoff. I dislike the term 'suppressed' because it presumes the very low TSH is due to suppression when sometimes it is due to insufficient thyrotrope (pituitary) activity. The study I referenced also shows that a high TSH (> 4.0) is also associated with ostoporosis risk although I've never heard a doctor point this out. All this is dependant upon the accuracy of TSH as a thyroid hormone marker, TSH is a poor marker. We should follow the evidence we have and take note that it is not perfect evidence.

[SeasideSusie Remembering in reply to jimh111]

I used the word suppressed because the OP did. For clarification my TSH is always <0.01 for whatever reason, once or twice it has been <0.005. Doesn't bother me, I have no life if my TSH is in range, so my choice is virtually bedridden with TSH in range, or have a part life with it that low. Easy choice when you're getting on a bit.

[Ansteynomad]

What do I do then? My TSH is suppressed and has been through treatment with T3 alone, NDT, Levo alone and now NDT again. On Levo my TSH is suppressed long before I reach a therapeutic dose. My GP will not entertain a suppressed TSH, which is why I self-treat. All he wanted to do was to reduce my Levo all the time, regardless of FT4 and FT3 levels

I am hoping that the fact that I am well enough to exercise will mitigate any risk, but it is worrying.

[Kell-E in reply to Ansteynomad]

It is not TSH that influences bone density. Many of us have extremely low TSH. FT3 is a much better marker for hyperthyroidism.

[jimh111 in reply to Ansteynomad]

I wouldn't worry. Thyroid hormone is just one of many factors that influence osteoporosis. It's frustrating that GPs take this approach but the blame lies with the specialists that guide GPs, they never mention that an elevated TSH carries similar risks, nor recommend normalising a TSH that is mildly elevated.

[diogenes Remembering]

Your choice: a good QoL now and for the future, with perhaps a small extra chance of AF and OP later, or otherwise a poorer QoL and less chance of problems.

[jimh111 in reply to diogenes]

..... and perhaps other problems associated with that poorer QOL. I just like to get the best facts we can without denying minor risks and then hopefully we can push for better thyroid science from the establishment.

[mushumouse]

Thanks all for your responses. This sounds like a bit of a minefield! As do many issues relating to the thyroid it seems! I will definitely do some reading on it.

The reason I used the term ‘suppressed’ is purely that this is what my Endo says. It wasn’t ‘suppressed’ when I was on Levo alone, but due to bad T4>T3 conversion he put me on a Levo and Armour mix which has ‘suppressed’ the TSH. I do feel much better on Armour but part of me wonders if it is worth it if it could cause osteoporosis, which obv isn’t clear, and just the hassle and cost - my endo appointments cost about £700 a year and the medication is about £500 a year. I perhaps wouldn’t be saying this if I could remember my symptoms on just Levo though! And the cost mainly concerns me now as I recently had a baby who is rather expensive, who knew!

[jimh111 in reply to mushumouse]

Sorry for so many posts, last one! Just to make it clear it is the endocrinologists who invented the term 'suppressed' without demonstrating that in each case a very low TSH is caused by hormone suppression. There's no blame attached to patients who use the term as it has become accepted by everyone - bar one person .

[jimh111]

T3 medications do not always give a very low TSH ncbi.nlm.nih.gov/pmc/articl... , it depends upon the dose. Lots of causes of osteoporosis, Armour is one of them, one of many. As you say your osteoporosis is not due to thyroid disease or taking thyroid hormone. So sorry you have this as well as having to look after your family. We may cross swords occasionally but I'm always in total admiration for the fiesty support you give to your family.

[Dramlouie]

I am on thiroyd and have a bottom or range T4, low range T3 and suppressed TSH at under 0.01 and I see an endocrinologist. No-one has done any other tests on me and I have severe joint problems and muscle tightness. I have complained for many many years and my dose always remains the same and see you in 6 months! I can hardly walk and I was so active being in the TA. I feel my life is passing me by I am so stiff, I am only 61. Surely there is something wrong somewhere, I feel totally ignored. I take K2 to keep calcium in my bones, I also make sure I get my D3 and I get out in the sun.