Is your Free T4 really in the Normal Range? Optimal vs Normal levels & More

Chances are VERY high that your Free T4 level isn't actually normal even though it may be in the "normal range".

Most people tend to blow off the Free T4 level because it isn't the 'free and active' hormone like T3.

But that is a big mistake!

Free T4 still has a story to tell and it's not something you want to miss out on.

For instance, your Free T4 level can actually help you determine how efficient your thyroid is converting T4 into T3 and may explain why you have a "low" TSH when you still feel like crap. ​

​In this article I'm going to help you understand what your Free T4 level means and teach you how to determine if it is really in the "normal range"...


Is your Free T4 Normal & Optimal?

​Unfortunately it isn't quite that easy...

There is no magic number that your Free T4 level needs to be in order for you to suddenly start feeling amazing.

It is just one small piece of a larger puzzle that is your entire health.

I've seen patients with low Free T4 levels who are asymptomatic, and I've seen patients with Free T4 levels in the upper 1/3 range who feel terrible. ​

Like other tests in medicine, it needs to be used in conjunction with your symptoms and other lab tests.

But before we get into the nitty gritty, let's talk about how to look at your own Free T4 level...​

Consider the example below:

Patient with hypothyroid labs

​Going off of lab tests alone you can see that this patients Free T4 levels fall within the lower 1/3 of the reference range. (Ignore her other lab values, we will get into those later)

If your Doctor were to see these labs he would absolutely tell you that your lab tests were "normal", but is that really the case? 

In treating over hundreds of patients I can tell you honestly that MOST patients feel significantly better when their Free T4 levels are towards the higher range, usually in the upper half.

​If you recall from basic Thyroid physiology, your Free T4 levels act as a reservoir or pool to draw upon when your body needs to create the active thyroid hormone Free T3. 

So when thinking logically about this...

The more Free T4 levels you have, the more you can draw upon this pool to create the active hormone... right?

It turns out that this is the way that most Doctors (and subsequently patients) think about the thyroid.

Unfortunately, for about 98% of the population, it isn't true.

And that leaves us with a big problem:

Why are our hypothyroid patients unhappy

We are basing treatment recommendations off of an incomplete picture and we are wondering why our thyroid patients feel terrible and are so unhappy. ​

Your Free T4 and Thyroid Function

Here's where things can get a little bit tricky, and why many Doctors may actually be telling you that your thyroid is "fine" when it really isn't. 

I just said that high levels of Free T4 is good, right?

But that isn't always the case. 

Refer back to what I said before about Free T4 being a reservoir for Free T3. 

What if you AREN'T converting T4 to T3. 

Well, let's just think about this logically again using this example:

I want you to think about your thyroid as a Dam. 

Under normal circumstances a Dam acts to hold back A LOT of water, and only let a certain amount of water go through in a controlled fashion. 

In this example the pool of water behind the Dam is your Free T4 levels, and the water going through is your Free T3. 

What will happen to the system if you suddenly can't let any water through? 

It all backs up, and the water behind the Dam continues to grow and grow. 


The same thing happens to your Free T4 level when there is a 'kink' in the system. 

But instead of water, your Free T4 level goes higher and higher...

Do you see the problem now?

A kink in the conversion process may actually cause your Free T4 levels to RISE and make you think that your thyroid function is NORMAL, when the exact opposite thing is happening. 

As your Free T4 level rises (because it can't convert to Free T3) it shows up as high levels of Free T4 in the serum. These high levels of Free T4 actually act to suppress your TSH (because your pituitary doesn't have the same deiodinases as the rest of the body).

So your lab tests look something like this:

  • High levels of Free T4
  • Low levels of TSH
  • Low levels of total T3 and free T3
  • High reverse T3 levels

​Meanwhile you are feeling terrible with every hypothyroid symptom in the book

Does this scenario sound familiar?

Don't worry...

If it is happening to you we are going to discuss how to correctly diagnose it, but first we need to talk about how T4 can be beneficial. ​

Does your T4 even matter?

​It's easy to think that T4 doesn't mean much because it isn't the active thyroid hormone in your body. 

And it makes sense, but there is still some value in using and testing for it.


T4 levels give you an idea about how you are converting T4 into T3.

In keeping with the analogy I described above, your T4 level helps you to understand how your body is processing your T4 and T3 thyroid hormones.

High levels of T4 with corresponding low levels of T3 may indicate that you need to focus on improving your T4 to T3 conversion.

You can read more about how to naturally increase your T3 levels and thus thyroid conversion here. ​


T4 levels can give you an idea if you are properly absorbing thyroid hormone.

Another huge benefit of testing your T4 levels is understanding if your body is actually absorbing your thyroid hormone. 

Naturally your T4 levels should increase as you take thyroid hormone (though realize your symptoms may not improve just because your T4 level increases).

By testing your T4 level both before and after you start thyroid hormone (this only applies to T4 only thyroid medication) you can get a rough idea as to whether or not you are absorbing the medication.

Believe it or not, absorption of thyroid hormone is a big deal and something that is frequently missed.

thyroid metabolism reset poster for side bar

You can find more about how to properly take your thyroid medication in this post which goes over how changing the time of day you take your thyroid medication can actually improve your thyroid absorption and thyroid function. ​


T4 levels can help you determine if you need to focus on improving your thyroid converion vs increasing thyroid hormone production.

This is primarily helpful for patients who know that they have hypothyroidism, but their physician is unwilling to treat them with thyroid hormone. 

Most physicians are willing to at least test both TSH and free T4 levels which can give you as the patient a lot of information.

If you know that your T4 and T3 levels are low then you can focus on taking supplements and taking action to increase your thyroid hormone production.

On the other hand, if your T4 levels are high and your T3 levels are low - you as the patient can focus on taking supplements designed to boost T4 to T3 conversion.

​Over 13 nutrients are involved in proper thyroid hormone production and 2 supplements can really help thyroid conversion. 

It turns out that many patients (even those on thyroid hormone) have deficiencies in these nutrients which lead to poor thyroid hormone production and conversion.

You can learn more about all of the nutrients required for proper thyroid function and conversion in this post. ​

If you have Hashimoto's then the supplements you should consider using are slightly different from the list above and you can find more information on which supplements are best for autoimmune thyroiditis here


​T4 levels can help you determine if you would benefit from adding in T3 thyroid medication. 

Let's say that you are taking T4 only thyroid medication (like Synthroid) and your T4 level is high (so you know you are absorbing it) but your T3 level is still low and you are still having symptoms of hypothyroidism. 

Even in the presence of a low reverse T3 (which means you are still converting thyroid hormone ok) may indicate that you might benefit from the addition of T3 thyroid hormone. 

Recall that T3 thyroid hormone is the most powerful thyroid hormone and is responsible for all of the good things that thyroid hormone does in your body. 

So remember:

While T4 isn't the best thyroid test, it can still give you plenty of helpful information - especially if your Doctor isn't willing to order the complete thyroid panel. ​

​How T4 changes with thyroid medication

Another very important factor is understanding how your free T4 level changes with different types of thyroid hormone.

This is worth mentioning because it isn't always intuitive and it can lead some patients into thinking that they are not heading in the right direction even though they might be. ​

T4 on Levothyroxine (Synthroid, generic Levothyroxine, Tirosint)

The way your T4 level changes when taking T4 only thyroid medication is actually intuitive.

Assuming you are absorbing enough thyroid hormone, your T4 level should increase as your increase your T4 dose.

Makes sense right?

Sometimes, though, this doesn't happen and even if it does it doesn't necessarily mean everything is "all good".

As I mentioned above, your T4 level might NOT raise if your dose isn't high enough and/or if you aren't properly absorbing the medication you are taking.

And, even if it does, there are studies showing that patients who take T4 only thyroid medication show lower T3 levels than healthy populations - indicating that many patients just don't do well on these T4 only thyroid medications. 

T4 only thyroid hormone and low T3

There are ways that you can improve the function of thyroid hormone if you are taking T4 only thyroid medication and not feeling better:

1) Consider switching to Tirosint. 

Tirosint contains 3 inactive ingredients and can help increase the absorption and effectiveness of thyroid hormone. 

​The case can even be made that you should consider switching over to Tirosint if you are currently taking synthroid or levothyroxine. 

2) Consider switching to 50mcg increments of Levothyroxine

The 50mcg tablet of levothyroxine contains the fewest inactive ingredients out of all ​of the other dosages. 

Changing your dose from 1, 100mcg tablet of levothyroxine to 2, 50mcg tablets of levothyroxine may help increase absorption and reduce any symptoms you may be having. ​

  • Bottom line: If you are taking T4 only thyroid medication (Synthroid, Levothyroxine, Levoxyl) then your free T4 level should increase. If it doesn't then you may have an absorption issue and you may benefit from switching to Tirosint. 

T4 with NDT (Armour, WP thyroid, Naturethroid)

​The way that T4 changes with both NDT isn't always straightforward.

Any thyroid medication that contains T3 thyroid hormone will generally cause your free T4 level to lower. 

The degree of how much it lowers largely depends on the dose of T3 you are taking. 

The higher the dose of T3 the lower your free T4 will go. 

The reason for this has to do with how T3 and T4 influence pituitary function. 

T3 thyroid hormone is 3-4 times more potent at lowering the TSH than T4 is alone. 

As your TSH lowers your body produces less T4 thyroid hormone by itself (and becomes more reliant upon medications to supplement thyroid hormone levels). 

As long as you have a functioning thyroid gland (assuming it isn't taken out or destroyed by radioactive ablation) then your thyroid will be producing SOME T4 and T3 even if you are taking thyroid medication.

But as you increase the dose of T3 you are taking then that amount your thyroid produces drops. ​

​This will usually result in a decrease in your Free T4 level. 

As you know NDT (natural desiccated thyroid) contains mostly T4 and some T3.

This ratio is close to 80% T4 and 20% T3, which means that the medication is still mostly T4 thyroid hormone.

But even that small amount of T3 is enough to shoot up T3 levels and drop T4 levels in the body.

One mistake I see patients (and doctors make) is increasing NDT dose while trying to get to some mythical and optimal T4 level in the serum.

In some ways this is futile as you increase the NDT dose it will drive down your T4 level in the serum which leads to higher and higher levels of NDT.

This can actually backfire and result in high levels of reverse T3.

If you are taking 4+ grains of NDT and still experiencing symptoms of hypothyroidism, then this may be happening inside your body. ​

  • Bottom line: With lower doses of NDT your free T4 level may actually drop somewhat. Higher doses of NDT (greater than 4 grains) will usually cause the free T4 to increase but this isn't necessarily helpful. 

T4 with T3 medications like Cytomel and liothyronine​

This is where things get really interesting. 

Taking T3 only thyroid medication like cytomel or liothyronine will cause your free T4 to drop below the "normal" range completely and even flag as low.

This has to do with the fact that you are suppressing the TSH with the T3 and so endogenous production of T4 decreased dramatically.

Taking T3 only thyroid medication also causes reverse T3 levels to drop to low levels as well (this is usually a good thing).

To recap what happens on T3 only thyroid medication:

  • TSH level falls
  • Free T3 level increases
  • Free T4 level decreases
  • Reverse T3 level drops

What you really need to get out of all of this is the fact that your free T4 levels don't necessarily need to be in some magical "optimal" range for you to feel good. 

Basing your treatment off of these ranges may lead to sub optimal treatment as you chase all the wrong results. ​

  • Bottom line: Taking T3 only thyroid medication will dramatically reduce your free T4 level and this isn't necessarily a bad thing. 

Symptoms of Low T4 & T3

​Low free T3 and free T4 levels may indicate low thyroid function, but they may also indicate a condition known as euthyroid sick syndrome or low T3 syndrome

​This condition is very similar to hypothyroidism in general but with a few changes. 

Low T3 and low T4 levels generally share many of the same symptoms as hypothyroidism with some slight changes.

Symptoms of low T3 + low T4 include:​

  • Constant fatigue
  • Reduced response to T4 only thyroid medications
  • Weight gain (even while on thyroid medication) 
  • Low resting heart rate
  • Low body temperature

Many of these symptoms result from low T3 levels directly or from the reduced conversion of T4 to T3. 

Patients who are taking thyroid medication (who still have low T4 levels) may experience many of these symptoms.

If you fall into that category make sure that you properly evaluate how effective your conversion is, and how effective your native thyroid hormone production is (used examples above). ​

thyroid metabolism reset poster for side bar

Why you need the Complete Thyroid Panel

Because testing for thyroid hormone levels isn't always intuitive, it's very important that each time you check your thyroid levels you order a complete panel. 

While not all lab tests may be necessary EACH and every time you get blood work, it's still a good idea to get these tests at baseline. 

Let's go back to the initial example we used in the beginning of this post. 

Patient with hypothyroid labs

​At first glance you may be thinking that this patient is completely normal. 

Her TSH is in the 1-2 range, her Free T3 is in the mid range, it's only her Free T4 that is in the low range.

But she is actually quite hypothyroid. I know this because I treated her!

​It isn't until you order her Reverse T3 level that you finally get a better picture as to what is happening to her. 

Elevated reverse T3 in Hypothyroid patient

​Once you see and understand her Reverse T3 level you begin to understand her thyroid physiology.

You see:

The only reason her Free T3 levels even look moderately normal is because her Reverse T3 levels are inappropriately blocking any Free T3 that she has.

Remember that Reverse T3 and Free T3 both compete for cellular binding.

If you take into account her high Reverse T3 level, her Free T3 level suddenly starts to make more sense. 

In her case her Free ​T4 level never got into the 'optimal high' range, but you can definitely tell that it is also inappropriately high for her, given that she can barely convert T4 to T3. 

​The bottom line:

You need a Complete Thyroid Panel if you want to have ANY idea of what is going on with your thyroid.

That means you need the following tests:

  • TSH
  • Free T3
  • Free T4
  • Reverse T3
  • Total T3
  • Thyroid Antibodies
  • Sex hormone binding globulin

​And remember:

Just ordering the tests isn't going to be enough.

You need to make sure that you and your Doctor know how to actually interpret them so you don't fall victim to the trap I just showed you above. ​

Recap + What you want your T4 to be

Your Free T4 levels can give you amazing insight into how well your Thyroid is functioning, but you need to remember that they are only a small piece of an even larger puzzle. 

It is possible that your Free T4 levels may be inappropriately elevated ​and that isn't always a good thing. 

If your Free T4 levels are high and you still feel terrible, then you need to make sure you are also checking your Free T3 levels and your Reverse T3 levels.

​Using these lab values together, in combination with your symptoms, will help you to understand how well your thyroid is functioning. 

So what should your T4 levels be?

If you aren't taking thyroid hormone, then optimal levels are generally in the upper 50% of the reference range.

If you are taking thyroid hormone then the upper 50% of the reference range doesn't hold, instead you need to be focusing on other factors. 

​Now it's your turn:

Are your free T4 levels high but you still feel terrible?

Is your doctor willing to order the RIGHT tests?

What has helped you feel better in this situation?

Leave your comments below!​

Dr. Westin Childs

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 115 comments
Aida Saldivar - May 7, 2016

Hi have hipothyroid from 11 years ago, I’m 36 and start having problems with mi hormones, my t4 1.2
T3 3.5 and tsh 0.01

    Dr. Westin Childs - May 7, 2016

    Hey Aida,

    You’ll want to check your reverse T3 levels and sex hormone binding globulin as well.

      Kali - January 20, 2017

      Hi Dr! I have gained 31 lbs in 10 months and have been unable to lose with diet and exercise. My PCP ordered TSH, FreeT3, and FreeT4 in July which were normal and told me that I was 35 and my metabolism was slowing down. I went back last week & he said my weight gain is abnormal because I continue to gain. I showed him your article and he agreed to order all of the thyroid labs and an ultrasound. So far only the TSH 0.95 (range .30-5), T3 total 144 (range 80-200) and Free T4 1.12 (range .93-1.7) results are in. When the reverse T3, globulin, and other come back, if they are normal how can I trust my PCP will know if there actually is hypothyroidism?

        Dr. Westin Childs - January 20, 2017

        Hey Kali,

        You can’t – which is why I generally recommend against using your PCP or endocrinologist for treatment, the single best thing you can do is find someone who is knowledgeable about what is mentioned in this article. Most people end up wasting many years trying to get their PCP or other physicians to treat them in the insurance model instead of looking outside of it for help.

Jodiann - May 7, 2016

This has become my life! I was diagnosed last August with Hashimotos Thyroiditis after a nodule biopsy. Since then it has been a nightmare!! Dozens of test & Dr’s all telling me my levels are normal! In the mean time my hair
Is falling out, The fatigue is so bad,I have brain fog, tightness in my throat, severe joint pain ,panic attacks and tingling in my head that brings on the panic attacks. I have recently developed swelling to my right temple. Going for a MRI I just feel like I’m not being heard! I went gluten free back in Oct. it has helped some but .. This has altered my life dramatically. I just want a Dr to know my struggle is real.

    Dr. Westin Childs - May 7, 2016

    Hey Jodiann,

    Unfortunately your story is not uncommon! Most doctors have been conditioned to ignore what they cannot explain or what doesn’t fit into the paradigm that they have created.

Tracy - May 9, 2016

Hi, Do all of your posts refer to people that have had their Thyroid removed also?

    Dr. Westin Childs - May 9, 2016

    Hey Tracy,

    The majority of the information presented here applies to patients with a sluggish thyroid and for those without a thyroid because thyroid physiology doesn’t change in the body, the main thing that changes is how your body gets the thyroid hormone (either endogenously or exogenously).

Jeannie Baracy - May 18, 2016

I feel very tired and have issues with blood pressure being low and blood sugar crashes which make me feel terrible and unable to stand without passing out. My T3 was very high (can’t recall the exact number), T4 was 0.07 and my TSH was 3.3. The doctor said I’m fine and to redo the tests in a few weeks. I asked him to check my prolactin levels as I was treated for high levels before and they were 18.8 which he said was normal. What on earth could be going on?

    Dr. Westin Childs - May 18, 2016

    Hey Jeannie,

    Hard to say what’s going on just from those numbers. You will need to look at more than just your thyroid, I would recommend looking at pituitary function as well as insulin and c-peptide.

Ashley Tabor - May 23, 2016

These are my test results almost exactly!

T4 free 1.1
T3 free 3.5
Rt3 27
Tsh 1.07
Thyroglobulin level 45

I’m having such a hard time finding a local doctor that will work outside the “normal” labs 🙁

    Dr. Westin Childs - May 23, 2016

    Hey Ashely,

    Unfortunately you may have trouble finding a doctor in the insurance model who looks at the thyroid correctly. My advice is to find someone outside of that model who can actually help you, the results will be well worth it!

Jaxcloward - May 25, 2016

I am a 61 yr old female having issues with fatigue and weight. I am 5’2′ and currently weigh 195. I have gained 25# in the last 3 years and I exercise lightly. These are my test results from Kaiser in Oct 2015.

T4 FREE Date: 10/24/2015
Value: 1.0 Ref range: 0.8 – 1.5 ng/dL Status: Final
T3 Date: 10/24/2015
Value: 107 Ref range: 58 – 159 ng/dL Status: Final
TSH Date: 10/24/2015
Value: 2.16 Ref range: 0.35 – 4.00 mcIU* Status: Final
CALCIUM Date: 10/24/2015
Value: 9.4 Ref range: 8.5 – 10.7 mg/dL Status: Final
Value: 83* Ref range: 15 – 65 pg/mL Status: Final
Pe Interpretation of Intact PTH results should take into account the serum
calcium concentrations and the physiological interplay between these two
elements in the various PTH/Calcium disorders.

The following levels of Intact PTH were determined by Nichols Diagnostics,
using a different assay.

PTH of 15-65 pg/mL with Calcium values ranging from 8.5-10.5 mg/dL

PTH 53-1180 pg/mL with Calcium values ranging from 10.5-16.3 mg/dL

PTH from undetectable to 22 pg/mL with Calcium values ranging from 10.5-17.6

PTH from undetectable to 21 pg/mL with Calcium values ranging from 6.3-8.5

Thank you!
Thank you for your help.

    Dr. Westin Childs - May 25, 2016

    Sorry, I can’t interpret your tests unless you are a patient of mine. You should take these to your current doctor for advice or seek out a new one if you aren’t happy with your current treatment.

Dirk - May 27, 2016

Sorry, but i don’t get it. The reverse T3 results in Your example aren’t that high (In the range). Why is it You still think it is too high? Did i miss something?

    Dr. Westin Childs - May 27, 2016

    Hey Dirk,

    It’s less about the reference range and more about how high it is relative to free T3. It’s the difference between the two that matters, not the actual number.

Anna - June 15, 2016

Hi Dr. Childs.

How would one increase their T4 levels? I currently take 32.5 mg Naturethroid (sp?), was taking 97.5 mg WP Thyroid. Had weight gain on the 97.5 mg, lost weight on the 32.5. But blood levels now reflect T3 Free 2.3, T4 Free .7, TSH 1.82. From reading your articles, seems I need a higher T4 level.

I am going to buy your five suggested supplements and see how I feel. I do notice when I take Vit A, Zinc, and Vit E, I have more energy….

I appreciate any insight you can provide regarding the T4 increase.


    Dr. Westin Childs - June 16, 2016

    Hey Anna,

    I don’t really focus on free T4 or T3 levels when treating – blood levels of thyroid hormones don’t really help in understanding what the tissues need and what they are actually getting.

      Anna - June 16, 2016

      Dr. Childs,

      So, according to this article, perhaps I should have the referenced tests ordered? I do believe my medical provider should be able to interpret the results. Do the add’l tests help one figure out what levels the tissue is getting? I’ve noticed more pain throughout my body on the lower nature-throid.

      Would you recommend those 5 supplements in the meantime?

      Thank you for your response.

        Dr. Westin Childs - June 16, 2016

        Hey Anna,

        I can’t say for sure because I don’t know your history. Getting those tests would be a good first place to start, but as I mentioned previously – most providers will probably just look at your results and tell you they are “normal”.

          Anna - June 16, 2016


          Thank you for such a great website though! Yes, a couple of my providers, one currently and my past PCP, say things are “normal.” But I know differently. Your articles are quite informative and helpful to those who do not understand what is going on.

          Thank you again!

          Dr. Westin Childs - June 16, 2016

          Thank you for the kind words and no problem! 🙂

          Sylvia L. Rodriguez - September 20, 2016


          I have 3 months ago a radiactive therapy I’m going from t4 free of 2.4 to know .83 and my tsh in .012

          My doctor said to wait 3 weeks and re-do the the test.
          He is waiting for t4 free going in .70

          My question is that I read articles saying this is danger, I start having irregular and long periods, tired, confusions and blow face. why i have to wait for start taking replacement hormones

          Dr. Westin Childs - September 20, 2016

          Hey Sylvia,

          I don’t know why your doctor wants you to wait, I would recommend you ask them – they might have a specific reason in your case.

Julie - June 27, 2016

I’d like to know how high free T4 can go, and at what level it can cause problems. TSH is on low end of normal range. I went to the doctor for something else and was surprised by a high T4 level.

If you are not able to answer my question because you can’t interpret results for me, I’d appreciate any links or articles that you think might be helpful.

Thank you!

jan - July 23, 2016

I just got blood test report.
I agree your points and they help to understand my situation.
But I need your advise to review my case again to give more detail advise.
I got RAI treatment in 2009(I did the subthyroidtomy in 1999 about, but the thyroid gland grew back to the normal size 25gram). I started taking the levthyroxine 88mcg quite stable for a long time for all the number testing TSH, T3, T4 till last year Oct. 2015 my TSH was up to 4.7MIU/L. Doctor decided to adjust my dosage to 100MCG in Jan, 2016. After that, TSH is going down to 0.41 MIU/L in the test of March, 2016 and the free T4 is 1.5ng/Dl. In this month of July 21, 2016, I tested again and the result was 0.458 TSh and 2.03 for free T4. My doctor gone for vacation will come back Aug. 1st. Her partner Dr. talked to me about my Thyroid hormone is little bit high. He asked me alternative back to 88mcg(take 88mcg , next day take 100mcg, I am really not sure this is a good idea or not, looking for the natural way) instead of 100 mcg or take medicine before the meal about 10-15 mins. Then, I will need to test again in August with my regular doctor.
After, I read your article and I really thinking whether is something involve like you mentioned the reverse T3 or other stuffs affecting. Since last year, the house is doing the new construction works. The contractor drives me crazy and not responsible. Therefore I am getting pretty stress about this. I am thinking it might aftect my body metabolism. I just wonder whether you can give me some suggestion about how to maintain in a good happy balance life. Thank you.

    Dr. Westin Childs - July 23, 2016

    Hey Jan,

    If you haven’t already I would consider looking into NDT to replace or add to your current dose of T4. Many patients do much better when adding some additional T3.

Desley Slater - August 4, 2016

Hi Dr Childs I did try to message you earlier today but I don’t think it went through. Im one of these people that cant take Liothyronine t3 No matter how low the dose is . High BP chest pains. Before I started T3 I was on 125mg of levothroxine which worked for quite a few months putting t3 up to 5.1 Then I started to get hyper . So I dropped back to 100mg of levo and added t3 . I have now gone back to just 100mg of levo but dont think its going to be enough. What dose would you recommend . as I have a problem converting t4 into.t3.
Last results T4 13.0 (7.0-16) TSH 0.15 (0.3-5.0) T3 4.5 (3.6-6.5) still had a little of the t3 in my system at this stage. Regards Desley.

Sharonne - August 4, 2016

Hi I have 37 of thyroid UK hypothyroidism symptoms and am trying to convince my gp to trial thyroid meds. My tsh levels r 2.23 my FT3 is 4.9 my FT4 is 10.5 and TPO anti is <1.0 should I continue to try and persuade a trial I'm 53yrs old and feel like 73 please help, they just say I'm depressed!!!

    Dr. Westin Childs - August 4, 2016

    Hey Sharonne,

    I can’t say because I don’t know your symptoms, labs are only a small part of the picture.

      Sharonne - August 4, 2016

      My symptoms are fatigue, in explained weight gain even though I trudge through an exercise programming 3/4 times weekly, painful calf and thigh muscles, loss of libido,cold all the time even when I’m hot I shiver, constant headaches burning feet memory loss poor concentration, loss of drive, wanting to be alone, nervous, anxiety and lack of confidence to name a few.

Sharonne - August 4, 2016

Hi I messaged earlier but cannot find a copy of my question…..??

Sharonne - August 4, 2016

Sharonne – August 4, 2016
My symptoms are fatigue, in explained weight gain even though I trudge through an exercise programming 3/4 times weekly, painful calf and thigh muscles, loss of libido,cold all the time even when I’m hot I shiver, constant headaches burning feet memory loss poor concentration, loss of drive, wanting to be alone, nervous, anxiety and lack of confidence to name a few.

Nadi - August 25, 2016

Hi docter,
My thyroid result is seems to be normal(tested 2 years back)
FT4 – 1.2 ng/dL
TSH – 0.8 uiU/ml

Yesterday i met an entocronologist to check my thyroid and other hormones, since we are strugling to conceive(9 years of marriage). She did an ultrasound of my thyroid gland and said that there is slight swelling. And prescribed levothyroxin natriy 50 mcg per day.
I have’nt shown her my previous result. But without checking my blood, she prescribed the medicine. Since i have the language issue, i couldn’t ask much to her.
Is it ok to administer this dose??

    Dr. Westin Childs - August 25, 2016

    Hey Nadi,

    Unfortunately I can’t answer that question for you. You will need to take it to your physician. All I can say is that hypothyroidism is a very common cause of infertility.

Heather - August 29, 2016

I recently had blood work done as my doctor is suspicious of thyroid issues. For as long as I can remember I have been enemic and constantly battle fatigue. Recently I lost my dad and that has sent me in a downward spiral for depression, but am being treated for that and am feeling better everyday mentally, however this fatigue is just constant. I could sleep 24 hours and still be tired. I am also battling cognition issues, short term memory issues, and focus issues. I cannot seem to retain information as of late – again chalk it up to depression. My weight has been a challenge as well. I used to work out regularly, but did not lose much. I will admit to not eating the best so do need some work there, however when I do diet and exercise I don’t see much of the weight coming off. Here are the recent results of my blood work:
T4, Free = 0.919
TSH = 2.73
Both are at the lower range. My doctor states more tests need to be down and that it appears my thyroid is slightly underactive. Any further insight you can provide? I don’t know much about thyroid activity, my brother has hypoparathyroidism.

    Dr. Westin Childs - August 29, 2016

    Hey Heather,

    If someone presents to me with symptoms consistent with hypothyroidism + labs similar to yours I would say the thyroid is not functioning optimally.

KR - September 2, 2016

I had a thyroidectomy about 6 months ago and recently my endo, who I trusted, has left Kaiser. My new doctor checking my levels about every 6 – 8 weeks and adjusting as need be, but they are only looking at TSH and Free T4. Currently my levels are 2.64 for TSH and 1.2 FreeT4. I feel sluggish and have have migraines almost every other day. The last time my headaches were this bad, was when I was undiagnosed with Hashimoto’s. Should I be asking Kaiser to do more tests? It is hard to find what target values are for a person who had their thyroid removed because of Hashimoto’s and not cancer. Before it was removed, I only felt well when TSH was in the low 1s. But Kaiser rarely did any of the tests you mentioned in your article.
Thank you!

    Dr. Westin Childs - September 3, 2016

    Hey KR,

    You are certainly welcome to ask for more labs but you will most likely be blown off. If your doctor didn’t order them to begin with then they don’t put priority on the labs themselves and even if you do get them to order the tests they won’t know what to do with them. My recommendation is to find someone who can help you further.

      BobbiJean - February 2, 2017

      I had a total thyroidectomy over a year ago, they’ve had me on synthroid every since ..100 then 150 and now 137.5 . I have never felt good since this operation and every endo I get referred to says the same thing ‘within range’ so I keep going to others. Why is it none of them so far will even try armour or cytomel with the synthroid? I’m so tired, migraines, muscle aches and pains , swelling in hands feet and eyes ..I’ve begged them to change this medicine. Any ideas on where to begin to find someone that will listen?

        Dr. Westin Childs - February 5, 2017

        Hey Bobbi,

        It can be difficult to find someone willing to change medication and listen, the best thing you can do is look outside of the insurance model because all physicians in that model will treat you the same way.

V - September 10, 2016

My menstrual period is hyper abundant on days 2 and 3 of menstruation. This lasts a few days and again at 24 days. The worst are the moments where the jet indented leaves. I take levothyroxine 31,5 because if I more I can not sleep well. Since taking t4 I have no overall fatigue or constipation. But I have some tiredness after eating. Because I sleep less deeply and less hours before taking the T4. I sleep about 6 or 7 hours a day. I need a little more sleep in the afternoon. Currently I have tsh T4libre 1.39 and 0.89. Dr. Says I should take more T4 to have the highest T4libre.

Frank Accardo - September 17, 2016

I’m sorry for my previous rambling letter. Here’s a shorter version of what I wrote earlier. On 125 mcg of synthroid, these were my lab results:

TSH-6.45 Reference Range (0.34-5.60)
T4 Free-1.1. Reference Range (0.6-1.1)

So, am I to assume that if I increase my dosage of synthroid to 150 mcg, my TSH will get lower and my T4 Free will get higher than the normal range, thus making me feel like hyperthyroidism? Because that is what I’ve been feeling on higher synthroid dosages even though my TSH is well within the normal range. Thank you.

Ruby - September 22, 2016

Hi, I used to be on 175 mcg Levothyroxine but my endo decided to introduce some T3 so now I’m taking 30mcg of Liothyronine & 25mcg Levothyroxine. My latest blood result shows that my THS is 6.65 & free T4 is 2.4, what does that mean? Doctor never bothered testing for anything else.
My endo apt is on 3rd October , I’m going to ask him to put me on T3 only medication , what should be the ideal THS on T3 only. And lastly we are trying to have a baby, is T3 only medication safe during pregnancy?

Regards, Ruby.

    Dr. Westin Childs - September 22, 2016

    Hey Ruby,

    I doubt your endo will put you on T3 only medication but it’s worth a shot – you will likely need much more than what you are currently on if your TSH is 6.6 on 25mcg of T3.

    In regards to safety during pregnancy you will need to talk to your Doctor about that, but most are not comfortable using T3 during pregnancy.

Nic - October 1, 2016

Hello Dr. Childs
First let me say thank you for taking the time to answer so many questions and sharing your knowledge with us. I come from a long line of familial thyroid and pituitary issues, most of which were hard to diagnose. I have discussed the difficulty of family member’s diagnosises with my primary caregiver only to be assured that TSH is the most accurate test for thyroid function. I expressed concern that I may suffer from hypothyroidism and was assured I do not and if anything am more on the hyper side, despite numerous symptoms that point to the opposite. I have had significant weight gain in the last three years (45 pounds to be exact), memory loss/brain fog, complete loss of libido, daily headaches with three or more migraines per week, gastrointestinal issues, fatigue, hair loss and vision changes. My most recent labs ordered only included TSH which was .97
Prior labs
TSH of 2.10 T4 .8
TSH 1.45 T4 .9
I do not have any labs in the last 3 years that include T3
Can you weigh in on this or do I need to provide more lab results?
My concern is not only for myself, but my daughter as well. She too has many of the same symptoms, has had one doctor say based on labs she may have hypothyroidism but tested just her TSH 6 months later and said it was within the normal range. I’m wondering how much we need to push and what other tests to request. Thank you for any guidance you can give!

Carrie - October 13, 2016

I just had my blood work done, not the entire thyroid panel as you suggest but my Free T4 showed low at .7 and my TSH showed normal at 1.52. I have to repeat my labs in 3 months so will ask for the Free T3 and the Reverse T3.

    Dr. Westin Childs - October 13, 2016

    Hey Carrie,

    If you have to ask for the tests then the chances of your doctor knowing how to treat with them is probably slim to none.

      Carrie - October 13, 2016

      Hi Dr.

      All of the Drs. I have seen tell me nothing is wrong, that I have anxiety. Maybe it is true but I have felt off so requested the blood tests to check for perimenopause and thyroid. Everything comes back “normal”, yet I continue to not feel 100%. I have only a couple symptoms of hypothyroid but that low number I received worried me. Thank you for your response.

Amy - October 14, 2016

TSH .27
FT4 .8
FT3 3.2
T3R 12

I have Hashimoto’s. Doc says fine, but I feel hypo. Is this possible. I have been tired, tingling in hands an feet, slight weight gain, and some low grade headaches, and muscle fatigue.

Varsha - October 15, 2016

Hi Doctor , I am varsha.Thank you for such a good article. I was on Homeopathy earlier when I got my thyroid at the age of 18. I used it for 6 months with yoga and good lifestyle i could cure it. Since then my TSH levels were between 4-5.
After my marriage because of my lifestyle disturbance and hormonal imbalance the TSH level shooted up to 8. Since then it was shuttling between 8-10 inspite of using homeo. Now that we were planning for lids I has to reduce my TSH. So since last month i am using Thyronorm 50mg. surprisingly now my test report is as follows TSH-0.08 FT4-6 And AMA negative. I am not sure how to analyze if good or bad.
Kindly Help me doctor.Now i am 25.

Beverly Luetkemeyer - October 16, 2016

Where can you find a miracle doctor who listens. I’m 61. I have been fighting hypothyroid symptoms my entire life. Every doctor I get will not listen. When I try to discuss anything they get angry and tell me to stop reading articles. (The inference is that I am too stupid to understand them anyway.) My current doctor finally ordered a few more tests after talking down to me for an hour and explaining how the thyroid works with a very basic little drawing that wasn’t even completely accurate. (She spelled pituitary for me like I was 4 years old!) When those extra tests (free T$ and free T3 plus antibodies came back abnormal, she confessed that I might have “extra problems” and switched me to Armour, “to heal my thyroid”. I don’t see a lot of difference, but some. Where can I find a really good thyroid doctor? I live in Central Missouri. BTW, my 24 year old daughter in Ann Arbor is having lots of symptoms too. She tried to get testing. They refuse to test anything but TSH.

Lucy - October 26, 2016

This describes me exactly! about 5 years ago a very good doctor figured this out for me and had me on small doses of T4 and T3. My doctor moved and so did I so I was seeing a different doctor for a spin which at that time she decided to take me off from my medications to see how I did. They did tests that kept coming up with my T4 higher than normal but not unusually and everything looks normal! Normal was a nightmare to say the least. My hair was all laying in a pool on the floor, in the shower, rolling down my arms in hunks, I couldn’t piece together my thoughts, I was exhausted to the core, my skin and nails were so brittle they would just crumble, and so many more issues that were just out of the blue after going off the medications. I also was catching every virus and cold that came along, which I tend to not fight that stuff really well to begin with but it was unusually bad. I am happy to say I am back on my medications and doing just fine.

NIna - November 3, 2016

I am wondering if I am having an issue with Hypothyroidism or Hashimoto’s. I currently have all of the symptoms, but also have recently been diagnosed as having PCOS. My endo did a TSH and Free T4. My TSH was very low at .01 and my free T4 was regular at 1.1. I also have a 4cm nodule on my left lobe and a 1mm nodule on my right lobe. I had the larger one biopsied, but it was found to have insignificant atypical cells. Any insight? I am beginning a Hashimoto’s diet, but would also love answers as we are dealing with fertility issues as well. Thanks!

    Dr. Westin Childs - November 3, 2016

    Hey Nina,

    Hard to say without complete labs, but I’ve never really seen anyone who had PCOS who didn’t also have thyroid issues.

Lindsay - November 21, 2016

Wow, finally an article that makes sense to me and talks about more than just TSH. I had my thyroid removed almost 20 years ago when I was 20 years old. I am a diagnosed Celiac so I ham strict gluten free for the last 6 years. I have been fairly stable through out the course of treatment until this past year when I gave birth to my second son. It seems like I just do not ever feel normal anymore. My endo orders all of those tests (except reverse T3). I just had bloodwork done again last week and everything is “normal” but I feel like crap constantly. I am in Canada so our numbers are a bit different, but I will give you what I have.

free t3 – 3.5 pmol/L
free T4 – 11.4 pmol/L
TSH – 0.35 ug/L
TPO – 27

I mean according to this if I went by TSH only I would be considered almost hyperthyroid. But I don’t feel hyper. To be honest I have symptoms of both hyper AND hypothyroidism. It is the strangest thing.

Are there any other tests you would recommend for me to have done? I have been reading a bit about this pituitary function but I can’t seem to see what the treatment is for it if it is suppressed, so I am a bit lost. Thank you for any advice or suggestions you can give me. 🙂

Dawn - November 28, 2016

My T4Free was .85 & my TSH 1.44 but they did not check T3Free. I still have symptoms that suggest there is still an issue even though my Dr told me the levels are in normal range. What should I do?

Deb - December 15, 2016

I just got my blood work back and my dr. wants to decrease my medication. I have graves disease and have been feeling very anxious so I had blood work done.
T4 Free 1.20
Tsh 4.78
Triiodothyronine, Free Serum 2.6
TSI 380
Im having a hard time keeping weight on and lowering my dosage of methimozole will make it harder to keep weight on. I left a message with my concern but haven’t heard back.
Do these numbers seem like I should be losing weight?

Dawn - December 20, 2016

A very enlightening article! I have been newly diagnosed with hypothyroidism, however, they only checked my Free T4 and TSH levels.

Free T4 1.0 ng/dL (not flagged by the lab as low – lab range 0.9 – 1.7 ng/dL)
TSH 8.35 mcIU/mL (flagged as high – lab range 0.34 – 5.60 mcIU/mL)

I’ve started taking levothyroxine and am due for follow up labs in 6 weeks. After reading your article, I’m wondering if the labs done so far are not telling the whole story. Should I call my Dr. and ask to get a baseline for my Free T3? I’m concerned that the issue could be more related to the conversion of T4 to T3 rather than low T4 levels. Is that a reasonable concern? There also hasn’t been any discussion of trying to figure out WHY my TSH levels are elevated – would it be normal to try and figure out the cause of the elevated levels: to check for nodules or confirm a diagnosis for Hashimoto’s? Thanks for any advice you can offer. Trying to figure this new diagnosis out and the best way to self-advocate.


    Dr. Westin Childs - December 21, 2016

    Hey Dawn,

    Getting those numbers as baseline is a good idea, but you will find that many physicians don’t order those tests because they don’t know how to interpret them correctly. As a result getting them will not likely change treatment for you from that provider.

dan bauer - December 21, 2016

you mention that ideally free t4 should be in the high end and that if they are and tsh is low that could be a conversion problems and involving reverse t3.

Do you have an article on low end of t4 with high tsh insights?

I am on low end of free t4, low end of t3 and tsh of 7


    Dr. Westin Childs - December 21, 2016

    Hey Dan,

    High TSH levels with low free T4 would indicate low thyroid hormone production. Low thyroid hormone production seems to mask conversion problems because substrate for conversion is also very low.

AnnC - December 30, 2016

T3, Reverse
20 ng/dL

T3, Free
2.7 pg/mL

1.21 uIU/mL

1.0 ng/dL

I’m a little confused by the use of the words “high” and “low” because I think that higher numbers indicate lower functioning of the thyroid? But, my numbers above seem to match almost exactly the profile of the woman you analyze above…if so, I will print out and take to my naturopath. My mother and sister both have low thyroid and all three of us have the exact same symptoms but my thyroid always come back “ideal” yet I don’t feel “ideal.” Thanks!

    Dr. Westin Childs - December 30, 2016

    Hey Ann,

    Thyroid lab values can be confusing to interpret which is why I recommend that you see a specialist to help you. Your confusion comes from the TSH, where high levels generally indicate low thyroid. This is not true of the other thyroid lab values (although they are not necessarily straight forward either). To the untrained eye your lab tests may look fine, so if you’ve been told that previously you probably need to find a new provider to help you further.

Deepali Jain - December 31, 2016

I had Hypothyroid for past 20 years. Since last year my TSh levels are <0.01 uIU/mL and my T4 levels are normal (1.2). I had lost weight last year but now i feel normal. My doctor has given my anti-thyroid medicine (5 mg) but that is not helping. I have lost lot of hair as well. Please advise.

    Dr. Westin Childs - December 31, 2016

    Hey Deepali,

    Your Doctor must believe that you are hyperthyroid, you should have your thyroid stimulating immunoglobulins checked to confirm if this is autoimmune or if it is related to a Hashimoto’s thyroiditis.

Emily - January 10, 2017

Hi Dr. Childs,

Wondering what your thoughts are on using Ashwagandha as a supplement to help balance the thyroid? I was diagnosed with Grave’s 3 years ago and am now in remission, but feel I’m experiencing symptoms of hypothyroid now, even though I’m technically ‘within range.’ Latest test results were Free T4 (1.0), Free T3 (2.7), and TSH (1.49). I am exhausted with no energy, cold all the time, having a hard time losing weight, and have thinning hair. I’d love to do something to get more in balance, but my Dr. (who I really do like and seems open to any of my ideas or questions) is concerned about putting me on dessicated t3 if I do not really need it as she fears it might tip me back into hyper again. Thoughts?

    Dr. Westin Childs - January 10, 2017

    Hey Emily,

    I am currently writing an article on Ashwagandha and thyroid function which will be out soon, but the answer to your question is that yes I really like it, especially for thyroid patients. It can help with weight loss, libido, energy levels and even directly with thyroid function. It should be used in conjunction with other therapies (not by itself), however.

      Emily - January 10, 2017

      Thats great to hear. Why is it not good to take on its own? What would you recommend taking it with?

Sam - January 20, 2017

Hi, I am 46 male, I was on synthroid for last 2 years. Originally before going on, had tsh 7.0 and free t4 of 15(10 to 25)canadian range, and was very symptomatic of hypothyroidism, tired, memory loss, dry skin, high cholesterol, and no libido.

Recently, I unilaterally stopped taking medication, was finding that i was getting extremely sleepy even though tsh was controlled at 2.0 and free t4 was in upper half. I felt i was getting over medicated, last dose was 175. Long story short, 8 weeks after stopping synthroid, new doctor sent me for tests, came back tsh 25.77, free t4 10.

Most of my symptoms are ok other than severe lack of motivation. This doctor feels my results are fine, no need to be on medication, and that tsh is not important as long as free t4 is within normal, even though it sits on the minimum normal. Should i be concerned, does she have a valid point. Another question if I may. Is it normal for tsh to go much higher after stopping synthroid than prior to going on it. Is it just an adjustment phase and that the thyroid will start working harder on its own and the tsh will settle back down. Or would have the tsh gone much higher over time regardless of whether being on syntroid or not. Thank you for your informative work.

    Dr. Westin Childs - January 21, 2017

    Hey Sam,

    Symptoms should never be ignored, especially in the face of suboptimal lab results.

    It’s also worth evaluating your free and total testosterone levels to determine if that is contributing to your symptoms as well (my guess is that your testosterone is probably in the 200-300 range).

Heather - January 21, 2017

I had my thyroid checked at the gynecologists due to lack of period for 7 months and my tsh level was 0.008 and freet4 was 1.45. I have an appointment with an endocrinologist in a couple of weeks..
From what I had found online, aside from this article/forum, I self diagnosed myself as hypothyroidism.. but then I found ur article.. upon further research, I found an article about Subclinical hyperthyroidism.. without knowing anything else, because I have not had further labs, would u think this is possibly my condition?

    Dr. Westin Childs - January 21, 2017

    Hey Heather,

    Either or could be contributing to your situation but there is no way to tell for sure without further testing. Make sure to also check for both TSI antibodies and also antibodies for Hashimoto’s, because hashimoto’s can have episodic bouts of hyperthyroidism before things calm down.

Deborah Murray - January 22, 2017

Below are my test results.
I’m on .25ml Synthroid and .5ml Cytomel.
Should I adjust my meds?

TSH 1.470
FT4 .99
FT3 4.2

    Dr. Westin Childs - January 22, 2017

    Hey Deborah,

    I never adjust dosing based on lab tests alone because lab tests are frequently inadequate at determining tissue levels of thyroid hormone.

Dawn Lin Cox - January 22, 2017

Hi! I’ve been wondering whether the TPO # has to be a certain # in order to be officially Hashimottos especially considering it fluctuates! Mine was 75, my TSH 1.15, T4 Free .85 & T3 Free 2.8

    Dr. Westin Childs - January 23, 2017

    Hey Dawn,

    Your antibody levels mean relatively little without associated inflammation and infiltration of white blood cells into the thyroidal gland tissue, this can be diagnosed with ultrasound (sometimes) or biopsy.

    Elevated antibodies without the presence of inflammation are likely a precursor to the condition (or an indication of other problems in the body), but are not as significant as true autoimmunity of the thyroid gland tissue.

Mike - January 28, 2017

How can I find a doctor in my area (Chicago) that is willing to treat the symptoms like you?

I have been bounced around from Endo to Endo who only care about TSH and continue to tell me “you should feel great!”, and they also don’t believe that RT3 is a valid condition/test.

    Dr. Westin Childs - January 28, 2017

    Hey Mike,

    You will generally have better results if you look outside of the insurance model. Unfortunately I don’t have any contacts in the area, but I’m sure in a big city like Chicago there are at least a few.

Yulia - February 9, 2017

I’ve been hypothyroid for a long time and having very poor conversion of T4 into T3. I was on natural desiccated thyroid medication for years. I went from almost 2 grain of WP thyroid ( which was way too much for me) to not being on medication AT ALL!!! What made the difference in me converting T4 into T3 is taking iron on daily basis.I didn’t realize how crucial iron is in thyroid production and conversion. Also, i take adrenal supplement by Gaia to combat stress and support adrenals as it’s really important for thyroid health. Now, i have high normal T3 levels, my body converts all T4 into T3 like crazy! I never thought that there was possibility of me getting of medication and converting T4 very well…I focus on supporting my thyroid with all important nutrients that it needs to produce thyroid hormones:iron,selenium,iodine etc. Also, I learned that it’s important to control your stress levels for healthy thyroid function and doing exercises. Hope it helps to all of you who struggle with thyroid issues:) Good luck to all of you!

Maryam - February 16, 2017

My TSH IS 1.3 IU/L
T4 is 14.7 ng/ml
T3 is 1.8ng/ml
I feel tired n fatigue heavy head headche and my legs are heavy in the morning cant concentrate and i have exams to write. I foget easily. Am 22 yrs

    Dr. Westin Childs - February 16, 2017

    Hey Maryam,

    The best thing you can do is find someone knowledgeable to help you further in accurately diagnosing and treating your thyroid.

Jean M - February 21, 2017

I had to fight to get my doctor to order TSH, Free T4 and T3 tests, even with all the symptoms I have and have had over the years. I had constant fatigue, loss of concentration, thinning coarse hair, loss of outer eyebrows, and several other symptoms. Not to mention my age is 60 and diagnosed with Rheumatoid Arthritis. My test results were TSH 1.04 uIU/ML, Free T4 1.0 ng/dL, and T3 90 ng/dL, which he says are in the normal range. After pestering him, he finally agreed to prescribe 1 grain of Armour thyroid. I do feel better, but feel I can do much better with an increase, but, as usual, Doctor will not increase dose, in fact, he wanted to cut down my 1 grain to half a grain. After fighting back against this, he consented to keeping it as is. How can I get him to increase the dosage or do you think I should keep the dose as is. It gets tiring having to argue with him when I tell him how my body feels. This is the 2nd doctor I switched to, as my first doctor completely refused to do any tests.

    Dr. Westin Childs - February 21, 2017

    Hey Jean,

    There’s really no way for you to argue with a doctor or to get them to see it the right way, it’s far better to spend your time looking for someone else outside of the insurance model to help you further.

Ashley - February 26, 2017

So frustrated with constant test results all saying I have a normal thyroid. Over the summer when doctor sent me for a full panel of blood work as part of a physica, he also checked my TSH. Everything’s normal….

Another doctor I went to see in early fall said my TSH was slightly higher but still normal and suggested I have additional thyroid testing completed. I had those tests completed and a nurse called me telling me everything was normal. Shortly thereafter talking to my dad I found out that he has a thyroid problem and my grandmother did as well.

I stay so tired all the time and my mom thinks I have a form of mono. My friends make fun of me when it’s time to go out in the evenings and make me take energy shots so I can function and get so tired in the afternoons at work that not only do I get dizzy I have to bite the insides of my mouth to keep from closing my eyes I often worry maybe I’m on narcolept. I’m 33 and except for being 5’8″ and 220 lbs…(obese) my vitals are great! Doctors probably think I’m a hypochondriac at this point.

Recently I went and saw the same doctor I saw over the summer of 2016 and told him that my dad’s thyroid issues are with his T3. I don’t understand much about the thyroid so therefore I didn’t know what kind of details to provide. My recent results say that my TSH is 2.030 uIU/mL, my thyroxine T4 free is 1.19 ng/dL and my triiodothyronine free is 2.9 pg/mL.

I’ve never had any reverse testing completed on my thyroid. Doctors usually blow me off once they get these results, saying I’m normal.

I’m just so tired of feeling so exhausted all the time. I work out three to four times a week (2 times a week is with the trainer) I buy meal Preps that are high protein low carbohydrates and take regular multivitamins I sleep anywhere from 8 to 10 hours and still feel so unrested each day.

Not sure if anyone could shed some light on my latest results as of 2/16/17. 33yo F, height 5’8″, 220 lbs, minimal high cholesterol, BP good, cardio good, weight train 2x week with cardio min 250 calories, and 500 cardio calories on my “off” weight training nights….usu92x week. other than extreme fatigue, thin nails, hair breakage no health issues…

    Dr. Westin Childs - February 27, 2017

    Hey Ashley,

    There may be other factors contributing to your symptoms (nutrient deficiencies and other hormone imbalances, etc.) make sure you get evaluated by someone who understands all of these factors and looks at more than just the thyroid.

Louise Basham - February 28, 2017

Hi, I have enlarged thyroid gland with nodules but bloodwork “normal”. The scanner doctor said it looked like autoimmune disease but my endocrinologist disagrees. My Free T4 is 13.7pmol with a free T3 of 4.2pmol. My reverse T3 is 20. My TSH is low (1.3) but I take Metformin and I have seen that this drug can lower TSH in patients. I have all the symptoms of hypothyroid but no-one will help me. Would it help to take 50 micro grams of Levothyroxine. I have been suffering for a couple of year. Thanks

    Dr. Westin Childs - February 28, 2017

    Hey Louise,

    The best thing you can do is get a complete evaluation of your thyroid + hormones to identify the main issues causing your symptoms.

      Louise Basham - March 1, 2017

      Hi, I have had 3 endocrinologists look at this but they although enlarged, noduled thyroid and just being inside ranges they will not help. I read on your page that if Free T3 was just in the normal range but low and my reverse T3 was high (mine 20 so upper levels but in range] the Reverse T3 could be blocking my T3. Hypothetically, if I take Levothyroxine would it help this situation at all?


Deborah Williams - March 2, 2017

Hi, I am having so many hypothyroid sypmtoms, however my doctor always says everything is fine. I therefore am now seeing an Endo privately. My blood results are TSH 3.63, FREE T4 10.00, FREE T3 5.00. Would you say these results are normal. By the way I am in the UK so not sure if you can relate to these figures.
Many Thanks for the very informative post.
Kind Regards

Betsy - March 17, 2017

Hello, I am one of those on NDT 90 and have below range Free T4 and upper 3rd range free T3, I would get occasional hyper symptoms and have to skip a pill here and there to compensate. So I decided to add levo 25 to help give my free T4 a boost and eventually lower my NDT. I felt ok on 90 Armour but not optimal. I am post RAI for hyperthyroid. My recent tsh was 1.19 and I was experiencing hyper symptoms at that time…sweating, lighter periods, increased bowel, increased hunger and night sweats. Now they subsided except for increased hunger and sweating with intolerance to heat. In you article you state T4 can run low on NDT, but I think supplementing with T4 and reducing NDT might help alleviate the hyper symptoms I get here and there. I know you cant give advice, but have you had patients on both levo and NDT that worked well for them?

    Dr. Westin Childs - March 18, 2017

    Hey Betsy,

    I don’t have any patients on both T4 & NDT.

      Betsy - March 18, 2017

      Could you explain why you dont chose that route for your patients? If your patients run low on T4 but normal to high end T3 and still dont feel great, how do you compensate them? I know diet plays a huge roll and if other labs are good, their diet is good, do you just ignore the low T4? Doesn’t The brain need T4 to pass the blood brain barrier to convert to T3? So if one is low on T4 and the brain needs it, wouldn’t it suffer causing the symptoms of depression, anxiety since there is not enough in storage for it to use? It seems a person would benefit having at least mid range T4, not below level and if that cant be achieved on NDT only, how would you treat your patients?

Sue - March 26, 2017

Hi! I am a little confused on how to calculate the upper 1/3 range of T3 and T4. I had results come back today TSH 0.07uIU/mL…I have NO thyroid and Dr wants super low due to cancer history. My current Dr is ok with anything below 1.0…this seems too low. FT4 – 1.0ng/dL range(0.76 – 1.46 ng/dL). FT3 – 3.36pg/mL range(2.18 – 3.98 pg/mL)and total T3 163ng/dL range(75 – 180 ng/dL).

Medications – Armour 60MG twice a day(6am and 6pm) and brand Synthroid 0.025MG(6am). In a previous post I saw you mention you have not treated a patient with NDT and T4. You also talk about how NDT works low T4 and high T3 and that’s what happened to me. In your patients where this happens; it’s ok with low T4 and high T3 as long as not symptomatic? My open minded Dr wanted to try adding a little T4 and lower Armour so that T4 would raise and T3 would lower…and it did but according to my labs today my TSH dropped a bunch and T3 and T4…well that is where I was trying to calculate optimum levels. My RT3 was under 15.

Current symptoms – hair loss increase, dry skin worsened, low energy, low motivation, bloating, overweight, I feel cold more often, more frequent bowel movements. Symptoms seem to be under both hyper and hypo symptoms.

I did read about getting other hormones tested and am working on that.

Thank you!

M.E. - April 10, 2017

Dr. Westin Childs,

I am so very frustrated. I have symptoms of hypo by my labs are as follows:
TSH 1.11 (.34-5.6)
T3 Free 3.2 (2.3 – 4.2)
T4 Total 7.8 (4.5 – 12.5)
T4 Free .8 (.6-1.6)

Should I ask for Reverse T3? I do not know where to go with this!
Thank you,

mark R - April 18, 2017

Total thyroidectomy 9/1/16 latest test TSH 1.05 Free T4 1.9 Seven weeks earlier TSH 5.92 T4 1.9 still don’t feel quite right also having problems with acid reflux which seems worse in the last couple of weeks since taking 1.50mg Tirosint any insight would be helpful

Miriah Thompson - May 1, 2017

Hi, I just got my test results back and my tsh is .638 and my free t4 level is .97. What does this mean? I have a family history of hypothyroidism and many symptoms of it also. I’m constantly tired, have unexplained weight gain, dry hair, dry skin, my hairstylist says i have some hair loss but i haven’t noticed anything. Should i see a specialist instead id my regular doctor?

kathy - May 7, 2017

Hi Doctor,

I am 51 yrs old and my bloodwork is always I would say perfect, I just had bloodwork done and my TSH was 6.38 and T4 was 1.23, doctor said after this one bloodtest that I have hypothyroid and wants me on medicine for the rest of my life. I have no systems of hypo and I feel terrific so should I get more specific bloodwork done by a specialist instead of 1 doctor just diagnosing after 1 simple bloodtest.

    Dr. Westin Childs - May 7, 2017

    Hi Kathy,

    It’s probably a good idea to retest your TSH in a few weeks to see where it lands. 1 test is not really enough to diagnose hypothyroidism in the face of zero symptoms.

Noemi r - May 11, 2017

Good afternoon Dr. Thank you for the informative article. I’ve been struggling with the same issues for years and my PCP, and an endocrinologist have said labs are normal,but my TSH seems to fluctuate often. For example in Oct 2016 my TSH was 2.07, Dec 1, 2016 it was 0.80 and in March 2017 it was 1.41 references being 0.40-4.50. The complete labs in Dec 2016 were the following: thyroid <1 (reference <9)… T3 Total = 89. (Reference 76-181)….. T4, Free = 0.9 ( reference 0.8-1.8). .
TSH = 0.80. (Reference 0.4-4.5)..
I'm a 45 year old female, with thinning hair, depression, foggy thinking, tiredness, joint pain in fingers and growing facial melasma. Are these numbers really normal? Thanks in advance.

    Dr. Westin Childs - May 11, 2017

    Hi Noemi,

    Labs only show part of a very complex picture and the set of labs that you have isn’t complete. You would benefit from a complete evaluation plus a complete set of hormone + thyroid labs.

Miriah - May 11, 2017

Hi, I just got my test results back and my tsh is .638 and my free t4 level is .97. What does this mean? I have a family history of hypothyroidism and many symptoms of it also. I’m constantly tired, have unexplained weight gain, dry hair, dry skin, my hairstylist says i have some hair loss but i haven’t noticed anything. Should i see a specialist instead of my regular doctor?

Jonathan Castro - May 16, 2017

hello Doctor. Before writing, I really want to thank that still exist doctors like you. You don’t know how happy I felt at reading your article. I’m 28 and I’m colombian and In the period of July-oct 2016, I started to take Synthroid (25 mcg) due to a high level of TSH (6.0) and High Free T4.

After I started to take it, i noticed I started to present symptoms like High Heart Frequency, my hands were shaking a lot and the most horrible things were the imsomnia and loss of weight that I went trough. I was really scared and Didn’t know what to do. I took again the thyorid profile exams in oct 2016 and I stopped taking the synthroid when I looked that my TSH was in 2.6 uU/Ml, however, My free t4 was High (1.8 ng/dl). four months later, my free T4 was like today, in a value of 1.55 (i think is still high because imnsomnia has came back and also, some minor shaking of hands).

My last results with Free T3 included are the next:

TSH: 2.7 uUI/ml
Free T4: 1.7 ng/dl
Free T3: 4.62 pmol/l

and the results for the examens taken in may 2017 are the next:

TSH: 2.2 uUI/ml
Free T4: 1.55 ng/dl
Unfortunately, I didn’t take the Free t3 Exam

What do you think about them? do you think the cause of my loss weight, imsomnia and minor hand shaking is that the free T4 is still high?

If so, what can i do to dropp it?

thank you so much for your answers.

Aeona - May 24, 2017

I’m glad I found this article. I have countless symptoms of hypothyroidism that occurred around 4 months after giving birth to my youngest daughter. I’ve lost tracked of the symptoms. I’ve had blood work done on several occasions. I’ve long suspected hypothyroidism, but my blood work has come back in normal ranges. My doctor didn’t seem too worried about pursuing further testing, so I plan to order the tests myself and visit another another.

I had blood work done back in March. I’ve been dealing with chronic fatigue, body-wide joint and muscle pain, numbness and tingling in arms and hands, hair loss, weight gain, cold and heat intolerance, night sweats, brain fog, etc., for 2.5 years. I dropped out of my graduate program because it was difficult to stay on track with coursework.

In March, my TSH levels were 1.88 and free T4 .88. The free T4 was flagged as abnormal/low. I just want answers, and the two doctors I’ve seen have all said things look normal. I don’t feel normal. The chronic fatigue, aches and pains are debilitating.

    Dr. Westin Childs - May 24, 2017

    Hi Aeona,

    You need a much more comprehensive evaluation than just assessing your thyroid. You need to look at inflammatory markers, nutrient deficiencies, hormone imbalances, viral infections, etc. You are not likely to find this kind of work up in conventional medicine, however.


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