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Osteoporosis with low TSH
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Osteoporosis with low TSH

I know some of you have been on thyroid replacement for literally years and are happy with your thyroid being suppressed with a TSH <.09 or so. Since the concern many Drs have is that a low tsh can lead to osteoporosis and heart problems, I was wondering if any of you long term folks have had regular bone density scans and heart monitored. It seems if your TSH indicated hyper but you have no hyper symptoms then your bone density and heart would also be unaffected.
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649848_tn?1357751184
It's not the level of TSH that causes the bone density or heart concerns, it's high levels of FT3 that cause the trouble.  I don't have the sites right off hand, but gimel has some that indicate studies to bear this out.

My TSH has been at < 0.01 since about May 2008.  I do have regular bone density tests.  I have had osteopenia since approximately, 2000 or 2001; however, my latest bone density (June 2010) showed that I have actually rebuilt lost bone by implementing a regimen of calcium and magnesium, along with exercise, in spite of having low TSH for the 2 yrs prior to the bone density test.  

Likewise, I have regular heart checkups and while I do have leaky heart valves, they are not thyroid related.  My cardiologist is the only doctor I have who doesn't panic at the sight of my lower than low TSH.  

I'm due for a cardio check up next month, and will be due for another bone density in June.

In my opinion, you are correct - "It seems if your TSH indicated hyper but you have no hyper symptoms then your bone density and heart would also be unaffected."
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Avatar_n_tn
I seem to do better with a lower Tsh though I have to say I'm in the process of titrating since I still have a lower normal FT3. My Tsh is not as low as yours. I am 59 and have never had a bone scan and have not had my heart monitored so I'm thinking it might be a good idea. At 90mg Armour my BP runs about 114/74 and pulse 72-80.
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649848_tn?1357751184
I had my "baseline" bone scan done at approximately age 50, and every 2 years since.  I had osteopenia at my very first scan and did not have thyroid condition at that time, though I had had a hysterectomy, which my doctor felt put me at risk.  As you can see, my low TSH has not affected my bone scan at all; seems life style has as  much to do with it, as anything.

I've had high blood pressure since I was in my mid 40's and have been on medication since then (dx'd hypo at 57 yrs).  I only had  my heart checked out a couple years ago, because I'd began experiencing shortness of breath and some palpitations.  Those were initially put down to my being hyper, though I was not.  I was sent for a heart workup, which showed the leaky valves, but actual heart function is normal for my age.  

Talk to your doctor, then make a decision an necessary monitoring.  If you don't have heart issues, there may not be a need for that expense.  As my cardio told me - "even though your heart is functioning normally, right now, we can't predict *the big one*".

I should be so lucky as to have bp at 114/74 or pulse 72-80...... my bp is usually much higher than that, and pulse, much lower.  
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Avatar_m_tn
My TSH has been around .05 for well over 30 years now, and I have never had any hyper symptoms.  In fact I had lingering hypo symptoms until learning about the importance of Free T3 here on the Forum.  Got mine tested and it was confirmed as low in the range.  convinced my doctor to switch me to an NDT type med.  Now my Free T3 is 3.9 (range of 2.3 - 4.2) and Free T4 is .84 (range of .60 0 1.50), and I feel best ever.  

I was gong to give you a link to some great info about all this, but can't get it to work, so I'm just copying it here.  The letter was written by a good thyroid doctor that I totally respect for his knowledge and experience.



For Physicians of Patients Taking Thyroid Hormones
Mild-moderate thyroid insufficiency is quite common and is an unrecognized cause of depression, obesity, high cholesterol, cold intolerance, atherosclerosis, chronic fatigue, and fibromyalgia. It is often secondary, so the TSH is normal, but the FT4 and FT3 levels are low in the reference ranged. Thyroid supplementation to produce higher FT3 and FT4 levels within the reference ranges can improve mood, energy, and alertness; help with weight control, and lower cholesterol levels. I have prescribed thyroid hormones for your patient because his/her symptoms, physical signs, and/or blood tests suggested that he/she had inadequate levels for optimal quality of life and long-term health. If they showed clear improvements, I kept them on the thyroid supplementation. The final dose we decided upon was based on symptoms and signs first, and on free T3 and free T4 levels second. As the TSH was usually normal initially, it is frequently suppressed when thyroid levels are optimized clinically. FT3 and FT4 are usually within the ranges, ruling out significant thyrotoxicosis.
We were all taught that the TSH perfectly portrays a person’s thyroid hormone status, supplemented or unsupplemented, and we need only obtain a “normal” TSH to know that our patient had no excess or deficiency of thyroid hormones. In fact, there is no reason to believe that the hypothalamic-pituitary axis is always perfect, and lots of evidence that it is not. TSH-based thyroidology is an unjustified faith in the infallibility of the hypothalamic-pituitary axis. One must instead base the diagnosis and dosing on symptoms first, and on the free T4 and free T3 levels second. Even here, “normal” is not good enough. The labs’ reference ranges for FT4 and FT3 are not optimal ranges; they are statistics: 95%-inclusive population ranges. They are excessively broad (2 to 3x from bottom to top) and define only the bottom 2.5% of the population studied as “low”. The prevalence of hypothyroidism is much greater than 2.5%.
T4-only therapy (Synthroid®, Levoxyl®), to merely “normalize” the TSH is frequently inadequate treatment as the H-P axis overreacts to once-daily oral thyroid hormone peaks, compared to the gland’s steady 24-hr glandular secretion. TSH-normalizing T4 therapy often leaves both FT4 and FT3 levels relatively low, and the patient symptomatic. Recognizing this, Nat. Acad. of Clinical Biochemistry guidelines call giving enough T4 to keep the TSH near the bottom of its RR (<1) and the FT4 at or just above its RR. But this is not sufficient; the ultimate criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose.
Excessive thyroid dosing causes many negative symptoms, and such patients do not feel well. I suggest lowering the dose in any patient who has developed insomnia, shakiness, irritability, palpitations, overheating, etc.. Atrial fibrillation can unfortunately occur in susceptible patients with any increase in their thyroid levels. It should not recur if the dose is kept lower than their threshold. Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies.
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Avatar_m_tn
Forgot to add that I have had EKG, Echocardiagram and stress test in last 3 years without any problem being identified.  Also no problems with bone density.
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Avatar_f_tn
I could not tell you if my heart or bones are affected. Doctors never mention it.

I have been on medication for 18yrs, and the last TSH level was 036.
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Avatar_n_tn
Thanks. I think at the very least it's time for me to request a bone scan
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