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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Does The TSH Result Show Hyperthyroidism?

I am confused about the state of my thyroid

in 2005, my TSH was 6.83
I used 50mg EUTROX then my doctor gradually increased the dose to 200mg

last mont my TSH result was TSH 0.014
a new doctor diagnosed me as HYPOTHYROID and gave me EUTROX 200mg during weekdays and 150mg during weekends.

if my TSH 0.014 shouldn't be I a HYPERTROID?

do you think my doctor is mistaken?
Fri, 3 Mar 2017
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Diabetologist 's  Response
Hello,

Welcome to healthcare magic.

I have read your question completely and understand your concerns.

You are right in saying that you should be called as Hyperthyroid, but there is a small difference regarding the terminology which I will try to explain.

In 2005, your TSH was 6.83. I am assuming your T4 and T3 would have been normal then. Anyway for your TSH of around 6, normally T4 and T3 would remain in normal range anyway. You had Subclinical hypothyroidism.

Hypothyroidism is a condition where your thyroid gland ( present in front of your neck) is not producing adequate thyroid hormones- T3 and T4. There is a feedback mechanism between your brain pituitary gland and your thyroid gland. Due to any reason if your thyroid hormones production decreases, your pituitary gland will secrete a hormone called TSH ( thyroid stimulating hormone) which then acts on your thyroid gland and tells it to produce more thyroid hormones.

So in Overt hypothyroidism, a patient's thyroid is not working well, hence their T3 and T4 levels are reduced. But conversely due to above feedback mechanism their TSH increases ( normally beyond 20-30)

Similar thing happened with you in 2005. But with one small difference- your TSH was only marginally increased , your T3 and T4 was normal. This situation with normal T3 and T4 but with increased TSH is called Subclinical hypothyroidism.

Treatment for both types of hypothyroidism is with Thyroid replacement hormone called Levothyroxine- brand name Eutrox. You were started on 50 mcgs and then increased to 200 mcgs.

Now over time your thyroid hormones have been over replaced, so with same above feedback from pituitary gland, your TSH is low. But it is not that low, and I feel your T4 and T3 would still be in the normal range. This is called Subclinical hyperthyroidism. in your case it is due to increased drug dose from Eutrox.

So ideally you should be called as Subclinical Hyperthyroidism secondary to over replacement by levothyroxine. This is very easy to manage. One just needs to reduce your Eutrox dose and your TSH levels will come back to normal range by 2-3 months. That is precisely what your doctor did.

If your T3 and T4 is high with low TSH, then is proper Hyperthyroidism ( called Overt Hyperthyroidism). Treatment is different, with different drugs.

Hence to avoid confusion , and even for future reference, your doctor has mentioned you as Hypothyroid., but he did the right management in your case.

please check your TSH levels in 6 weeks, if still below the normal range, your Eutrox dose will be reduced further.

I hope this answer has helped you.

Thank you

Regards
Dr Sunita Sayammagaru
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Does The TSH Result Show Hyperthyroidism?

Hello, Welcome to healthcare magic. I have read your question completely and understand your concerns. You are right in saying that you should be called as Hyperthyroid, but there is a small difference regarding the terminology which I will try to explain. In 2005, your TSH was 6.83. I am assuming your T4 and T3 would have been normal then. Anyway for your TSH of around 6, normally T4 and T3 would remain in normal range anyway. You had Subclinical hypothyroidism. Hypothyroidism is a condition where your thyroid gland ( present in front of your neck) is not producing adequate thyroid hormones- T3 and T4. There is a feedback mechanism between your brain pituitary gland and your thyroid gland. Due to any reason if your thyroid hormones production decreases, your pituitary gland will secrete a hormone called TSH ( thyroid stimulating hormone) which then acts on your thyroid gland and tells it to produce more thyroid hormones. So in Overt hypothyroidism, a patient s thyroid is not working well, hence their T3 and T4 levels are reduced. But conversely due to above feedback mechanism their TSH increases ( normally beyond 20-30) Similar thing happened with you in 2005. But with one small difference- your TSH was only marginally increased , your T3 and T4 was normal. This situation with normal T3 and T4 but with increased TSH is called Subclinical hypothyroidism. Treatment for both types of hypothyroidism is with Thyroid replacement hormone called Levothyroxine- brand name Eutrox. You were started on 50 mcgs and then increased to 200 mcgs. Now over time your thyroid hormones have been over replaced, so with same above feedback from pituitary gland, your TSH is low. But it is not that low, and I feel your T4 and T3 would still be in the normal range. This is called Subclinical hyperthyroidism. in your case it is due to increased drug dose from Eutrox. So ideally you should be called as Subclinical Hyperthyroidism secondary to over replacement by levothyroxine. This is very easy to manage. One just needs to reduce your Eutrox dose and your TSH levels will come back to normal range by 2-3 months. That is precisely what your doctor did. If your T3 and T4 is high with low TSH, then is proper Hyperthyroidism ( called Overt Hyperthyroidism). Treatment is different, with different drugs. Hence to avoid confusion , and even for future reference, your doctor has mentioned you as Hypothyroid., but he did the right management in your case. please check your TSH levels in 6 weeks, if still below the normal range, your Eutrox dose will be reduced further. I hope this answer has helped you. Thank you Regards Dr Sunita Sayammagaru