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What Does A Low TSH Mean?
Question: My wife got into thyroid problem after her first delivery that was cesarian as child was not in proper position. In XXXXXXX 2013, it was 6.73 ulU/mL (0.55-4.78). She started taking Thyroid 25 as per doctors prescription
In August 2013, it was 5.640 so still on higher side
In Sep 2013 her thyroid came 4.188 that was within range. However after 2 months it was again on the higher side of range.
About 3 months back, doctor asked her to increase the dosage to Thyroid 50 s her weight was increasingly a lot and she had other problems also.
We got her TSH tested again recently 2 weeks back and found that now TSH is on lower side. TSH, Ultrasensitive, Serum is 0.24 ulU/mL (range is 0.55-4.78)
We are confused as to what does lower TSH now mean? Does that mean a completely different problem? What are the problems she will face due to this? What treatment she should have? When we asked a doctor, he said just reduce the dosage from Thyroid 50 to Thyroid 25. However he did not explain whats happening. Please explain whats happening and what we should do?
In August 2013, it was 5.640 so still on higher side
In Sep 2013 her thyroid came 4.188 that was within range. However after 2 months it was again on the higher side of range.
About 3 months back, doctor asked her to increase the dosage to Thyroid 50 s her weight was increasingly a lot and she had other problems also.
We got her TSH tested again recently 2 weeks back and found that now TSH is on lower side. TSH, Ultrasensitive, Serum is 0.24 ulU/mL (range is 0.55-4.78)
We are confused as to what does lower TSH now mean? Does that mean a completely different problem? What are the problems she will face due to this? What treatment she should have? When we asked a doctor, he said just reduce the dosage from Thyroid 50 to Thyroid 25. However he did not explain whats happening. Please explain whats happening and what we should do?
Brief Answer:
You have to tritrate the dose
Detailed Answer:
Dear XXXXXXX
I am happy to welcome you to the Healthcare Magic forum. I have gone through your history and will try to guide you to the best.
First let me assure you that caesarean delivery has nothing to do with the mothers Thyroid function.
At the outset let me request you to upload all the reports of your wife on this forum - ALL and not only thyroid reports. It will help me to have comprehensive view of her health status and evaluate the effect of Thyroid on her health.
Her initial levels of TSH as mentioned by you were 6.73 μIU/ml. These are higher values to some extent however, not very high. So minimal dose of 25 μg was adequate to start with. It did bring down her TSH levels to 5.640 μIU/ml and then to 4.188 μIU/ml showing that the dose given to her was indeed adequate. You have mentioned that after two months again it was on the higher range. I would have appreciated had you mentioned the precise levels. How much high it went? Please inform me. Also please let me know what were the levels of TSH when her dose was increased to 50 μg.
After increasing the dose to 50 μg, within 2 weeks the levels of TSH felled too low - upto 0.24 μIU/ml suggest that this dose was too high for her. Hence your doctor has brought it back to 25 μg. Now it is but natural for you to be worried about het TSH levels going high again.
I do have a definite plan about your Thyronorm tablets in my mind but for the missing link. Please inform me the TSH levels when your Thyronorm (or different trade name) dose was increased to 50 μg. Also please inform me elaborately whether that time she had any aggravated symptoms like lethargy, apathy, low appetite and still increase in weight, or any other symptoms. You might consider those symptoms negligible but they may be very important for me. So please narrate detailed history. If you can scan the case history sheet of your wife, as maintained by your doctor and upload it for my review, that will be great.
Also please let me know whether your wife is breast feeding your child? If so does she have sufficient milk for the baby? Are there any problems in breast feeding.
Further I would like to know whether her post delivery period was uneventful of not. Did she have too much of bleeding or bleeding for prolonged time (which otherwise stops by 10th day). Please appraise me all this information.
Till that, I would advise her to continue on 25 μg Thyronorm tablets and keep a watch on the TSH levels. If they start rising and touch 6 μIU/ml, then only increase the dose - not straight a way to 50 μg but only on one day in a week take 50 μg and rest all six days take 25 μg daily. Then again we shall monitor the TSH levels and decide whether dose needs to be increased. However, please do not jump to 50 μg daily straight a way. Gradually go on increasing the dose and titrate it with her TSH levels.
In her diet, please avoid broccoli, soya, cauliflower, cabbage which have adverse effect on the absorption of iodine.
I hope you are getting her TSH levels done on empty stomach for 14 hours.
Also, I hope she is consuming Thyronorm tablets in the morning on empty stomach and not taking anything by mouth for next half to one hour.
You have mentioned about Glycomet SR 1000 mg for her. Is she diabetic? If so, she has to be regular on these tablets. I would like to know her Blood Sugar Levels (Fasting and post meal) and her HbA1c levels. Diabetes definitely has interrelation with thyroid.
I do respect your doubt about completely different problem. I shall be able to opine on that only after you upload her all the reports. However, she does have low grade hypothyroidism, as evident from the TSH levels you have mentioned. Do not doubt that. Go slowly in increasing the dose, titrate it with her TSH levels and she will be in control.
Please do not loose your heart. The hormonal problems are always tricky. No dose is fixed for the lifetime and has to be titrated and adjusted as per the levels of hormones in the blood. So please keep on monitoring regularly and she will settle down soon.
I hope you have got the picture much clarified. I am awaiting all the information and the reports I have requested for.
With all the best wishes for your wife ....!
You have to tritrate the dose
Detailed Answer:
Dear XXXXXXX
I am happy to welcome you to the Healthcare Magic forum. I have gone through your history and will try to guide you to the best.
First let me assure you that caesarean delivery has nothing to do with the mothers Thyroid function.
At the outset let me request you to upload all the reports of your wife on this forum - ALL and not only thyroid reports. It will help me to have comprehensive view of her health status and evaluate the effect of Thyroid on her health.
Her initial levels of TSH as mentioned by you were 6.73 μIU/ml. These are higher values to some extent however, not very high. So minimal dose of 25 μg was adequate to start with. It did bring down her TSH levels to 5.640 μIU/ml and then to 4.188 μIU/ml showing that the dose given to her was indeed adequate. You have mentioned that after two months again it was on the higher range. I would have appreciated had you mentioned the precise levels. How much high it went? Please inform me. Also please let me know what were the levels of TSH when her dose was increased to 50 μg.
After increasing the dose to 50 μg, within 2 weeks the levels of TSH felled too low - upto 0.24 μIU/ml suggest that this dose was too high for her. Hence your doctor has brought it back to 25 μg. Now it is but natural for you to be worried about het TSH levels going high again.
I do have a definite plan about your Thyronorm tablets in my mind but for the missing link. Please inform me the TSH levels when your Thyronorm (or different trade name) dose was increased to 50 μg. Also please inform me elaborately whether that time she had any aggravated symptoms like lethargy, apathy, low appetite and still increase in weight, or any other symptoms. You might consider those symptoms negligible but they may be very important for me. So please narrate detailed history. If you can scan the case history sheet of your wife, as maintained by your doctor and upload it for my review, that will be great.
Also please let me know whether your wife is breast feeding your child? If so does she have sufficient milk for the baby? Are there any problems in breast feeding.
Further I would like to know whether her post delivery period was uneventful of not. Did she have too much of bleeding or bleeding for prolonged time (which otherwise stops by 10th day). Please appraise me all this information.
Till that, I would advise her to continue on 25 μg Thyronorm tablets and keep a watch on the TSH levels. If they start rising and touch 6 μIU/ml, then only increase the dose - not straight a way to 50 μg but only on one day in a week take 50 μg and rest all six days take 25 μg daily. Then again we shall monitor the TSH levels and decide whether dose needs to be increased. However, please do not jump to 50 μg daily straight a way. Gradually go on increasing the dose and titrate it with her TSH levels.
In her diet, please avoid broccoli, soya, cauliflower, cabbage which have adverse effect on the absorption of iodine.
I hope you are getting her TSH levels done on empty stomach for 14 hours.
Also, I hope she is consuming Thyronorm tablets in the morning on empty stomach and not taking anything by mouth for next half to one hour.
You have mentioned about Glycomet SR 1000 mg for her. Is she diabetic? If so, she has to be regular on these tablets. I would like to know her Blood Sugar Levels (Fasting and post meal) and her HbA1c levels. Diabetes definitely has interrelation with thyroid.
I do respect your doubt about completely different problem. I shall be able to opine on that only after you upload her all the reports. However, she does have low grade hypothyroidism, as evident from the TSH levels you have mentioned. Do not doubt that. Go slowly in increasing the dose, titrate it with her TSH levels and she will be in control.
Please do not loose your heart. The hormonal problems are always tricky. No dose is fixed for the lifetime and has to be titrated and adjusted as per the levels of hormones in the blood. So please keep on monitoring regularly and she will settle down soon.
I hope you have got the picture much clarified. I am awaiting all the information and the reports I have requested for.
With all the best wishes for your wife ....!
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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