Is my TSH suppressed? Doctor wants to lower my ... - Thyroid UK

Thyroid UK

137,140 members160,827 posts

Is my TSH suppressed? Doctor wants to lower my dose :(

PInk54 profile image
19 Replies

Hi there

I'm a first time poster asking for some advice or opinions please? I, like many others I believe, was taken off my prescribed dose of 3 x 20 microgram of T3 (liothyronine) last year, and put on 1 x 20 microgram of Liothyronine and 1 x 75 microgram of thyroxine. I was originally prescribed the T3 by Dr Skinner, who was of the opinion I that I was one of those people who didn't respond to T4 alone. I had been previously diagnosed with CFS/fibromyalgia. This was 22 years ago and for almost all that time I have been well in terms of thyroid symptoms. I will be forever grateful to the late Dr Skinner for his help.

I was tested 6 months after they changed the medication and the doctor was worried as my TSH was suppressed and threatened to lower the dose I was on. After I insisted that I didn't want that, he left it but tested last month. I haven't felt as well for the whole year - very fatigued, dry skin and hair and constipated often. I've had a recent test and my results are below. I've got a telephone appointment booked with my doctor and I'm worried he's going to lower my dose due to the suppressed TSH. Any help gratefully received!

Serum Free T3 level: 4.3 pmo/L (normal range 2.8-7.1)

Serum Free T4 level: 16.9 pmo/L (normal range 9.0-26.0)

Serum TSH level: 0.02 mu/L (normal range: 0.27-4.20)

Written by
PInk54 profile image
PInk54
To view profiles and participate in discussions please or .
Read more about...
19 Replies
shaws profile image
shawsAdministrator

Did you get your blood draw at the very earliest time, fasting (you can drink water) and allow 24 hours between your last dose and the test and take it 'after' blood test?

PInk54 profile image
PInk54 in reply to shaws

Hi, yes, I deliberately didn't take my meds a day before the test and it was at 8.30am - although I can't remember if I'd had any breakfast - they definitely didn't tell me to fast...

shaws profile image
shawsAdministrator in reply to PInk54

This is the method for blood tests:-

We make the very earliest appointment, and it is a fasting test (you can drink water) and do not take thyroid meds until afterwards.

Your results may not be accurate if you didn't take your thyroid hormone dose the day before the test and also didn't take your dose until after the blood draw? Don't worry as it is a learning curve :)

Just to go over the method.

Make your appointment for a blood test about a week or two before, so you get the earliest possible time. It is a fasting test (you can drink water) and don't take thyroid hormones until after the blood draw.

PInk54 profile image
PInk54 in reply to shaws

Thank you - that’s good to know and thank you for the advice re levels... I’ll let you know how I get on. :)

fuchsia-pink profile image
fuchsia-pink

Welcome to the forum.

I'm sorry you are having to deal with an ignorant TSH-obsessed GP ... Sadly it's not unique. Once you are on T3 meds your TSH is inevitably suppressed. It doesn't matter. It's just what happens - in the same way as your garden gets wet when it rains. There is no increased risk of osteoporosis or heart attack. And you are ONLY over-medicated when free T3 is over-range - and yours very clearly isn't.

I would argue as best you can for an increase in meds .... most of us need both "frees" to be in the top third of the lab range (or higher), but your free T4 is only 46.47% through range and free T3 a feeble 34.88% through range. It's hardly surprising that you don't feel properly well! And reducing meds even further isn't going to help is it?

I'd suggest saying that in addition to the dose increase you clearly need to get your "frees" up, you would like him to test key nutrients, as it's important that these are good. That's ferritin, folate, vit D and B12. I've had some success with my GP by saying that these tests are recommended by Thyroid UK (but the vit D test is hard to get on the NHS so you may have to concede that one). If he freaks about the imagined risk of bone density issues, ask for a Dexa bone scan to use as a benchmark, so you can both see it isn't declining in future.

And going forwards always have an early morning, fasting blood test (when TSH is highest) and leave 24 hours from your levo and 8 - 12 hours from your lio to have a good representative level of hormone in your blood.

Good luck x

PInk54 profile image
PInk54 in reply to fuchsia-pink

Thank you so much - that's really helpful. Re B12 and vitamin D - I have been taking suppplements of both of these so I think levels would be fine - but I won't tell him, and ask for a test as ferretin and folate might be off - good suggestion, thank you for your help.

SlowDragon profile image
SlowDragonAdministrator

Do you always get same brand levothyroxine at each prescription

Same brand of T3

Do you normally take T3 as single dose, or split into 2 or 3 smaller doses

You should always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

But When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last small dose T3 at roughly 8-12 hours before test

Essential to regularly retest vitamin D, folate, ferritin and B12

Do you know if you have autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

shaws profile image
shawsAdministrator

Tell him that neither FT3 and FT4 is near the top of the ranges and that's what you'd like to achieve and can he please increase your dose.

Tell him (only if he mentions it to you) that also due to the adjustment down of your previous doses has made you symptomatic again, something you didn't want to happen.

If he is only going by the TSH, tell him that's not a thyroid hormone but from the pituitary gland and the aim is to have a TSH of 1 or lower and, NO, you will not be overactive.

Also state that TSH is not a thyroid hormone it means Thyroid Stimulating Hormone and that if it is low that's what your aim is.

StillEverHopeful profile image
StillEverHopeful

I was told by an endocrinologist that so long as TSH was detectable it was below range and not suppressed but that Ft3 & Ft4 needed to be in range or else dose would change.

Pixielula profile image
Pixielula

It’s a very well known fact for endo’s who know what they are doing) that people who take T3 only, have a suppressed THS. I have been on 60mcg T3 only for 11-12 years. Every time they do a blood draw I have to tell them to test my T3 levels, I also have to remind them my THS is suppressed so as I don’t get a panicked call from some medical professional. I usually do get a phone call from some panicked medical professional any way…. I suspect the reason they took you of most of the liothyronine is due to the cost and not due to your health. I also suspect 75mcg is not an adequate replacement for the 40mcg of lio they have removed….. before I went onto T3 only I was taking 250mcg levo. Did they give you a reason for BBC taking you off?

PInk54 profile image
PInk54 in reply to Pixielula

That’s my understanding of TSH and T3 too. They took me off as they mentioned the price of it, but also tried to scare me with talk of heart attacks and low bone density. They tried to put me solely on T4 but I insisted on seeing an endocrinologist who just repeated what the doctor said but let me stay on some T3. It’s clearly not enough as I have symptoms back, but I can feel I’ve got a battle on my hands. They haven’t fulfilled my latest prescription and won’t until I speak to the doctor but I’ve had to wait two weeks for an appointment!

Pixielula profile image
Pixielula in reply to PInk54

Sadly that is normally the case, they did it too my brother he was on T3 only, when the price started going crazy they took him off and put him back on levo without any consultation. Love him he still believes his doctor is doing what’s best for him!!!!!! I kicked up an absolute stink when they tried it with me… Somerset CCG still took me off it mind you! And I spent a couple of years buying it online and holidaying in country’s I could buy it over the counter. Now I’m back getting it prescribed and I have a endo who knows my THS is suppressed and is not too bothered by it…. It has been a struggle

Marymary7 profile image
Marymary7

Don't take any Biotin in any supplements it interferes with the testing.

Judithdalston profile image
Judithdalston

My Gp is doing the same thing all lockdown panicking about TSH below range even tho on combo T4 100 and T3 12, and both frees under 50%. They think I am on 50 mcg levo , not sure re T3 (despite having had a print out 3 years ago that I take T3 ). I’ve resorted to getting a private endo appointment from Thyroid U.K. recommendation in the hope he will produce a report that the GPs acknowledge re I need at least 100 levo (if not more as 125 produces better frees) plus the T3. I have fibro too, which is really disablitating, and have never found a thyroid hormone replacement dose to improve it ( have been on T3 75 mcg only), did you improve your fibro pain and fatigue?

PInk54 profile image
PInk54 in reply to Judithdalston

Hi, I'm so sorry you are having similar a similar problem...when will they learn?! Yes, my fibro pain did improve after I went on the T3, but it took time - around a year or even more. I think it's still there a little and manifests in the fatigue more than the pain (but it was the other way). I think I may have to go the private route too - I have a conversation with the GP today...I stated my case and she took not a blind bit of notice, just kept repeating that my TSH was supressed. I refused to lower my dose and so she insisted in re-testing my TSH in two months....it'll be the same no doubt, so I've got no choice but to look elsewhere. I really dread my health deteriorating further and being back at square one.

Best if luck to you, I really hop you can find a way forward.

Judithdalston profile image
Judithdalston in reply to PInk54

My GPs seems to be holding back the levo prescription until I have nhs bloods done tomorrow! I’m not sure how much to stress with the private endo that it is the pain and exhaustion that affects my quality of life so much as these may not be seen as hypo but fibro symptoms, the trad. hypo symptoms that I do have like constipation, weight gain or hair falling out are by comparison just inconvenient! My zoom appointment is next Wed. I’ve just seen an nhs sleep apnoea specialist who added to his post consultation letter that some of my problems were probably over medicated for hypothyroidism.... just wish those who don’t really know anything about it would but out!

Catseyes235 profile image
Catseyes235

I discovered recently that my TSH had been well below ‘normal’ range for 15 years. I was on 150 mcg T4 so had reduced it to 125 but never really made a difference and a further reduction left me with hypo symptoms. I have only just had T3 prescribed.

I wonder if there are any notes written by Dr Skinner that you can get your hands on. Problems with T4 conversion need to be recognised especially amongst GPs who are mainly guided by T3 avoidance due to costs.

The young (to me ...probably in 30-40s) endo I saw recently said these problems with conversion were not uncommon! Good luck.

PInk54 profile image
PInk54 in reply to Catseyes235

Thank you - it does seem to be common. I am going to write to the Practise Manager tomorrow and ask them to refer to Dr Skinner's original notes. No idea if they'll be there but no harm in trying. Thank you for replying and good luck to you.

holyshedballs profile image
holyshedballs

here is a letter I wrote for someone else . Its a bit out of date around the GMC Consent guidelines but copy it, paste it into a word processor and adapt to suit your own circumstances

Your Address here

no_reply@example.com

Date:

Dr’s name here

Surgery address here

Post code here

Dear Dr *********

Unilateral Reduction of my dose of litheyronine (T3)

Mental Capacity Act 2005

Good Medical Practice 2013

Good Medical Practice Consent: patients and doctors making decisions together 2008

Montgomery v Lanarkshire Health Board 2015

Bolitho v City and Hackney Health Authority 1993

I write following my appointment with you on ??/??/???? regarding your wish to reduce my ???mcg dose of T3.

During the appointment I told you that I did not want to reduce my dose of T3 because I feel good on this dose. I feel well, I can do my job to the best of my ability and I can contribute properly to my family life. I am not as irritable or fatigued. I can think clearer. I told you that my signs and symptoms return on a lower dose. You said that you wanted to reduce my dose because my Thyroid Stimulating Hormone (TSH) was too low and thereby there is of a risk of Osteoporosis (OP) and Atrial Fibrillation (AF). I showed/told you about research that shows that this not the case. (See appendix 1 attached.) I told you that you have no logical justification to reduce my dose of T3.

You did not carry out or refer me for an Electrocardiogram (ECG) test to establish a baseline or detect any abnormalities in my heart’s electrical activity despite your concerns about AF.

You did not refer me for a DEXA scan to establish a baseline or detect any abnormalities in my bone mineral density despite your concerns about OP.

You then reduced my dose of T3 to ??mcg.

Good Medical Practice

I am sorry to say that because you simply went ahead and reduced my dose against my wishes you did not comply with the preamble of the General Medical Council’s Guidance for Doctors Good Medical Practice 2013:

“The duties of a doctor registered with the General Medical Council”:

“Work in partnership with patients. Listen to, and respond to, their concerns and preferences. Give patients the information they want or need in a way they can understand. Respect patients’ right to reach decisions with you about their treatment and care.”

Mental Capacity Act 2005

During the appointment you did not assess me to determine if lacked Mental Capacity as laid out in section 3 of the Mental Capacity Act 2005. Therefore I am consider that you have assumed that I have mental capacity in accordance with section 1(2) of the Act.

Consent: patients and doctors making decisions together/Montgomery v Lanarkshire Health Board 2015

As I have, and you have assumed that I have, mental capacity to make decisions about my health, I am sorry to say that you did not follow the model in the General Medical Council’s Code of Practice Good Medical Practice Consent: patients and doctors making decisions together. This is important because the medical negligence case of Montgomery v Lanarkshire Health Board 2015 stated at paragraph 93 that following the model at paragraph 5 of Consent: patients and doctors making decisions together is a legal obligation.

The Guidance at paragraph 5 of Consent… states

If patients have capacity to make decisions for themselves, a basic model applies:

A. The doctor and patient make an assessment of the patient’s condition, taking into account the patient’s medical history, views, experience and knowledge.

B. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.

C. The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.2

D. If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.

With regard to part A

I told you about my condition and that it is my experience that on a reduced dose of T3, my signs and symptoms will return.

You did not assess me for signs of over treatment or refer to my blood tests for T3 and or T4 for to see if they were over their reference ranges.

I showed/told you that there is research that shows that low TSH does not cause OP.

I showed/told you that there is research that shows that OP and AF more likely when T4 and Liothyronine (T3) are too low or too high.

I told you that I do not have signs or symptoms of hyperthyroidism such as palpitations, tremor, or sweating.

I told you that I get some of my information from the internet and patient support groups. Their Lordships and Ladyship in the Supreme Court in Montgomery v Lanarkshire Health Board 2015 said at paragraph 76 of the judgement:

“it has become far easier, and far more common, for members of the public to obtain information about symptoms, investigations, treatment options, risks and side-effects via such media as the internet (where, although the information available is of variable quality, reliable sources of information can readily be found)3 (and) patient support groups…It would therefore be a mistake to view patients as uninformed, incapable of understanding medical matters, or wholly dependent upon a flow of information from doctors.

The idea that patients were medically uninformed and incapable of understanding medical matters was always a questionable generalisation, as Lord Diplock implicitly acknowledged by making an exception for highly educated men of experience. To make it the default assumption on which the law is to be based is now manifestly untenable”.

I told you that you had no logical justification to reduce my dose of T3.

With regard to part B

You simply said that there is a risk of OP and AF due to low TSH. It has been shown that the risks of OP or AF is due to either too much or too little for the individual patient’s T3 and T3.

You did not quantify the risk of OP or AF in a way I could understand or at all. Therefore you have no adequately explained the options to me and the possible risks or benefits of staying on my dose, raising my dose, changing to Liothyronine (T3) or having a mixture of T3 and T3.

By not quantifying the risks of the above options to me personally, you have not given me the opportunity to weigh the risks and benefits of each option as required in part C of the GMC’s model.

You did put pressure in me to accept your decision by simply saying that you are reducing my dose.

With regard to part C

I have the mental capacity to make decisions about my health. I have read the research referred to above. I understand that the risk of OP and AF is from having too much or too little T3 and/or T3 for me as an individual. I don’t have the signs or symptoms of too much T3 and/or T3. My blood tests show I am not outside the reference range for T3 and/or T3. I have weighed up the theoretical and mostly unfounded risks of staying on my dose against the actual risks of lowering my dose. I have also considered the non clinical factors of lowering or remaining on my dose, such as the impact on my family life and work life if my signs and symptoms recur, as they will do if my dose is reduced.

I have assessed the risks of OP and AF by lowering my dose to be much higher than remaining on my dose.

I have decided to remain on the dose I am on.

With regard to part D

Remaining on my dose is clearly of overall benefit to me. I feel well, I can do my job to the best of my ability and I can contribute properly to my family life. I am not as irritable or fatigued. I can think clearer. Reducing my dose will result in harm to my health by the return of my signs and symptoms. It will also negatively impact on my work, private and family life. Further, as described above, there is no reliable evidence that low TSH actually causes OP or AF.

If you are still of the opinion that you want to reduce my dose to ??mcg, please explain how remaining on my current dose would not be of overall benefit to me in writing. It is important that you quantify the risk of OP or AF to me as an individual in your written explanation. Good Medical Practice at paragraph 47 says that you must treat me an an individual. Please be aware that there is another body of responsible medical opinion that agrees with maintaining a dose of thyroid medication that suppresses TSH without causing thyrotoxicosis and had been recognised as such by the General Medical Council.

Lack of logic to reduce dose of T3

I am unaware of any guidance to unilaterally reduce a patients dose of T3 and/or T3. Such guidance does not appear in the British Thyroid Association’s statement on the management of primary hypothyroidism. Recommendation 7 states:

“Although fine tuning of serum TSH levels within the reference range may be indicated for individual patients, deliberate serum TSH suppression with high dose thyroid hormone replacement therapy (serum TSH <01 mU/L) should be avoided where possible as this carries a risk of adverse effects such as cardiac rhythm disorders including atrial fibrillation, strokes, osteoporosis and fracture (1/++0). As an exception, patients with a history of thyroid cancer may require deliberate suppression of serum TSH if there is a significant risk of recurrence”.

It does not recommend that ALL patients on thyroid hormone replacement therapy unilaterally have their dose reduced. It states “where possible”.

This recommendation is now out of date following research that low TSH is not a factor in OP or AF but excess or low T3 and/or T4 is. To blindly follow this out of date statement is in conflict with a doctors legal obligation to follow the model consultation in Good Medical Practice Consent: Patients and doctors making decisions together.

The Royal College of General Practitioners Curriculum states at 3.17 that a GP should:

“Recognise your central role as a primary care physician in managing diabetes mellitus and hypothyroidism”,

and

“Recognise the potential for abuse of thyroxine and propose strategies to reduce dosage”.

I can assure you that simply being on a dose that makes me well is not abusing thyroxine especially if my blood tests for T3 and T4 are within their reference ranges. Any strategy to reduce dosage must be logical. This is confirmed by the medical negligence case of Bolitho v City and Hackney Health Authority 1993 which states that a doctor’s actions must be logical even if it is supported by a responsible body of medical opinion. For the reasons above, I do not believe that your action to reduce my dose without any evidence or following the BTA statement contrary to my well evidenced and argued wishes to remain on my dose of T3/T3 is logical.

If you have concerns about me suffering from AF or OP please refer me to a cardiologist for an ECG test and an Orthopaedic specialist for a DEXA scan.

I hope you reconsider your decision to reduce my dose of T3 and/or T3 and restore it to the level that makes me feel well and contribute to my work and family life. I value my actual health more that an unfounded and unquantified potential risk in the future so much that if my dose is not maintained or restored, I will take this matter further by way of complaint to the Clinical Commissioning Group, the General Medical Council or by a claim for negligence.

Yours Sincerely

Sign here

Type your name here

Appendix 1

Thyroid Stimulating Hormone and Bone Mineral Density:

Journal of Bone and Mineral Research, Vol. 33, No. 7, July 2018, pp 1318–1325

DOI: 10.1002/jbmr.3426Evidence 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

1Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands

2Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands

3Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark

4Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, London, UK

ABSTRACT

With population aging, prevalence of low bone mineral density (BMD) and associated fracture risk are increased. To determine whether low circulating thyroid stimulating hormone (TSH) levels within the normal range are causally related to BMD, we conducted a two-sample Mendelian randomization (MR) study. Furthermore, we tested whether common genetic variants in the TSH receptor (TSHR) gene and genetic variants influencing expression of TSHR (expression quantitative trait loci [eQTLs]) are associated with BMD. For both analyses, we used summary-level data of genomewide association studies (GWASs) investigating BMD of the femoral neck (n.32,735) and the lumbar spine (n.28,498) in cohorts of European ancestry from the Genetic Factors of Osteoporosis (GEFOS) Consortium. For the MR study, we selected 20 genetic variants that were previously identified for circulating TSH levels in a GWAS meta-analysis (n.26,420). All independent genetic instruments for TSH were combined in analyses for both femoral neck and lumbar spine BMD. In these studies, we found no evidence that a genetically determined 1–standard deviation (SD) decrease in circulating TSH concentration was associated with femoral neck BMD (0.003 SD decrease in BMD per SD decrease of TSH; 95% CI, –0.053 to 0.048; p.0.92) or lumbar spine BMD (0.010 SD decrease in BMD per SD decrease of TSH; 95% CI, 0.069 to 0.049; p.0.73). A total of 706 common genetic variants have been mapped to the TSHR locus and expression loci for TSHR. However, none of these genetic variants were associated with BMD at the femoral neck or lumbar spine. In conclusion, we found no evidence for a causal effect of circulating TSH on BMD, nor did we find any association between genetic variation at the TSHR locus or expression thereof and BMD. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

Appendix 2

Serum Thyroid-Stimulating Hormone Concentration and Morbidity from Cardiovascular Disease and Fractures in Patients on Long-Term Thyroxine Therapy

Robert W. Flynn, Sandra R. Bonellie, Roland T. Jung, Thomas M. MacDonald, Andrew D. Morris, and Graham P. Leese

Ninewells Hospital and Medical School (R.W.F., R.T.J., T.M.M., A.D.M., G.P.L.), University of Dundee, Dundee DD1 9SY, United Kingdom; and School of Accounting, Economics and Statistics (S.R.B.), Edinburgh Napier University, Edinburgh EH14 1DJ, United Kingdom

Context: For patients on T3 replacement, the dose is guided by serum TSH concentrations, but some

patients request higher doses due to adverse symptoms.

Objective: The aim of the study was to determine the safety of patients having a low but not suppressed serum TSH when receiving long-term T3 replacement.

Design: We conducted an observational cohort study, using data linkage from regional datasets between 1993 and 2001.

Setting: A population-based study of all patients in Tayside, Scotland, was performed.

Patients: All patients taking T3 replacement therapy (n 17,684) were included.

Main Outcome Measures: Fatal and nonfatal endpoints were considered for cardiovascular disease, dysrhythmias, and fractures. Patients were categorized as having a suppressed TSH (0.03 mU/liter), low TSH (0.04–0.4 mU/liter), normal TSH (0.4–4.0 mU/liter), or raised TSH (4.0 mU/liter).

Results: Cardiovascular disease, dysrhythmias, and fractures were increased in patients with a high TSH: adjusted hazards ratio, 1.95 (1.73–2.21), 1.80 (1.33–2.44), and 1.83 (1.41–2.37), respectively; and patients with a suppressed TSH: 1.37 (1.17–1.60), 1.6 (1.10 –2.33), and 2.02 (1.55–2.62), respectively, when compared to patients with a TSH in the laboratory reference range. Patients with a low TSH did not have an increased risk of any of these outcomes [hazards ratio: 1.1 (0.99 –1.123), 1.13 (0.88 –1.47), and 1.13 (0.92–1.39), respectively].

Conclusions: Patients with a high or suppressed TSH had an increased risk of cardiovascular disease, dysrhythmias, and fractures, but patients with a low but unsuppressed TSH did not. It may be safe for patients treated with T3 to have a low but not suppressed serum TSH concentration. (J Clin Endocrinol Metab 95: 186–193, 2010)

You may also like...

TSH suppressed - Doctor wanted to lower my dose of T4

Following yet another blood test, that gave a tsh reading at 0.014 she reduced my dose by 25mcg...

Latest results - suppressed TSH means Doctor wants to lower my thyroxine dosage!

increase my dose despite my TSH being suppressed? I know my doctor would like to lower it until my...

TSH 0.08 Physician wants to lower my dose of levothyroxine. Your opinions please

The normal range for the lab for TSH is 0.55-4.78 My Free T4 is 1.4 ng/dl, with the normal range...

GP wants to lower my Thyroxine dose due to low TSH

from my GP as my TSH is showing as “low” at 0.19 I tried to explain that this is “normal” for me,...

Can you ever lower dose on T3 or is TSH suppressed?

managed to lower their dose in a T3 containing medication (NDT/metavive/T4&T3combo) ? Your TSH is...