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Low TSH and my DEXA shows Osteoporosis....but my FT3 is great

I just got a DEXA bone density scan which shows I have osteoporosis and osteopenia. I'm also 59 and post menopausal with very low Vit D levels. Anyway I'm taking supplements. I'm sure this is commonly asked but of course it's now an issue for me.

My FT3 is now to a level it probably has never been. I'm taking 90 mg Armour and have no hyper symptoms. My BP runs about 114/72 with pulse 70-80. My temp is up from 96.4 to 97.6 No hair falling out, no weight loss or increased appetite. No heart arrhythmia.

I guess osteoporosis aside, if the issue is not to go by TSH with a preference to FT3 levels, are there studies that correlate FT3 with risks of osteoporosis instead of TSH. If FT3 is not above range is that not considered "hyper" therefore not likely to further affect bone density? It makes sense and I certainly feel better but for me it's almost an act of faith to believe it if that makes any sense. Just looking for a little direction in this balancing act. In order for me to get a TSH in range my FT3 would likely be in the basement and the FT3 level makes more sense to me than TSH. Your thoughts?


TSH   0.04    (0.45-4.5)
FT4         1.03    (0.82-1.77)
FT3           4.1     (2.0-4.4)
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Avatar universal
Both T4 and T3 med spike FT4 and FT3 levels short term and cause a suppressive effect on TSH.  The ATA/ AACE Guidelines for Hypothyroidism clearly state that the day's thyroid med should be delayed until after the blood draw for thyroid tests.   This avoids false high FT4 and FT3 and helps prevent the doctor from making the wrong diagnosis about your levels.  If you will read my paper in the following link you will understand that thyroid med must be adjusted as needed to relieve symptoms.  Everyone is different and may need different doses.

ttps://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

In addition, FT3 does not directly cause either bone loss or bone growth.  FT3 only affects metabolism and thus affect whatever bone condition you have.  I have done lots of study on this and found a lot of info that listed the vitamins/minerals needed for good bone growth.    I later found that I could get everything I needed from two tablets of Centrum Silver taken daily, along with Vitamin K2.   After starting this regimen I had a 2 year followup bone density test that that showed significant improvement.  
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Avatar universal
I agree with you, artms, on getting adequate thyroid replacement.  In my case I had radioactive iodine 30 years ago and my thyroid was not found on ultrasound when last checked in 2019.  If your thyroid is missing in action you likely need T3 more than someone who still has functioning thyroid tissue left.  You need to keep your Vitamin D levels up to snuff, say in the 30-40 range , and do regular weight-bearing exercise to  improve your bone density.  If your basal body temp is below 98 and your resting heart rate is in the 50's, 60's or low 70's with normal BP, you probably need whatever thyroid hormone you currently take.  You probably don't want your T3 above the upper limit of normal, but the TSH will stay suppressed for anyone taking T3, according to my new endocrinologist, whom I like a lot.
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Avatar universal
Hi! I had labs done after taking my NP Thyroid and my T3 was marked pretty high. A week later I got labs without taking my meds prior. It has been 24 hrs and everything was normal. And I feel great on this dosage, but am experiencing some bone loss. So could it be that T3 spike that could cause bone loss, would micro dosing throughout the day be better for bones? But that’s elongating the T3 in my body, so would that be worse? I’m so confused and any help would be greatly appreciated.
Thanks!
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Avatar universal
Congratulations both on your scan results and on firing your doctor!  Thanks for getting back to us.
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Avatar universal
Great news.  Thanks for the feedback.  That kind of info is very valuable for members with similar issues and similar doctor responses. Thankfully, we  have learned that much of the dogma those types of doctors  try to feed us is wrong.  
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Avatar universal
I have an update!  
Back then I had seen an endo who told me I was taking too much Armour and she wanted my TSH around 1. No can do! I would tank so I fired her. I continued to test and adjust my meds.I am happy on 90 mg and my tsh is subclinical hyperthyroid. My worry was osteoporosis. I had a DEXA and I'm happy to report  osteopenia in my lumbar has stabilized and osteoporosis in my femur is now osteopenia! I'm taking vitamine D and calcium and happy as a clam!
Just wanted to share my guinea pig results.
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Avatar universal
So thyroid replacement will increase the metabolic rate of bones,  not just the loss of bone density.  I think I've got it!  
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Avatar universal
You will not find any correlation between bone density and FT3.  FT3 does not cause bone loss.  As described by the doctor, increasing levels of FT3 would only increase the rate of bone loss or formation.  The bone loss or formation is dependent on the other factors listed.  

For info, my TSH has been about .05 or less for over 30 years now, without ever having hyper symptoms, or bone loss.  In fact I continued to have lingering hypo symptoms with that TSH level, until learning about the importance of FT3.  Got mine tested and confirmed as low in the range.  Doctor agreed to switch me to a NDT med.  After some tweaking my FT3 is now 3.9 (range of 2.3 - 4.2) and I feel best ever.

For many patients the FT3 will never get high enough in its range to relieve symptoms without TSH becoming suppressed.  Symptoms are what really matter.  Not TSH level, or even FT3 or FT4 levels.   TSH cannot be shown to correlate well with either FT3 or FT4, much less with symptoms, which are most important.
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Avatar universal
I have been taking 8000 u/day D3 and will start calcium and magnesium. My Dr already mentioned she would want me to cut back on meds. I got these labs on my own. She would be horrified at how low my TSH is and would have me on less than 1 gr and ill to get it into range. Not an option but I don't want to be cavalier about it either. It would be great for me to get a correlation between FT3 and density. I feel dense trying to understand the irrelevance of TSH when in range with Frees and asymptomatic. I believe it,  but am having a hard time grasping it.  Since it does have implications I want to get it right. I feel too good to let it go and it's possible to educate my Dr if I can completely understand the mechanism myself.
Oh and thanks guys!
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649848 tn?1534633700
COMMUNITY LEADER
Totally agree with goolarra and gimel.  My TSH stays at < 0.01 all the time, and I actually rebuilt bone I'd lost to osteopenia, by taking 1200 mg calcium daily and exercising.  If your vitamin D was low, your body would not have been absorbing calcium properly.

You might talk to your doctor about trying a calcium supplement, with magnesium and vitamin D, since both are needed for adequate absorption of calcium.  

Do make sure, though that you don't take vitamins, particularly calcium, within 4 hrs of taking your thyroid med.  
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Avatar universal
Totally agree with goolarra.  Plus, I thought you'd like to read this quote from a good thyroid doctor.

"Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies."
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Avatar universal
You're absolutely right.  Low TSH is only a worry for osteoporosis IF (the big fat IF) it accurately reflects that you are truly hyper.  If your FT3 is in range, and you have no hyper symptoms, then you are not hyper.

Meds with T3 in them (T4 meds can do this, too, but it seems not as often) often suppress TSH so that it no longer reflects accurately if you are hyper or not.

Your numbers look great, and I'll bet your bones don't object to them, either...
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