An Article from Mary Shomon's News Letter..I found it very interesting and also a backup to what poster's on this site are saying..

[blsdnsvd]

Low TSH Levels May Be Safe for Patients Being Treated for Hypothyroidism
Thursday April 8, 2010
There is a part of me that wants to look at the above headline, and get a bit snarky and say "Oh, really? This is actually NEWS to endocrinologists?'" (But I won't.)
What I will tell you is that several researchers out of the University of Dundee in Australia made a presentation at the Annual Society for Endocrinology BES meeting, held not long ago in Manchester, England. The upshot of their research was that it may be safe for patients taking thyroxine replacement drugs (i.e., Synthroid, Levoxyl, etc.) to take enough of the medication to have a low -- but not suppressed -- thyroid-stimulating hormone (TSH) level.

"This is the first population-based study to show that having slightly lower TSH levels when taking thyroxine replacement is not detrimental to health," Graham Leese, MD, BMSc, consultant in diabetes and endocrinology and honorary reader at Ninewells Hospital and Medical School, University of Dundee, Australia, said in a press release.

This was a fairly sizeable study population of more than 16,000 patients thyroxine replacement drugs between 1993 and 2001. The patients were categorized as

Raised TSH -- TSH above 4.0
Suppressed TSH -- TSH less than 0.04
Low TSH -- TSH less than 0.3
The had interesting findings. Compared to patients who had a TSH level within the reference range:
Patients with raised and suppressed TSH levels had an increased risk for heart disease, heart rhythm disturbances, and bone fractures
Patients with low TSH levels did not have an increased risk for heart disease, heart rhythm disturbances or bone fractures
In a press release, study author Graham Leese said: "Our findings confirm that it may be safe for patients with hypothyroidism to take marginally higher doses of thyroxine than our currently recommended."
This latest finding is a more ammunition for patients to take to doctors who think that any treatment -- as long as it gets you somewhere into the old (and actually outdated and insufficient) TSH normal range of .5 to 5.0 -- is all we need.

[goolarra]

My lab sheets have FT3 on them, but in a weird place.  TSH and FT4 are "bundled" at the top of the sheet under "thyroid", but FT3 is down at the bottom of the page under "miscellaneous" or some such nonsense.  I still believe doctors can "write in" anything they want...those preprinted sheets can't have EVERY test a doctor might want on them.  I can't believe that almighty doctors let labs tell them what they can and can't order!  I've not always had my doctors order FT3, but the lab certainly knew what it was when it was ordered.

Well, if you do end up interviewing new endos, you know one of the questions you want to ask...do you test FT3?  All I can say is that you might have to insist on FT3.  One good question for her is "Why not?".  It's a cheap test.  I think they should order it regularly, without asking, but there really is NO excuse for refusing a patient's request (after my insurance discount, I pay $10 for FT3).  I'd just say that I'd like to have it for my records and to establish my personal history that I can keep in my posession in case I ever have to change doctors (people move, doctors move, health plans drop providers, etc.).  When endos are this reluctant to order FT3, it really raises a big, red flag for me...run, don't walk, away.  Even you PCP was willing to order FT3!  I know it's easier said than done, but just don't take "no" for an answer.  If she doesn't give, give her the boot...

[blsdnsvd]

I'm wondering how i can get my Free T3 tested from my Endo being that it's not on the panel of testing...and honestly im wondering if it's the docs to blame or the companies who do the testing for instance, Free T3 is no where on the lab slip and must be written in, whereas Free T4 is included in the group of testing.

My Endo has already told me that she isn't going to test the Free T3 unless my levels do not improve but i did fax her a copy of my labs that i requested from my gp. I wish i knew about this before i chose this endo....over a year ago.

I'm gonna get tough with this "fiesty" woman...but i may end up with a new Endo!....

[LazyMoose]

As far as the Frees go, New England journal of medicine seems to back up the importance of proper Free T levels. I dont know how well respected that is in the medical community, but it sounds impressive.

[goolarra]

I really think from the doctor's perspective (drug companies a different story) that they are simply ignorant.  They were taught in med school (HOW many years ago) that TSH was the gold standard for thyroid diagnosis (and it was back then).  They were taught that all you need to use is T4 meds and that if FT4 was okay, so was FT3.  We all know where that gets many of us.  

Many of them never pick up a medical journal (maybe some profit motive here - reading isn't billable).  And many of them simply do not understand how to use a reference range.  They think that the minute a patient is "in range" their work is done...go home, eat less, exercise more, your problems are no longer thyroid related.  Some of us are only comfortable in the top of the range, some in the bottom, and the vast majority right around the middle.

We have to get tough with our doctors.  I always ask my doctor what tests we'll be running next time.  He usually orders FT3 automatically, but one time it got lost somewhere and I had to hold the phlebotomist hostage until FT3 was added!  I have crappy insurance due to self-employment, and I literally PAY for all my labwork, so I'm damn well going to get what "I" want to see.  We're all paying, either directly or indirectly through health insurance, for all this.  The doctor is your employee.  He's an ADVISOR.  He gives you the benefit of his experience and education (and ability to write prescriptions!).  Patient/physician relationship should be a partnership, not a heavy-handed paternalistic relationship that reduces us to being children.

Okay, think you found one of my pet peeves???  LOL  

[froggy0936]

Great post Barbara! I wish these doctors would get with the program and we could all feel well!
I found out that even though I wrote Free T3 and Free T4 on my lab slip yesterday, the lab wouldn't test them because the slip was a computer printout from the dr's office and they don't do tests that are handwritten in! I know that my Gp will do it, so I'm going to have to go the route you did. I just don't understand for the life of me what the big deal is about getting these tests? I'd hate to believe Dr's WANT to keep patients sick so they keep coming back?!! All of this nonsense and suffering for the "almighty dollar?"
Talk with you soon!   Lynda xo

[blsdnsvd]

I believe that all of us hypo patients should protest and see where that get's us...Ha.

[redheadaussie]

I had read that article too. Go Aussies! We are always on the front for medical research..BUT our stupid doctors HATE being told they have been doing it wrong for years!
I have my endo saying my Free T3 is just a little bit under the 'normal'  (3.2...ref range starts at 3.5) so won't treat it. So if they found a new ref range for it and it ended up say 4.0 would he then treat, just cos the numbers change? Symptoms my dear Watson, symptoms!
Many of our labs here still use the old outdated levels to test us. Drives me nuts!
Great find and posting!

[blsdnsvd]

I truly wonder if endos read these articles and take them seriously because i think that my endo should. She is one who doesn't test the free T3 but does test the Free T4's...I had to get my gp to test them...but i soon go for labs (already have the slip) even if i write in Free T3 they may not do them based on the other labs that she suggested.

I will definitely bring it up to her attention when i go for my followup because i purposely faxed her my results that the gp requested based on my persistence and i haven't heard from her yet!..That was about 3-4 weeks ago.

[ChitChatNine]

Thanks for sharing this with us!

C~

[juliva]

It's frightening to find out just how outdated info is and or how little these doctors know concerning the thyroid. I can only hope to find a Endo with a serve thyroid condition who understands all this first hand.

Thank God for this forum!!!!

[goolarra]

I should have also said that the American Association of Clinical Endocrinologists (AACE) recommended so long ago that I forget the exact year (2001 or 2002?) that TSH range be adjusted to 0.3-3.0.  Very few of our labs are using that range eight to nine years later and neither are most doctors (although there are some out there who do know better).  With "progress" moving at that kind of pace in the medical community, it's amazing that we're not still using leaches.

[goolarra]

You're preaching to the choir here...couldn't agree more.  This rationale also applies to FT3 and FT4 ranges.  Although we all know that TSH has many other defiiciencies compaired to FT3 and FT4 when used as a diagnostic, FT3 and FT4 ranges are also based on a flawed population (original population included all people who were not on meds, so early stage Hashi's and people with hypo symptoms are part of the "normal" group).  These ranges have NEVER been adjusted to correct the "normal" population...and that's the reason I can't type "normal" without the quotes anymore!!!

[juliva]

Well.. That makes me feel better about my Endo trying to keep my TSH in the low" range lately.. Maybe he read the article! Lol!
As for me I'll sneak up or should I say down to it. I know I do well in the suppressed range.. Just not sure about that low"

Interesting article though and one to definitely to keep in mind about the heart and bone related issues.

Thanks for posting the info!

[blsdnsvd]

I will tell you about this new study out of Australia that can provide more ammunition to people with hypothyroidism who have endocrinologists who are riding the "your TSH is normal, therefore your remaining symptoms are not thyroid-related" bandwagon.