Suppressed TSH - Any New Research Ahead of Appointment with New Endo ?

[Timmersby]

Hi All

I have returned to Australia to live after living in the UAE for 14 years, where I had a very empathic and progressive Endocrinologist.

It is of no surprise that upon my return home (a) I had to wait 8 months to see a private Endocrinologist, and (b) the reaction to my suppressed TSH led to the advice from the GP (which I have ignored) to completely stop all T3 medication !

I have my first appointment with the Endocrinologist next Wednesday, and I was hoping someone would be able to provide me with any new research that would point to a suppressed TSH not being the bogey man that most GPs and Endo's believe it to be. I am being defensive of course, and assuming that they will not be progressive and will think the sky is falling as well.

I had a bad patch in 2023 when my new Endo took me off T3 for 6 months to see if my TSH would increase - which it did not and I was miserable. The Endo's report read "of note, TSH is always suppressed even on LT4 alone". I had a TSH dilution study to check for lab interference / idiopathic deficiency which did not show anything specific.

For background, I have Hashi's and am a bad converter, so since 2013 have been on combination T4/T3 therapy. I am now on 150mcg of thyroxine and 20mcg of liothyronine. My TSH has been suppressed, consistently, since this time. I have regular DEXA scans and ECGs, and all have been normal.

To me, Reverse T3 being 'normal' is irrelevant given I am taking T3, and it is as simple as taking liothyronine suppresses TSH and TSH is a pituitary hormone, not a thyroid hormone ! Also, and if it might be in any way related, my prolactin is always low and has been for years (though I successfully breastfed my son 32 years ago). I have had an MRI which did not show any pituitary gland abnormality.

My most recent labs are:

Date: 6 Dec 22 10 Jul 24 22 Nov 24 17 Feb 24 Reference Range Units

TSH: <0.009 <0.009 <0.009 <0.009 (0.3 - 4.0) mU/L

Free T3: 4.5 7.2 6.5 4.9 (2.6 - 6.0) pmol/L

Free T4: 13.6 14.1 17.2 14.8 (9.0 - 19.0) pmol/L

Reverse T3: - - - 528 (140 - 540) pmol/L

Prolactin: 1.8 2.3 2 1.90 (1.8 0 20.3) ng/L

I have had a adrenocorticotropic hormone (ACTH) test in January 2023 with the following result:

Date: 27 Jan 23 Reference Range Units

ACTH 6.5 (1.6 - 13.9) pmol/L

If there are any words of wisdom from the collective brains trust on this forum, I would be incredibly grateful.

Thank you !

[serenfach]

First, have a look here - loads of very useful stuff helvella.blogspot.com/p/tat...

Then some stuff I have found (could be repeats)

medscape.com/viewarticle/di...

a bit old but may be useful - thyroid.org/patient-thyroid...

One they cannot argue against - thyroidpatients.ca/2019/03/...

and a useful site to look around - paulrobinsonthyroid.com/thy...

My TSH is usually around 0.02 which sends the GP into a flat spin, but I tell him to check my notes and it has been this way for years, so he then leaves me alone. I take NDT. They know nothing about NDT so say nothing to not reveal their ignorance.

Hope this helps. Why when thyroid problems are so common, are they so ignorant and seem to want to keep us ill is beyond me.

[Timmersby in reply to serenfach]

@serenfach - Thank you so much for taking the time to respond to my post, and for the invaluable resources - I have looked through them all and have some great take outs up my sleeve for this week's appointment. I am hoping not to have to use them, but my experience (like most of us here) suggests that I will !

Very much appreciated