negligible TSH reading

[ellens126]

I had a thyroidectomy in 1994 and was on Synthroid 100 mcg for years and then my blood work began showing signs of hyperthyroidism.   The endocronologist changed me to Levoxyl 88mcg and every time my bloodwork is checked I am at the lowest threshold for normal or below the norm for TSH.  My bone density is being affected and I have not had a good night's sleep in ages because of the hyperthyroidism and now they want to lower my dose again.  I have been on Lunesta for at least 3 years and am gradually weaning myself off of it because I do not feel it is a good thing to be taking.  Even on Lunesta, I do not sleep well. No one has ever been able to explain  the thyroid and the role of replacement hormone to me so that I have a good, working knowledge of how things work.  I am very frustrated.  I do not think the answer is to keep lowering my dosage of Levoxyl.  I know people my age, approximate weight and height with thyroid glands who take higher doses than I.  Yesterday's test at my physical only checked TSH. Could this be a pituitary problem?

[gimel]

For info, a simple explanation is that TSH is a pituitary hormone that is produced in response to the levels of the thyroid hormones in the blood.  When you start taking thyroid meds, the TSH goes down in response.  TSH moves in the opposite direction to thyroid hormones.  However, TSH does not adequately correlate with Free T3 or Free T4, much less with symptoms, which are most important.  

With your thyroidectomy, that thyroid med dosage is likely to be inadequate, yet your doctor is reducing your meds based on TSH levels. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

Many hypo patients taking thyroid meds find that their TSH will be suppressed below the so-called "normal" range.  This does not mean that you are hyper, unless you do have hyper symptoms, due to excessive levels of the  biologically active thyroid hormones, Free T3 and Free T4.  Without testing beyond TSH you will not know if you have excessive Free T3 and Free T4.  So that is the first thing you need to have done.  Note that Free T3 and Free T4 are not the same as Total T3 and T4.  If your doctor resists, then you should insist on it and don't take no for an answer.

I think you can get some good info from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is then sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

Note in the last paragraph this info.   "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."

I also suggest that you should be tested for Vitamin A D, B12, ferritin, and a full iron test panel.  Hypo patients are frequently low in these areas as well.  When you have further blood test results, please post results and their reference ranges shown on the lab report and members will be glad to help interpret and advise further.  

[Totie]

I had a TT back in 1994 as well. I was on 200mcg for more than 10yrs then in gradually started needing less as I aged. The last stable dosage was 125 for about 5yrs. Now for the last 8 months have been upped to 200mcg again of Synthroid. I don't know about bone density test because I am 42yrs old and they say I don't need one.

I think everyone reacts different to medication. Where you are going hyper I am going hypo. I weight 100 lbs but my TSH still won't go below 3.74.

We will see where this dosage takes me....

Hang in there getting the dosage correct takes a lot of patience..