[snelsen]

#1059917

I subscribe to a cardiology journal. Just received this report this morning. Notice that the study has over 1/2 MILLION participants. Which increased the validity exponentially.

My story.
THis is not a surprise to me, but a big worry. I have had a suppressed TSH for years, and despite trying to reduce my TSH T3, T4, for the past 15 years, it has never moved to even the low end of the normal range (.4-4.5) I am at .09 right now. I am on 112 mcg of Synthroid. When we got to 77mcg, and this is waiting around 9 months for each decrease, I developed extreme hypo symptoms (very very cold, and developed gastroparesis..) but my TSH did not budge. I could not move. So, since I could not eat, we slowly increased my Synthroid until I could eat.

Here is the beginning of the article. The reference is included in the this post. Let me know if you cannot access it. I do not know if my membership precludes sharing this article, but it seems it can be accessed, because it is a recent international meeting. Notice the only lab they are looking at is TSH.

“Copenhagen, Denmark – Subclinical hyperthyroidism is associated with a 20% increased risk for cardiovascular mortality, primarily driven by heart-failure deaths, according to a large study in more than half a million individuals from general practice in Denmark, reported here at the 2013 European Congress on Endocrinology.

“The main finding is a 20% increased risk of mortality in all levels of hyperthyroidism, including overt and subclinical but also high-normal, euthyroid patients, those lying in the lower range of the normal thyroid-stimulating hormone [TSH],” Dr Christian Selmer (Gentofte University Hospital, Hellerup, Denmark) said in an interview. Selmer presented his findings, for which he received a Young Investigator Award, on April 29, 2013.”

Here is the link

http://www.theheart.org/article/1534179.do?utm_medium=email&utm_source=20130501_heartwire&utm_campaign=newsletter

Shirley

[Kimberly]

#1178743

Hi Shirley – Interesting info! Did the print version talk about recommendations for patients who are impacted by this issue…more frequent checkups, lifestyle changes, etc.?

Also, did they separate out the cause of the overt/subclinical hyperthyroidism (Graves’ post RAI/Surgery and on replacement, Graves’ ATDs, Undiagnosed), Hashimoto’s in a hyper phase, post-partum thyroiditis, post thyroid cancer, etc.)*? The thyroid cancer group would be particularly interesting to look at, since their TSH levels are deliberately kept low in order to reduce the risk of a recurrence.

Thanks for posting!

*Edited to clarify

[Ellen_B]

#1178744

Hello Shirley,
I had no problems with your link finding Dr. Selmer’s findings on subclinical hyperthyrodism. My question is when Dr. Selmer speaks of 20% increased mortality in all levels of hyperthyroidism is he lumping all types of hyperthyroidism? I think he is. Would the risk be much lower if he looked at just subclinical hyperthyroidism alone?

You might be interested (if you have not already done so) in looking at the American Thyroid Association guidelines for management of hyperthyroidism and other causes of thyrotoxicosis. The link to those guidelines is: http://thyroidguidelines.net/sites/thyroidguidelines.net/files/file/THY_2010_0417.pdf
The guidelines were drawn up a while ago (in 2011) and are not as recent as your article.
What is interesting to me is the chart dealing with the subject of when to treat subclinical hyperthyroidism. In the chart patients are lumped into two different groups—one group with a TSH below 0.1 and another group with a TSH between 0.1 and 0.5.
(By the way the lower limit of the normal range for this chart is 0.5mU/L)
The chart indicates patients are more likely to be treated when the TSH is below 0.1 than when it is between 0.1 and 0.5. (Your TSH of 0.09 is very close to the 0.1).
When figuring out whether to treat or not to treat, other factors such as age and underlying conditions must be considered as well.
In the less than 0.1 TSH group the over 65 people are more likely to be treated. In the same group (less than 0.1) those who are under 65 with certain conditions such as hyperthyroid symptoms, heart conditions and osteoporosis are also likely to be treated. In the less than 0.1 group if one is under 65 and has no symptoms treatment is only considered. However if you are in the group with TSH between 0.1 and 0.5 and you are under 65 and asymptomatic no treatment is indicated.

How worried you should be about your TSH numbers your doctor should be able to tell you. He will know all the factors that should be considered—including underlying conditions. It would be nice if questions on the subject were simple and had simple answers. Life always has to be complicated!

I just want to thank you for bringing your article to our attention. It has provided food for thought. Along the way I hope my words have brought a little bit of clarity.

I wish you the very best in finding the treatment that is right for you.
Ellen

[adenure]

#1178745

I haven’t looked at the article, but what if your TSH is low, but your resting heart rate is the lower end of normal, your blood pressure is good & all other heart health indicators are good (like cholesterol). Is the increase for heart failure still present just based on TSH even when everything else is normal? I ask bc my TSH slipped from 1.6 on the 112 Synthroid to 0.29 in 4 months without a dose change. So, I’m taking 112 six days a week & 100 one day a week. My T3 is low normal & my free T4 is high normal. My resting heart rate is 63 or so.

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