'Normal' TSH ? LOW TSH and Heart Problems/ HIGH TSH and Heart Disease

[Rella48]

Dr. M L, I've read several messages where you've referred to studies that say low TSH (<.3) causes heart problems. Were these studies done on patients taking T4 only synthetic (Synthroid)? Were they hypO or Graves patients? I'm concerned so could you please tell me where I can find the reports on those studies? Following is a study-"Proper Treatment of Hypothyroidism Found to Prevent Heart Diseases":
  
http://www.medindia.net/News/View_news_main.asp?t=ru&x=5823

I've had untreated HypO for years but now I'm symptom-free. I've been on the same Armour dose 10 mos. My TSH is below .00 depending on when I took my last dose. I had 4 TSH tests done in a 6-hour period:

2.8 TSH at 8am-(17 hrs after last Armour dose),
.0001 TSH at 9am-(1 hr after 180mgs);
.018 TSH at 11am-(3 hrs after 180mg); and
1.02 TSH at 2pm-(6 hrs after 180mg and 1 hr before my 2nd dose of 180mgs).

I've had no hypER or hypO symptoms. In your opinion, am I at risk for heart damage, anyway? Should I decrease my dosage and risk hypO symptoms returning?

It's been reported that 1.0 TSH is normal for most people not taking thyroid replacement. Have any studies been done concerning a "normal" TSH # for those of us taking thyroid hormone? Because the hormone circulating in our blood causes the TSH result to vary so much as my tests show, aren't symptoms much more important than TSH #'s when it comes to dosage adjustment and heart damage? Are thyroid patients at risk for heart damage anyway? Shouldn't more studies be done?

Thank you in advance for your time and answers to my questions.

Rella

[MinnieM]

I want to ditto Nurse's comments.  Where is Dr. Mark located?  Wish he was here in Houston. He has been very helpful.  I am on 3 Grams of Armour and thanks to Dr. Mark I am taking 1/2 in AM and 1/2 in PM.  I have had bouts of Tach and A-bib.  I most likely will switch to Synthroid very soon.

[NURSELPN]

The prior post was to Chocobabe & you.  Thanks

[Ussie]

My TSH has been suppressed to under 0.01, you could say nonexistant. When my Ft4 and Ft3 are not in the upper 1/3 of the range, I have depression, anxiety,low body temperatures.

I did have RAI for Graves disease.

[mshypo]

Yes, the TSH debate continues..as every test to check thyroid function has been debated...and eventually discarded.  Haven't they all had problems and haven't they all been discontinued eventually?  I do not understand how the medical establishment has gotten away from what worked - diagnosing hypothyroidism from the patient's medical history, symptoms, and physical findings.  

As for stating "body temperature is not dependable to reflect thyroid function", I believe it might well be true that is is more dependable than the TSH lab test as lowering of body temperature is an extremely prevalent symptom of hypothyroidism.  True, hypo is not the only problem that may lower the patient's temperature, but it is definitely the most common reason...and this is being ignored by the vast majority of doctors. My own experience is that I had a lowered temperature for over a decade before my TSH rose high enough to get a hypo diagnosis.  My life would had been entirely different if docs had looked at low body temperature and symptoms instead of saying "normal" because of a faulty TSH test.

As for those tests regarding a low TSH that you refer too, investigation reveals those tests are all about true hyperthyroidism and not for those on oral thyroid hormone replacement.  In fact, it would appear that the real threat to a hypo person's health is remaining hypo due to undertreatment due to dosing by the TSH.  

[NURSELPN]

Even though I am a nurse, I am certainally no expert on thyroid, but I have experienced hypothyroidism since the early 80's & then last year I was treated for hyperthyroidism due to Graves. Until the symptoms got so pronounced, that they almost stopped me in my tracks, it was hard for me to differentiate hypo from hyper.. Yes their are some suttle differences, but many symptoms are alike, i.e. generalized weakness, muscle aches, brain fog, breathlessness, hair loss, ridges on fingernails, palpitations, goiter, just to name a few. Also I had low blood pressure when I was hyper., not everyone has the same symptoms. Until my symptoms escalated into full blown hyperthyroidism I could not tell the difference. Then the other hyper. symptoms came into play & believe me you don't want to go there. My hyper status was documented first in my TSH long before my symptoms escalated. I also now know I was experiencing periods of extreme hyperactivity that would come & go for at least 3 yrs.prior to my diagnosis . But like hypo symptoms they come on so slowly you don't even realize they are there until they are out of control. If my hyper state would have been caught earlier my immune system may not have attacked my thyroid or my eyes & it may not have affected my health so much. My TSH was consistently <.03 for almost nine years before my diagnosis but seeing I wasn't having any hyper symptoms I was maintained on the same dosage of Synthroid & my Free T's weren't checked. But this was done that way because I was asymptomatic. The one thing I would like to advocate is that (Family Physican's) be educated to always check the free T-3 & free T-4 with the TSH. Especially if the TSH is low.  I feel you must combine the lab results including the TSH with the symptoms of the pt., as Dr. Mark has said.  But you can't just go by symptoms. TSH, free T-3 & free T-4 are important too..
I'm not saying that one med is any better than another, that too depends on an individuals reaction. I have taken both Synthroid pre-hyperthyroid & now Armour post-hyperthyroid treatment & have had good results with both of them.
I'd like to say thank you to Dr. Mark for making this disease so much easier for us to deal with & offering your knowledge so freely. I wished I could have been able to talk with you while I was undergoing treatment for my hyperthyroid state. I know I have gained alot of knowledge from you so far. It's great to have an Endocrinologist at our finger tips. Thanks again.

[nelsonchatham]

Dr. Mark's web address is on the thyroid home page.  
I think you meant 3 GRAINS of Armour...which is an average dosage according to some studies and slightly less than a full replacement dosage according to some docs.  Although palps are not uncommon at all when someone is raising their dosage (the heart has to adjust..and btw A-Fib can be a hypo symptom too), I am wondering how long you were untreated (which could have caused heart problems...and does mean extreme caution in dosing with desiccated thyroid extract since it does push the heart to normalcy) and if your adrenal function is normal (which could cause those problems) since many hypos have adrenal dysfunction as well.  There are a lot of thing to consider in a patient before jumping to conclusions.  Low Ferritin is another lab to check...The Broda Barnes Foundation recommends it be 100 to avoid problems with the thyroid hormone.

Good luck on the Synthroid though...although all I've ever heard are tales of years of misery and worsening hypothyroidism on T4 medications.  Maybe you'll be an exception?