Endo has suggested DEXA scan due to suppressed TSH

[Mickeydooley]

I recently wrote to my endocrinologist regarding his decision to reduce my levo on the basis of a suppressed TSH. In my email I told him that I had been feeling better on my increased dose of T4 and t3 and that I was disappointed to learn that he had recommended this reduction because my TSH was suppressed even though my T4 and t3 results were well within range. (He recommended the reduction even before my t3 results came back). I also suggested that it was not unusual for TSH to be suppressed whilst on combination treatment and that I understood from research that providing t3 was not over range there was little or no effect on bone mineral density or cardiac disease, which he originally stated were his main concerns. I asked to continue on my current dose and be retested in 6 weeks. I agreed that if my t3 was over range at that time I would be happy to reduce my levo then.

I just received a response. He states that the evidence is well established that TSH suppression, even with normal T4 levels, is linked to reduced bone mineral density and fractures and although the evidence is less well established for those on T4/T3 treatment we still need to be cautious. He has told me I can stay on my current dose but has suggested a DEXA scan to ensure there is no issue with it at present. I don’t know anything about this scan and will have to see what it involves. He asks if this is reasonable? I suppose I will have to accept the DEXA scan but do I just bite my tongue now? After all I’m getting to stay on my current dose. Maybe less said, soonest mended?

[SlowDragon Administrator]

Many people have seen improvements in bone density on T3/T4 combo

Even if bone density was currently poor (if been on Levothyroxine mono therapy a long time) ....it may now be improving on T3

How long have you been on combination therapy

How long on just Levothyroxine previously and was FT3 low?

What vitamin supplements do you currently take?

Was vitamin D low ?

Do you supplement magnesium and vitamin K2 mk7?

Suggest you agree to Dexa scan (ideally another in years time too)

Osteoporosis can be linked to low FT3

thyroidpatients.ca/2018/07/...

[Mickeydooley in reply to SlowDragon]

I was diagnosed in 2007 and have been on levo since then. I was put on T4/T3 treatment in August this year. I’m not a good converter and have hashis (although when endo tested levels were within range so apparently I don’t have autoimmune condition). As for vitamins/supplements I currently take selenium, magnesium and vit d/k2 spray. (Vit d level last time was within range but low). I also take probiotics for gut health.

I have just replied to endo accepting his offer of the scan.

[SlowDragon Administrator in reply to Mickeydooley]

If you had Hashimoto's in past ....you still have Hashimoto's now even if antibodies are within range

Vitamin D needs improving to at least 80nmol and around 100nmol is often better

Important to also keep folate, ferritin and B12 optimal

[Mickeydooley in reply to SlowDragon]

All other vitamin tests were good in July. Thank you once again for your responses. I’m finally gaining enough courage to question the endos I meet all due to the great advice here. (Last one didn’t take too kindly though!) Much appreciated.

[Hibs1 in reply to Mickeydooley]

No harm getting the scan to prove him wrong. There is nothing to it. Make sure no metal in what you're wearing or you'll need to take it off and wear a gown. E.g. Jeans, bra. Lie on back with legs over a sort of wooden block and they move the scanner over you at angles, if i remember rightly. They will probably take your height and weigh you. I was automatically referred for mine by the Coeliac disease clinic and have osteoporosis

[Mickeydooley in reply to Hibs1]

Hope I do prove him wrong! What did they do regarding your thyroid treatment? I’m terrified to be taken off the meds that have made me feel warm and sleep well for the first time in so many years I can’t remember! I still feel I have a way to go symptoms wise (e.g. energy levels) but if my bones suffered over the last 30 plus years due to insufficient T3 and haven’t recovered he may decide it’s my T3 and I’m concerned about that.

[Mickeydooley in reply to Mickeydooley]

I know I’m over thinking this! Sorry! 😁

[Hibs1 in reply to Mickeydooley]

Had the bone scan two years ago, as I said via the Coeliac clinic as a standard referral so it's then taken to be due to malabsorbion of vitamins and minerals that form the bones, even though I'd never bean vitamin d tested at that point(I had to ask for it myself). So as I'd been undiagnosed all my life, symptoms put down to other things or ignored, osteoporosis not a surprise. So thyroid did not come into it. Though I'm now beginning to wonder since the thyroiditis happened in February this year!

[Mickeydooley in reply to SlowDragon]

If my bone density was poor due to low t3 in the past and I’ve only been on T3 since August is it too soon to have seen any improvement with combination treatment?

[SlowDragon Administrator in reply to Mickeydooley]

I would argue it was...and insist on staying on current dose and redo bone scan in a year

[Mickeydooley in reply to SlowDragon]

I think I’d have a good case. My TSH has only been suppressed on this last reading. Never has been before so if my bones aren’t good now it’s hardly from T4/t3 treatment.

[Hibs1 in reply to SlowDragon]

What a good link that is

[SlowDragon Administrator]

Looking at previous posts you were left on inadequate dose of Levothyroxine (75mcg) for years and vitamin D too low

healthunlocked.com/thyroidu...

Hopefully now you have vitamin D higher - around 100nmol

[Mickeydooley in reply to SlowDragon]

Yes 75mcg since 2007. Many, many trips to different gps who told me my results were normal. I have been supplementing with vit d and K2 spray but haven’t had levels retested since July.

[SlowDragon Administrator in reply to Mickeydooley]

Seems we'd be better off if a robot saw Thyroid patients.....at least they might follow guidelines!

[SlowDragon Administrator in reply to Mickeydooley]

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

[thyr01d]

I'd say be grateful and say yes to the scan. My GP does not do them, though asked to by my Consultant, he now writes to her regularly to make sure I get them. Without the scan, how will you know what state your bones are in? You will presumably want to do something if there are signs of deterioration, and even if you didn't, when your endo offers something I think it's a good idea to co-operate and appreciate.

Apologies if that has come over as patronising, not meant to be.

[Mickeydooley in reply to thyr01d]

Not at all. I’m grateful for the advice. Thank you.