Significance of TSH

[kvmj]

I was diagnosed in 03/17 with hyperthyroidism. I let symptoms go on for years and am paying the consequences. I developed a-fib, mitral valve regurgitation, congestive heart failure and severe osteoporosis. I think that my endocrinologist is good, but I usually see a nurse practitioner or physician's assistant. The cause of my hyperthyroidism is two benign nodules on the right hand side of my thyroid.

I have been prescribed Methimazole. Dosage has varied from 0 to 20 mg. per day. I also take Metoprolol Succinate ER 100 mg, Furosemide 20 mg. twice daily and Xarelto 20mg. .My labs are all good except for thyroid. These are my last three:

Date TSH (2.4-5.6) FT3 (2.5-3.9) FT4 (.58-1.64)

08/07/17 <.01 5.7 1.24

09/23/18 <.01 4.5 .93

01/22/19 <.01 4.0 .92

I have been taking 10 mg. Methimazole since August. The NP I saw yesterday wants me to increase the dose to 15 mg. and repeat labs in 7 weeks. She's very concerned about the low TSH which I thought was the least significant value and is pressuring me to undergo RAI. She's concerned with the effect of TSH on osteoporosis. What do you think?

[greygoose]

It is the least significant. The most important is the FT3. As you can see from your labs, the TSH really bears no relation to your FT3 which, in the last one, is well below mid-range, yet your TSH is still suppressed.

You say you ignored hyper symptoms for a long time, during which time, your 'normal' level of TSH - secreted by the pituitary - became down-grade. Suppressed is probably now your 'normal' TSH. It will not rise, no matter how much they suppress your thyroid hormone. And, if they continue to try, they are going to make you very ill.

There is no proof that a suppressed TSH is the cause of, or has any effect on, osteoporosis. It's high T3 that causes the damage. So, if yours was high during the years you ignored your symptoms, that could be the cause of your osteoporosis - but even that's not certain. Now, your T3 is low, which is also harmful for bones. Do you have your labs from the time you were diagnosed?

Are they absolutely certain that it is the nodules that are causing the hyperthyroidism? If so, there's not very much you can do about it, except remove the thyroid, as far as I know. But, did they ever test antibodies to see if you have Grave's?

[kvmj in reply to greygoose]

I posted once before: healthunlocked.com/thyroidu...?

By the way, my adrenals were low because I had taken a hefty dose of steroids the night before and the endocrinologist said that showed that they were working fine. By ruling out Grave's and adrenal problems, there's nothing left but the nodules. I might agree to a partial thyroidectomy with the hopes that what's left can function normally. I wish there was another solution.

[greygoose in reply to kvmj]

So, according to that post, you never did have your antibodies tested.

[kvmj in reply to greygoose]

My antibodies were checked and found to be within normal range.

[greygoose in reply to kvmj]

OK, so how do you feel with those levels? If you feel ok, I see no reason why you should have RAI. Only if you feel unwell.

[kvmj in reply to greygoose]

I feel okay, but considering all the other things wrong with me, I'm not sure that I would notice. I was aware that i was tachycardic, but my GP never brought it up so I didn't. I usually had a heartbeat of 250 BPM and I felt okay then too. The last couple of years before diagnosis, I developed a tremor.

My heart rate has never been under control, but my average is 82 BPM. So, I've asked to be switched from Metoprolol to Propranolol since it has some benefit for the thyroid. I don't really expect it to make a difference.

[greygoose in reply to kvmj]

Well, your last test, the FT3 was only just over-range. So, if you feel ok, why not continue like that? It doesn't matter about the TSH.

What benefit does propranolol have for the thyroid?

[kvmj in reply to greygoose]

I think that Propranolol blocks beta receptors on the thyroid as well as the heart. My heart rate varied from 49 to 164 when I wore a monitor.

I'm inclined to think that you're right about my dosage of Methimazole. This same dose has made me hypo before.

[greygoose in reply to kvmj]

OK. I didn't know that the thyroid had beta receptors.

[Redditch]

I think I'd be happy on those results. I'd stick if I were you. A low TSH stops iodine getting to your bones. You could supplement with Lugol's iodine a drop a day.

[greygoose in reply to Redditch]

I've never heard of that before - low TSH stopping iodine getting to your bones? Do you have a link to that information?

[Hidden]

Hi kvmj. I noticed they posted that you had joined and pulled up your profile.

Just wanted to introduce myself and say welcome as I am also in the US (Atlanta).

My 2 forums are AFA (had afib since 2011 and doing very well) and also belong to Thyroid UK. What I've learned here has gotten me on the right track with effective thyroid care because both forums helped me know what questions to ask and what level of care I deserve and should expect.

Hope things will start going smoothly for you.

Welcome. 🐱 irina1975

[kvmj in reply to Hidden]

I'm in Charleston, SC and belong to the same 2 forums which have been immensely helpful to understanding my conditions.

I'd like to get the Watchman because I hate Xarelto for leaving bruises all over my left forearm.

[Hidden in reply to kvmj]

Just got up for a few minutes (2:45am-i'm a night owl) and saw your post-I guess you saw I got a Watchman in Jan 2018. VERY happy to be off anticogulants!! I'm doing fine. Happy to share if you want. Ir was easy surg and recovery-very happy I did it.

Today is my B'day-75- so will get back to you prob Sun or Mon.

I was born in Summerville SC. Small world. I agree about the 2 forums. They have helped me a lot- well back to bed.

Goodnight! irina

[kvmj in reply to Hidden]

Happy birthday. Enjoy.