TSH and bone density

[Laundretta]

Hello lovely people. My TSH is currently suppressed to 0.005 (0.27-4.2), T3 measured at 5.86 (3.1-6.8) and T4 19.5 (12-22).

I'm taking 12.5 mcg T3 split over 2 doses and 125mcg T4. Before the test I took my usual night time dose of T3, but bloods were taken at 9am fasted and without my morning dose of T3 or T4.

I feel really well atm with no symptoms of overmedication.

The GP report that comes with the medichecks results highlighted the risk of osteoporosis with continual suppression of TSH. I'm finding conflicting information in medical journals online as to whether the lack of TSH per se has an impact on bone health, or whether bone health is impacted with an excess of thyroid hormone alone. I don't otherwise feel overmedicated and my results are in-range.

Anyway, I thought I'd ask what our experts feeling is on the matter and what tests could I add to my regime in order to monitor the situation?

Thanks in advance

X

[diogenes Remembering]

The allegation that suppressed TSH can lead to osteoporosis is largely based on the situation in true hyperthyroidism, where TSH is suppressed and FT3/4 above normal. In such cases OP is definitely a problem (among many other things). The situation on treatment is quite different with perhaps suppressed TSH but normal FT3/4. It's often impossible to undo the suppression by whatever treatment. However a best solution I have sen in papers by Leung, suppresed TSH in such situations may add up to 1 extra fracture per 1000 patient-years. Not a big problem in my eyes. The upshot is whether you wou ld like better health over your life, and risk the very small chance of OP (due to supressed thyroid) later on. Otherwise you would have an unsatisfactory state of health with inadequate treatment.

[Laundretta in reply to diogenes]

Thank you replying and setting my mind at rest.

[Nanaedake in reply to Laundretta]

The best thing it seems that anyone can do for bone health whether taking thyroid hormone or not is ensure good vitamin D levels and do the right kind of exercise for maintaining bone density. That's weight bearing and resistance exercise. For example, the BBC program comparing bone density found women who jogged maintained 30% higher bone density than those who didn't do any regular exercise. It was a better exercise than cycling. Walking regularly is weight bearing too although more impact could be better if you are healthy and strong according to findings.

[wellness1 in reply to diogenes]

Often the discussion of suppressed TSH is framed as leading to osteoporosis. Do you characterise the risk or need for concern as any different once osteoporosis is established?

[diogenes Remembering in reply to wellness1]

Osteoporosis arises by many routes. A particular situation for an individual getting OP cannot be safely ascribed to any one cause. Post menopause can be another reason. General frailty arising from something else but secondarily reponsible for OP can also figure. There probably is a genetic influence as well. The fact is that the small extra chance of OP is statistical, not individual. Thus one can't ascribe a single case of OP to thyroid TSH problems with any certainty ,.

[wellness1 in reply to diogenes]

Thank you. Sorry, I didn't phrase my question well. I understand OP can be caused by many factors. I'm not referring to assessing the role suppressed TSH may have played in the development of OP. I'm interested in whether, in an established OP patient, more concern about TSH is justified. (if that makes sense)

[diogenes Remembering in reply to wellness1]

I would say not. The damage from whatever cause has been done. You will not get back from suppressed TSH quickly if at all by dose manipulation. Especially if on suppressive dose for some time

[wellness1 in reply to diogenes]

Thanks for sharing your insights. My TSH has probably been suppressed a few years now. Endo is fine with it quite low, but not 'undetectable' and I feel a conversation coming about this and OP.

May I trouble you with one more question? We often hear members describe painful shoulder conditions, in my case currently bursitis and frozen shoulder. I understand this is an association but not well understood. You shared with us an article from Naature on a thyroid hormone network in synovial tissue in euthyroid RA andOA patients. particular reference to T3, IIRC. Currently my reading and comprehension are suffering. Sorry to ask, but might this have any possible relevance for the shoulder conditions hypothyroid patients experience? I know I am asking for conjecture on your part, but I may need to put forward some science-based argument to the endo for an increase inT3 even if it results in a TSH drop of 0.05 or whatever with its (possible) implications for osteoporosis .

Sorry if I have misread potential unresearched implications of this research for those with thyroid conditions and apologies to Laundretta for this detour on her post, but it does actually relate, however circuitously, to TSH and bone densty.

[diogenes Remembering in reply to wellness1]

If this is anything it may be secondary. That is, if you become ill, and don't move around as much, muscles can atrophy.. I wouldn't think these conditions are anything other than an indication of general mobility.

[wellness1 in reply to diogenes]

ah, once again, didn't phrase the q correctly. Not speculating T3 level would have caused. I know what's going on there. Just wondering if thyroid hormone levels might possibly play some small role in affecting recovery/outcome. Sorry and thanks for your patientce.

[diogenes Remembering in reply to wellness1]

Surely so, but only because your whole being is being stimulated by better horomne delivery. Frozen shoulder will never go away without exercise to free the stuck muscles up.

[wellness1 in reply to diogenes]

Makes sense, of course. Just wondered whether something distinctive about synovial tissue in this regard. BUt thank you. Yes, broader approach being taken. Thanks, again

[tattybogle in reply to wellness1]

There is always the argument that being stuck on the sofa too frequently is no good for bone health, cardio health ,or joint rehab. (not scientifically impressive , i grant you , but true none the less )

[wellness1 in reply to tattybogle]

absolutely and I will definitely make that argument wrt the tradeoff of thyroid hormone levels and TSH. Just exploring whether something a bit more 'science-y' wrt a thyroid hormone network in synovial tissue in joints might help the case. Bit of a reach as the study doesn't deal with hypothyroid patients anyway. But as discussed above, everything works better when those levels are optimal. Cheers, tattybogle .

[TaraJR in reply to diogenes]

diogenes this post was quite a while ago, but please do you have the title of this paper by Leung, or a link to it? Many of us are told we cannot stay with a slightly suppressed TSH because of the OP risk, despite normal FT3 and FT4 levels, and we're threatened with medication reduction. When we take T3, our TSH is often suppressed but we fight a battle so many times with doctors over this as they do not accept that happens and is ok.

The Leung paper sounds ideal to quote to them!

[diogenes Remembering in reply to TaraJR]

This paper should help you:

Thyroid stimulating hormone and bone mineral density: Evidence from a two-sample Mendelian randomization study and a candidate gene association study

March 2018 Journal of Bone and Mineral Research

DOI10.1002/jbmr.3426

Nicolien A van Vliet et al

[SeasideSusie Remembering]

Laundretta

I would go with what Diogenes has said.

Your results look perfect for someone on combination replacement hormone and you feel well.

My results are similar (also on combination replacement) and depending on which lab does the test and how low the machine measures, my results are always <0.01 or <0.02 or <0.005 and have been for many years. I don't have osteoporosis or atrial fibrilation (which is another thing they like to throw at us) and thyroid-wise I feel optimally medicated.

[Laundretta in reply to SeasideSusie]

Thank you SeasideSusie. I’ve been on combination replacement for about a year now and feel pretty good for it on the whole. Do you find or have experience of requirements changing seasonally? I spend quite a bit of time outside (skiing) in the winter, which last year coincided with me still finding the right dose, as I’d been adding t3 very gradually. So by December the dose went up to 125 t4 and 18.75 t3, which worked. Then as the weather got warmer in spring I felt very slightly over medicated (a little ‘wired’, not sleeping quite as well, occasional palpitations and very warm hands) so for the last 8 weeks I’ve been on the 125/12.5 dose and feel good again.

[SeasideSusie Remembering in reply to Laundretta]

Laundretta

I never feel any different seasonally, although I know some people do so I've never had to change dose for that reason. It's good that you can read your own signs and alter your dose if necessary.

[abitsad]

Watching this closely as my TSH is also suppressed while my FT3 and FT4 are in range. I'm also on T3 15mcg and T4 112mcg. Without T3 my FT3 is below range, but I get a "perfect" TSH. You could get a bone density scan.

[MMaud in reply to abitsad]

Abitsad - What risks concern you with the DEXA scans?

[abitsad in reply to MMaud]

MMaud, I deleted it since I actually don't know. I was once told by a GP to have one done only to be told by another not to. I thought it was because they said there may be some risks, but I may have misremembered. I've just looked up DEXA scan and it sounds safe.

[MMaud]

I began T3 in September, in combo with T4. At my review in May, my TSH was suppressed. I was personally unconcerned about it, but was concerned what the Endo's approach to it would be, bearing in mind they seem to be in two polar opposite camps.

Thankfully the Endo's approach was "that often happens on this regime", s we'll keep an eye on your bone health".

Continuing good luck with it Laundretta. Isn't it just marvellous to feel marvellous? I feel like a new woman.

[SlowDragon Administrator]

Osteoporosis can occur due to LOW Ft3......not just high FT3

thyroidpatients.ca/2018/07/...

On almost any dose of T3 it’s almost inevitable that TSH will be suppressed

The most important result is FT3 followed by Ft4

Plus optimal vitamin levels