I'm will be 65 in a few months and I have a battle of doctors on the issue of 'what is a proper TSH for a senior?'
My Hashimoto's makes my TSH a rollercoaster (from TSH around 6 and two months later, 4,0). The specialist said 'that's perfect! Let's increase your dosage again.' She chuckled and said "you're not old!" I wasn't reassured or amused because my issue is health/safety, not vanity, thank you. My father passed of a heart attack (also hypo and in his case under-treated and then over-treated by a new doctor).
I'm currently at 50 mcg levothyroxine. A higher dosage and I have tremors and my heart races.
Here's the second opinion:
The generalist disagrees with increasing the dosage now, he wants to see a new TSH/T4/T3 test in a month. He feels 4,0 is ok for a person of my age and cites studies that some seniors can be over-medicated and a very low TSH could have risks if you have pre-existing conditions.
The last time I achieved 4,0 the TSH continued to rapidly spiral downward (same consistent dosage) until I was at TSH 1,0 and not feeling well. I was taken off levothyroxine for 3 months and by the 5th month without medication my TSH gradually rose to 6.5. I was restarted on 25 mcg and the TSH dropped to 4,0 for almost 3 months then slowly crept up.
As I write, what my thyroid is doing doesn't make sense, so I can't expect others in the community to suggest the right answers. I'm just raising this as a general observation about TSH, age and dosages.
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Hafa
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My thoughts - I don't believe there is a "general" correct TSH for seniors, or anyone for that matter. It's FT4 and, more importantly, FT3 that are the results we should be looking at. What about those with Central Hypothyroidism where the TSH doesn't respond - what are they going to do about those patients whose TSH is very low?
I am 74 and my TSH been suppressed, to my knowledge, since 1997 and possibly before that. I've been diagnosed/treated since 1975 but only have a copy of resuts since 1997. My TSH always comes back as <0.01 or <0.02 or <0.005 or 0.005 depending on which lab does the test. My FT4 and FT3 are well within range and I test regularly. I do have some medical conditions but not the ones they like to scare us with - osteoporisis and atrial fibrilation.
I am 71, been treated for hypothyroidism for sixty years. Started long before any TSH testing was done. Since it’s introduction I have always had a suppressed TSH. A GP decided to refuse me levo when ndt was not available. After sone time my results were TSH 1.38 (0.27 - 4.3) FT4 4.8 (12 - 22) FT3 1.7 (3.1 - 6.8) . Proof that TSH is not an appropriate measurement for those being treated. I was very unwell, no one at the surgery says a word about TSH to me now. Try not to worry and stick with fT4 and fT3 results rather than any TSH.
This business of 'seniors' having higher TSH, I think it has been totally misunderstood (deliberately?). Older people with no thyroid problems tend to have a slightly higher TSH, but not that high! Not 4. But, doctors latch onto anything that allows them to reduces doses like bull terriers on a bone.
When you're on thyroid hormone replacement, the TSH doesn't behave in the same way. It's a very bad indicator of thyroid status, and us such should be ignored unless it's too high - 4 is too high for someone on thyroid hormone replacement. And, the TSH itself doesn't cause problems, that's not its job. It's the active hormone, T3, that can cause symptoms, etc. if it is too high or too low. But they don't even bother to test that!
There are far to many variables that affect TSH levels - like the time of day - for it to be used the way doctors use it. But, they have very little understanding of thyroid, anyway.
You are only on a what is usually regarded as a starter dose, a very small dose, so your tremors and racing heart are more likely to be caused by under-medication, not over. If I were you, I'd be putting my foot down very firmly, and demanding an increase right away.
I'm 77, by the way, and my TSH has been suppressed for years.
Interesting that I could be under-medicated, as the specialist says, while the generalist isw putting on the brakes. I think there is also age-related bias in doctor-patient relationships. If I inform myself and ask questions, it's considered that I'm "worried".
Yup, they've got an excuse for everything! And always the wrong one! They cannot admit that all these symptoms can be due to under-medication. And they don't like being asked questions because they just haven't got the answers, so they return the question against the patient. Just one of their little tricks.
If you feel fine with a TSH of 4.0 stick with it. TSH is a little higher in the elderly and those with a high normal TSH live longer than those with a low normal TSH. So, your generalist is taking a sensible approach.
I thought it was high or high normal Free T4 that was the dangerous one, officially, because it raises the risk of cancer?
Personally I don't care about my TSH because it has never even reached 6, and is often really low in range or under range. I care about feeling well now.
When last tested my TSH was 0.02. My Free T4 was at 33% through range and my Free T3 was at 46% through range. I raised my T4 dose slightly despite my under range TSH.
My results have been better than this but having Covid towards the end of last year seems to have screwed things up and lowered both FT4 and FT3.
I know that you and I don't see eye to eye on the subject of where TSH "ought to be" and how important it is in people with thyroid disease. I just care that people feel well, not that they might get a few months more life at some nebulous time in the future.
People with a higher TSH live longer, they tend to have a lower fT4 and similar fT3. N general these people will have a pituitary that is working normally.
jimh111, that's also what I had seen in some brief research about higher TSH in seniors. By the way, I'm in France and they waited until I reach TSH 8 to start medication.
Yes that’s correct, people with a slightly higher TSH live longer. Waiting for TSH to reach 8.0 is too high if they have symptoms, in the UK it’s worse, they wait until it’s 10.0.
The TSH blood test was originally introduced to be used as a diagnostic tool to help identify a person suffering with hypothyroidism and was never intended to be used once any patient was on any form of thyroid hormone replacement.
Once on any form of thyroid hormone replacement it is essential that you are dosed and monitored on your T3 and T4 levels being in range, and balance at around a 1/4 ratio T3/ T4 and high enough in the ranges to relieve symptoms.
Hashimoto's is a little more difficult to treat as your gland comes under attack and your T3 and T4 levels become erratic and jump around causing hyper / hypo symptoms - but ultimately you will become more hypothyroid as the thyroid gland becomes further damaged and disabled by this AI disease and you will require full spectrum thyroid hormone replacement.
In reality, what we really need to know is what our Free T4 and Free T3 are, and the Free T3 is the one that is most important. If it is too low we have hypothyroid symptoms and if it is too high we feel hyperthyroid. The level of Free T3 that might be perfect for an individual can vary. One person may feel great with Free T3 at 50% through the range, someone else might feel well when Free T3 is at 75% through the range. Free T4 is important as well, but not quite as important as Free T3. Some people like having high or slightly over the range Free T3 and almost zero Free T4, some like both to be at 70% through the range. It is all trial and error.
But TSH? It doesn't have any effect on symptoms. It is getting the right levels of Free T3 and Free T4 that matters.
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One thing that is common in people with thyroid disease is having low levels of nutrients. The most important nutrient tests are vitamin B12, folate, vitamin D, and ferritin (iron stores). If ferritin is low or high it is worth getting an iron panel done. Unfortunately doctors rarely agree to do iron panels so most of us use a finger-prick test from Medichecks to do this.
Having nutrients at good/optimal levels increases the tolerability of thyroid hormones a great deal.
You can see what a huge difference it made for me personally, at roughly the same TSH level:
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