what is the difference between a supressed tsh and a low tsh

[annamae26]

so full of questions today  does anyone know what is the difference between a suppressed tsh and a low tsh- was reading the new research and can t find the difference

[jh7407]

Hmmmm. I just realized when the other doc lowered my levo dose he also prescribed 4000mg per day of fish oil.Today when looking at ingredients on the back of a vitamin A jar, it says-'soy bean oil'.I just researched fish oil caps a little(they look similar) and am reading that they usually contain soy oi as well.If I'm not misstaken, soy products should be avoided by people taking levo.Maybe thats partly why I felt like I was on my way back to hypoland.

[jh7407]

Again, thank you so very much for these clues.

[gimel]

The main thing to be learned from your test results is that your testing is inadequate.  TSH is a pituitary hormone that is affected by so many variables that at best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T3 and Free T4.  Of these Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate at all.  So an important question for you is what other symptoms do you have besides brain fog?

From your limited tests, seeing that the TSH increased from 8/16 to 3/12 made me wonder if you have been tested for thyroid antibodies that are related to Hashimoto's Thyroiditis.  With Hashi's the autoimmune system produces antibodies that attack and eventually destroy the thyroid gland.  Along the way, natural thyroid hormone production decreases, requiring gradually increasing amounts of thyroid meds.  The two tests for Hashi's are TPO ab and TG ab.  Those tests should be done.

Even though your Free T4 is within the so-called "normal" range that does not mean that all is okay.  Your Free T4 is below the middle of the range.  In itself that is not a problem, as long as there is adequate Free T4 to be converted to T3, which is what is used by the cells of your body, and also as long as your body is adequately converting the T4 to T3.  The best way to know is to always test for Free T3 and free T4, along with TSH, each time you go in for tests.  If the doctor resists testing for Free T3, then you should insist on it and don't take no for an answer.  Many of our members, myself included, report that Symptom relief for them required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range.  

When you go back for more testing I also suggest that you should be tested for Vitamin A, D, B12, and ferritin.  If your Free T3 test shows that you have poor conversion of T4 of T3, then I would also suggest extending the testing to zinc and selenium.

As test results are available, be aware that results that fall just in the low end of the ranges does not mean that all is well.  If you will post results from the recommended tests, members will be gland to help interpret and advise further.  

[jh7407]

8/16/11 -.112mg levo for 3 mos approx. tested- tsh .18 ref.-.4-4.5 ,
t4 free- 1.2 ref.- .8-1.8 .  3/12/12- still on .112 levo.(tried some kelp pills) tested- tsh 2.42 ref -.4-4.5 , t4 free- 1.1 ref.- .8-1.8. brain fogged still.

[gimel]

I have accumulated a list of doctors recommended by other members, but the closest one for you would be in Fresno.

[jh7407]

thank you so kindly for your reply.i'm working on getting med records now.I live in manteca,ca area.

[gimel]

In the U. S., thyroid medication such as T4 meds, or desiccated natural thyroid meds, are available only by prescription.  If you will please post your thyroid test results and their reference ranges shown on the lab report, members can assess the adequacy of your testing and treatment.  Also, if you will tell us your location, perhaps a member can recommend a good thyroid doctor for you.

[jh7407]

wherer can you get levo without a scrip? My doc's got me brain fogged and doesnt seem to care.

[annamae26]

thank you for your responses. i am understanding more and more every day. have been sick for so long and i feel like i am frantically searching for wellness. i don t want to waste any more time of my life feeling sick. it is such a long journey but i am so grateful to have all of you on this board and i read everyting -  thank you

[Smilerdeb]

Its not the TSH that puts me into A fib...its the FT3 being higher than it should.
When the FT3 is too high for me, obviously the TSH goes down.
What I really meant by my posting is...if my FT3 goes up, my TSH reacts almost immediately and goes lower.

Sorry for the confusion...it is the FT3 that causes the heart issues with me.
If my TSH drops, my FT3 has usually gone up and I say USUALLY because I had good stable levels for quite a while and then my TSH just kept rising.
After 3 months (I had a feeling what was wrong) as I had a higher than usual TSH, a good FT3 but no HYPO symptoms from the TSH going higher.
It turned out to be a Pit. Tumour.

annamae.....prior to RAI , I was obsessive in getting well.
I researched all I could and found that regardless of what was 'right' for everyone else was not right for me.
I also discovered that what was right for me, was crap for others.
Since I got my levels right with 'tweaking my meds' with my Doc, I am not as obsessive as I know what to do should hiccups arise.

I used to take everything that I read on the net as 'gospel' when in actual fact...not all of it is.
Everyone has different molecular cells and DNA which means our bodies all react differently to different symptoms, hormones and levels.

I researched what was best for ME.
I can give advice on what I know but that doesnt mean I am right.
I can tell my story like everyone else here but what I did may not work for them.
The main thing to remember is...keep your options open.

All my TSH told me was :
1. I had a Pit. Tumour
2. If it was too high, I would ache and my FT3/4 would be a fraction too low.

But I have also had high TSH and normal Ft3/4.

The thyroid is a very complex organ.

[gimel]

I.m sure that Deb will give you her take later, but I think the answer is that TSH does not influence heart symptoms directly.  It is primarily FT3 and secondarily FT4 that affect metabolism and most other body functions.  When FT3 and FT4 are optimal for Deb, her hypothalamus/pituitary system apparently regulates her TSH into the 2.3-2.5 range.  Other members report widely different TSH levels when their FT3 and FT4 are in the same range as Deb's.  For example, mine is less than .05.  The TSH level is only the hypothalamus/pituitary response to the body's perceived levels of T3 and T4 in the blood.  As such, TSH is clearly only a fair indicator and it does not correlate well at all with hypo symptoms.  That's why so many members emphasize FT3 and FT4 levels and symptoms, instead of TSH.

[annamae26]

deb or anyone who can answer--you say that if your tsh is under 2.5 or so you will go into a-fib, well why does your tsh influence your heart symptoms. i thought that the frees t3 & t4 were that major active thyroid hormones that impact our symptoms- and that tsh was an antiquated guess test only an indicator at best of thyroid function.  what am i missing here please educate me....    

[Smilerdeb]

My FT4 is usually around 17.0  (10.0 - 19.0)
My FT# is usually around 4.6 (3,0 - 5,5)

Anyone looking at the FT3 level would say it is too low but any higher and I get the same thing...HYPER and h/rate around 140-160,

TSH is always good between 2.3 -2.5 (0,5 - 4.0)

I have no aches and pains, I have no hypo/hyper symptoms at these levels and I have no thyroid lol.

Bear in mindd though that I have had a murmur since birth and also suffered with Bradycarda and Tachycardia.

My FT4 when first diagnosed in 2007 was around 29,9 and my FT3 was around 33,0.

So since these levesl are good for me,.....I tend to stick to them.
Doc says super high drug sensitivity so goes along with what I do.

Sometime I may get hyper symptoms so I cut back on 12.mcg in that week and the levels stay the same.

I call it weird lol but am happy with my levels.

Umm I dont see my Doc as much for thyroid as I used to ...he says I have it down to a 'fine art' lol.

I have never taken T3 (as I dont need it ) and had every test possible.

But I must add that prior to RAI...I was so sick I wanted to die.

I got my life back....one of the lucky ones.

[gimel]

How much do you charge your doctors as a consulting fee?  LOL

My TSH has been less than .05 for over 25 years, in order to get my thyroid hormone levels high enough to relieve most symptoms.  Obviously our TSH results show pretty clearly the fallacy of the "Immaculate TSH Belief".  By the way, I'm curious as to what are your FT3 and Ft4 levels that work so well for you.

[Smilerdeb]

So what do you think of my doses Gimel lol .
I am on T4 as follows:

Week 1 = 62,5mcg 4 x week and 50mcg 3 x week
Week 2 = 62,5mc x 3 week and 50mcg 4 x week.

I have gone up the thyroid ladder to 75mcg daily and wham! bad HYPER
Then went to 62,5 mcg daily and again..by 4th week...HYPER.
So now I do it the way as posted above and am fine.

Disregard my TSH that went to over 7.0 because of the Pit, Tumour (now removed).

Doc agrees with my dosing and Cardio says I know thyroid inside out and also heart issues too and to continue the good work lol.

I cant have my TSH lower than 2.3 or I get A fib.

Personally I think it is being undiagnosed for many years...as Docs traced back my thyroid issues to 1985 yet was only dx in 2007.

That is basically the reason I have mitral and triscuspis valve prolapses....from  the heart overworking for too may years.

I guess I am on one of the lowest levels of T4 compared to others and feel great too.

[gimel]

Just ran across an article written by a doctor that I have communicated with in the past and was favorably impressed with his knowledge and approach to treating thyroid patients.  His comments on TSH were very interesting and I thought would be a worthy addition to this thread.  

The doctor was speaking with a patient who was concerned that a low TSH was a dangerous condition that indicated too much medication and was a potential cause of bone loss.  This doctor stated that the reverse was true, that a test result that showed a TSH greater than zero was an indication the the body was still asking for some thyroid hormone. I thought this was a very interesting thought --that the body is still asking for some thyroid hormone, rather than the interpretation we've all heard -- that a suppressed TSH says the body has too much TSH.  

He also said, "Fortunately, doses less than 120 mg (2 grains) per day of Armour Thyroid (equivalent doses would be 200 mcg/day Synthroid/Levoxyl (T4) or 50 mcg/day Cytomel (T3)) have been studied long term and do not cause any long-term side effects, not even osteoporosis. In fact, those taking thyroid had thicker bones than those patients not on medication!13  Doses greater than that have not been studied, so to be safe, we will need to do annual bone density screening if we go higher than 120 mg/day. "

http://www.thyroid-info.com/articles/woliner.htm

[goolarra]

I agree with you, Deb.  WE don't even really need bloodwork, because WE know how WE feel...at least we do once we've been at this thyroid game for a while.  It's our doctors who need the bloodwork because it's the only way they can "get inside our bodies" and see what's going on.  But, it's no replacement for the "real" thing (feeling the symptoms).  Your symptoms will tell you everything...you just have to be a bit cautious about interpreting those that can "cross over".

[Smilerdeb]

My attitude has always been that 'if you feel unwell' then you most probably are.....for the simple fact that YOU know your body better than any Doc/Endo/Surgeon.

Most times I have been right on this and even my own Doc who has worked with me on my thyroid issues says the same.
He says.."Debs, if you dont feel right then you are probably right" and then one by one we eliminate the symptoms and tests to get to the bottom of it all.

Ive had this Doc for over 25 years....hes a year older than me and open to anything I sugggest.
he also has the attitude that I may not always be right in my way of thinking but am very rarely wrong.
I doubted what I was able to do and had no confidence after the 'bashing' that Graves gave me.
I call him my Lifesaver.

He was the one who encouraged me to do my med endorsed Div. 2 Nursing.

[artfemme]

Thanks again...will read, at least it gives me something to come to my primary doctor with that will help to argue with the Endo. I too would have to read the data to care about the low v. suppressed argument, but am looking for info that low-range TSH isn't going to have a deleterious effect as long as the Free T3 and Free T4 are normal :-D

[gimel]

This is a link to that info.  Personally I'd have to see the actual study data before I could accept that there is a significantly different effect between what they call low TSH and suppressed TSH.  At any rate, it is a significant step forward that someone in the medical community has done such a large scale study and refuted the old belief that TSH suppressed to even the lower end within the range was enough for them to be alarmed.

The last time I went to an Endo, he took one look at my TSH of .04, I think it was, and immediately said I had to reduce my throid meds, even though I was still having some hypo symptoms.  So we parted ways very quickly.  I always thought it was very revealing that about half of the patients in his waiting room  (apparently hypo patients) were snoozing.  LOL  

http://www.sciencedaily.com/releases/2010/03/100315230910.htm

[artfemme]

gimel thanks for this thread, it was just what I needed...smart women w/moxy and info! I feel less alone, which is 1/2 the battle for wellness, I think. Could you all tell me the link to read the TSH study you discussed? Also, annamae, I'm new to this, but my intuition about my own body tells me this: I needed more T3 in the beginning, then after a year my body started working better (see my post from yesterday" Low TSH....." for my experience) and I became hyper. I cut the T3 in 1/2, to 12.5, felt awful w/hypo symptoms, added 25 mcg. to the 50mcg T4 I was already taking and felt better again. Initially T4 didn't work for me by itself, seems like it needed T3 for it to kick in. But now my body seems to need the gentler version. Also, my acupuncturist suggested I have my Vit. D level checked. My Dr. told me it was unnecessary, but finally gave in. Bingo! had practically none in my system. Started taking 1000 units, felt better right away. I think it's synergistic w/ thyroid, protects bones...just my personal opinion based on how I feel. When I altered my thyroid meds, the Vit D level went down w/out changing the dose, so now I doubled it to 2000 units (which I read is the new recommendation anyway) and am taking it simultaneously w/ thyroid meds in am. Anybody else have an opinion on Vit D??

[Barb135]

Well, I think  I can say that I have found one doctor who has gotten over the TSH belief; that's my endo.  Although there are some things about him that I'm not crazy about, I will give him the utmost credit for doing all the relevant testing *every* time AND I just saw him this morning and he's not the least bit concerned about my suppressed TSH - even wrote new scripts to enable me to keep my thyroid levels where they are, which will also keep my TSH where it's at..........

In view of that --- I'd also like to say thanks to all you guys and gals, who have helped me with research, test values, and everything else to get where I'm at..............THANKS.

[gimel]

I totally agree with you about not being concerned about a low TSH caused by meds sufficient to relieve symptoms.  As an example.my TSH has been less than .05 for over 25 years.  in my opinion the absence of a pituitary hormone (TSH)  cannot possibly be the causal factor for the potential problems brought up so often by the doctors.  The absence of TSH is nothing more than the hypothalamus/pituitary response to T4 and T3 levels.  If there were a potential problem,  wouldn't it would be evident by the presence of excessive levels of the active thyroid hormones, FT3 and FT4, and by symptoms?  When there are no hyper symptoms evident, and FT3 and FT4 are within their reference ranges, yet TSH is suppressed, where is the problem?

In my prior post I quoted studies only to convey to Annamae that there is scientific data that supports my biased opinion.  Maybe some day the medical community will get over the "Immaculate TSH Belief", and start emphasizing the actual, biologically active thyroid hormones, and new reference ranges for them, as well.

[Smilerdeb]

As I said Barb...this is my own personal opinion and I have researched a lot over the past 3 years.
There is a lot of controversy over the TSH but I do base my opinions on what I have seen here with others and my own personal dealings with the TSH.

I may be totally wrong but until I find out different, this is what I believe.