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what is the difference between a supressed tsh and a low tsh
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
I use "low TSH" to mean the lower end of the reference range or somewhat below and "suppressed" to mean below range, especially when the result of meds that have a tendancy to drive TSH "artificially" low (T3). I don't know if there is a widely-accecpted, quantitative definition??? There isn't for anything else that has to do with thyroid! LOL
I'm sure that goolarra is correct that there are no generally accepted definitions for low or suppressed TSH. I did notice in the article posted by blsdnsvd that the researchers that ran the study used these.
Suppressed TSH -- TSH less than 0.04
Low TSH -- TSH less than 0.3
Suppressed TSH -- TSH less than 0.04
Low TSH -- TSH less than 0.3
yes they did and i still don t understand the difference its me i know. the research says that if its low its ok but not if its supressed or high right?
can t wrap my head around it- how do you tell a five year old what is the difference between low tsh and supressed tsh there is a difference in the research outcome- does it mean that if its supressed you are more likely to have heart probs and osteo?? but if its low you re not?
I saw that definition in blsdnsvd's post, but had already forgotten where I had read it! Oops, time for a meds increase! Thanks, gimel. I went looking on the internet earlier, but couldn't come up with a definition.
I'm assuming, annamae, (and you know what that does, since I haven't read the actual study) that the authors studied a group with TSH below 0.3 and only detected a significant increase in negative consequences in patients with TSH below 0.04. But, you're right - it's a bit of an amorphous concept to discriminate between "low", "very low" and "suppressed"...forget explaining it to a five-year-old! Some things simply require, "You'll understand when you get older." LOL
Once again, as with all things that have to do with TSH, 0.04 must be a bit of an arbitrary cutoff. I'm sure individual differences come into play, and what's more important is FT3 and FT4 levels. I think we often have to use fairly broad terminology (like upper third of the range, midrange, etc.) so that we don't imply too much precision (i.e. TSH of 0.05 is fine, but TSH of 0.03 is a strict no-no). I'm feeling like I'm not explaining myself all that well...
I'm assuming, annamae, (and you know what that does, since I haven't read the actual study) that the authors studied a group with TSH below 0.3 and only detected a significant increase in negative consequences in patients with TSH below 0.04. But, you're right - it's a bit of an amorphous concept to discriminate between "low", "very low" and "suppressed"...forget explaining it to a five-year-old! Some things simply require, "You'll understand when you get older." LOL
Once again, as with all things that have to do with TSH, 0.04 must be a bit of an arbitrary cutoff. I'm sure individual differences come into play, and what's more important is FT3 and FT4 levels. I think we often have to use fairly broad terminology (like upper third of the range, midrange, etc.) so that we don't imply too much precision (i.e. TSH of 0.05 is fine, but TSH of 0.03 is a strict no-no). I'm feeling like I'm not explaining myself all that well...
well i will read and re read your post and get it sooner or later i hope by tues when i have to see my dr who says my labs are normal but my frees are bad and my tsh is high and she is only concerned with that-- so i was going to mention the new tsh study but you know what --- why bother, i just will play the game and say i want more levo i guesssince i have symptoms and felt better a month ago before she decreased my meds because my TSH went too supressed !!!!!!!! oh mercy im flipping here thank you for listening
Well, the fact of the matter is that I think TSH ought to be all but ignored in so many cases once we're on thyroid replacement hormones. TSH is unreliable at best. FT3 and FT4 are the numbers we really have to look at. And, of course, if you really want to feel good, symptoms have to be paramount. So, if you felt better before the decrease, you have "proven" that you need more than you are taking now. The goal is to feel well, and if you can say, "I felt better before the decrease", then it's a no-brainer to me.
If your frees are "bad", that should be her main concern. How bad are they?
If your frees are "bad", that should be her main concern. How bad are they?
my ft3 went from 444 to 262 and tsh from.01 to 2.5 i will get the ft4 in mail tomorrow. dr app on tuesday. i have decided that if she won t increase the levo- if the ft4 is too low that i will order the levo online and treat myself. i am on 50 m-f and 75 on s&s and t3 lio which i have not been taking because i was afraid that my tsh would go low and she would freak and cut my levo even more- tired of these games and if i have to treat myself i will. i can order my own labs and get levo onlie without a script. im in an hmo and even if she gives me an endo conssult who know if the endo will know what they're doing. on tuesday i plan to tell her i felt better last lab even though i was .01 and 444 and then i plan to tell her that i have been reading everything and ask her to treat my ft3 and ft4 and see what she says- what do you think? i value your input so much. i can t go dr shopping because of the hmo constraints-- do you think i could treat myself ?I KNOW WHAT I NEED...i need to get back on the t3 and if the ft4 is on the floor like i feel then i need a coulple of extra days of 75 levo right?
COMMUNITY LEADER
It's very frustrating when your doctor won't treat you according to your symptoms. I would never recommend self treatment though as that can be dangerous. I don't even know if the levo you would order online is "standardized" like you would get from your pharmacy or not.
I think almost everyone would consider me as having a "suppressed" TSH since I'm sitting at a lowly < 0.03. However, my FT3 and FT4 are upper 1/3 of range and mid range respectively and I feel better than I have in years.
I totally agree with goolarra that your doctor should be looking at your symptoms first and it shouldn't be too hard to figure out that if you felt better before the decrease, she decreased you too much............what is the lab's reference range on that FT3 since these ranges are lab specific?. If that were from my lab, it would be out of range, high, which would indicate hyper.
Also, what did your FT4 come back at? Result, along with reference range. Why is your doctor prescribing T3 med when your FT3 is already high?
I think almost everyone would consider me as having a "suppressed" TSH since I'm sitting at a lowly < 0.03. However, my FT3 and FT4 are upper 1/3 of range and mid range respectively and I feel better than I have in years.
I totally agree with goolarra that your doctor should be looking at your symptoms first and it shouldn't be too hard to figure out that if you felt better before the decrease, she decreased you too much............what is the lab's reference range on that FT3 since these ranges are lab specific?. If that were from my lab, it would be out of range, high, which would indicate hyper.
Also, what did your FT4 come back at? Result, along with reference range. Why is your doctor prescribing T3 med when your FT3 is already high?
I know you can order your own labs online, but are you sure you can get levo without a prescription online??? I don't think you can.
I understand your frustration...I spent my first year on meds basically treating myself... ironically when I knew virtually nothing about thyroid. However, now that I have a great endo, I have to say that I don't recommend it.
What's the range on your FT3? I can see that it took a major nosedive, but just wondering where it is in the range now. How long before these labs did you d/c the Cytomel? Did you d/c just to "rig" you labs so she wouldn't decrease? That IS a game that you shouldn't have to play.
I don't know how far your approach will get you (asking to be treated on the basis of FT3 and FT4), but I certainly think you have a right to request it. You also have a right to be treated in the way that best alleviates your symptoms, and if you felt better before the decrease, that speaks volumes.
You do need to get back on the T3 if you felt better when you were on it. What was your FT4 before the decrease (with range), and what was your dose before the decrease?
I'd ask for a referral to an endo...what do you have to lose? You can't do a whole lot WORSE than your current doctor!
I understand your frustration...I spent my first year on meds basically treating myself... ironically when I knew virtually nothing about thyroid. However, now that I have a great endo, I have to say that I don't recommend it.
What's the range on your FT3? I can see that it took a major nosedive, but just wondering where it is in the range now. How long before these labs did you d/c the Cytomel? Did you d/c just to "rig" you labs so she wouldn't decrease? That IS a game that you shouldn't have to play.
I don't know how far your approach will get you (asking to be treated on the basis of FT3 and FT4), but I certainly think you have a right to request it. You also have a right to be treated in the way that best alleviates your symptoms, and if you felt better before the decrease, that speaks volumes.
You do need to get back on the T3 if you felt better when you were on it. What was your FT4 before the decrease (with range), and what was your dose before the decrease?
I'd ask for a referral to an endo...what do you have to lose? You can't do a whole lot WORSE than your current doctor!
my labs in january 09 were tsh .01 range .40-4.5, ft3 is 444 range 230.420, t4free 1.4 range .8-1.8 i was on 75 levo every day and 12.5 t3. i did feel hyper. then she decreased to 50 m-f and 75 sat & sun and told me to half the t3- she thought i was taking 25 of the t3. so i stopped taking the t3 since i was feeling hyper on my own didn t tell her that. my labs for last tuesday were tsh 2.5 and ft3 262 and i will get my ft4 in the mail tomorrow. she said to stay on 50 m-t and 75 s*s and same t3. i had not been taking the t3. now i have symptoms again and if my ft4 is low i want a slight increase in the levo and i want to take only 5 mcg of the t3- it makes me feel better but i am afraid it will supress my tsh and she will cut my levo down again. so i have to quit the t3 2 weeks before the draw so my tsh is not real low. its craazy. i must need the t3 because it dropped from 444 to 262
my ft3 went from 444 to 262 high is 420 i will research the levo online thanks for the fyi
Of course, the problem with manipulating your labs to fool your doctor is that now WE don't know what your FT3 would look like if you had kept taking the T3. I think you have to tell her you stopped taking it, or your labs are going to look really whacky to her and confuse the heck out of her.
Okay, so in January, your FT4 looked good...maybe even a tad high, but nothing to be concerned about. On 12.5 mcg (which the doctor thought was 25 mcg???...I had forgotten about that...she really put you on 25 mcg???) your FT3 was over the top and you were understandably feeling hyper. So, it seems clear to me that she should have left your T4 alone and decreased your T3 enough to relieve your hyper symptoms and get FT3 back in range. I think your idea of decreasing to 5 mcg is very reasonable. If you get 5 mcg tablets, you could always go up to 7.5 mcg by splitting if the 5 doesn't do it for you.
So, how to deal with this now??? You're right it is crazy to have to go through this to get what you, yourself, know you need. I'd point out the January labs. FT4 was just fine, FT3 was over the top (on half the dose she had prescribed - yikes!), which (dare I say this???) suppressed your TSH to 0.01. So, it's clear that all that was really necessary back then was to lower T3 meds a little, which would have brought FT3 back into line and brought your TSH up a little, too, most likely.
Unfortunately, if you don't tell her you quit the T3 before the labs, she's going to want to increase your T3 "back" to 25 (which you never really took) to get your FT3 back up. Oh my, what a mess! I think you have to either talk her into treating you by symptoms and FT3 and FT4 (kind of allowing you to treat yourself with her supervision) or get her to refer you. This is madness. I'd take the chance on the referral and hope you get someone you can work WITH. It's no fun to have to con your doctor.
Okay, so in January, your FT4 looked good...maybe even a tad high, but nothing to be concerned about. On 12.5 mcg (which the doctor thought was 25 mcg???...I had forgotten about that...she really put you on 25 mcg???) your FT3 was over the top and you were understandably feeling hyper. So, it seems clear to me that she should have left your T4 alone and decreased your T3 enough to relieve your hyper symptoms and get FT3 back in range. I think your idea of decreasing to 5 mcg is very reasonable. If you get 5 mcg tablets, you could always go up to 7.5 mcg by splitting if the 5 doesn't do it for you.
So, how to deal with this now??? You're right it is crazy to have to go through this to get what you, yourself, know you need. I'd point out the January labs. FT4 was just fine, FT3 was over the top (on half the dose she had prescribed - yikes!), which (dare I say this???) suppressed your TSH to 0.01. So, it's clear that all that was really necessary back then was to lower T3 meds a little, which would have brought FT3 back into line and brought your TSH up a little, too, most likely.
Unfortunately, if you don't tell her you quit the T3 before the labs, she's going to want to increase your T3 "back" to 25 (which you never really took) to get your FT3 back up. Oh my, what a mess! I think you have to either talk her into treating you by symptoms and FT3 and FT4 (kind of allowing you to treat yourself with her supervision) or get her to refer you. This is madness. I'd take the chance on the referral and hope you get someone you can work WITH. It's no fun to have to con your doctor.
(dare I say this???) suppressed your TSH to 0.01. got the best laugh thanks i needed it. i'll let you know what happens tuesday. all you say is wise. i think i'll just tell her i felt better before the decrease and then she will know that i feel better "lower" and then i can just take the t3 how i feel i need it- or if i get any resistance i will request an endo consult. i will tell her about ft3 & ft4 and t3 meds supressing tsh too - anyway i know what i need and im going to get it one way or another. not going to stay sick with symptoms even if i have to treat myself. and yes can get levo online without a script btw. thanks for being there!!
OMG, I just got online looking at what you can buy without a prescription...frightening. I'm terrified of what I'm going to be getting in my inbox after googling that. This can't be legal. I had an online drug company harassing me for months...they called 10+ times a day, often two or three times within a half hour, wanting me to buy my anxiety meds from them (I don't take anxiety meds). NOTHING turned them off. I finally had to buy a phone that was capable of blocking calls, and that stopped them.
Quick look, but prices seemed high, and they obviously don't take insurance. The cheaper prices seemed to be for Eltroxin, even though they called it Synthroid or Levoxyl.
Best of luck with your appointment...be tough...let us know how it goes.
Quick look, but prices seemed high, and they obviously don't take insurance. The cheaper prices seemed to be for Eltroxin, even though they called it Synthroid or Levoxyl.
Best of luck with your appointment...be tough...let us know how it goes.
Just be upfront with the Doc with the opening line....."I know your not gonna like this but".......
To try and fool a Doctor is unwise.
Be prepared and say exactly what you have done.
Only way to go........
To try and fool a Doctor is unwise.
Be prepared and say exactly what you have done.
Only way to go........
The difference between a SUPPRESSED TSH and a LOW TSH is:
Suppressed is med induced to keep TSH low.
Low TSH is just that...low.
Thats the medical terms for it.
Suppressed is med induced to keep TSH low.
Low TSH is just that...low.
Thats the medical terms for it.
COMMUNITY LEADER
Deb, are you saying that suppressed is intentionally med induced?
I'm thinking of my own, what *I* would call suppressed because it's way below the range (< 0.03) but yet it's med induced; not intentionally, but has to stay there in order for my FT's to stay where I need them.
I'm thinking of my own, what *I* would call suppressed because it's way below the range (< 0.03) but yet it's med induced; not intentionally, but has to stay there in order for my FT's to stay where I need them.
Yes Barb...according to the Austalian Medical Association...suppressed means 'intentionally' suppressed by medications.
Suppressed is not bad Barb...if its needed then meds is the way its done.
Just as people are kept in med induced comas.........(I know its a different thing completely but just giving an example).
They are kept in med induced comas usually to allow the brain swelling to go down.
Suppressed TSH in your case is to keep your FT3/4 at a level good for you.
Hope that clears it up.
Suppressed is not bad Barb...if its needed then meds is the way its done.
Just as people are kept in med induced comas.........(I know its a different thing completely but just giving an example).
They are kept in med induced comas usually to allow the brain swelling to go down.
Suppressed TSH in your case is to keep your FT3/4 at a level good for you.
Hope that clears it up.
COMMUNITY LEADER
Thanks Deb -- you *did* clear that up and I'm really glad to have you say it's not a bad thing, because every time someone tries to get my TSH up, they send me to hypo he//. I promised my endo that only HE and I will decide about my thyroid med(s).
There are many medical cases where certain 'levels' are kept 'suppressed ' by meds.
This is so that other organs can function and perform normally or as close to normal.
In thyroid cases...TSH is suppressed to try and stop recurring cancer...just as your TSH is suppressed to keep your levels at a comfortable state.
Its not a bad thing...far from it.
Sometimes its a neccessity.....for quality of life in the medical world.
This is so that other organs can function and perform normally or as close to normal.
In thyroid cases...TSH is suppressed to try and stop recurring cancer...just as your TSH is suppressed to keep your levels at a comfortable state.
Its not a bad thing...far from it.
Sometimes its a neccessity.....for quality of life in the medical world.
deb- but there is a distinction in the new study that implies that a supressed tsh did not fare as well as a low tsh right? ie heart disease, osteoporosis etc
I have a hard time accepting that particular part of the study. I just don't get the logic to there being a difference in the effects of a low vs. a suppressed TSH, by their definitions. To be convinced I'd have to see the actual data from the study and understand it myself. It may have been one of those studies where the result from being suppressed was not conclusively different, so to cover themselves, they are just saying there could be a difference, and it is yet to be verified. By the way I've had a suppressed level of TSH for over 25 years as a result of taking a full daily replacement amount of thyroid med.
well i will search for the data because it is very important- btw thank you for the article you sent me. saw my dr yesterday and it went well. she agreed to treat the ft4 & the ft3-symptoms and i feel like we are on the same page. glad you're doing well. o a;sp read something on dr lowe s site about the danger of overly supressed tsh and he is a strong advocate of t3 meds. if you want the link i will send it to you but you are probably familar with it..
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