Frequently Asked Questions
AWARENESS
SUPPORT
ADVOCACY
for Western Australians
                   Answered by Monique Atkinson – Patient Advocate

Is a low TSH safe if you are on thyroid hormone replacement therapy?

New research shows it may be safe to have a low TSH level between 0.04 mIU/L and 0.4 mIU/L which is
below the normal reference range. The first population based study monitored 16,426 patients who were
on thyroid hormone replacement therapy between 1993 and 2001. The research was presented by
Graham Leese from the University of Dundee in Scotland, at the Society for Endocrinology BES 2010 in
Manchester.

The study looked at how variations in patients’ TSH levels affected their long term health. Patients who had
a low TSH as defined above did not show an increased risk of heart disease, bone fractures or
dysrhythmias. The findings confirm it may be safe to take higher doses than currently recommended.
Some patients only feel well when their TSH is low with thyroid hormone levels at the upper end of the
normal reference range.

According to this particular study, patients with a suppressed TSH, which was defined as a level below
0.04 mIU/L and a raised TSH over 4.0 mIU/L, were at an increased risk of heart disease and bone
fractures. However newer studies on the osteoporosis controversy show that people on thyroid hormone
replacement therapy with a low or even suppressed TSH don’t have an increased risk of osteoporosis.


I was diagnosed with Hashimoto’s. My TSH is high normal and I have many
symptoms of an underactive thyroid, but my doctor says I don’t need any
treatment yet. Should I see another doctor?

Yes, some doctors are more knowledgeable about thyroid disease than others.

When you are finally diagnosed with Hashimoto’s thyroiditis, many doctors still like to wait for your TSH to
go up to around 5 mIU/L or even higher and then start treatment. By that time you may already have
suffered from hypothyroidism for many years (even decades). If you have symptoms of an underactive
thyroid then you will not only suffer unnecessarily, but your health may deteriorate further. Early treatment
may also avoid complications. Low normal levels of circulating thyroid hormone (free T4) can easily be
treated with a small dose of thyroxine without decreasing the TSH too much (and still keeping it in the
normal range). The best test of all will be your response to a therapeutic trial of thyroxine and subsequent
improvements of symptoms.

If you are planning a pregnancy then it is crucial that you receive early treatment, because research has
shown that low maternal thyroxine levels (free T4) cause poor developmental outcome in the baby.

According to The Journal of Clinical Endocrinology & Metabolism ‘Subclinical Hypothyroidism Is Mild
Thyroid Failure and Should be Treated’, the LDL cholesterol can be lowered with a supplement of thyroxine
if the TSH is at the higher end of the normal range.
jcem.endojournals.org/content/86/10/4585.full


I have Hashimoto’s and I take thyroxine, but I still don’t feel well. Will I ever
feel well again?

The most common reasons why you may not feel well on thyroxine are as follows;
  • You may not be getting enough thyroxine, because your doctor may be too focused on the TSH test.
  • You may be taking too much thyroid hormone, which is evident by clinical signs, such as hot
    sensitivity, palpitations, fast resting pulse, weight loss or weight gain, change in appetite, frequent
    loose stools, inability to hold your fingers still etc.
  • If you are on full replacement therapy you may just need a combination of thyroxine (T4) and
    triiodothyronine (T3), the two main hormones produced by a healthy thyroid gland. Conventional
    medicine can prescribe thyroxine and Tertroxin (artificial T4 and T3). However most doctors are not
    familiar with Tertroxin. Tertroxin is available on the PBS, but it is an authority script which means that
    the doctor needs to state the following; “replacement therapy for hypothyroid patients who have
    documented resistance to thyroxine sodium”. Integrative practitioners can prescribe desiccated
    thyroid hormone or slow release T3 capsules made by compounding pharmacies.
  • You may have other underlying issues, such as nutritional deficiencies. For example (low levels of
    iron, B12, vitamin D, selenium, tyrosine, magnesium etc.)
  • You may suffer from adrenal insufficiency. This can happen if your adrenal glands are no longer
    producing adequate amounts of cortisol. Alternative medicine believes most people with
    hypothyroidism have some sort of adrenal dysfunction. However in practice most hypothyroid
    people actually have high or excessive levels of cortisol.
  • You may have other underlying conditions which have not been diagnosed. For example, you may
    suffer from coeliac disease or non-coeliac gluten intolerance, rheumatoid arthritis or type 2
    diabetes etc.
  • Dietary factors, such as too many goitrogens in the diet or too little or too much iodine.
  • You take iron, calcium or fibre supplements within 3 hours of thyroxine which interferes with the
    absorption of thyroxine.

Most people who are in the early stages of the disease do well on thyroxine only if the dose is right.
However studies have shown that people on full replacement therapy are more likely to experience
symptoms of an underactive thyroid on thyroxine only.


Is there a cure for Hashimoto’s?

No, there is no cure, but replacing thyroid hormone is ESSENTIAL. We cannot live without thyroid hormone.


Is there a connection between thyroid disease and gluten?

Yes, many thyroid patients have non-coeliac gluten intolerance and some have coeliac disease. If you
suffer from bloating, flatulence, malabsorption, tiredness after eating gluten, constipation or foul smelling
fatty stools then it may be wise to ask the doctor for a blood test (antigliadin IgG and coeliac panel). You
must be on a normal diet before you do the tests, because the tests become negative once you are on a
gluten free diet. The diagnosis of coeliac disease is confirmed by a positive biopsy obtained through an
endoscopy. Studies have also shown that thyroid antibodies are gluten dependent and decrease on a
gluten free diet, but a gluten free diet may not stop thyroid disease from progressing further. However most
patients with autoimmune thyroid disease and non-coeliac gluten intolerance (gluten sensitivity) or coeliac
disease feel better on a gluten free diet. For more information contact the Coeliac Society on 9451 9255 or
visit their website www.coeliac.org.au


What doctors specialize in thyroid disease?

General practitioners can diagnose and treat autoimmune thyroid disease. Sometimes patients are
referred to endocrinologists or thyroidologists (doctors who specialize in thyroid disease). For nodules,
goitres and thyroid cancer you may be referred to an endocrine surgeon as well.


Disclaimer  The information provided is for educational purposes only and is not intended to be medical
advice. The contents must not be relied upon in place of advice and treatment from a qualified medical
practitioner. Thyroid WA Support Group Inc. and the author disclaim any liability whatsoever.

Thyroid WA Support Group Inc.  -  ABN  84 263 220 330