I’ve seen this on my nhs app after my doctor asked an endocrinologist about my TSH.
Endo reply. If her dose was reduced in May, then I would have expected the TSH to have responded by now.; Therefore results suggest she is still on too much thyroid hormone replacement. Her T4 and T3 can be in; the normal range but are higher than she needs, which is why the TSH is suppressed. The reference; ranges are for the general population, but individuals have their own much narrower range. The TSH is; the best guide of adequate thyroid hormone replacement.; Having a suppressed TSH increases the risk of osteoporosis, arrhythmia's and heart failure long term,; therefore I would recommend and encourage her to reduce the dose further with repeat TFTs 3/12 after; reducing.; (she needs to understand these risks, if not wanting to reduce).
Doctor is calling me Monday it says.
is this true what the endocrinologist is saying?
I’m going to be forced to reduce now.
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Tjqui00
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It's a load of rubbish! The TSH has nothing to do with bones or hearts. This endo needs to go back to med school! Bet s/he is a diabetes specialist who knows nothing about thyroid but think they know everything.
The TSH is most certainly not the best guide of adequate thyroid hormone replacement - especially not at that level. All it tells you is that the pituitary is happy with the amount of thyroid hormone in the blood. But the pituitary is somewhat biased because when there's thyroid hormone in the blood, the pituitary gets served first. So the pituitary can be satisfied but other parts of the body still very hypo. And it doesn't tell you how well you convert T4 to T3 because the pituitary does not distinguish between the two.
The TSH test was never designed to use for dosing. That's just lazy doctoring. It was designed as a diagnosis tool. But even then you need the FT4 and FT3 tested and be guided by them,, because the TSH can be affected by so many things - like the time of day! And doctors never, ever take that into account, so just goes to show you how much they know about TSH.
Also, they confuse the effects of a suppressed TSH due to hyperthyroidism, where the FT4/3 are very high (and it's the high FT3 that does the damage) and a TSH suppressed due to taking exogenous thyroid hormone, where the TSH can be suppressed very easily whilst the FT4/3 remain low.
I have always refused to lower my dose based solely on a low TSH. I do not give a fig about my TSH. It's been suppressed for well over ten years, and I'm still here to tell the tale.
Your TSH is suppressed, yes. But so what? It's suppressed because your pituitary considers that you do not need it anymore. That would no happen if your bone and heart health depended on the TSH. The body would not cut off something as important as that. But it's not important so why continue to make it?
The TSH has only two jobs:
a) it tells the thyroid when it needs to make more thyroid hormone because the pituitary thinks there's not enough in the blood. You don't need it for that because you're on thyroid hormone replacement and your thyroid is no-longer working.
b) it initiates conversion of T4 to T3. I can't tell you if you still need it for that because I don't know what you're taking, nor your FT4/3 levels. But your pituitary has decided you don't.
I don't really know what you can say to your GP, because I don't know your GP. But you could just refuse to reduce your dose. Tell her you're aware of the (imaginary) dangers of a a low TSH and you're willing to take the risk because you prefer a good quality of like now, rather than a possible - but not guaranteed - longer but more miserable life.
I take 100 mcg for 2 days and then 75 on the 3rd day. Ft3 5 (range 3.8-6) ft4 16 when top of range is 18.
I was taking 100 mcg every day up until May I think it was when my ft3 was over range at 6.6 and ft4 was over range. The small reduction seem to lower ft3 a lot and ft4 quite a bit but made no difference to my TSH.
Not really different, no. Plenty of people on T4 mono-therapy have a suppressed TSH. And it still doesn't matter, and still doesn't automatically mean you are over-replaced. And TSH still has nothing to do with hearts and bones.
As you have Hashi's your FT3 going up to 6.6 probably has more to do with your disease than your dose, due to the way it acts.
You were only taking a small-ish dose at 100 mcg but you never absorb 100 mcg. Absorption varies from person to person, but it is never absorbed 100%. And of what you absorb only 30% maximum will be converted to T3. So, highly unlikely that 100 mcg is going to produce a TSH of 6.6. It's just not logical. Unfortunately, doctors seem to be singularly lacking in logic. Far more likely that you had a Hashi's 'hyper' swing.
But it's really, really not about the TSH. To know if you're over-replaced and need to reduce your dose, you need to look at the FT3 and the FT4. And until they agree to do that, just refuse to reduce your dose. Because it will make you very ill. And for nothing.
starts at the end of the first reply from Tattybogle : " To understand why TSH stays suppressed for a long time after an episode of hyperthyroidism/ overmedication, (or ANY T3 use) has finished... "
and is continued in detail much further down in another reply from me : " CONTINUED HYSTERESIS ~ Why TSH remains lower for quite along while following episodes of hyperthyroidism / overmedication .... (or any T3 use) , it is due (at least partly) to a mechanism called 'Hysteresis'.
My TSH has been suppressed over 10 years. At one point I was on 150 mcg. 75 seems such a low dose. I’m not happy with it bringing my T3 down to the bottom of the range which it will and don’t think I believe that’s the right range for me. I’ll probably end up being on 25 mcg to get my TSH up.
The more you are forced to reduce Levo dose ….the lower vitamin levels drop because when hypo we have lower stomach acid and this leads to poor nutrient absorption and lower vitamin levels
The lower vitamin levels are ….the lower TSH will be because low vitamin levels result in poor conversion of Ft4 to Ft3
Don’t let them bully you
If Ft4 and Ft3 are well within range you are not over medicated
As we get older it becomes increasingly important to maintain GOOD vitamin levels
Think I’m going to tell my doctor I’m seeing a consultant under my husband’s private health insurance and maybe they’ll test all my vitamin levels. None of mine when last tested are that good. I thought my vitamin d at 90 was good at the time and my vitamin b12 at a bit under 500 was. I’ve always worried about my ferritin levels. Just hope the consultant won’t also base my dose on my TSH.
Your endo doesn’t seem to be laying the law down, using terms like ‘encourage her to reduce the dose further’ and ‘she needs to understand the risks’. So it seems to me you would be saying to your doc that yes, you are aware of the risks but are prepared to take them. He can only ‘encourage’ as advised by the endo, nothing more.
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Tyranny of the TSH
Low TSH
