Maybe nothing is required. It all depends on how you feel currently (symptoms), and how you got to a TSH of .049.
Have you been diagnosed with thyroid problems? Are you taking any thyroid meds? And then of course, how about any symptoms?
By itself, TSH is totally inadequate as a diagnostic for thyroid problems. TSH is a pituitary hormone that is affected by so many variables that it reveals very little. Just as a start, we need additional information such as symptoms, and also the levels of the actual, biologically active thyroid hormones, free T3 and free T4 (not to be confused with total T3 and total T4).
I don't have the exact figures for the T3 and T4, but the doctor did not check free T3 or T4. I was diagnosed with Hashimotos about 10 years ago, and I take T3 and T4 synthyroid. I am now experiencing having a sore throat most of the time, have nodules that are about 16-21 mm, one on each side, and I've been obese for about 15 years, not able to loose weight and keep it off for about 15-20 years. I am just going up and up until recently, when two months ago I gained 7 kilos, and last month I lost 11 kilos. I am going through the change of life also. Actually one doctor thought I was a thyroid patient about 13 years ago, but only tested T3 and T4, and I was sub-clinical I guess. It wasn't until my antibodies went up and I insisted on checking why I couldn't loose weight, and after a injection full body exray, that finally I was sent to an endocrinologist, who definitely said I had Hashimotos and Hypothyroidism. I read on the internet that many people have symptoms of obesity, bad nerves, digestion and elimination problems; until they tried natural medicine, but my doctor said it was illegal where I live. So I ordered some natural thyroid support items. I just wonder if Pituitary problems are at the core of the problem. One doctor 20 years ago said I had an odd Pituitary hormone level but after a pregnancy echogram they found nothing wrong, and did nothing about it. I was later taking anti-depressants and tranquilizers, and although I came off the anti-depressants about four years ago, I still take the minor tranquilizers, and good bacteria from the doctor and a pill that moves the bowels and controls gas, although it doesn't always work. I have added some vitamines and minerals Omega 3s, and I have been able to come off blood pressure pills, as I have cleansed myself and watch what I eat, and am now in the normal range. I just have a little high TG and creatine and uric acid, which is being monitored.
Tests for total T4 and total T3 are somewhat obsolete and don't really tell enough about your thyroid status. In addition, the ranges are so broad that just being within the "normal" range doesn't preclude having symptoms. I suspect that you are having hypo symptoms, with maybe the occasional hyper period that sometimes occurs with Hashi's, when excess hormone is released because of nodules.
I think the first thing you need to do is to get the doctor to test for free T3 and free T4, along with TSH, so that you know the levels of the biologically active thyroid hormones. If these FT3 and FT4 results are in the lower half of their ranges, that would be consistent with having hypo symptoms, and indicative of needing medication, without regard for TSH level.
Before taking medication, if your TSH was low, with T4 and T3 levels in the lower half of their ranges, then that would indicate a need for testing of the pituitary function. If your low TSH occurred only after taking meds, that is not unusual. Many members report having TSH suppressed when on thyroid meds. That does not mean you are hyper. You are hyper only when experiencing hyper symptoms and excessive levels of thyroid hormones, which you do no have.
In my opinion the best way to treat a thyroid patient is to test and adjust levels of the actual, biologically active thyroid hormones, FT3 and FT4, with whatever type of medication is necessary to relieve symptoms, without being constrained by resultant TSH levels. If you doctor has a problem with this approach, then you may have to find a good thyroid doctor that will do so.
You said: "I take T3 and T4 synthyroid". I don't understand. Synthroid is a T4 only med; do you take an additional T3 med with it, such as cytomel?
Sometimes, when we are on a T3 med, our TSH is suppressed more. I'm on generic T3 med, along with my T4 med and my TSH routinely runs less than 0.01, but I don't worry about it because my FT3 and FT4 levels are okay.
Wow thanks for the info. on the FT3 and FT4 and how this is more important than the actual T3 and T4. My doctor is also a Thyroid patient, but he is old and likely to retire soon. I go to him because he is sympathetic and speaks English, and there are no other doctors in the whole area I live in that will take an English patient. I would have to travel far to get one. I already travel one hour every month to see him. It makes sense that when the nodules go up and down, that changes the numbers. I'm definitely not hyper! I was just confused to be told I was in the normal range with such a low TSH, but I guess it could be normal. That is a relief! I know I need another doctor, but as mentioned, I couldn't obtain one around where I live. So I wrote here. If my self medication for hypothyroidism works, I'll be o.k. I think. We'll see. And soon, I think my doctor will retire, as he is around 80 years old. Then I will have to do something. Thank you for the info. I know I may have Pituitary problems as well, and have had MRI's, but brain specialists said there was nothing wrong. I doubt it, as I know in my family way back, there was a giantess, and so Pituitary abnormalities are on my mother's mother's mother's side. But perhaps it is just normal according to Barb135? Thank you so much for your info., because I will ask for the F3 and 4 tests next time. He will probably be o.k. with that. I don't think he is up on the latest news. But he is kind.
My medicine is from another country, I am living abroad, and it is Thyradin-S4-50, .05 x2 a day, and Thyradin S-25, .025 x1 a day. The doctor said that was T3 and T4. He said it was synthetic, and that he could not give me natural medicine. He also said the T3 was very strong medicine, and it still shows up on the blood test on the low side in the normal range. So he seemed a little concerned but not overly. He measures the nodules on both sides each time. No other normal doctor does that here. He is knowledgable, but old, and kind. Thank you for telling me about your TSH level, I feel relieved. That is exactly what my doctor said, as long as the T3 and T4 are o.k., then I shouldn't worry about it. However, as I wrote to gimmel, I had reason to wonder about my Pituitary, which no body so far has implicated except myself....
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.