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Thyroid Diseases

Extremely low thyroid stimulating hormone

08/11/2009

Question:

I am a 43 year old woman. I have had hypothryoidism for several years, starting out at 25 mcg, then to 50 mcg, then recently 100 mcg. I have been feeling ill and very weak and tired. I am on psychiatric meds which worked, but suddently now I am depressed and listless, like a flattened effect, such as no emotions, no motivation, not caring about anything, etc. I recently had a thyroid test taken, and my T3 and T4 levels were fine; however, my tsh level was very low at .02! The doctor said that didn`t make no sense and wants to recheck it in a couple weeks. I have done a lot of research and can`t find much on it except that it is rare. Have you heard of this and what it could be? I just want to feel better. Thanks.

Answer:

This is a common problem. The TSH is a very sensitive test - it is like asking your own pituitary gland whether it thinks there is the right amount of thyroid hormone in your body. Even though the free T4 and T3 are within the normal limits for a large population of patients, the low TSH says that this is not the right dose of thyroid hormone for your particular body. You need to be on a slightly lower dose. However, the fact that your free T4 and T3 are normal does tell us that your symptoms are not from your thyroid, and that further adjustments off your thyroid pills are not likely to make you feel any better. You and your doctor need to look for a different explanation for your weakness and tiredness.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University