thyroid test

[BEuthyroid]

I recently became hyperthyroid with a tsh of <.06  after being euthyroid on Synthroid 125mcg for the past 18 years. My GP is using only the TSH level to adjust my dose. Is there an additional blood test that would provide more information to assist with this process? (He says T4 won't give accurate results since I am on synthroid) What would cause this to occur after being stable for so long?  Could it be from my recent chemotherapy or the resulting 'forced menopause'? (Received 4 cycles of Cytoxan & Taxotere completed 7 weeks ago.)
(20 years agoI had graves disease and was treated with radioactive iodine.)

[Barb135]

I've had osteopenia for about 6-7 yrs.  My TSH has been suppressed to 0.02 or thereabout for well over a year and according to my latest DEXA in July, I have actually rebuilt bone tissue.  I take 1200 mg calcium and 200 mg magnesium daily.  

[BEuthyroid]

Thanks for all the info.  Now I'm better informed to approach my GP.

[gimel]

Totally agree with Goolarra.  It's should be all about symptom relief, through adjusting the levels of the "Frees".  Regarding the issue about osteoporosis, I have read articles written by doctors saying that increasing thyroid medication does not affect osteoporosis unless the bone loss condition already exists due to other hormonal problems.  In that case the increase in metabolism from thyroid meds may speed up the process, but that the best solution was to fix the other problems, not restrict thyroid meds.   Also, if there is ever a concern for this a bone density scan is quick and easy to have done.

[goolarra]

There really isn't a "recommended" level for TSH or any of the other thyroid tests.  We really all have to figure out where we feel best...often a time-consuming, frustrating process.  I guess if a certain level relieves your symptoms but puts you at slightly higher risk of osteoporosis, you have to weigh what feeling good now means to you versus possibly getting osteoporosis later.

I'm glad to hear your history is so readily available to you.  I think that will help you a lot in sorting this all out..  

[BEuthyroid]

Excellent suggestion, thank you.
The current GP took over for my retired one, so it's all in my chart. In fact I asked the current GP to look back and see what my levels were last time it was checked late in the spring and she said my TSH was already low (.2 perhaps - unfortunately I didn't record the numbers, but the T4 was in normal range.)  However, I recall my old GP had told me my levels were normal and renewed my prescription for a year.  I did ask this GP to just do the tests my previous one had ordered and that's when she said it wouldn't  give accurate results. Thanks for helping me realize what I knew on some level.   I'm going to go back and ask for that referal and for copies of the last few years results so I can try to make some sense of it.  I used to always record my levels, but since it had been good for so many years I got lax.  

You mentioned some people have suppressed TSH to limit the hypo symptoms and I'm thinking this may be what my retired Gp had been doing.  Is there a recommended range that one can safely suppress their TSH without risk of osteoporosis?

[goolarra]

That sounds like a good idea.  You have enough going on withour throwing an inadequate GP into the mix.  It's extremely difficult to sort our menopauase symptoms from thyroid symptoms, whether induced or natural.  Throw in the chem, and it all becomes almost impossible.  

Can you get thyroid test results from the retired GP?  That would be so helpful for comparison in evaluating how your thyroid status has changed (or not).  I'd try to gather some history.

[BEuthyroid]

Thanks for your reply, that is helpful.  
I don't really feel hyperthyroid, though its difficult to distinguish with all the other stuff that is going on.  I am very fatigued and I guess what I've been calling hot flashes could be heat intolerance. Unfortunately my GP retired and this is the replacement, but I'll see if he will refer to an endo, and then maybe i'll look for a new GP.

[goolarra]

Adjusting meds by TSH alone is a prescription for disaster, and, in my opinion irresponsible.  Your doctor is dead wrong about testing FT4.  He should be testing that along with FT3 and adjusting meds according to those and your symptoms.  TSH is a distant third in importanvce in thyroid testing.  (FT3 is #1, FT4 is #2.) Yes, of course, your Synthroid will effect the results of the FT4 test, but that's the point, isn't it?  You want to know what your medicated levels are.

Are your really hyper?  Do you have hyper symptoms?  If you do not have hyper symptoms, then you are not hyper.  Many people have their TSH suppressed below range in order to alleviate hypo symptoms.

It sounds like you may need a new doctor.