Re: Metformin and TSH
- From: "J.C. Hartmann" <jch@xxxxxxxxxxxx>
- Date: Thu, 20 Oct 2005 12:45:21 -0500
Wes Groleau wrote:
J.C. Hartmann wrote:
It seems that some US Army endos at Walter Reed have evidence that metformin suppresses TSH production without inducing hyperthyroid.
I assume you meant "hypothyroid" above
No, I meant hyper. Thyroid Stimulating Hormone, as its name implies,
stimulates the thyroid to produce T3 and T4. Serum TSH and serum T-3 and
T-4 are counter-regulatory. Normally, serum levels of TSH are high when the thyroid levels are low (because the body is trying to stimulate additional thyroid production) and low when the thyroid gland is overactive (and the body is trying to down regulate thyroid function).
In this paper, the docs measured decreased TSH, but no concomitant increase in T-3 or T-4. They attribute this to a previously undocumented side effect of metformin.
It was a very small patient group (n=4), and the first report of this side effect that I have seen reported. I imagine that their call for further research is to rule out metformin-induced measurement error (similar to Vitamin C causing erroneous BG readings), or to see if the met (which operates largely in the liver) interferes with conversion of T-4 to T-3 (which also happens mainly in the liver).
The reason I posted this here is that many diabetics also have potential thyroid problems. Many docs will say that a low or normal TSH rules out hypothyroid. That low or normal TSH *may* be artificially caused by metformin, masking TSH levels that are really above normal, indicating hypothyroid.
Jim .
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