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TSH and Osteoporosis


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#1 Rella

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Posted 09 June 2009 - 03:24 PM

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Does anyone have any really good medical articles from big sources about the connection between TSH and osteoporosis. My doctor is trying to gradually reduce my replacements, but I already think I am a bit low. However, because of my osteoporosis (I am only 33.), and the fact that my TSH is virtually non-existent, he is no longer comfortable to raise my dose. My recent bone scan was 50% worse than the one I originally had 2 years ago which then "only" diagnosed me as having osteopenia. I do still have elevated Trab and TSI. However, I had "normal" functioning TSH levels before surgery, but have only had 3 "normal" levels since then. I don't know why. My doctor is fairly open-minded, but is still convinced that TSH is the most accurate thyroid test. He does run my FT3 and FT4, but figures with my extremely low TSH and worsening bones, I MUST be hyperthyroid.
Any help you can offer, articles, or encouragement would be appreciated.
Thank you.


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#2 AngelTrujillo

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Posted 09 June 2009 - 03:46 PM

Hello Rella,
I am sorry that I do not have any articuls that would need.
I do know that TSH is not a good indicator for dosing replacement.
I have had 3 docotrs lower my dose on me so that my TSH would come from 0.01 up to 2.
It made me so sick and I almost had to go to the hospital the last time, because I was so bad.
I do not have bone issues that I know of, but I do know that if you are hypER or hypO it messes with your bones.
There is fine line in there.

I am sure some one will be here shortly to give you the information you need!
Hang in there!!


Angel

#3 SusieQ

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Posted 09 June 2009 - 06:12 PM

Hi Rella,

Nice to see you around. Sorry that your bone issues have worsened though. :^(

My main concern is why does your dr not put you on a bone mending/building medication given that you had bone issues a couple of years ago? There are several to choose from. One may be appropriate for you. I do think that a more proactive approach needs to be taken rather than worrying about your lack of TSH.

Speaking of TSH, I do not have a link that would support your argument with your dr. I see his dilema given how drs are trained to go by the TSH in spite of the situation a Graves person finds themselves in with low TSH when eurothyroid. He believes what he reads and you show up with osteoporosis, which supports what he reads. In his mind, you need a downward dose adjustment to try and close the barn door. But all the animals have left the barn already.

I assume you are taking quality calcium supplements daily, along with vitamin D and magnesium. Boron helps with bone building too. 1500mg calcium would be a minimum dose for you, daily. For note, I take 5000iu vitamin D a day, 1000-1500mg calcium a day, 1000-2000mg magnesium each day considering the parathyroid problem I had with surgery. I had my levels tested a few times and usually, the above calcium doses keep me within range, but my last calcium test came back slightly below normal. The vitamin D, while seems like a high dosage, keeps me at 83 (30-100). Magnesium comes in the top of range. I mention this just for a reference for you if you need it.

I am very sorry your bone problems have continued to accelerate Rella. You are so young. I had hoped that you would have been on Actonel or one of the other bone building meds by now...

I think there is something to it more than your low TSH because you have not been hyper in a long time. Perhaps you have a genetic predisposition. Have they measured your parathyroid hormone levels? This is where I am not an expert and have not been able to find a good explanation, so I am not sure if PTH is the same as vitamin D or if it is something else, but it is worth having your dr check into considering your condition.

I hope the babies are happy and well. They must be getting so big now.

Take care, Susie

(last labs were mid-range FT3&4 with 0.00 TSH, as usual. dr said all is well and keep on doing what I am doing, as usual)

#4 Lakelover

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Posted 09 June 2009 - 06:39 PM

Hi Rella,

SusieQ - as usual makes some excellent points!

Do you do any sort of weight bearing exercises? It's a great way to build bone. My last dexascan showed increased bone after regular weight bearing exercising.

What are your last few labs?

Rose

#5 Rella

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Posted 09 June 2009 - 08:18 PM

Quick reply to calm your worries...
I am on my third month of Boniva and have had no side effects. I took 50k Vit D for two months and moved my level from 36-46, now will go on 2k a day and retest in a couple months.
I will answer more, but I have to run right now.

#6 Rella

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Posted 09 June 2009 - 09:48 PM

I started doing some weight bearing and walking on a more regular basis after I received these last results. I had gotten very off track with my pregnancy and postpartum. What exercises do you do?
That is great that you noticed a change in your density. Was that difference just because of your exercises?

Here are my most recent labs. We haven't been taking them as frequently because I am having too much fluctuation. I am sure I am lower now than my last labs indicate as I have been tired and sluggish and less motivated. We will probably retest in a month or so, but unless I am really off the chart, he is not likely to indulge me and up my cytomel. The last dose I was on pre-pregnancy was .088/7.5. I am thinking that was probably about right, but was never on it long enough and even then I still had fluctuation, though not as bad as with the preg and postpartum.
Thank you for your help.

Almost 10 months Postpartum
3/25/09: FT3: 2.7 <2.3-4.2>
FT4: 1.47 <0.61-1.76>
TSH: 0.003 <0.350-5.500>
Currently: Levoxyl: 88mcc & Cytomel: 5mg

8 months Postpartum
2/6/09: FT3: 2.4 <2.3-4.2>
FT4: 1.40 <0.61-1.76>
TSH: 0.032 <0.350-5.500>
Levoxyl: 100mcc & Cytomel: 5mg

3 months Postpartum
9/9/08: FT3: 3.5 <2.3-4.2>
FT4: 1.21 <0.61-1.76>
TSH: 0.020 <0.350-5.500>
Levoxyl: 100mcc & Cytomel: 10mg

1.5 months Postpartum
7/25/08: FT3: 2.4 <2.3-4.2>
FT4: 1.08 <0.61-1.76>
TSH: 0.016 <0.350-5.500>
Levoxyl: 100mcc & Cytomel: 7.5mg

2 weeks Postpartum
6/13/08: FT3: 3.0 <2.3-4.2>
FT4: 1.30 <0.61-1.76>
TSH: 0.014 <0.350-5.500>
Levoxyl: 112mcc & Cytomel: 12.5mg


Hi Rella,

SusieQ - as usual makes some excellent points!

Do you do any sort of weight bearing exercises? It's a great way to build bone. My last dexascan showed increased bone after regular weight bearing exercising.

What are your last few labs?

Rose



#7 Rella

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Posted 09 June 2009 - 10:09 PM

Hi Rella,

Nice to see you around. Sorry that your bone issues have worsened though. :^(

My main concern is why does your dr not put you on a bone mending/building medication given that you had bone issues a couple of years ago? There are several to choose from. One may be appropriate for you. I do think that a more proactive approach needs to be taken rather than worrying about your lack of TSH. The reason my lack of TSH came up was because I was complaining about being too low again. :) I am on my third month of Boniva, so we are addressing that medically. I have also started back with regular walking and weight bearing exercises.

Speaking of TSH, I do not have a link that would support your argument with your dr. I see his dilema given how drs are trained to go by the TSH in spite of the situation a Graves person finds themselves in with low TSH when eurothyroid. He believes what he reads and you show up with osteoporosis, which supports what he reads. In his mind, you need a downward dose adjustment to try and close the barn door. But all the animals have left the barn already. Yes, I agree with you and I see where he is coming from. I'm glad you see where he is coming from. I think his arguement holds much more water than mine. Though I did remind him again today that I still have elevated Ab and thus could be the reason for my TSH. That of course baffles him since I am post TT and I didn't have those problems with suppressed TSH pre-TT. Ahh I must be a medical phenomina. :blink:

I assume you are taking quality calcium supplements daily, along with vitamin D and magnesium. Boron helps with bone building too. 1500mg calcium would be a minimum dose for you, daily. For note, I take 5000iu vitamin D a day, 1000-1500mg calcium a day, 1000-2000mg magnesium each day considering the parathyroid problem I had with surgery. I had my levels tested a few times and usually, the above calcium doses keep me within range, but my last calcium test came back slightly below normal. The vitamin D, while seems like a high dosage, keeps me at 83 (30-100). Magnesium comes in the top of range. I mention this just for a reference for you if you need it. Back in February or so I started a new line of products from Enriching Gifts. They are supposed to be super absorbent. I take their coral calcium which is 1500/day as well as their multi vits and plant enzymes. However, the enzymes work to loosen the bowels, so I can't take much Mag. I think I will reduce the amount of enzymes and try to take more Mag. I used to take 1500 of mag a day, but since cut way back because of the bowel effects. And as I said I will be going on 2k Vit d/day. Are you thinking that I should be on the top end of the range for all these minerals?

I am very sorry your bone problems have continued to accelerate Rella. You are so young. I had hoped that you would have been on Actonel or one of the other bone building meds by now...

I think there is something to it more than your low TSH because you have not been hyper in a long time. Perhaps you have a genetic predisposition. Have they measured your parathyroid hormone levels? This is where I am not an expert and have not been able to find a good explanation, so I am not sure if PTH is the same as vitamin D or if it is something else, but it is worth having your dr check into considering your condition. I did call and request that he check my parathyroid glands awhile back. This is what they tested for:
Calcium 9.7 (8.5-10.6)
PTH, intact 64 (15-64)
Interpretation
Normal: PTH (15-65) Calcium (8.5-10.6)
Primary or Secondary Hyperparathyroidism or Non-Parathyroid Hypercalcemia >65;>10.6
Hypoparathyroidism <15;<8.5
Non-parathyroid Hypocalcemia 15-65; <8.5
Vit D 36.4 (21-100) now I am 46
Potassium 4.0 (3.5-5.2)
Mag 2.3 (1.6-2.6)
Phosphorus 4.0 (2.5-4.8)
So he said everything looked good.


I hope the babies are happy and well. They must be getting so big now.

Take care, Susie

(last labs were mid-range FT3&4 with 0.00 TSH, as usual. dr said all is well and keep on doing what I am doing, as usual)
Yeah!!!



#8 AngelTrujillo

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Posted 10 June 2009 - 12:26 AM

Hello Rella,
It looks to me that your FT3 is a bit low. I bet that is making you kind of tiered.
As for your calcium and such it looks good except your Vit D, but I think you know that already. If you can you should take a short 30 minut walk in the sunshine in the morning or early evening. It will help give you a bit more Vit D the natural way and should also help you te feel a little bit better too.


Sorry I was not much help.
I do know that after a TT yoru antibodies can be floating around in there for years. Dose not make sence to me, one would thing if you remove what yoru body is attacking that it would calm down. Some people don't work that way though. There are a few people here on the board that have had TT and still have antibodies so you are not the only one.


Angel

#9 soops

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Posted 10 June 2009 - 05:30 AM

I don't have much to add as Susie aka Captain Calcium has dealt with most of the important points.

However, as someone who, post TT, has no parathyroid function at all, I have to deal with vit D, calcium and magnesium issues on a daily basis.

Susie was correct in suggesting that 1500mg of calcium a day should be your aim. I would like to mention two things here. Firstly, the body absorbs calcium better from the diet than from supplements so if you can increase your dietary intake of calcium that would be better. Also, the body can only absorb a certain amount of calcium and so it is best to try and take the calcium throughout the day rather than in one large dose. I am also sure that I read somewhere that if you have an apple or apple juice with your calcium, it helps the calcium absorption.

I can't advise on Vit D levels as I have to take a more active form but I would suggest Susie is spot on. If you can get out in the sunshine though for at least 15 minutes a day it would help. Suncreams block 90-95% of UV rays so if you are going outside obviously protect your skin but for 10-20 mins use no suncream, then slap it on so you don't get burnt! There are two tests for vitamin D, the vit D3 test and the 1,25 dihydroxy vitamin D test. You could always get both checked to make sure it is converting properly, which it should be as your PTH levels look fine.

Magnesium levels. I wouldn't dream of taking such high levels of magnesium. The RDA is 300mg a day. Anymore than that and I would spend most of the day in the bathroom. Again try and get magnesium from the diet.

There are many things that effect the absorption of calcium such as too much sodium, smoking, caffeine, fizzy drinks etc so try and limit those. Also, and not too freak anyone out but undiagnosed celiac disease call also effect absorption. Calcium can also be lost through normal bodily functions.

The only other thing I would suggest is that you get a 24-hr urine test. This just checks on the level of calcium you excrete in your urine. It just keeps a check on absorption and makes sure your kidneys aren't overloaded.

Try and keep up with the weight bearing exercise.

Take care
Su

#10 Marti

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Posted 10 June 2009 - 07:20 AM

A couple more thoughts...

It is my understanding that bone density is related to FT3 and FT4 levels and not TSH. The reason why doctors always look at TSH when discussing bone density is the same reason why many still dose ATDs according to TSH. That is old school. That being said, if you mess with your replacement levels I think you are much more likely to see a problem with the FT3 and FT4 as opposed to improving your done density.

As for vitamin D, I've been reading up on that. My level is a startling 17 - doctor wants it over 40. Strangely my bone density is just normal. I agree that going outside in the sun 20 minutes a day is a good idea, but it is not the "cure" for vitamin D deficiency. You need to expose a lot of your skin to the sun (shorts and tank top) during the time of day when the sun is the strongest to get enough vitamin D. Also, the body can only store vitamin D for a week or two. So, although you can get enough vitamin D through sun exposure during the warmer months, almost everyone in the US is not be able to get enough vitamin D through sun exposure year round. They say as much as 80% of the people living in the northeast is vitamin D deficient - and I am just one of them!

Rella, I am really glad to hear that taking the 50K of vitamin D has made such a good improvement on your vitamin D levels. It is encouraging, since I am starting 50k of vitamin D on this week.

Interesting discussion...

#11 SusieQ

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Posted 10 June 2009 - 01:25 PM

Hi Rella,

Whew. Wipes brow. So glad to hear that your dr has put you on Boniva. That is fantastic news. I feel a lot better knowing this.

Also very glad to hear that you have started weight bearing exercises. I know as a mommie with little ones it can be hard to find the time, but think of it as you un-guilty pleasure. Something for you, and the time made, is time gained. Do stick with it, and work your way up slowly. Even if if you only get 15 minutes a day, go ahead and tell whoever that right now you are busy, but you will get back to them shortly. I know that in my house, the phone always rings when I am on the treadmill or using the boxflex. Never fails and I wonder if there is some kind of cosmic connection sometimes. lol My friends know that if I am in the middle of a workout, they come 2nd and that is okay. My kids are older than yours, but I did teach them when they were very young that when mommie is doing her exercises, they can sit quietly and play crayons or trucks (soap blocks was a big hit to keep them busy during workout time. about 15 bars of soap--in wrappers of course, and the world is yours for 20 minutes) until she gets done. Then a big hug and praise for being quiet and playing nicely while mommie was exercising and you are on your way and your workout is done for the day.


""Yes, I agree with you and I see where he is coming from. I'm glad you see where he is coming from. I think his arguement holds much more water than mine. Though I did remind him again today that I still have elevated Ab and thus could be the reason for my TSH. That of course baffles him since I am post TT and I didn't have those problems with suppressed TSH pre-TT. Ahh I must be a medical phenomina.""


Yes, this can a hard battle to overcome and not to be a downer, but I think you are not going to win this one. The teaching that is done is so thorough on TSH being the end all, you probably can't say anything to convince him otherwise. I think a lot of us would have hoped that we would have made more progress in this dept, but we have not inspite of our numbers. Well, you, me and lot of others are these medical phenomenons (wink wink). The prevailing opinion among the drs is that after TT, you are cured. This is not true as we know, it's more of a side step than a cure. But since we are not cured, we can still have TSH suppression issues. I do consider myself extremely lucky not to have to fight this battle. I wish I had a bit of advise here for you to plead your case, but I don't.

I was looking at your labs you posted and your levels are actually pretty stable for post-partum, so that is very good. Your latest labs show your ft4 in a nice place, but you are probably feeling sluggish from the ft3 being a bit on the low side. Probably another 2.5mcg of cytomel would fix that, but doesn't sound like this will happen. Your other labs are pretty good too, don't you think? I take it then, looking at your set of labwork that the PTH and vitamin D are indeed two separate things. Soops probably knows the answer to this since she has had to learn everything calcium/vitamin d related since her surgery. Our inhouse expert in that subject. She calls me Captain Calcium, but I think she really wears that cap.

As for the enzymes...those can have a fast forward effect on the bowels as you have found out. They are supposed to help you absorb and process your nutrients more effectively, but for you, I might want to pass on that for the time being. And yes, taking the amounts of magnesium I take would probably not let you out of the restroom. I think taking a lower amount would work well for you and looking at your magnesium lab, you are doing well with that anyways--which is very good to see. I don't hold onto magnesium or potassium well, thus the higher dosage for me. Some camps believe in at least that amount of magnesium for proper calcium absorption (citing calcium being notoriously hard to absorb), but most people do have bowel effects at those higher doses.

You ask about being at the top of range for these assorted minerals...It seems to me, from what I have read that mid-to-upper range is always best regarding this. Some articles I have read from researchers suggests that the current RDAs on vitamin d, boron, and magnesium are lower than they really should be and even more 'experts' say that the RDA for vitamin d will be officially raised in the years to come. Things move very slowly at the federal govt level, so I won't hold my breath on that one though.

So, I guess you just need to find a happy medium on your thyroid meds. With luck, maybe you are your dr can come to a pleasant compromise on this and maybe backburner the TSH discussion if possible. Not likely, but good thoughts go far sometimes. Your bone building program is in place, so you just need to make sure you eat a lot of calcium rich foods and take all your pills (!) and do your exercises. I think the latter will have a positive effect for you. Also, do a google on calcium blocking foods and try to limit those all things considered. I forget now which they are, but I do remember being surprised at a couple of them.

Soops has made some good suggestions and gives you things to think about.

Rainbow light makes some good calcium products in case your current brand does not improve your status as hoped. Another is Bio-Terrain, which is a powdered calcium product that I used to use when I was in parathyroid crisis. That was the only thing that allowed me to come of the ungodly doses of calcium I had to take in the first month post-TT. I could not find this product for a few years to my saddness, but I recently found it again via the internet and some little company. I ordered some and have begun taking it again. I find that one very easy to absorb. Tastes yucky though. Having the calcium labs every now and then, I can see which product really does work and which don't work as well.

Hope that helps. You got some good advise from the members so you can't lose!

Off to see pictures now!

Take care, Susie


#12 cd3764

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Posted 10 June 2009 - 03:11 PM

Hi there, Rella

Your thread caught my eye since I have had to battle with my endo about her concerns of bone loss as a result of low TSH.

I have done extensive research on the topic and consulted with Elaine Moore. Elaine was able to provide resources
to substantiate the fact that low TSH in the presence of excess hormones (or as a result of excess thyroid hormones) does
not cause bone loss - it is the excess thyroid hormones that causes bone loss. Sorry to say, though, I found a few more
recent articles/studies that show perhaps that is not the case after all and low TSH could possibly cause bone loss (sigh).

Honestly, even though your doctor is incorrect that TSH is the most accurate measure of thyroid function, he could very well be
correct that low TSH will cause bone loss....it seems the jury is still out on that one.

I am fortunate in the fact that I have done weight-bearing exercises for most of my life and always consumed calcium-rich foods -
we shall see how well that bodes for me once I get the results of my recent bone density test. It was recognition of my lifestyle
coupled with my request for the bone density test that convinced my endo to dose me by my FT4.....I told her I'd rather take
Actonel than be hyPO for me. I empathize with you.

Many on here have already given you great ideas to restore bone density....I hope you can try some of them.

Hopefully, you will be able to restore some bone density and your doctor will then stop worrying about TSH.....there are enough articles
out there to show that FT4 levels (and not TSH) are the best indicator of thyroid function. And, it is a well-known fact that the Graves'
antibodies "act" in lieu of TSH to stimulate the thyroid so-o-o-o, since you're still testing positive for antibodies (some people can have them for years,
especially after times of stress - physical or emotional), that could explain your low TSH as well.

Best of luck to you!

:) Carol

#13 Lakelover

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Posted 10 June 2009 - 07:23 PM

Hi Rella,

Have they tested your antibodies? I know I had the low TSH battle awhile back and I insisted that my GP test my TBII which showed elevated as expected. I have not had the TSI done.

I would have to agree with Carol in that it is the excess of thyroid hormone - not the low TSH that causes bone loss. Unfortunately there is much controvercy on this topic and the proof either way is lacking. I have yet to find any studies to prove my point but if low TSH was truly the cause of bone loss then there should be more of us who have low or no TSH with bone issues.

As far as weight bearing exercises - when I was doing them - I have a weight machine and did a workout of my entire body, nothing to necessarily bulk me up more of a total muscle work over. I now walk daily and am trying to convince myself to get working out again.

Rose





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