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Q: Hello,
I have a question which does not seem to have been asked on the forum before. Can anyone give me reasons WHY a TSH can be suppressed OTHER THAN BY ELEVATED THYROID HORMONES? There simply has to be other reasons why it would be suppressed as you’ll understand in reading on.

I've done thousands of panels using TSH along with Free T4 and Free T3 (many times I include Reverse T3 and antibodies). Many times the TSH is becomes significantly suppressed as I try to raise my patients FT4 and FT3 into the normal range. They feel better with adequate FT4 and FT3 yet their TSH is now very suppressed. The problem is that when they see another practitioner and the practitioner becomes alarmed at the low TSH, my patients become scared, go along with the other provider in lowering their dose and then come back to me weeks later feeling bad again (with low thyroid symptoms).

My observation is that if we only use TSH as a test of thyroid function, we are missing about 30% of the population who have some form of actual thyroid hormone disorder (meaning abnormal FT4, FT3, RT3 and/or antibodies). I could have written the reply by Dr. Manzanero abou TSH not being the test of choice in monitoring thyroid function. Therefore, please, please, can anyone shed light as to other reasons for why some people’s TSH suppresses so very easily when simply raising their levels into the normal range?

Carolyn R. Walker, MSN, ARNP
Family Nurse Practitioner
Owner, Prevention & Healing of Iowa
http://www.preventioniowa.com

A1: The research in my book shows there is absolutely no relationship between the TSH and basal metabolism. Fifty of my pain patients who had normal TSH values averaged 15% below normal on BMRs. The most severe woman was 48% below normal. There is no scientific evidence to support the usage of TSH other than additional erroneous blood tests that do not reflect cellular metabolism, which is where the thyroid does its work. Refer to my book, "Hypothyroidism Type 2: The Epidemic" for over 100 references including long-term studies thousands of patients. Like type 2 diabetes, the vast majority of hypothyroidism is cellular in origin and blood tests will never be able to diagnose the problem.

Mark Starr MD

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A2: Carolyn

I had the privilege of getting to know Dr Broda Barnes many years ago. He originally did his PhD studying the physiology of the thyroid and its effects on the human body. His major complaint of modern medicine was that doctors treated numbers (waving a lab report around) and not patients. He tried to underscore in a myriad of ways the importance of looking at, examining, and treating patients - not numbers on paper. That is what you appear to be doing: Treating patients.

The problem becomes exactly what you say - other doctors who treat numbers.

There are other reasons than hyperthyroidism why the TSH can be low. TSH is a pituitary hormone and thus reflects the activity of the pituitary. If the numbers are low it can well be because the pituitary is not working correctly. One example would be empty sella syndrome in which multiple pituitary hormones are not being produced adequately. Also, trauma to the head, even minor trauma including whiplash and concussions, can damage the pituitary in such a way that it is not able to adequately perform. There was a major article in JAMA two or three years ago dealing with this issue.

If you treat patients, not just numbers on paper, you are choosing to face issues like you have raised. But, I believe, we need to continue to do the right thing for the patients - don't do a performance for other docs.

Warmly,
Rick
Richard S. Wilkinson, M.D.
Wilkinson Wellness Center
302 S 12th Ave
Yakima, WA 98902

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A3: My first response is that Thyroid Blood tests are notoriously inaccurate to the point of being almost worthless. I do uunderstand that other practioners rely heavily, if not 100% on them, instead of clinical symptoms, so this is an issue we do need to be aware of. I've noted the same thing in my patients. Central Hypothyroidism is when the pituitary doesn't release enough TSH to push the thyroid to make T4. Primary Hypothyroidism is when the pituitary is screaming at the thyroid, but it doesn't respond. In the first, the TSH is low, in the second, it is high. I believe most folks have a mixture of primary [the thyroid is either iodine deficient, or is toxic from environmental halides] and central [the pituitary is underactive as well, which can result from an underactive hypothalamus or a myriad of other reasons] and peripheral [selenium deficiency, DHEA deficiency, etc] hypothyroidism. This brings me to another point: hypothyroidism used to be called Myxedema in the old days because of the clinical signs one sees. Now that we call it hypothyroidism, we forget that there are at least three other sites/organs that can cause the same myxedema [hypothalamus, pituitary, peripheral tissues]. So we see that it is way more complicated than what modern docs pretend when they order a TSH.
My advice: 1)Forget the labs 2) tell the patient that all the other organs/tissues weigh in on thyroid function and that the labs are unreliable [I always say, "there is no perfect test"] and that we should treat YOU, not the piece of paper printed off a machine in a lab.
Thomas Eads, MD
Greenwood, IN

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A4: This is so-called central hypothyroidism due to low pituitary gland function.

I also have a question. Why TSH is higher normal range when T3 free is also high? I have several patients with this problem. Clinically they are hypothyroid.

Elena Koles, MD
UOK Optimal Health Center
Northbrook, IL 60062

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A5: central hypothyroidism ie deficient TSH/TRH production.
(Thyroid (T3+T4) dosing - like appropriate human HRT, or cortisone replacement, or metformin prohormone therapy, or treating hypertension & ischemic heart disease - is surely more clinical judgment- observation & bedside--based with a watch, BP machine, glucometer, thermometer, scale & tapemeasure - than lab- or other hi-tech based?. )

neil burman http://www.healthspanlife.wordpress.com

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A6: Dear Carolyn:

Serum TSH as you know is an inverse indicator of the responsiveness of the thyroid to stimulation for iodophore uptake of iodine. However, TSH has an impact on metabolism independent of its thyroid stimulating activity, which is inversely related to its serum level. TSH, regardless of the activity of the thyroid is extremely influential in determining the rate of apoptosis, cellular metabolism, conversion of estrone to estradiol, etc. Thus, when TSH is very low in the serum, it reduces apoptosis and can promote the growth or expansion of a cancer through a high catabolic state with elevated metabolism. Of course, when it is very high, it can also promote cancerous growth by increasing insulin levels, increasing prolactin and estrogen production independent of FSH probably through lipolysis. Prolactin increases peripheral estrogen receptors. So, when the increased insulin levels are combined with the increased estrogen and estrogen receptivity, we have a recipe for an explosive growth of a cancer. Also, this same situation can perpetuate chronic infections, especially parasitic infections.

The biology of functions is a mathematically based calculation of the functional activity of the body based on the management of the body through the endocrine and neuro-vegatative systems. It evaluates the metabolic activity of the body both in its basal structural activity as well as in its adaptation to stressors.

There is a seminar July 31st about this system just outside of Salt Lake City.

You can read about the seminar here: http://www.eimcenter.com/Seminars.html

And about this system, Endobiogeny and the biology of functions here: http://fullspectrumhealthmd.com/Endobiogeny.html

I hope to see you there.

Sincerely,
Kamyar Hedayat, MD
Full Spectrum Health
http://www.fullspectrumhealthmd.com

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A7: Dear Carolyn Walker,

What shows up for me as missing here is a consideration of iodine levels. Remember, there are as many cells in the body as stars in 500 galaxies, and they all have receptors for iodine. When Iodine is supplemented, TSH often rises, due to its little-known function as NIS (Sodium Iodide Symporter), whose job it is to assist the iodine into the cells where its action is. Have you tried either an iodine patch test or the 24-hr urine collection test for global iodine, available from Dr. Flechas? That might be part of your answer. Perhaps Dr. Brownstein will shed more light on this. He says in his book that 85% of the people he's tested show up deficient in iodine.

regards,

Nancy Adams, LMT

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A8; In reviewing a large number of lab tests and reviewing the literature we have found that petrochemical solvents may supress TSH. Try running the US Biotek urinary Environmental Pollutants panel.

Mark Schauss
President
Lab Interpretation LLC

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A9: i tell my pts that some people can drink 5 cups of coffee & go to sleep, so blood tests don't always reflect what the tissue response will b, as i'm sure the blood caffeine level would b hi in the above coffee drinkers, jim privitera m.d. covina cal.

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A10: Hypothalamic receptor sensitivity perhaps. I'm assuming you mean with thyroid hormone supplementation.

Either way look above thyroid gland, i.e. hypo or pituitary

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A11: In college, I worked as an orderly in an ER. The elder statseman Internist would look at the medical students and ask, "Well, son, are you going to treat the patient or you going to treat the paper?" Far too many act, think and feel a human test is like an algebra test with answers either right or wrong. Too many use testing as a method of not listening to the patient, not evaluating the history, and looking for an easy (but often erroneous!) "right / wrong" "black/white", "yes/no". Too many have forgotten Baye's theorem and that human tests have 4 interpretations: true positive, true negative, false positive, and false negative. What is most important is the answer to the question, "How do you feel?". Reality check: What is the street value of thyroid hormone? You can't shoot it, smoke it, shoot it, or sell it. You can't use it to stay awake. You can't use it to lose weight. It does not induce euphoria. If you don't need it, you aren't going to take it. Folks are only happy on the right dose. Should you check levels? Absolutely! They are not worthless - BUT - the answer to the question: "How do you feel?" trumps the labs. {Below "abnormal" labs, you note: "Above labs noted. Pt without Sx of hyper- or hypo- thyroidism. Will Continue current dose and monitor closely.}

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A12: it seems that in that class of patients that the pituitary gland set point for thyroid activity is low. A question might be is why the pituitary gland regulations set point is too low? or How to regulate or adjust the pituitary set piont or function?

CrainoSacral Therapy often normaizes pituitary function.

Cold adaption verses Obiecity also influenes thyroid set point.

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