# Is there a generally accepted clinical "definition" of TSH suppresion?



## joplin1975 (Jul 21, 2011)

I realize 1) I am borrowing trouble; 2) am being a wimp; and 3) am probably asking a dumb question, but if y'all don't mind humoring me for a bit, I'd appreciate.

So to review, after my surgery/RAI, I was very much undermedicated by my endo (50 mcgs of Synthroid), which put my TSH up in the 120s. She (the endo) has since put me on a once-every-four-weeks blood draw schedule...I was immediately bumped up to 100mcgs in November and then 137mcgs in December. You can see the progression of my TSH drop in my signature, but my January labs had my TSH at 7.88. I get my blood drawn today and should have the results on Saturday.

My surgeon (who I adore and trust without qualifications) was very much unpleased with the endo's decisions. In my November follow up appointment with him, he said he would call the endo about my case and was willing to see how things shook out, but if my TSH wasn't "properly suppressed" he would "strongly encourage" me to permit him to manage my Synthroid dosage and more or less ditch the endo entirely.

He apparently thought I was getting my blood work done last week so he called to check on things. Once we got on the same page that the labs would be done this week, he said, fine, we'll see what the results are, but he still really believed I would do better on 150 mcgs because of my weight (I'm 5'5"...usually hovering around 140, but since the surgery, I'm up to about 160. Heavy for my height, but I'm naturally "stocky"/athletic build so I do carry the weight well, all things considered) and due to the fact that I'm a runner & rider (I'm back to my 25 miles a week, plus two boot camps classes/week and my daily riding). He said if my TSH wasn't "leaning toward _slightly_ hyper" when I got my blood drawn this week, he'd like me to come in and have a conversation with him about him taking over my care. He felt that since there was some lymph node invasion, we needed to "stay on top of things" and that taking the wait-and-see approach was not something he'd advise.

This is all fine and good...and I appreciate him being so proactive on following up, but (there's always a but, right!!??)...I feel AWESOME right now. And each time I've bumped up my dosage, I go through a two to three week period where I feel so dang anxious, tense, and jittery that I want to come out of my own skin. I routinely say I'm so much more comfortable feeling hypo than hyper.

My endo has also talked about TSH suppression, but neither doctor has ever mentioned a number (or a range) that sort of "defines" what that means. If my surgeon thinks I need to bump up, I will, because he's the bestest...but if I can stay at 137mcgs, I would like to. I can't seem to find a clinical definition online of how one defines TSH suppression, so I'm wondering if you all have that information so I can better understand what number I should be hoping for. Thanks!


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## Octavia (Aug 1, 2011)

That's a great question! I've had labs drawn pretty rarely since my surgery, but the TSH numbers I remember are .05 and .007, both of which the oncologist was happy with. When I had my post-surgical/pre-RAI appointments with this oncologist, and the nurse was explaining everything to me, she said that the goal is to keep my TSH at 0.1 or lower, with a normal Free T4, so balancing the two is key. (The 0.1 number is from my written notes, so I'm inclined to trust it...no memory involved!)

I don't remember the source, but yesterday, I read something that said .05 or less qualified as TSH suppression.

Hope that helps.


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## joplin1975 (Jul 21, 2011)

Ah, thank you so very much. Previous to my last phone conversation with the surgeon, I was thinking at or around 1...but when he said leaning towards slightly hyper, I started to think I needed to revise my "goal" number.

Thanks!

*** Edited to Add -- obviously my google skills were lacking last night. I found this a few minutes ago, which is helpful (in the event anyone else is curious):

The American Thyroid Association's Guidelines (2009) make several recommendations regarding TSH.

For initial TSH suppression, for high-risk and intermediate-risk patients, the guidelines recommend initial TSH below 0.1 mU/L, and, for low-risk patients TSH at or slightly below the lower limit of normal (0.1-0.5 mU/L). (Recommendation 40).

For long-term management, the guidelines recommend (Recommendation 49):

In patients with persistent disease, the serum TSH should be maintained below 0.1mU=L indefinitely in the absence of specific contraindications.

In patients who are clinically and biochemically free of disease but who presented with high risk disease, consideration should be given to maintaining TSH suppressive therapy to achieve serum TSH levels of 0.1-0.5mU=L for 5-10 years.

In patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.3-2mU=L).

In patients who have not undergone remnant ablation who are clinically free of disease and have undetectable suppressed serum Tg and normal neck ultrasound, the serum TSH may be allowed to rise to the low normal range (0.3-2mU=L).

About 85% of postoperative patients are low-risk, according to the guidelines.

http://www.thyca.org/tsh-suppression.htm


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## Andros (Aug 26, 2009)

joplin1975 said:


> I realize 1) I am borrowing trouble; 2) am being a wimp; and 3) am probably asking a dumb question, but if y'all don't mind humoring me for a bit, I'd appreciate.
> 
> So to review, after my surgery/RAI, I was very much undermedicated by my endo (50 mcgs of Synthroid), which put my TSH up in the 120s. She (the endo) has since put me on a once-every-four-weeks blood draw schedule...I was immediately bumped up to 100mcgs in November and then 137mcgs in December. You can see the progression of my TSH drop in my signature, but my January labs had my TSH at 7.88. I get my blood drawn today and should have the results on Saturday.
> 
> ...


Excellent excellent question. I believe that Octavia has it right.

Here is an abstract that will verify.
http://hormones.gr/pdf/HORMONES 2010 57-59.pdf

My TSH is kept at 0.03. It has been very stable at that number for years and years.


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## joplin1975 (Jul 21, 2011)

Andros said:


> Excellent excellent question. I believe that Octavia has it right.
> 
> Here is an abstract that will verify.
> http://hormones.gr/pdf/HORMONES 2010 57-59.pdf
> ...


Oh, thank you! Book marked!


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## Octavia (Aug 1, 2011)

Andros said:


> Excellent excellent question. I believe that Octavia has it right.
> 
> Here is an abstract that will verify.
> http://hormones.gr/pdf/HORMONES 2010 57-59.pdf
> ...


Thanks, Andros - great article!


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## Andros (Aug 26, 2009)

joplin1975 said:


> Oh, thank you! Book marked!


You are quite welcome! Now you can ride into the sunset on your mighty steed!


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## joplin1975 (Jul 21, 2011)

Well...poop (how eloquent and mature, uh?).

My TSH actually went up slightly, to 8.38. My surgeon said this would happen once I got back up to my regular milage & started riding regularly again, so I guess he wins the guessing game this month.  I have a Monday appointment with the endo and presume she'll increase my dosage, but I'll also call the surgeon for his advice.

It's just weird because, really, I feel fantastic.


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## Butterflyjkg (Nov 29, 2011)

You know, it seems that everyone's doctor has their own ideas about what is considered supression. Like I said before, I am new at this and I don't really know squat about it. My TSH was just tested and it was 1.5, which I am told is EXACTLY where I need to be... between .75 and 3. I think it depends on what type cancer you had.. was it encapsulated?... did it spread to Lymph nodes, etc.

Speaking of that, how does it "usually" go? or is there no "usual" with Thyroid cancer. Does it always start in a nodule or what? Mine was a tiny nodule and within that there were some bad cells, but it did not go beyond the nodule....it was fully encapsulated. Can it be there with no nodule? or does it start IN a nodule and then go beyond the nodule and just go everywhere? Maybe my TSH acceptable level is a little higher on the scale because mine was super tiny and didn't go beyond the margins of the nodule? I'm wondering how that goes.....


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## joplin1975 (Jul 21, 2011)

Just bumping this up so I can over-analyze and obsess about numbers...the usual. 

I've been on 150mcgs on Synthroid for six weeks now and my endo just faxed me the results

TSH: 2.81 (.04-4.5)
Free T4: 1.5 (0.8-1.8)

A note about the free T3...my endo doesn't routinely order it, although she will with new patients and if existing patients request it. I initially requested it, but then my insurance company has been giving me heck about the frequency of blood draws and has started to deny some coverage. I'm battling with them now about, but the endo said if I make progress she'll fax over a new requisition sheet, until then we were sticking with TSH and Free T4 to save me as much money as possible.

Six weeks ago on 137mcgs, my numbers were (same ranges):
TSH: 8.38
Free T4: 1.2

With the fax, the endo sent a note that said: "Numbers much better. If no heart palps/hyper signs, continue with 150mcgs & re-run labs in six weeks. If yes, let me know."

Based on the suggested ranges in the posts above, my TSH is still too high. While I feel fine right now, I do feel like I'm right on the edge of being hyper. I have no idea if this is just me getting used to not being hypo or something else. No palps, jittery feelings, excessive sweating, etc...but I don't need nearly as much sleep as I used to need and I do have some trouble falling asleep because I'm simply not tired. Just lots and lots and lots of energy. I'd prefer not moving up again if it can be helped.

I have a follow up appointment with my surgeon on the 12th. He's much more aggressive with regard to replacement hormone dosing so I'll ask his opinion at that time, but I'm wondering if the endo's plan sounds like a good or if you'd be more inclined to call and discuss an increase?


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## polly (Oct 29, 2010)

Nothing really to add to this since I'm easily confused by the TSH thing : ) but wanted to say hi and hang in there.

I feel great myself since surgery. My next Endo appointment is in April and can't wait to see what my labs wills show.


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## Octavia (Aug 1, 2011)

joplin1975 said:


> Just bumping this up so I can over-analyze and obsess about numbers...the usual.
> 
> I've been on 150mcgs on Synthroid for six weeks now and my endo just faxed me the results
> 
> ...


I wonder if, instead of a daily increase, you could go up to 162 on alternating days? Your TSH does need to be lower, as you know. I feel your "pain" on the not sleeping part...really I do.


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## joplin1975 (Jul 21, 2011)

Octavia said:


> I wonder if, instead of a daily increase, you could go up to 162 on alternating days? Your TSH does need to be lower, as you know. I feel your "pain" on the not sleeping part...really I do.


Duh, good idea. I don't know why I was immediately thinking the only answer would be to go up to 175 on a daily basis. *smacks forehead*

You too with the sleep? It's weird...I'm not "suffering" much, but it feels very strange not to need a solid 8 hours of sleep every night.


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