Avatar universal

Isnit possible formyour TSH to be suppressed and still have hypo symptoms?

So I pretty much already know that, this is possible. I’ll try to be as short as possible here. I’ve been on this journey for over 6 years and I felt, I finally found a good dr. She has been treating me with supplements and let me stay on the synthetic thyroid meds. I’ve been on them since the beginning and am ok with sticking to what ain’t broke. So I’ve been on 50 mcg of Levo and 20mcg of Liothyronine. The T3 med was the med that brought me back to normal.  Once I started the T3 years ago, my TSH has been suppressed. I found this holistic md who would continue to treat me regardless of a suppressed TSH. Recently, she’s decided it might be the cause of bone loss. I had a dexa scan and I am in osteopenia. However, I was a smoker & coffee drinker for years and my grandmother had osteoporosis so. This could have nothing to do with my TSH.
Last week, she decided to try reducing my meds and I’m a wreck!  I know from past experiences, this is not going to work out well. I tried telling her that I had been on 25 of Levo and 5 of Lio and my TSH still has not budged. After doing some research of my own, I found some info on the pituitary and hypothalamus that I feel might be the reason for the suppressed TSH. I suffered from low body temperature for many years. My Free T3 is in the high range, my Free T4 has been either at the bottom or below the range for years. In my mind, I’m still under medicated but feel pretty good for the most part. What can I do? In a couple weeks when the dose decrease affects me and  I’m going to feel like a popsicle and not be able to get out of bed. Trust me when I say I’ve relayed all of this to her and she just shakes her head. I am looking for another dr but I’ve been thru 10 and it’s very limited here so there aren’t many left for this issue. I spend 2500 a year on this woman and I’m beginning to feel taken advantage of. I’m truly at a loss here and would welcome any suggestions.
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Avatar universal
Osteo is more a function as noted above, primarily of too low of TESTOSTERONE.  Also calcium without magnesium can result in calcification, yet brittle bones.  You really need the testosterone and magnesium along with calcium to build strong bones.

The fact that men have SOOO much more testosterone than women is the primary reason why Osteo is a female problem primarily.  Females have little (comparably) testosterone to men so any loss, typically after age 40 and certainly post menopause results in bone loss.

many women who get testosterone hormone replacement, they re-build the bone density.

Therefore, I would recommend that you get your sex hormones tested.

Interestingly, for strong bones in men, they need to have sufficient estrogen levels.  if estrogen levels get too low in men they too will have bone density issues.

Another consideration.  When they compare or use a "normal" for bone density. I believe they use the bone density average of a 29 year old woman.  And regardless of age of the woman, they compare their current density with that of the healthy 29 year old. They do NOT compare the result with that of someone of the same age.  

In my opinion, that makes sense. To compare what the body wants to when it was in the prime and health.  Using that same logic, they should compare the same hormone levels with someone who is in their prime.

yet for both men and women, when it comes to sex hormones, the do NOT compare to a healthy younger person, they put all ages into the population to determine the "normal range".  So that the testosterone level of a 80 year old and a 25 year old man may set the lower and upper limits. Or at best they will compare the test results to someone else of the same age.

So what that means, is that if everyone in your age group feels like crap, as long as you feel equally as crappy, you  are "fine".  Why not compare the levels to what makes a person feel well, and when older (like they do for women and bone density) compare to that healthful normal levels.

So to recap.  For bone density you need at least three building blocks, Calcium, Magnesium and Testosterone.  In the "proper" balance, which I contend ought to be compared to the levels when the male, or female is in their prime years.

Just my thoughts on the matter.
Helpful - 0
Thank you.  Makes complete sense to me!  
Avatar universal
The quoted suppressive effect of only 5 hours was likely related to a less than full daily replacement amount of thyroid med, which would cause a much longer suppressive effect.   From a reliable source,  "Unlike continuous delivery or   secretion, oral TRT dumps the entire day’s T4 or T4/T3 into  the  circulation  within  a  few  hours.   Four  hours after a  daily  T4  dose, patients’ FT4  levels  are 13%  to  36%  higher,and  the  FT3 levels 8%  higher  than at the 24hr troug).   After a large daily T3 dose, the FT3 levels at 3hrs are 100 to 300% higher than at the 24hr trough.  Even with these peaks and troughs, the TSH level varies little over 24hrs with once-daily T4 or T3 monotherapy. (https://academic.oup.com/jcem/article-abstract/39/5/923/2684928?redirectedFrom=fulltext).    A single large T3 dose (50mcgs) given to controls reduces the TSH from 1.3mIU/lto a nadir of 0.5mIU/l at 12hrs. At 24 hrs the TSH is still near its nadir (0.55mIU/l), even though the T3 level has returned to near-baseline(161). Clearly both the T4  and  T3  peaks  have  a  long-lasting  suppressive  effect  on  TSH  production."

Doctors mistakenly think the suppressed TSH is due to too much thyroid medication.  Instead it is the expected result of the method of delivery:  the full day's dosage all at once.  There is even a study done that showed that the suppressive effect could be reduced significantly by splitting the same dose in half or into thirds and taken over the day.  

It is important to understand that, " TSH is not a thyroid hormone or prohormone.  TSH-deficiency has no pathological effects.  A low or suppressed TSH indicates only that there will be reduced intrathyroidal and peripheral T3 production. The fear of a low TSH on TRT arises from population correlations seen in UNTREATED persons, in  whom  a low  TSH  is  correlated  with thyrotoxicosis and  its  sequelae."
Helpful - 0
1756321 tn?1547095325
Excerpt from Dr Izabella Wentz's article: Accurate Lab Tests When Taking Thyroid Medications...

"Combination Medication

If you’re taking a combination medication that contains T3, like Armour, Nature-Throid, WP Thyroid, compounded T4/T3, or the medication Cytomel (liothyronine), the timing of your tests does matter and may make a huge difference in getting you on an appropriate medication dose. This is because T3 has a half-life of only 18 hours to three days, depending on the person. In some, that’s less than a day for it to start rapidly declining in your body.

When scientists monitored the levels of TSH, free T3, and free T4 in people with hypothyroidism who were taking combination thyroid medications over a 24 hour period, they found that TSH levels may be falsely suppressed for 5 hours after taking a T3 containing medication. Right after taking a T3 containing medication, the TSH level begins to drop and stays suppressed for five hours. The TSH level then begins to increase again five hours after the dose and continues to rise until 13 hours after the last dose, after which point it stays stable. So in order to get an accurate representation of your stable TSH on a T3 containing medication, you would need to postpone your T3 containing medications until after your test—or wait 13 hours after testing!

Free T3 levels are also affected by a recent dose of T3 containing medications. T3 levels increase after the dose is given, and hit a peak at four hours after the dose.

This means that if you were to take your thyroid medication before getting your thyroid function tests done, your lab results might show that you are overdosed, even when you may be accurately dosed, or they may show your labs to be within normal limits when you may be truly under-dosed.

Thus, it is usually best to postpone your combination medication until after you get your lab tests done. I recommend getting your thyroid function tests done first thing in the morning, bringing your medications with you, and taking them right after you have your thyroid function tests to ensure that you get accurate test results.

**Please note, the half-life of the medications may vary per person, so some people may have a falsely suppressed TSH, even at the euthyroid state, when taking T3 containing medications.

This is when free T3 and T4 testing will come in handy, as well as of course, looking out for symptoms of hypo- or hyperthyroidism."
Helpful - 0
Also , the day I do My bloodwork I haven’t had any T3 in my system for 16 hours   My TSH is always suppresses.
She does state: "Please note, the half-life of the medications may vary per person, so some people may have a falsely suppressed TSH, even at the euthyroid state, when taking T3 containing medications." I adjust my medication all the time to how I feel. I am dealing with toxic mould exposure which is messing with my immune system. I get hyperthyroid so I stop medication then restart again when I am no longer hyper. I don't even bother with doctors other than to have my script filled. The only Dr who knew anything was an endocrinologist I saw who was like 100 years old lol. But he lives 8 hours drive away.
Avatar universal
There is extensive scientific evidence that a suppressed TSH when taking thyroid med does not mean hyperthyroidism unless you have hyper symptoms due to excessive levels of  Free T4 and Free T3, which you did not have.    Doctors just don't understand that a treated TSH is very different from the untreated state.   Our bodies normally get a continuous low flow of thyroid hormone from the gland.   When you take the entire day's thyroid med all at once, it causes the TSH to become suppressed for about a day.    The suppressed TSH level also reduces the conversion of T4 to T3, so that is why most people end up needing both T4 and T3 med,  to adequately raise their FT3 level.    And it is T3 that is used by your body.    

Regarding osteopenia,  "Thyroid hormone replacement does not cause bone loss as is commonly believed; it simply increases all metabolic activities in the body. If a person is already in a bone-losing state, such as a postmenopausal woman who is not on proper bioidentical hormone replacement therapy, then she will lose bone faster with better thyroid levels."   So the way to correct this is to assure adequate hormones and supplements, not to restrict thyroid hormone medication.  I have successfully improved osteopenia that I previously had.  

If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read at least the one page Overview of a full paper on "Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

Helpful - 0
While I completely understand and agree with what you said, convincing the dr of that, is improbable. She is one of the only ones in the area that treats this. I’ve been thru 10 drs and she’s the best of them.  I am beginning to feel like she sees dollar signs with me. I’m running out of options here.  Are you familiar with any reputable online drs that I might try?  I don’t mind spending the money as long as I’m certain I will be treated properly. Thanks for your time.
I am sending you a PM with info.  To access, just click on your name and then click on messages.  
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