This article has studied the QoL of subjects on therapy and the relationship if any, with TSH. They find that the higher the TSH (even within the healthy range) the poorer the QoL.
Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism
September 2020
Endocrine
DOI: 10.1007/s12020-020-02449-4
Marta Morón-Díaz,Pedro Saavedra-Santana, Maria del Pino, Alberiche Ruano, Mauro Boronat
I want to contrast the conclusions of this new paper (which I like but the conclusions don't surprise me) with this one from 2017.
Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
Link : nejm.org/doi/full/10.1056/N...
[My emphasis]
Abstract
Background
The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition.
Methods
We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points).
Results
The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (P<0.001), at a median dose of 50 μg. We found no differences in the mean change at 1 year in the Hypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], −2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, −2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest.
Conclusions
Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism.
I believe that the NHS is already using the results of this older paper to deny older people any thyroid treatment and to reduce the treatment of people who are already being treated with thyroid hormones because, it is claimed, it doesn't reduce symptoms in the elderly.
But in this older paper, the average TSH after treatment with 50mcg Levo had only reduced to 3.63. So they were all under-treated - no wonder they didn't lose many or any symptoms.
The authors were :
David J. Stott, M.B., Ch.B., M.D., Nicolas Rodondi, M.D., Patricia M. Kearney, M.D., Ph.D., Ian Ford, Ph.D., Rudi G.J. Westendorp, M.D., Ph.D., Simon P. Mooijaart, M.D., Ph.D., Naveed Sattar, F.Med.Sci., Carole E. Aubert, M.D., Drahomir Aujesky, M.D., Douglas C. Bauer, M.D., Christine Baumgartner, M.D., Manuel R. Blum, M.D., John P. Browne, Ph.D., Stephen Byrne, Ph.D., Tinh-Hai Collet, M.D., Olaf M. Dekkers, M.D., Ph.D., Wendy P.J. den Elzen, Ph.D., Robert S. Du Puy, M.D., Graham Ellis, M.D., Martin Feller, M.D., Carmen Floriani, M.D., Kirsty Hendry, Ph.D., Caroline Hurley, M.P.H., J. Wouter Jukema, M.D., Ph.D., Sharon Kean, Maria Kelly, M.Pharm., Danielle Krebs, Ph.D., Peter Langhorne, M.D., Ph.D., Gemma McCarthy, M.P.H., Vera McCarthy, Ph.D., Alex McConnachie, Ph.D., Mairi McDade, B.Sc., R.G.N., Martina Messow, Ph.D., Annemarie O’Flynn, Ph.D., David O’Riordan, M.Pharm., Rosalinde K.E. Poortvliet, M.D., Ph.D., Terence J Quinn, M.D., Ph.D., Audrey Russell, M.M.Sc., Carol Sinnott, Ph.D., Jan W.A. Smit, M.D., Ph.D., H. Anette Van Dorland, Ph.D., Kieran A. Walsh, M.Pharm., Elaine K. Walsh, M.B., B.Ch., B.A.O., Torquil Watt, M.D., Robbie Wilson, M.Sc., and Jacobijn Gussekloo, M.D., Ph.D. for the TRUST Study Group*
And the above authors came from the UK, Republic of Ireland, Switzerland, Denmark, Netherlands and the USA.
The idea that all these doctors and researchers from around the world went out of their way to deliberately deprive older people of enough thyroid hormones to make them feel well or to deny them altogether makes me feel nauseous. The research was clearly not performed for the benefit of the elderly and was only intended to save money.
I wonder if the NHS will pay any attention to the newer paper that diogenes has posted.
Hi, I wonder why the over 65s were given just 50mg. Is it a compromise with safety of taking higher dosage? I’ve read so many accounts of patients on high dosage but still having symptoms! My tsh is high (average 6.5) antibodies around 300 for tpo and tga, t4 14 and T3 5, vitamins all ok (I supplement), I’m off gluten, oats and dairy. Apart from brain fog, I feel ok and have been on these levels for years. Im very reluctant to become dependant on Levo. I’m making a big effort to remain active physically and mentally. Walking and yoga basically. I’m 50. I’m Franco British and I find French people are really sick of Levo since the medical scandal a few years ago where pharma changed composition and made a lot of people feel very ill.
“...I’m very reluctant to become dependant on Levo...”. Surely, if you need thyroid hormones, you need them, in which case you are dependant on them. There is no substitute for thyroid hormones.
Good luck.
Hi, I wonder why the over 65s were given just 50mg.
The people who took part in the 2017 study all suffered from subclinical hypothyroidism, not overt hypothyroidism. The very name of the condition they are diagnosed with denies symptoms and assumes that people cannot be ill. If anyone does have one or more symptoms associated with hypothyroidism they are assumed to have some other condition rather than overt hypothyroidism (because their condition is called subclinical so the symptoms can't be connected! The definition of subclinical hypothyroidism and the logic behind it is circular). The mental gymnastics that doctors and researchers go through in connection with subclinical hypothyroidism are bizarre.
Anyway, if researchers and doctors sincerely believe that subclinical hypothyroidism really has no symptoms and is not serious, then they would probably worry about "over-treating" the subjects in the study. So giving people 50mcg may seem entirely reasonable to the people carrying out the 2017 study.
...
My tsh is high (average 6.5) antibodies around 300 for tpo and tga, t4 14 and T3 5, vitamins all ok (I supplement), I’m off gluten, oats and dairy. Apart from brain fog, I feel ok and have been on these levels for years. Im very reluctant to become dependant on Levo.
Have you ever been treated with enough Levo to bring your TSH lower and your Free T4 and Free T3 up to the upper half of the range? If you haven't then you have no way of knowing whether the higher dose would be good for you. Healthy people don't have brain fog. Low T3 is associated with heart disease. See this link :
ahajournals.org/doi/10.1161...
Your T3 of 5 with a TSH of 6.5 seems to be unusually high, so perhaps you are just a good converter of T4.
You mention becoming dependant on Levo as if it is addictive. It isn't - unless feeling well and healthy is addictive. If I don't take sufficient thyroid hormones my memory suffers, I suffer from brain fog, I think my IQ drops by 20 points, my motivation to do anything disappears and I feel as if I suffer from dementia. So, personally, I wouldn't worry about "dependency". I just want to feel well and be able to think.
Anyone who takes thyroid hormones, who still has a thyroid, could come off their thyroid hormones, and although it may take a while, their thyroid will eventually kick back into action again to the best of its ability, even if it doesn't produce enough hormones to keep someone well.
If I had severely high blood pressure, say 200/120, I could be prescribed pills to lower it. I wouldn't tell the doctor that I only wanted enough to reduce my BP to 150/100. I would want it to be around 120/70 or something similar. The same logic applies to thyroid hormones. I would always want enough to return my health to "as normal as possible".
Have just had a read through (superficially) and a brief check of the protocols.
They claim to have gained informed consent from the subjects. That much, I believe, insofar they had forms signed by the subjects. But I could not find the actual consent forms to check what they said.
Is it likely, or even possible, for older people who are hypothyroid to fully understand the consent they are giving?
Many of us here would find it difficult enough to follow a consent form for such a study at the best of times. When actually hypothyroid, even more difficult.
Would you consent to NOT be treated as part of such a study? That is, if you understood the implications of the sham treatment and dose adjustments. I offer that accepting non-treatment (as a certainty on one arm) or inadequate treatment (as a likely consequence of the other arm) implies a lack of appreciation of the study.
If I understood adequately, I would not have consented.
Theorerically the ethics of these studies with multiple treatment arms is that they should only be done when there is no knowledge about which treatment is better. i. e. No one is being given a treatment that is known to be inadequate, anyone would be equally happy to receive either of the treatments given the knowledge before the experiment.
In real life with these thyroid studies this seems to be extremely flimsy. Although in the pretty horrible elderly patients study they concluded the no thyroid treatment was better anyway 
I appreciate your response. You are right to highlight the ethical basis.
I think my fundamental problem is believing that any of the subjects actually understood sufficiently for it to be deemed "informed" consent. Mind, did any of the medical/scientific people understand sufficiently?
That's very true I think consent is a dodgy area anyway.
I'd prefer it if things were done more honestly and it was accepted that usually it is the medical "expert's" decision, and the patient is on the back foot in terms of knowledge, status, and who knows what else and often can't give good quality consent. It seems like getting consent is much more of a box ticking exercise to protect doctors who are probably doing harm
Thank you, yet again - much appreciated - still got that 'fight' on my hands. 
It just shows how the concept of healthy range of TSH is such a joke even in academic papers, when are all the so called experts, academics and professionals going to realise there is no healthy range.... there’s just one healthy point, each individuals set point for TSH and treatment as much as pathology cocks that up! Finding our tsh set point is the holy grail and no clinician should judge thyroid status on TSH, ever.
Low serum free thyroxine level is correlated with lipid profile in depressive patients with suicide attemptAnother paper showing low FT3 in Hashimoto's and poorer QoL as a result
High TSH, in range T4? Paper showing less satisfaction with T4 therapy than when healthy
Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism
