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Low TSH - Should I be concerned?

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Thyroid Disorders
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Posted 9/15/2020 1:23 PM (GMT 0)
I just had my yearly checkup and my blood test came back with a TSH of 0.128 ( Normal is 0.450 - 4.500). Looking at past years test it has been around 1.5. ( 2 years ago it was 0.48)

Based on this my doctor had the lab test my T3 and T4.
T4 Total 6.4 ug\dL ( Normal 4.5 - 12.0 ug/dL)
T3 Uptake 26% ( Normal 24 - 39%)
Free Thyroxine Index 1.7 ( Normal 1.2 - 4.9 )

My doctor just called and said that everything is fine. Should I assume I am good until next years checkup? I am wondering if I should request another test in a few months to see if it has changed or maybe make an appointment with an endocrinologist just to be safe to see if I have subclinical hyperthyroidism.
Posted 9/19/2020 12:27 PM (GMT 0)
Dear eramsl,

Your TSH is indicative of being hypERthyroid, the tests that your doctor ordered are considered obsolete and of little use except for the free T4, your doctor should have ordered the antibodies tests to see whether you have an autoimmune disorder that is causing your hyper, so I think that you should perform the following tests TSH, Free T3, Free T4, antiTPOab, TGab and TSI antibodies, and to go to an Endo doctor with those tests results with you.

You don't have to have the hormones high to feel hyper, it is enough to have low TSH and normal Free T3/4 to be hypERthyroid.

Best,
Posted 11/14/2020 9:52 PM (GMT 0)
"You don't have to have the hormones high to feel hyper, it is enough to have low TSH and normal Free T3/4 to be hypERthyroid."

Disagree on this. But everyone is a little different. If this is your experience, than your situation is not to common.

Its the hormones that make you hyper or hypo, not the TSH. TSH is not a cell consumable hormone.

And yes, modern hormone testing is needed here, which "eramsl" has not had.
Posted 1/19/2021 11:27 AM (GMT 0)
UPDATE: I saw an Endocrinologist in October. He wanted me to get some additional blood tests in three months which I just had.

T3 Total: 97 ng/dL Normal 71 - 180 ng/dL
T4 Free Direct 1.07 ng/dL Normal 0.82 - 1.77 ng/dL

I have not heard from him yet but it looks like these results are good. I'll update again after I hear from him but from what I see online I have Subclinical Hyperthyropidism based on my low TSH result from September. I am guessing he will say it is fine and I should get it rechecked at my next yearly checkup in September. Is there anything I should request from him in the short term or does retesting at my next checkup make sense? I have no specific symptoms that I can tell.

UPDATE: Just receive email from my Doctor that my Thyroid studies are normal.

Post Edited (eramsl) : 1/19/2021 6:05:22 AM (GMT-7)

Posted 2/6/2021 9:44 PM (GMT 0)
Certainly not bad news.

Your feel well (correct?). Great. Just remember, your tsh and hormone ratios are a little at odds with what average is.

Your Dr is outdated with testing choice, for the second time. Is this Dr old?

The "Free T3" test is readily available, not the same as T3 total, yet this Dr chooses not to use it.

It would be wise to look at this in the future again, but ask specifically for "free T3".

"T4 Free Direct" is prob the same as Free T4.
Posted 2/9/2021 12:03 PM (GMT 0)
Hi Astroman,

I have low TSH too at 0.09. I was hypo for years and suddenly last week this TSH level went to 0.09. My doctor lowered my meds but did not want to stop it yet.

My issue now is Dry mouth that it wakes me up. Also have stomach sensitivities due to too much PPI and antibiotics. So everything seems to be a complex.

I have another blood test end of next month. But this dry Mouth seems to be tough that no remedies worked.
Posted 2/14/2021 10:46 PM (GMT 0)
Thanks, yes the Endocrinologist is on the older side. I am due for my next checkup in September and will request the newer test with my normal yearly bloodwork. I do feel fine although as I get older it would be nice to have something to blame for minor issues other than age. When I met with him my understanding was that the T3 and T4 levels are what matters and the TSH is just an indicator that governs the T3 and T4 levels but that the actual TSH levels aren't that important by themselves. I may have misunderstood but I think that is what I was told.
Posted 2/15/2021 10:57 AM (GMT 0)

Somebody said...
When I met with him my understanding was that the T3 and T4 levels are what matters and the TSH is just an indicator that governs the T3 and T4 levels but that the actual TSH levels aren't that important by themselves

TSH remains the golden standard to diagnose and treat thyroid diseases, it is true that it is not a thyroid hormone but it is released by the pituitary and it is the hormone that controls the thyroid.
Posted 2/18/2021 9:15 PM (GMT 0)

hypoHashimoto said...

Somebody said...
When I met with him my understanding was that the T3 and T4 levels are what matters and the TSH is just an indicator that governs the T3 and T4 levels but that the actual TSH levels aren't that important by themselves

TSH remains the golden standard to diagnose and treat thyroid diseases, it is true that it is not a thyroid hormone but it is released by the pituitary and it is the hormone that controls the thyroid.

"

------------------------------------------------------------------------------------

TSH being "the gold standard", is wrong. It should not be and thus is why so many people being treated for thyroid issues do not feel well. This is what happened to me for years.

The t4 and t3 hormone levels need to be considered as well.

A smart Endo who has successfully helped patients symptoms, vs just a TSH value knows this and will to some extent find the patients levels where optimal symptom relief is achieved. And who's to say the pituitary is working correctly? - very limited options for testing that gland.

And for patients already on thyroid med, the longer they're on it, the further the TSH will be driven down, even if there are no hyper symptoms or high levels of T4 and T4.

Post Edited (astroman) : 2/18/2021 2:19:55 PM (GMT-7)

Posted 2/24/2021 6:18 PM (GMT 0)
"TSH being "the gold standard", is wrong. It should not be and thus is why so many people being treated for thyroid issues do not feel well. This is what happened to me for years.

The t4 and t3 hormone levels need to be considered as well.

A smart Endo who has successfully helped patients symptoms, vs just a TSH value knows this and will to some extent find the patients levels where optimal symptom relief is achieved. And who's to say the pituitary is working correctly? - very limited options for testing that gland.

And for patients already on thyroid med, the longer they're on it, the further the TSH will be driven down, even if there are no hyper symptoms or high levels of T4 and T4."


My husband was given a script for the synthroid and tested - everything in range...so the Doc said that was a good amount....but he was still slightly symptomatic...and on his own...he bumped up the dose and felt better. His tests were still in range...but the Dr. refused to write a script for that amount. It's ridiculous....since his FT3 and FT4 were still in range...just a little 'higher' in that range.

He knows how he feels...and it's a shame that he can't get the amount he feels he needs.

I don't think our Endocrinologists are that great around here, either...
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