TSH suppression - any reason not to?

[1Kel12]

Hi,

My doc says we are now suppressing my TSH and basically there is no reason to test for it anymore. She says it doesn't damage the thyroid to suppress it.

From here on out she will check only FT3, I asked her to do FT4 this time and she is checking my reverse T3 just on a hunch, she doesn't know what is causing my thyroid problems since I don't have Hashi's.

Is suppression "safe" and long term NDT use? Thoughts or if someone could point me to solid research would be appreciated. I suppose I don't have much choice but I would still like to know.

Best, Kel

[goolarra]

Thanks, yes, I commented on your thread yesterday.

[des900]

i too thought like this i tried to suppress or even tied to bring TSH under normal range and what i got is full of hypo symptoms like poor circulation, increased cholesterol, bone loss (sciatica back pain). sleepy most of the time etc. probably due to increased T4 to RT3.

my thread regarding thyroid http://www.medhelp.org/posts/Thyroid-Disorders/Subclinical-Hypothyroidism--TSH-not-able-to-bring-to-normal-level/show/2760079#post_13351007

for me if i take more levo t4 get converted to rt3 which is making my t3 to go even low thus making situation even worse.

taking t3 medicine alone or desiccated one might be useful but in my country (India) there is nothing like t3 alone or desiccated one medicine available to buy also doctors have no idea regarding that.

[goolarra]

I agree with you that many factors ultimately determine whether we feel hypo or not.  There are many people for whom T4 mono-therapy doesn't work.  

The original poster above is on desiccated thyroid, which is a T3/T4 combination.  So, I don't understand your concern about an initial high dose of T4.

"Also its found those who are under TSH suppression scheme for long time bone loss is found and can result in various related conditions."  This is not true.  It's levels of FT3 and/or FT4 that are too high that can result in bone loss, not a TSH level that is too low.  You are confusing hyperthyroidism (over medication) with TSH suppression.  They are not the same thing.  Low TSH without high FT3 and/or FT4 and hyper symptoms does not indicate hyperthyroidism or over medication.  TSH is subject to influence from any number of factors in the thyroid/hypothalamus/pituitary axis and the influence of meds.  

http://www.tiredthyroid.com/blog/2012/04/30/osteoporosis-thyroid-levels-low-tsh/

The thyroid requires TSH in order to produce hormones.  So, you are not going to get a spike of TSH from the glands if there's no TSH available.  FT4 and FT3 have to be monitored to make sure that the levels do not get too high.  By monitoring FT3 and FT4, you can make sure that the TSH is just BARELY suppressed, i.e. FT3 and/or FT4 levels haven't gotten too high.  It's a very important distinction that suppressed TSH and hyperthyroidism are not the same thing.

[des900]

There are several mechanism regarding proper thyroid functioning and using it for optimum metabolism. yes thyroid only produce T4 and bit of T3 but giving T4 all needed directly won't make all perfect especially in people who have other issues like T4 to T3 conversion problem, adrenal issues, vitamin deficiency and several other deficiencies why may or may not be diagnosed.

So if its blindly given high dose of T4 without regarding about other things the body may not respond well. Chances of metabolism slowing down and poor circulation might be experienced which might go unnoticed due to poor T3 conversion. Also its found those who are under TSH suppression scheme for long time bone loss is found and can result in various related conditions.

For TSH suppression the needed does might be very high which itself leads to a high concentration of T4 in system. Also since thyroid is still functioning chances of getting spike of T4 from glands there which might make one to go into hyper mode.

[goolarra]

It's not suppressed TSH that causes the effects you list.  TSH causes NO symptoms whatsoever.  It is nothing but a messenger from the pituitary to the thyroid to tell it to make thyroid hormone.  Once on meds, what is important is FT3 and FT4 levels.

T4 can't be made without TSH, so why would suppressed TSH increase T4?

All the symptoms you list are symptoms of overmedication, i.e. hyperthyroidism.  However, if there are no hyper symptoms, and FT3 and FT4 are properly adjusted, then TSH isn't an issue at all.  

[des900]

Suppressing TSH can lead to increased T4 which in turn can cause osteoporosis, tremors, palpitations etc so its not a good thing though some doctors practice it.

[1Kel12]

Wow, thanks.

I'll look into central hypothyroidism.

Re Hashi's - I had both tests for antibodies, negative. No gluten intolerance or other autoimmune diseases. Doc feels certain not Hashi's. So I assume I don't have Hashi's but if I'm missing something, please advise.

I requested FT4 and she was ok with running it for me. I will have my labs this week or so.

She IS nice and by far the most helpful to date.

But I want to stay on top of my treatment/fact check etc I'm afraid I've just lost confidence with MD's anymore.

So far it sounds like NDT is pretty safe, that is a relief to hear.

Thanks for your time!

Kel

[gimel]

Well, I'd like to give your doctor a gold star for being among the few that recognize and accept that suppression of TSH is not the end of the world.  My TSH has been about .05 or lower for at least 35 years, with never any hyper symptoms.  There are other members with similar experience.  

But of course that is only anecdotal info.  If you don't have Hashi's, the likelihood is central hypothyroidism.  So, please note the following info from the scientific study in the link..

http://www.ncbi.nlm.nih.gov/pubmed/12481949

"Suppression of TSH by thyroid replacement to levels below 0.1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p < 0.0001). In conclusion, in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus, insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment."

[Barb135]

There are quite a few of us here on the forum who have suppressed TSH and none of us have suffered from adverse effects of it... TSH is a pituitary hormone that stimulates the thyroid to produce thyroid hormones.  If your thyroid is not working for one reason or another, TSH is basically useless.

I don't necessarily agree with not testing Free T4, since that's the storage hormone and inadequate or too much FT4 can contribute to symptoms of either over or under medication.

Are you certain you don't have Hashimoto's?  

TSH suppression is not going to harm you, nor is long term use of desiccated hormones.