Hi everyone
I keep hearing that low TSH is bad for bone health. My question is - does the thyroid stimulating hormone actually exert an effect on bone health, and the absence of it is bad for our bones, OR, is it simply that with graves the low or non-existent TSH is combined with high thyroid hormones, and high thyroid hormones are the risk.
Cheers,
Sim
You might find these links interesting :
This article: jamanetwork.com/journals/ja... mentions that endogenous subclinical hyper is more risky but doesn't seem to separate out those of us who are hypo/medicated. It also includes as subclinical hyper people whose TSH is below 0.45, but that's considered normal in some countries, so it's hard to know what to make of that.
The second link is interesting, especially this but from diogenes: "Its well known that hyperthyroidism, where TSH is very low or undetectable, gives rise to increased risk of bone thinning. This is due partly to direct action of TSH on osteocytes, cells concerned with bone density. The converse isn't true, that bones thicken on high TSH - one is ill in a way that obviously needs urgent treatment before any such thing could happen".
That's worth following up. Cheers.
Great summary, thanks. I Am also wondering if and what steps should be taken, as a preventive stance. I am supplementing after graves required TT with a combo T4&T3, consequently my TSH is suppresed. No issues as of yet but the future is what concerns me.
I have the same concern. And I was told that if our TSH is suppressed on thyroid meds we should watch the levels of estrogen that acts protective on the bones, and if that one is low supplement with natural estrogen. That is what I am doing. Also my doctor advised me to switch to NDT from synthetic combo as he claims it is better option for the bones. But I already have lower bone density after years for beeing hypo and lyme so must be specially careful. Additionally keep vitamin D top of the range.
that's interesting, did he say why?
Honestly I did not ask. He only said he see it from his experience that patients put on NDT have their bones recover. His focus is on bone health so he did lot of research and I trust him. He said best results are from high dose vitamin D. Additionally of course exercises and no stress. He told me he had some cases where people learned to let go and relax and had spectacular bone improvement! Possibly has something to do with cortisol.
There's a bone health forum on HU, & a free website called saveourbones.
I make sure to have enough vitamin D3, magnesium & boron to counteract my high dietary calcium intake. It's important to have some exercise that puts stress on joints for new bone growth. Yoga & pilates are good.
I can't find any research that proves that TSH has a direct effect on bones. In fact there is a piece of research that shows that TSH does not have ANY effect on Bone Mass Density.
link here
There is a very recent pieced of research that shows that EXCESS TSH has a negative direct effect on the heart.
link here
The papers are on my home computer so I'll update this post with them when I get home from work.
It seems to me that the evidence so far is that it is mostly the excess or lack of T3 that causes Atrial Fibrillation or Osteoporosis. Now we need to factor in the excess of TSH and together with the lack of sufficient that contributes to AF. Not the lack of TSH.
It seems to me that the doctors are so indoctrinated that TSH tells us everything that they cant see the wood for the trees. They very rarely consider T3 for anything, including well being and that the real cause of AF or OP in these circumstances is an excess of or lack of the correct amount for the individual patient of T3 - mostly.
The real question is "what TSH?"Mine as a postTT, on substitution with combo T4&T3, regular levels on 24h test...iM not sure at all. But also not 100% that they're awfully wrong. 
I have a suppressed TSH but my T4 and T3 are in the higher quarter but within their reference ranges. I have weighed up the risks and benefits of having a suppressed TSH or having a TSH with in the reference range but T4 and T3 lower in their reference ranges at level that brings on my symptoms.
From my own research and the help of this forum, I cannot find any evidence that it is suppressed TSH that causes AF or OP all by itself. The best research say is that suppressed TSH is ASSOCIATED with AF and OP. So is smoking and other risk factors.
The research I have read suggests that too much or too little T4 or T3 causes AF or OP.
I think that having too much TSH and not enough T4 and T3 is more likely to cause AF or OP in me in the future.
I think that raising my TSH by reducing my dose of T4 will definitely and almost immediately (not a theoretical risk in the future) bring about a return of my signs and symptoms which will definitely make me ill.
In accordance with "Good Medical Practice Consent patients and doctors making decisions together", I have weighed up the risks and benefits of having a suppressed TSH or a TSH within the reference range and I have chosen to remain with a suppressed TSH.
If I have concerns about low Bone Mineral Density, I will ask for a DEXA scan. if I have concerns about AF I will ask for an ECG test. I already have a blood pressure monitor that checks for AF and a KARDIA heart monitor to check for AF. So far, no AF. I also take Vit D3 supplements to take calcium out of my blood and Vit K2 supplements to help transport the calcium to my bones. Now that I am not so fatigued, I have joined a gym. I work out and swim regularly to help maintain bone density and heart function,a s well as just feeling fitter and better.
In other words, I prefer to feel good now and take other preventative measures, and run the minute risk of AF or OP in the future because I think there either isn't a risk or if there is a risk, it is not much more than if I wasn't taking T4 and I am taking preventative measures to mitigate that theoretical risk.
If future research proves that suppressed TSH definitely causes AF or OP I will discuss this with my doctor to find a way forward.
holyshedballs, my tsh is suppressed also and of course, it freaks out most doctors (except my naturopath). And I can track it to exactly to after I started taking t3. I tried lowering my t4 meds after one doc freaked out about my suppressed tsh and I got very tired. No thanks! Now I'm seeing an alternative practice and the RN tells me that I need tsh for bone health (actually seeing her for bioidentical hormones as I was just diagnosed with osteoporosis). I can't believe this info and she wants me to lower my t3. I will be reading all of the articles with the posts. Lower my t3? My ft3 and ft4 are in great shape but she's going strictly by tsh. So disappointing...
The TSH test was designed to be the only blood test necessary to diagnose and treat thyroid problems. From the TSH test doctors are supposed to be able to work out how much active thyroid hormone is in the system. Therefore when TSH is extremely low doctors make the assumption that the active thyroid hormones are too high and this could cause osteoporosis.
However when The Free T3 is tested there in no need to use TSH to try to guess how much Free T3 you have. Doctors really have so little understanding of thyroid blood tests!
Your links don't work for me. Can you post them again please.
i was at work so I didn't have access to the papers at the time. I have re-posted below with the titles of the papers.
Ah ignore me, I found the links further down. Cheers!
Hi, are you able to update this with the links? Cheers.
Useful open access article on this:
Thyroid Res. 2014; 7: 12.
Published online 2014 Dec 20. doi: [10.1186/s13044-014-0012-0]
PMCID: PMC4314789
PMID: 25648501
The influence of thyroid dysfunction on bone metabolism
Dominika Tuchendler and Marek Bolanowski
This is the link: ncbi.nlm.nih.gov/pmc/articl...
Still somewhat frustrating as it only refers to t4 therapy.
I assume that Big Pharma tells endos about 'bone health' for the reason that a very low or suppressed TSH may be just what we need to feel better and have relief of clinical symptoms. Except, for many it doesn't as our dose is restricted to the TSH and/or being given 'extra' prescriptions for the symptoms as the dose hasn't relieved ALL of them as an optimum dose is supposed to do. More funds for the pharma companies.
Read on this link - by an Expert on hormones what he states about the TSH.
If someone has had thyroid cancer they have to have a suppressed TSH and I doubt they get other serious issues.
Looking at the literature, an awful lot of it links low TSH to increased bone fracture in older women who are not on thyroid medication. It appears that this finding (which could be due to things other than TSH eg too high an FT3) has been transferred directly to patients under T4 treatment, without really finding out if the transfer is correct. One study by Leung (archived in TUK) shows one extra fracture per 1000 patient years in a meta-analysis - which isn't a great effect.
I keep wondering whether someone having been hypothyroid, possibly for many years, before diagnosis is showing the effect of that on their bones?
As I understand, most bone changes are slow. If someone has been hypothyroid for ten years, then gets treated, it would be easy to point the finger at thyroid hormone for any bone issues when the underlying cause was the hypothyroid years.
That's a really good thought Helvella, and, I was found to have osteopoenia before being switched onto T3 because I was not improving despite being on T4 for many years (and before that undiagnosed for decades). I had a DEXA scan straight away, before having been on T3 for any time, and there was osteopoenia, which history would fit totally with your theory. I know that's only one case but perhaps you'll hear from others with similar stories.
That's a good thought too, helvella. Or the autoimmune disease itself might be implicated.
My endo made this same suggestion to me because I prefer my TSH to be suppressed. However I found this related study and have printed it out to show to her.
You have said that you are on T4/T3 combo. Well I had a dexa scan a couple of years ago and was told that I have osteopenia (early osteoporosis). I never had a test prior to being diagnosed with Hashis, but I didn't have dairy for about 20 years because I had a gall bladder problem in my 30s and the slightest dairy made me have terrible pains, so I guess had I been tested, then I would have shown evidence of osteopenia then. Anyway that is just some background.
I started on T4/T3 combination in January this year and had a Dexa scan in May. My endo told me yesterday that my scan was normal. Spine is good, hips are low side of normal , but normal. I told him that is evidence that T3 is working! He said why? I've only seen him 3 times (first time last November), so he hadn't gone far enough back in my file to see that osteopenia diagnosis. I told him that I had previously been diagnosed with osteopenia. He had no answer. I have also had very low TSH <0.05 or lower ever since I started thyroid treatment! My endo on Wednesday said this is normal when on medication. I was stunned!!! We all know this but I have never had an endo conform this is over 6 years and I’ve had to battie them to stay on my thyroid dose. I looked through my medical records and in 6 years i’ve seen 14 endos/thyroid nurse specialists. I’m sticking with this one!
I can't find any research that proves that TSH has a direct effect on bones. In fact there is a piece of research that shows that TSH does not have ANY effect on Bone Mass Density.
Thyroid Stimulating Hormone and Bone Mineral Density:
Evidence From a Two-Sample Mendelian Randomization
Study and a Candidate Gene Association Study
Nicolien A van Vliet,1 Raymond Noordam,1 Jan B van Klinken,2 Rudi GJ Westendorp,1,3
JH Duncan Bassett,4 Graham R Williams,4 and Diana van Heemst1
There is a very recent pieced of research that shows that EXCESS TSH has a negative direct effect on the heart.
Thyroid stimulating hormone directly modulates cardiac
electrical activity
H. Alonso a,1, J. Fernández-Ruocco b,1, M. Gallego a, L.L. Malagueta-Vieira c, A. Rodríguez-de-Yurre a, E. Medei b, O. Casis a,⁎
It seems to me that the evidence so far is that it is mostly the excess or lack of T3 that causes Atrial Fibrillation or Osteoporosis. Now we need to factor in the excess of TSH and together with the lack of sufficient that contributes to AF. Not the lack of TSH.
It seems to me that the doctors are so indoctrinated that TSH tells us everything that they cant see the wood for the trees. They very rarely consider T3 for anything, including well being and that the real cause of AF or OP in these circumstances is an excess of or lack of the correct amount for the individual patient of T3 - mostly.
Thyroid Stimulating Hormone and Bone Mineral Density:
Evidence From a Two-Sample Mendelian Randomization
Study and a Candidate Gene Association Study
Nicolien A van Vliet,1 Raymond Noordam,1 Jan B van Klinken,2 Rudi GJ Westendorp,1,3
JH Duncan Bassett,4 Graham R Williams,4 and Diana van Heemst1
Full Paper : onlinelibrary.wiley.com/doi...
...
Thyroid stimulating hormone directly modulates cardiac electrical activity
H. Alonso a,1, J. Fernández-Ruocco b,1, M. Gallego a, L.L. Malagueta-Vieira c, A. Rodríguez-de-Yurre a, E. Medei b, O. Casis a,⁎
thanks.
Interesting post. I just had a DEXA scan last week as ordered by by reluctant Endo that I was dragged in front of for having the temerity of been prescribed T3 (by someone else) some years ago and having a suppressed TSH. The graphs I saw on the technicians screen show some damage that I am sure he will attribute to the T3 - nothing to do with my other immune problems or the weight loss I have managed to achieve whilst well on T3 of course! Feeling a fight coming on and the need for a second opinion. Any thoughts gratefully received.
Fight for your right to continue on T3. Others on this forum will have more information on maintianing bone health but my simple solution to OP fears is to advise doctors that so far there is no evidence that suppressed TSH directly affects bone health. As you say, the damage could be caused by any number of things but not suppressed TSH (in my view).
I take Vit D3 and K2 for many things but also including BMD support.
I would ask for regular DEXA scans to see if the damage advances.
Thanks Holyshedballs will give it a go
I’ve been on Levothyroxine for years now and also have osteopenia. Take calcium and Vit D4. GP makes me feel I’m making a big fuss so I’m sure I was misdiagnosed then undermedicated for years.
Hypothyroid & bone/liver bloods
T3 and suppressed TSH plus bone density
Low TSH
