Still low or no TSH 4+years post op - Question and Answer Forum - Elaine Moore Graves' Disease and Autoimmune Disease Education

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Wednesday, February 08, 2012

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Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

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Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.

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Still low or no TSH 4+years post op

2/28/2009 12:02 PM

Lakelover

Joined: 2/28/2009

Posts: 1

Still low or no TSH 4+years post op

Hi Elaine,

Battles continue with the doctors treating me because I struggle to produce TSH 4+ years post op with FT-4 in mid range and FT-3 in low range. I have finally begun a test of additional Cytomel to raise mt FT-3 and the TSH immidiately disappears completely. What if any tests should I be requesting to make the doctors feel at ease with my lack of TSH? They are afraid to increase replacement for fear of malpractice and bone deterioration. I have shared the Brokken articles but they just won't accept the medical facts of antibodies. I tested TBII 18 months ago which cane back at 22 (<16 normal) I see a GP now because she has been more willing to work with me, my Endo flat refused to replace me on any figure but TSH.

Thanks!

3/1/2009 10:04 PM

Elaine

Joined: 8/1/2008

Posts: 3174

Re: Still low or no TSH 4+years post op

Hi Lake Lover,

I have the same problem and don't secrete TSH. It's actually a pretty common problem after permanent treatment for hyperthyroidism. Fortunately for me, my doctor looks at my FT4 and FT3 levels. Some endos understand this and don't even order TSH levels on Graves' patients on replacement therapy. You could ask for a bone density scan to see if the concern over bone loss is legitimate.

A TRH test could also be helpful for showing if patients like us produce TSH in response to thyroid-releasing-hormone stimulation. Before Brokken's reports showed the antibody connection causing a low TSH, other researchers noted that patients on full replacement hormone often have an intact pituitary-hypothalamic-thyroid axis. this just means that the brain is smart enough to realize we no longer produce thyroid hormone and don't have a need to make TSH. Ordinarily, if thyroid hormone levels are low, the hypothalamus secretes TRH and this causes us to produce TSH. there's a question as to whether we stop producing TRH or no longer respond to it. I'm not sure if this has ever been researched but if it has, such studies could also be used to show why we're not secreting TSH. A TRH would be more helpful academically than for us since it could potentially raise our thyroid hormone levels. In this test, TRH is administered and TSH levels are tested before and twice after the administration to see if there's an increase in TSH. I'll try to find out if there are any studies on this that could help with interpreting our test results. Best, Elaine

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Still low or no TSH 4+years post op

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