Using TSH to Manage Thyroid Treatment is a House of Cards Ready to Collapse

I recently put out a blog post that introduced an important new piece of research that shows that a suppressed TSH whilst on thyroid treatment does not mean that the patient is hyperthyroid.

Here is the blog post link:
https://paulrobinsonthyroid.com/suppressed-tsh-on-thyroid-treatment-does-not-mean-the-patient-is-hyperthyroid-research/

The research shows that thyroidless (athyreotic) thyroid patients require enough T4 (Levothyroxine, Synthroid) medication to get their FT3 levels up high enough to feel well. When this happens TSH is suppressed. The research shows that TSH suppression on thyroid treatment does not mean the patient is hyperthyroid.

A person not on any thyroid treatment who has suppressed TSH could easily be hyperthyroid (unless they have a pituitary issue, e.g., hypopituitarism which results in low TSH). But the genuinely hyperthyroid person on no thyroid medication, with low TSH, is a totally different case. Yet this assumption that low TSH always implies hyperthyroidism has been applied to thyroid patients under treatment and used to keep many under-medicated.

Being thyroid less is just at one end of the spectrum of thyroid patients. Many thyroid patients who are on thyroid hormone treatment have some loss of thyroid hormones from their thyroid gland. These people may also need very low TSH in order to get well.

However, IF you accept that TSH can be suppressed in a thyroid patient on treatment (which you have to because the research is compelling), then the consequences of this are significant.

This means that on thyroid treatment, TSH could be anywhere from just inside the top of the lab range right down to near zero. Thyroid treatment might even need to be increased when TSH is suppressed in order to get a therapeutic response i.e. to eradicate a thyroid patient’s symptoms. This does not mean that the patient is hyperthyroid. It simply acknowledges that the person needs more T3 in order to feel well, i.e. enough of the actual active thyroid hormone.

Currently, TSH is being interpreted in the same way as it is for an individual not on any thyroid treatment (and who may be genuinely hyperthyroid). This is incorrect and is likely to keep many thyroid patients under-medicated.  

Ok, so where does that leave us in terms of knowing if a thyroid patient is properly treated?

The answer is “Nowhere” if TSH is the only measure! 

TSH tells us very little about whether the thyroid medication dosage the patient is on, is correct for them. It may not even inform if the right type of thyroid medication is being used. If TSH does change as the thyroid dosage is increased or lowered, then at least it might be safe to assume that the pituitary gland is at least working. However, being low in the range on TSH does not mean the patient is correctly treated with the right amount of thyroid medication, or even the right type of thyroid medication!

The use of TSH to determine correct treatment level is flawed! 

Doctors and endocrinologists are ultimately going to have to face up to the science and begin to ignore their sacred TSH. It is not the beacon of light onto the correct treatment level at all.

The logic of using TSH comes crashing down!

The house of cards collapses!

This has to happen at some point. Research findings and science cannot be ignored forever! 

Best wishes,

Paul