Is your Free T4 really in the Normal Range? (Probably Not)

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 their Free T4 level because it isn't the 'free and active' hormone, especially when compared to free 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 terrible

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 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.

And this correlates well with newer studies which show that patients with hypothyroidism require a higher free T4 to achieve a normal TSH (1). 

This study showed that, while treating patients with hypothyroidism, the goal should be to obtain a free thyroxine level in the upper part of the reference range

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...

As your free T4 level increases, 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 at least 15% of the population, it isn't true (2).

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 (3).

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

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 are 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? (What if your body isn't utilizing that T4 correctly?). 

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 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(4)).

So your lab tests may look something like this:

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

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 (5).

High levels of T4 with correspondingly 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 (6).

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

low free t4 due to malabsorption of thyroid hormone

Naturally, your T4 levels should increase as you take thyroid hormone (though it is important to realize that 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 (7).

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


T4 levels can help you determine if you need to focus on improving your thyroid conversion 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.

join 30,000 plus thyroid patients

Over 13 nutrients are involved in thyroid hormone production (8) and some supplements may help thyroid conversion. 

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

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), this 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 quite 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 (9) 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 Levothyroxine dosages (For example the 100mcg tablet and so on). 

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.

3) Consider switching from Levothyroxine to Synthroid or Synthroid to Levothyroxine

While these medications may appear to be the exact same, studies have shown that they are not bioequivalent (10). 

What this means is that your body may process them differently which may result in varying thyroid levels. 

This is an easy test because all you have to do is switch from taking one medication to the other and you may notice a difference. 

  • 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 NDT aren't as straightforward as it is with T4 only medications.

Any thyroid medication that contains T3 thyroid hormone, at high enough doses, will generally cause your free T4 level to drop (11). 

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

impact of T3 medications on free t4

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 (12) 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 your 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 and very high levels of free 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 do not necessarily need to be in some magical "optimal" range for you to feel good. 

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

Instead of laser focusing on your free T4, make sure that you look at your T4 in context with other thyroid lab tests

  • 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, but some patients with it may not experience symptoms, whereas all patients with hypothyroidism will experience symptoms. 

If you suffer from low T3 and/or low T4 then you are also very likely to experience all of the symptoms of hypothyroidism, but with some other slight changes. 

Symptoms of low T3 and 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 (13) which should spark further investigation by your physician.

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).

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 obtain 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 all of these tests to create baseline values that you can compare further testing to. 

Let's go back to the initial example we used at 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 and 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...

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 that 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 (14).

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.

Conclusion + Recap

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

Now I want to hear from you: 

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 or questions below!

References (Click to Expand)

how to tell if your free t4 is normal versus optimal

Dr westin childs photo

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

246 thoughts on “Is your Free T4 really in the Normal Range? Optimal vs Normal levels & More”

  1. 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

    • Hey Aida,

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

      • 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?

        • 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.

    • Hi, I have Hashimotos and have ALWAYS been hypo despite being on 4 grains of NDT. My T4 WAS 0.8 Tsh 0.01. I recently started intermittent fasting and in 3 weeks my Free T4 jumped up to 6.4 Which has NEVER happened! So slowly I have been titrated down to 2 grains, which I have only been on for 3 days. I can’t sleep at night, I am NOT tired, I feel crawly like my skin is crawling and I feel like I restless leg syndrome suddenly! I have gained 20 lbs in the last year and CANT seem to lose it despite being on a plant based whole food diet. I am having some heart palpitations but its not too bad. I can’t find a doctor to properly treat me!

    • Hello.
      My TSH is 2.08
      T4 is 6.1
      T3 is 2.3

      All fall into optimal levels however my practioner put me on NP Thyroid to help make me feel better.

      Should I take NP thyroid? I started with 1 60mg pill today. I don’t want to alter my thyroid and make me Hyperthyroidism.

      I do have dry skin, shedding hair, mood swings.

  2. 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.

    • 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.

    • I am in the hospital now. 33 years old. I had a hypertensive crisis. My TSH came back as 4.91 and my free T4 came back as 0.99. Doctor said it came back fine. I’m having extreme fatigue and weakness upon exertion especially, I’m freezing all of the time, putting my heat up to 78 at home. Just don’t feel good most of the time to be honest. Have high blood pressure, nausea/diarrhea/occasional vomiting. Stomach swelling. Weight gain. I’ve went from 189 to 207. My highest weight ever. What can I do? More tests weren’t offered because he said it was fine.

    • 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).

  3. 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?

    • 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.

  4. 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 🙁

    • 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!

      • Can you say more about the type of doc you should look for? I have many many symptoms and have had for years, as well as strong family hx of hypothyroidism, but all my tests are “normal” (though not optimal – TSH 1.83, free T4 – 0.84, free T3 – 2.0) and I’m trying to figure out what referral to ask for or what “kind” of doctor to seek out. Thanks.

  5. Greetings,
    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.

    NORMAL RANGE (n=253):
    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.

    • 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.

  6. 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?

    • 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.

      • Hi Dr Childs,
        Can you elaborate more regarding how to assess if the Reverse T3 is high relative to the free T3. I know your answer above mentions its more about the difference between the numbers, not the actual numbers, but I have almost identical lab results as your example of the hypothyroid patient (TSH .844, T4 1.17, free T3 3.3, reverse T3 16.4) that on a surface analysis of lab results looks normal.
        My doctor read the results the same, everything normal, (Although I’ve gained a significant amount of weight the last few years (30-ish lbs). I’m trying to find a reference to provide to her, so she will take another look at my lab results, and see my T4 may not be converting my T3 well enough, possibly making me hypothyroid.

        • Hi Marissa,

          You are in a patient population which needs to be very carefully assessed prior to treatment. While it may be true that you are indeed slightly hypothyroid at the cellular level, it also might be true that your lab results are an anomaly and your symptoms are due to something else. If that is true then treating you with thyroid medication would do more harm than good. Figuring out where you stand is very important and should be done by a competent physician. I will tell you that most conventional doctors would rather NOT treat in these situations for the reasons stated above. I would also say that most “integrative” physicians would tend to treat in this situation which may result in overtreatment of some patients.

  7. 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.


    • 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.

      • 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.

        • 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”.

          • Understandable.

            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!

          • Hi!

            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

          • 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.

  8. 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!

  9. 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.

    • 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.

  10. 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.

  11. 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!!!

    • Hey Sharonne,

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

      • Hi
        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.

      • Hi, I was diagnosed with hyperthyroidism a month ago due to being over medicated.I recently got my labs done to see if my levels have improved. I was told that my labs were good but my t4 was still high but still in the normal range.I have no thyroid, so I’m confused why if my t4 is high why would it be in the normal range.

  12. 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.

  13. 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??

    • 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.

  14. 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.

    • 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.

  15. Hello,
    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!

    • 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.

      • 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?

        • 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.

  16. 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.

  17. 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.

  18. 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.

    • 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.

  19. 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!

  20. 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.

    • 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.

      • 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.

  21. 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.

  22. 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.

  23. 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.

    • Hey Beverly,

      Generally you will have to look outside of the insurance model if you want to find the best quality of care.

  24. 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.

  25. 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!

    • 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.

  26. 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. 🙂

  27. Hi!
    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?

  28. 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?

  29. 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.


    • 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.

  30. 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


    • 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.

  31. 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!

    • 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.

  32. 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.

    • 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.

  33. 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?

    • 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.

  34. 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.

    • 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).

  35. 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?

    • 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.

  36. 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

    • Hey Deborah,

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

  37. 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

    • 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.

  38. 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.

    • 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.

  39. 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!

  40. 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

    • Hey Maryam,

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

  41. 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.

    • 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.

  42. 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…

    • 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.

  43. 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

    • 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.

      • 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?


  44. 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

    • Hey Deborah,

      By my standards, and if accompanied by hypothyroid symptoms, those are not normal lab tests.

  45. 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?

      • 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?

        • I have same problem. T3-(3.6). T4-(.91). Tsh-(2.93). Doctor says it’s normal but I have severe insomnia. My brain just doesn’t want to shut off at night even though iam super tired and sleepy. Wonder how I can get that t4 higher so I can feel better. Taking np throid 60mg.

  46. 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!

  47. 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,

    • Hi M.E.,

      Getting the right tests is only part of the battle, the other (and more important part) is getting the right treatment.

  48. 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

  49. 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?

  50. 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.

    • 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.

  51. 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.

    • 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.

  52. 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?

  53. 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.

  54. 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.

    • 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.

      • Hi Dr. Childs,

        Thanks for responding to my comment. I appreciate it. I’ve been tested for RA and Lupus, and it came back negative. My vitamin D and B12 levels are in the upper range due to taking supplements over the years. I was told two years ago that my symptoms could be related to insufficient vitamin D, but since then I’ve been taking high levels of it and still feel the same. My symptoms have actually progressed since then. I did have blood work done that showed elevated ESR, but the doctor said it could be anything and wasn’t alarmed by it. The only other test that was in abnormal range on my most recent blood work was higher cholesterol levels.

  55. Hi, I have been battling hypothyroidism for the last 5 years, I am currently 30yrs old. Still working on feeling better- my prescription changes every 4-6 weeks, usually an increased dose. I am currently on 1.25mcg of Levothyroxine and even though some symtoms have disappeared I am still feeling fatigued, hair is constantly falling out, cold all the time, back and forth constipation/diarrhea and horrible weight gain even though I have cut out all gluten, processed foods, salt and sugar.
    My current test was

    Thyroid Stimulating Hormone [TSH] 1.69
    hyroxine Free [Free T4] 17

    My Dr says these are normal results but I still don’t feel good. Is there anything else I can do to help?


  56. Hi Dr.Childs! I wish you were accepting new patients! I am a mess! Was diagnosed with Hashi’s in 2014 and currently on 3 grains of westhroid which I split the dose 2x per day. I also have PCOS and diabetes in superb control for many years. Seems my case is complex and I am at a stand still in Treatment. I have done the AIP diet for a few yrs and then just hit a wall w weight loss and fatigue even though my TSH is 0.1! My anti-thyroglobin antibodies are ALWAYS >1000! TPO fluctuates currently 21.7 I lost 89 lbs bk in 2009 and have kept it off but CANT get under 200 lbs! I just was on the ketogenic diet for 3 months faithfully and only lost 3 lbs!! I just purchased your hormone & weightloss mastery guide the other day and am confused as where to begin because of fatigue, pcos and hashi’s! I feel overwhelmed and I need to feel better and lose weight.its mandetory that I lose 20 lbs before my tummy tuck the December! My goal is labs are so confusing to me free t4 0.9 free t3 4.1. My head just spins with all of this because all I want to do is sleep.

    • Hi Heather,

      Losing 20 pounds shouldn’t be an issue, just make sure you start with the recommendations in the guide and then you can tweak it as you go based on how you feel. It’s almost impossible to start out with exactly what you need just by guessing, and most people take a while to figure it out – the good part is you should be losing weight as you do this.

  57. Hope you can help me, about to be retested, but my last results are this:

    TSH 1.16 /mL

    T4 7.3 /dL

    T3 109 ng/dL

    Free T4 1.13 ng/dL

    Free T3 3.2 pg/mL

    Reverse T3 12 ng/dL

    T uptake 1.02 TBI

    Antibody 17

    • Hi Linda,

      Looking at a set of labs without context is largely useless. For instance you need to interpret them in the setting of your current symptoms, your change in symptoms, other hormone abnormalities, nutrient deficiencies, etc.

      So I can’t really give you any opinion on those labs.

  58. Hello Sir,

    I hope that you can help me regarding my thyroid problem.
    I have delivered baby boy on 01/06/2017 with C-section. I had thyroid test on 06/01/2017 and result are given below
    1. THYROXINE, FREE (FT4) – 0.46
    2. TSH W/RFX TO FREE T4 – 6.500

    Please have a look my results and suggest me.

    Note: Prior pregnancy i did not have thyroid, tested on 02/08/2016

  59. Hey Doc! I am just beginning my journey concerning my thyroid. I’m a 45 yr old female dealing with extreme fatigue regardless of amt. of sleep, severe hand and face dryness and 10 lb weight gain in past year. I recently had my TSH (2.55) and Thyroxine Free (.79) tested. My PCM said my numbers looked good, all normal. My Vitamin D was low and subsequently am taking 1000/day. I realize some of my symptoms could be from perimenopause, or just “older age” and I have chronic lumbar pain (bulging disc, arthrosis, and bone spurs) which prevent extensive exercise. My Mom also diagnosed in 60’s with Hypo. However, the more I read, the more I think I need to pursue more testing and perhaps a referral to an endocrinologist if PCM won’t go along??? Any suggestions to pursue a full thyroid panel and subsequent consult? Or any other ideas from just these 2 results? One other thought, I looked back on testing from 2012-1.42, 2014-1.12, 2015 1.98, 2017-2.55) if this rising trend helps?
    Thanks for any assistance you can offer.

    • Hi Tia,

      You should absolutely pursue a full thyroid lab panel. If you don’t have a full panel then you really can’t make assertions about relative cellular thyroid levels, peripheral conversion status, etc. It’s worth pointing out that asking an endocrinologist for these tests will likely be futile, given that they generally follow a “TSH or nothing” mentality (much like most physicians).

  60. Will you do a video on Graves Disease and/or RAI? That was the start of my Thyroid problems when I turned 20 (2008). Gained 30 lbs in 2 months, was also very petite, athletic, skinny – worked out 2 hours a day. Then I was hit with Graves and my world ended. Had radioactive iodine treatment the summer of 2009, was put on levothyroxine 112 mcg. Only lost half of the weight I put on. In 2015 was lowered to 100 mcg of levo and I’ve gone back up in weight and have felt terribly fatigued and exhausted since the start of 2017. My doctor never listened to my complaints of being tired and weight gain I think because he was a older man set in his ways and didn’t really care about how I was “feeling” if my levels were “in range”. I just made an appointment with a new Endo hoping that since she’s younger and a female she will be more open to new methods and thinking outside of the box as your YouTubes reflect in the way you do things. I am interested in going the Armour Thyroid route and hope she is able to work with me on that, and if not, at least direct me in a different way with supplements that may help in my conversion if that is actually the problem. Thank you again for making these videos and I appreciate any feedback on my situation or if you are in fact going to do a YouTube on Graves and/or RAI.

  61. This post explains what I’ve been experiencing for the last 2-3 years! I’ve been increasing my NDT hoping that would increase my FT4. But my FT4 has always remained at 0.8-0.9 (bottom of the range) while the TSH is very suppressed at 0.006 (!). Will it be wise then to decrease my dosage and aim for a higher TSH (say 0.5-1) since the FT4 won’t really increase on NDT?

    Also, I’ve been trying to get pregnant but afraid to do so because my FT4 is low, and supposedly that’s what the baby needs (as opposed to FT3) at least during the first semester. Will a FT4 of 0.8-0.9 affect the baby?


    • Hi L.V.,

      Low thyroid hormone may negatively impact both fertility and potentially fetal development, it’s not advisable to undergo pregnancy unless your thyroid is treated adequately.

  62. Hi.

    I got my thyroid results and do not understand them.
    TSH 1.14 0.27-4.2 mIL/u

    Free t4 12.7 12-22 pmol

    Free t3 5.5 3.1-6.8 pmol
    My symptoms are tiredness and lethargy
    Why is t4 so borderline but every thing else is in good range.
    My eyes feel constantly tired. It’s horrible.
    Any ideas? Would I benifit from taking t4?


  63. Dr. Childs, I read through this post, but did I miss your treatment plan? How did you treat this patient in the end?

  64. What was your treatment for the woman in the example with high rt3?
    My tsh is 7.5, ft4 1.3 and ft3 2.6 with reverse t3 of 28
    A doctor gave me cytomel at the lowest dose possible in place of my 25 mcg synthroid and it made my heart feel weird. Any suggestions?

  65. Hello Dr. Childs,

    Thank you for this article. I found it very insightful, and quite close to my current situation. I have been struggling with hypo symptoms for about 10 years now. The muscle inflammation was so bad at one point that it felt like my connective tissue had fused. I literally could not lift myself out of bed; I could only get out by rolling my entire body.

    Of the several doctors I had in that time period, none would test beyond TSH, and I even had one laugh at me saying “thyroid issues are something that happens to women.”

    I decided to fire my previous doctor after I told him that I have a family history of endo issues. My grandmother, and father both being hypo, my aunt and mother both having type 1 diabetes. He literally said, “I’m not concerned. We need to lower your cholesterol however…”

    This year, I was very lucky. After interviewing a couple doctors, I found an NP that understood that I was tired of throwing pills at the symptoms, that I wanted to find a primary cause. For the first time in 10 years. I got a full panel. What we found is very similar to this article. I have an appointment to discuss RT3 treatment next week.

    The results came back as:
    TSH: 1.58 Range .45-4.5
    FT4: 1.72 Range 0.86-1.77
    FT3: 3.3 Range 2.0-4.4
    RT3: 31.5 Range 9.2-24.1
    TPO: 14 Range 0-34
    SGBH: 79.5 Range 19.3-76.4
    Calcium: 10.4 Range 8.7-10.2

    Calcium has been consistently high on all my tests. I’m pushing for further testing for hyperparathyroidism.

    Any insights you could give that would help with communicating with my new NP would be greatly appreciated.

    Thank you so much!

    • Just wanted to followup. I have an amazing NP. He prescribed 25 mcg of Cytomel to bring up my FT3 and flush out the RT3. Told me that even though it’s clear I have a hypo issue, that getting too wrapped up in lab numbers wasn’t what was important. Treatment, and eliminating symptoms should be our focus. We’ll still observe the numbers only to make sure treatment hasn’t made anything go absolutely haywire.

      We’re looking at PTH and calcium in tandem now.

      Thanks again…

  66. Hi, Dr.

    Your article is the most thorough I have found. I am still confused though, I know that my doctor doesn’t know how to interpret the thyroid tests when I moved here, she took over medication prescribed in previous state and continued dosage. I am on 200mcg of Synthroid which for someone only 120lbs is a tremendous dose. I saw an endocrinologist who insisted I had Hashimoto’s without any further testing my thyroid levels and said dosages may go as high as 300mcg depending on the person. The only two blood tests that have ever been checked are currently .52 TSH and Free T4 1.8, I have symptoms of being over-medicated. If I am looking for a good endocrinologist what questions should I ask prior to scheduling an appointment to know whether or not they are not going to waste my time, or am I stuck doctor hopping until I can find someone who will listen to me that I know my own body?

    Thank you!

  67. Good evening. Over active, under active thyroid runs in our family. I was diagnosed with over activethyroid about 16 years ago. After I had my first son 17 years ago my thyroid was results showed normal. Then a few years ago I started taking eltroxin again. After my 3rd child about 8 yrs ago it became normal according to the blood results from my doctor. He said I don’t have to take any medication anymore. Drew blood yesterday to test thyroid because my eyes looks about big and loosing weight. Results show T4 11.9 and TSH 2.06 . Iso this normal. My mother still taking her medication. It became so bad that she went for the radiation treatment. Pls help. I feel tired. Sleepless night. Sometimes hard to breath

  68. I’m so confused. My free t4 is .72 ng/dl. My total t3 is 170 ng/dl. My Tsh is 2.7. My reverse t3 is 43.3 ng/dl. I CANNOT lose weight despite strict diet and exercise. My endo says Nothing is wrong. I feel like so much is wrong. What
    do I do?

  69. Lately I have been reading that NDT should be dosed by a persons weight? and that is states this in the RX info? Curious as to your thoughts on this – I have not been dosed that way (ever)

  70. I have familiar histor of hyperthyroidism. I asked my doctor to do a full workup. Here are my results:
    TSH 1.76
    T4Free .69 Flagged as Low
    T3Free 2.31
    Anti-TG <0.2
    ATPO <0.2
    I have typical symptoms of hypothyrodism. I feel tired after having slept 8 hours, weight gain, irregular periods, burst of energy at night.
    My doctors note to me read: "The thyroid is not quite normal: THERE ARE NO ANTIBODIES, but the amount of measurable thyroid hormone in your blood is a bit low. Please consider checking this again in about one month, no fasting needed to determine if this represents a trend. If the level is low again, or lower, a small dose of synthroid would be appropriate. If on repeat the level is normal, no treatment would be indicated"
    What does NO ANTIBODIES MEAN??
    I am really confused about the No Antibodies. Is this a good thing, Does this mean I do not have hashimoto but do have just hypothyrodism?

  71. Hello!

    I am on NDT and cytomel. My numbers look great except my T4s. According to your article I need to reduce the amount of cytomel I am taking in order to bring my T4s up?

    • Hi Tara,

      Not necessarily, reducing your T3 will naturally bring up your T4 but it doesn’t mean that you have to do this, it’s just a fact that it will happen.

  72. Hello Dr. Childs,
    I have been following all of your posts religiously as I am desperate to get some answers. My body seems to be responding atypically to NDT. I had “normal” ranges yet I was having many devastating miscarriages, hair loss, stubborn weight gain, fatigue & cognitive decline. I finally found an MD that would prescribe me NDT based off my symptoms.

    Before NDT-
    TSH: 2.63 mIU/L
    T4 FREE: 1.0 ng/dL
    T3 FREE: 2.9 pg/mL
    REVERSE T3: 16 ng/dL
    SHBG: 42 nmol/L

    After NDT 32.5 mg twice a day
    TSH: 0.46 mIU/L
    T4 FREE: 1.1 ng/dL
    T3 FREE: 2.5 pg/mL

    After NDT 32.5 mg three time per day
    TSH: 0.016 mIU/L
    T4 FREE: 1.14 ng/dL
    T3 FREE: 3.0 pg/mL
    REVERSE T3: 19.4 ng/dL
    SHBG: 118.6 nmol/L

    My TSH plummeted from 2.63 to 0.016
    T3, T4 and Reverse T3 ALL steadily climbing
    SHBG jumped from 42 to 118.6

    I’m experiencing more energy, better memory, better cognitive function BUT more hair loss, eyebrows falling out, pressure behind eyeballs & joint pain. : (
    My MD now has me taking 32.5 mg twice a day of M, W, Th and 1 pill on all the other days of the week. I was going to ask her about whether or not I need additional T3 but after reading this last article, I’m not so sure that’s the solution.

    • Hi Dianna,

      Each person will require a different amount, type and ratio of T4/T3 for optimal health. Lab tests can only help guide you into determining where to start or how to adjust, but they don’t give enough information to come up with the answer on their own.

  73. I haven’t been feeling well lately. Eyebrows thin on the outside and hair thinner than it was in one spot. I am freezing most of the time. I have had thyroid since I was21 I am now 75. My test this time was TSH 1.59 t4 – 0.65 and t3 2.24. I take Armour 120mg and 30mg again of Armour. As they do not have 150mg. My doctor said this is good but I cannot understand why I feel sad and feel like crying a lot.

  74. I have a majority of hypothyroid symptoms but my doctor insists that my thyroid function is normal.
    One year ago she only tested TSH, which was 1.26. My symptoms have gotten worse, so this time she tested TSH and Free T4; TSH 1.03; Free T4 1.12. All the other tests done to identify the cause of my symptoms came back “normal” as well, except a slightly lower Vitamin D level, but fixing my Vitamin D never helps (also, I take daily vitamins with Vitamin D to maintain “fixed” levels but it doesn’t help).

    Do I need more testing, and which test/s?

  75. Hi Dr Childs,

    I came across your article about Free T4 level. I had a lone afib in this late August. The blood test in ER shows my magnesium is 2.6 mg/dL (range 1.4-2.4 mg/dL), Free T4 1.78 ng/dL (range 0.89-1.70 ng/dL), TSH 2.692 mUnit/L (range 0.550-4.780 mUnit/L). My cardiologist said I might have thyroid problem.

    A blood test was done by my primary doctor two and half weeks after the afib episode. This time, TSH 1.87 (range 0.40-4.50 mIU/L), Total T4 8.3 (range 4.5-12.0 mcg/dL), Free T4 Index 2.2 (range 1.4-3.8), Free T4 1.2 (range 0.8-1.8 ng/dL), Free T3 2.8 (2.3-4.2 pg/mL), Total T3 103 (range 76-181 ng/dL), T3 Uptake 26 (range 22-35%). Primary doctor concludes that my thyroid function is normal. But my cardiologist said sometimes it’s hard to catch hyperthyroidism by just a simple blood test.

    From the above result, can you tell if my thyroid is normal?

    Great thanks!


  76. Hello-
    I’m a 47 year old female. I’m currently taking Armour 60mg. My latest blood test are listed below:
    Free T4 Direct .80
    Hemoglobin A1C 5.5
    TSH 1.630
    Total T3 126
    I’ve recently gained about 20 pounds in a couple of months. I have brain fog and I’m tired. Do you have any suggestions on further blood test or any recommendations in general. Thank you.

  77. My blood work that was done 10/23/17 showed my T4f was. 92 and my TSH was .74 I have all the symptoms of hypothyroidism but I also had a hysterectomy keeping both ovaries in Feb of this year my doctor says my thyroid function is fine but I do not agree with him. I was wondering what your thoughts are. My MCV was 96 and my MCH was 32.

  78. Greetings Dr. Childs,

    I have a lot of symptoms of a underfunctioning thyroid. The constant fatigue, brain fog, freezing rather easily. I’m quite miserable as this has been going on for over a year. My Dr. has checked my TSH 1.36 Free T4 1.27 and Free T4 1.29. I received a call to come in for more testing due to being in the low normal range. I’d like your opinion if you can spare the time. I would greatly appreciate it. Thank you Sir!

  79. Good morning Doctor. I am female 77 years of age play golf 3 times a week and attend the gym twice. I have had thyroid problems since 30 years of age. 100 mcg of eltroxin daily. Lately I have become very tired and weight has increased by 3kg in 3 months with no dietary changes also brain fog. I have a 30 hour per week voluntary job and need to be fit and alert. Only test my dr does is T4 13.0 and TSH 2.20 tests are labelled normal? Your comment would be really appreciated thank you. Sharon

    • Hi Sharon,

      By many new standards a TSH of > 2.0 would not be considered normal. This is a matter of how you evaluate labs and what research you look at, however. Depending on your symptoms it may be worth getting a second opinion.

  80. Hi Dr. Childs,
    I have been struggling to manage my graves disease for the past 2.5 years and it has wreaked havoc on every aspect of my life. I have been told a total thyroidectomy is my only option due to the challenges I’ve encountered with finding the correct methimazole dosage to manage my thyroid hormone levels. I seem to be highly sensitive to the methimazole, in that my Free T4 levels skyrocket quickly (it’s gone up to over 6), while my TSH levels remain severely low at 0.01. They say this means I am still hyperthyroid, despite my symptoms severely changing with the meds (increased hair loss, weight gain, constipation, irritability, fatigue, lethargy, etc.). I feel like they need to examine my T3 levels, but just getting them to test my blood levels beyond the Free T4 every 3 months has been difficult. My previous provider in PA had me do blood work every 2 weeks and checked all 3 levels, each time. Any insight into what may be going on? Should I suggest they try managing my T3 levels? I often feel like they minimize my concerns and thoughts about my treatment, so I am hesitant to say anything and feel pressured to rush into surgery as soon as possible. Is that really the only solution?

    Thank you for your time and consideration.

    – Jenny

    • Hi Jenny,

      In most cases it’s easier to treat hypothyroidism than hyperthyroidism. Taking out your thyroid will put you in the former group which may be part of the reason they want to remove it.

      In regards to your lab tests you probably won’t be able to get them to change how they manage or which tests they look at because they are looking at your labs through a completely different lens than what I discuss here. You can read more about this idea here:

  81. Hi, are there any doctors in South Africa who understand and are able to interpret these different thyroid tests results adequately? All the doctors I’ve been to only ever order the TSH test, and when it falls within the normal range, then they immediately rule out any thyroid issues.

    I am 34 and have every symptom of under active thyroid for years now, and both parents have also had thyroid issues (mother even had it in her 30’s). Multiple doctors have done numerous tests over the past 4 years and could not find any other medical condition, and hence I currently have all the symptoms, yet no diagnosis of any kind, and battling with symptoms that no one is able to treat.


    • Hi Rene,

      I’m sure there are physicians around the world who agree with what is written here, but I personally don’t know of any in that area.

  82. Hi Dr. Childs

    I’m 31 y/o mom with a kid from Malaysia. I got most of the hypothyroid symptoms (especially weight gain, depression, anxiety, fatigue,irritability & memory loss too). However when I did the thyroid function test, the doctor told me that it falls within the normal range & did not write a referral letter for me, thus I cannot set an appointment with the specialist. I would really appreciate if you can give me some advice

    Here is my result :
    T4: 64.5 nmol/l
    Ref. range: 64.0 – 167.0

    TSH: 1.25 uIU/ml
    Ref. Range : 0.38-5.33

    Free T4: 9.14 pmol/L
    Ref. Range: 7.46 -21.10

    Free T3: 5.67 pmol/L
    Ref. Range: 3.8-6.0

    Tq in advance ❤️

  83. I am having the hardest time figuring out what is going on with my thyroid and a doctor to actually help. First let me give you my TSH numbers 2012 1.029, 2016 .595, 9/17 <.008, 12/17 .942, and 2/18 1.701.

    Now my T3 12/17 2.3 and 2/18 2.3

    Last my T4 free 9/17 1.7, 12/17 .8 and 2/18 .9.

    In Sept of 2017 I was diagnosed with Graves disease and put on methlmazole. I did not believe it was graves as I was gaining weight and fast, so I did not take the medication. When I had the follow up blood work done the DR office called and suggested I lower the dose of the medication. I explained I never took the med. They recently sent me for another follow up and my numbers but quite a bit again.

    I am still gaining weight no matter what I try. I have a hard time sleeping yet I am tired a lot, my nails are brittle, my hair has changed texture. I am positive something is going on but now the DR said lab work is fine so no need to follow up.

  84. I feel like crap. Just got the results of the tests back and have an apt to see what I HOPE is a good Functional Medicine Dr next week. I want to go in prepared. Here are my results. Minus the saliva test as those results went directly to the Dr I do not have access to them.
    TSH 1.660
    Free T3 2.6
    Free T4 .9
    FSH 38.6
    Insulin 9.0
    HGB-A1C 5.2
    Avg Glucose 102.5

    I truly don’t have a clue what any of this means but, I’m tired of feeling exhausted, crabby, and this unexplained weight gain the past two years.

    Any advice or help would be appreciated SO VERY MUCH!!!

    Thank you,

    Marcie R

  85. Hi could you please tell me does the half life differ in synthetic T3 to the T3 contained in whole thyroid .Synthetic does not agree wih me and its take a week or more to come right .Thanks Desley

  86. Apparently labs often decide to skip the T4 test IF the TSH falls inside the “normal” range (“Reflex Free T4”).

    Presumably your doctor must order – I mean “request”! – a Free T4 test WITHOUT an accompanying TSH.

    • Hi Kat,

      Yes, that is correct. Many conventional Doctors order a TSH with reflex to T4 which means that the T4 will only be ordered if the TSH is abnormal.

      In order to get all of the tests they must be ordered individually.

      • My doctor did that, but the lab didn’t accede to her “request”. It seems they either ASSUMED they knew better or were following directives handed down from someone/somewhere else. Frustrating!

  87. Hello Dr. Childs
    I have had a worsening of all the hypothyroid symptoms over the past 6 years. Over the last year my hair has rapidly thinned, especially my eyebrows. The rest of the symptoms are also quite prominent, including now; a constant feeling of pain in my ankles when ever i get out of bed in the morning or sit for long.
    My doctor ordered the usual thyroid test. My FT4 is below range, but others are ok. What would you advise? Take an FT$ only medication?

  88. Hello Doctor,

    I was diagnosed with Hypothyroidism since 5 years and currently I’m on levothyroxin 100mcg.
    TSH 2.300 uIU/mL
    T4,Free(Direct) 1.74 ng/dL
    Triiodothyronine (T3) 101 ng/dL 71
    Thyroid Peroxidase (TPO) Ab 125 High IU/mL

    I have TPO antibodies which resulted in ALopecia Areata with Chronic Telogen Effluvium . My doctor has put me on Rogain 5% foam and Biotin 5000mcg but its been 7 months and I do not see any hair growth on the patched and my hair is thinning out alot.My iron levels are normal and Vit D is normal. Please advise . I’m completely concerned about my Hair growth .

    I’m trying to avoid wheat from my diet. Is there anything else I need to follow in diet to reduce my antibodies?

  89. Hello, so I’ve had hypothyroidism for about 8 years now and I’ve been quite normal for many of those years on .75mcgs dosage. Well, I just had a recent blood tests only for TSH and Free T4 Which is what usually is done and it came back 1.08 for TSH and 1.1 for FT4. My doctors nurse called me before I got my results (she saw them) and said I needed to be raised to 100mcgs. Now, I’ve been having symptoms of a low (hypo) thyroid again but those results don’t seem to warrant a med change, do they? I’ve sent her messages and she won’t respond so I don’t know why. If you understand something I don’t please let me know!

  90. I have Hashimoto. Currently, I am not happy with my PCP and endo. what other dr.s can help me? I’m afraid I’m going to be doing this run around for a long time.

  91. Hi,

    My lab results are

    TSH- 1.82
    Free T3- 2.7
    Free T4- 1.18
    Reverse T3- 22.7
    Thyroperoxidase AB- 14
    Thyroglobulin AB- <1

    I have a lot of the symptoms of hypothyroidism and I just want to feel better. Do you think that I am a candidate for treatment or should I be looking at other causes of my symptoms?

    My symptoms are fatigue, foggy brain, dry skin, hair loss, weight gain, abnormal menstrual cycle, low libido.

    Thank you!

  92. Good Dr. Childs,
    thanks so much for this article. You really break it down in terms that are understandable.
    I truly understand the reason for having the whole panel checked and the difference between LT4 and other meds. Where is your practice?
    Thanks so much.

  93. Hi Dr. Childs,

    I have been working to try to reverse my sluggish thyroid, as I think mine is a result of overactivity/undereating due to adrenal fatigue. First of all, my doctor is not supportive of testing T3, she says this, “Testing TSH and T4 are common, testing T3 not as much but we can certainly check it once. Reverse T3 testing is actually used to look for things other than thyroid disease.” How can I convince her to test my reverse T3 and Free T3 levels? I’ve been her patient for years, but should I look at switching to a new doctor?

    Also, I’ve been working to reverse this as I mentioned. I cut down cardio, increase my food intake (to an extent, as I can’t do too much without gaining weight due to my low thyroid function), I’ve tried Gluten-free, dairy-free, whole food-plant based, etc. I’ve started taking Ashwagandha, eating small meals frequently, etc. Just had my labs drawn, and Free T4 was only 0.7 (Range: 0.6 – 1.6 NG/DL) so still on the really low end. Can I ever fix this/heal my body?

    Please help!!!


  94. Dr. Child’s,

    Are there any additional supplements for competitive athletes whose optimal blood levels may need to be outside of the normal range? I am a collegiate student-athlete (sprinter), who 18 months ago was taken off Naturethroid because T4 Level was “normal” and given Cytomel. I gained weight and ran horribly. I went to an endo last month and was placed back on Naturethroid.

    Also, I am considering ordering the T3 Conversion supplement but am not sure if this is the recommended supplement rather than the Adrenal/Thyroid Restart supplement.

    T4 is 1.1 (0.8-1.4 range), T3 is 2.7 (3.0 – 4.7 range) and TSH is 2.19. I was taking 3/4 grain of Naturethroid daily and was increased to 1 grain daily as a result of the labs above. I am not sure which to order. Thoughts?

    Thanks for any recommendation you can provide!

    • Hi Private,

      There really aren’t too many ways to naturally improve thyroid function so your best bet is to start with supplementation (anything with adrenal adaptogens with your activity) and ensure that you are optimizing sleep/stress/diet/etc. This will probably give you the biggest bang for your buck.

  95. Dr. Childs,
    I am 69, had my thyroid removed by radioactive iodine. I can not lose weight (the 25 lbs that I seemed to gain in about a month after). I have a blood test every 6 mos. but never seem to have much energy, and I am depressed. last test results: T4 1.6 ATL 29 u/l TSH 1.24I AST 24 any suggestions? Thank Iris
    P.S Levothyroxine 135 MCG

  96. Hi!
    For the past couple of months, I have been having symptoms that would seem more like hyperthyroid (which grandma and aunt both had on the paternal side, and my daughter had thyroid cancer). I have night sweats, high pulse rate, and feel really nerved up most of the time. My weight is normal. I had my thyroid checked, and my results were TSH: 1.13, Free T4: 0.924, Free T3 3.4. Ideas? The docs here seem to only believe in “normal TSH means normal thyroid….Must just be anxiety.” I am so frustrated. I am in Michigan. Can you help? Thanks!

  97. I had Hashimoto’s, my glands became fibrous and were removed. No after care took place. I am now on 175mg of thyroxin. I have put on a lot of weight and feel all the symptoms. I would like to go on your weight loss program. I am vegetarian. Is your program suitable for me?

    • Hi R. Walia,

      Unfortunately, the program is not really designed for vegetarians/vegans as many of the recipes contain animal products.

  98. I had my thyroid removed in December of 2012: the endocrinologist is treating it with armour thyroid due to the issues I have with levothyroxine. I recently had my TSH level checked in April 2018 which was .08 ulU/ml and my T4 Free was also checked that was .86 ng/dl. I just went to see my pcp in may and she did a complete workup she had my TSH and T4 Free checked the information is as following TSH .09 ulU/ml and T4 Free is now .75 ng/dl is this something I should be worried about? I’ve never had my T4 free in low range any thoughts? My t3 free was checked in 2016 and was in normal range.

    • Hi Alice,

      You only really need to worry if you are also symptomatic (meaning experiencing the symptoms of hypothyroidism).

  99. Hi Dr,
    I had a baby about 7 months ago. Since then I’ve just felt off. At first I felt hot, sweaty and tired and now I’ve been so tired and my I go through periods when my feet will be freezing but hot. My temp sometimes gets a little higher then my usual temp. In the 98’s. Had all kinds of blood tests and scans done. I just had a tsh test and free t4 test done. TSH came back at 1.33 and Free T4 came in at 0.9. Are these considered the normal ranges? I had my tsh done in January as well which came back as 1.9.

  100. Hi Dr. Childs,

    I was diagnosed back in 2002 with hypothyroidism and adrenal fatigue. I’ve also had a weight problem since I was a child and have been on every diet known to man (Weight Watchers, Atkins, Rob Nevins, Herbalife, and Medical Weight Loss plan, just to name a few). Some worked for a period of time and some didn’t. While I lost weight on diets over the years, the weight always comes back on. I’m a 48 year old female and for the past 18 years I’ve become more vigilant in living a healthy lifestyle and to avoid Diabetes which runs in my family. I have successfully avoided Diabetes (at the moment) and while most of my lab results are great (even for an obese individual), I still struggle with finding that one thing that will help me lose weight and keep it off. Believe me I completely understand that everyone’s body responds differently to all the diets that are out and that there is no one cookie cutter program that works for everyone.
    When I was initially diagnosed with being hypothyroid, I was given Levoxyl. After doing more extensive research on hypothyroidism, I asked to be switched to Armour Thyroid which I took for a long time up until the formula was changed. I am currently taking 162.5 mg. of Nature-thyroid and while I seemed to do better on this than the Armour. There have been production issues so it was not available for a period of time. When I first started on the Nature-thyroid prior to the production issue I did feel better. It has since been slowly coming back to the market but I can’t get the 162.5 mg just yet so I have to take 2 lower doses that equal the 162.5mg. I was also treated with Cortef for my adrenal fatigue and was on it for a period of time back in 2002. I do realize that there are some doctors out there that do not believe in adrenal fatigue but my previous endocrinologist and Naturopath do. My Naturopath tried to elevate my A.M. Cortisol level through natural supplements (AdreCor and Cytozyme AD)which I took for a period of time but with no success. I asked him if I should consider going back on Cortef for a while and he agreed. He would of prescribed it to me but the State of CT does not currently allow Naturopathic Doctors prescribing rights. I went to my previous endocrinologist and she was fine with me going back on Cortef. However, she retired last summer and in January 2018 I went to a new endocrinologist who does not believe in adrenal fatigue. She wanted me to wean myself off the Cortef as she does not treat patients that are taking that. I have since stopped taking Cortef and went for blood work recently to check my TSH and cortisol (A.M.) levels. I’m still hypothyroid and my cortisol levels have come down a little bit since being off the Cortef. I go for blood work quite often as I believe in partnering with my doctors to obtain optimal health. Last December my Naturopath decided to do a 2-hour fasting glucose test even though my fasting glucose has always been great. He wanted to take a deeper dive to see if the results would show something different. After he got the results he told me that while I’m not diabetic and that I did such a good job of avoiding this disease that I’m actually a non-diabetic hypoglycemic. He told me I should be eating constantly (every 2 hours) to keep my blood sugar levels from dropping too low. I’m currently on a 1,700-1,800 “diet” and I say “diet” because it’s not a negative for me, it’s a lifestyle. I basically eat healthy and tend to go with a higher protein diet and while I do have carbohydrates, I eat good carbs. I have switched from eating non-fat items such as yogurt to full fat as my Naturopath pointed out the non-fat items are often higher in sugar than full-fat foods. I keep my sugar intake to a minimum and use Stevia (about 1-3 packets/day)but I also get natural sugar from fruit that I eat. And still I cannot lose weight….no matter what I do! Below are my blood test results from over the last year…maybe you have some suggestions that may help me find a way to lose weight. I even tried working with a personal trainer at the gym to build more muscle because I know that will burn fat all day…but have not been successful with that.

    June, 2017:
    TSH = 3.07
    T3 Uptake = 30
    T3 Free = 3.1
    Reverse T3 = 17
    T4 Total = 5.6
    Free T4 Index = 1.7
    Cortisol (a.m.) = 9.3

    August, 2017:
    TSH = 0.67
    T3 Uptake = 33
    T3 Free = 4.0
    Reverse T3 = 20
    T4 Total = 5.7
    Free T4 Index = 1.9

    December, 2017:
    TSH = 2.28
    T3 Uptake = 30
    T3 Total = 119
    T4 Total = 5.5
    Free T4 Index = 1.7
    Cortisol (a.m.) = 15

    July, 2018:
    TSH = 3.34
    T3 Uptake = 32
    T3 Total = 143
    T4 Total = 6.0
    Free T4 Index = 1.9
    Cortisol (a.m.) = 11.0

    My previous endocrinologist felt that my body did better when my TSH level was around 1.0. I felt good with it there too but as you can see from the above results that last time it was anywhere remotely near 1.0 last August, 2017. It was actually below 1.0. My Naturopath explained to me that our bodies are not static so while readings may be one thing at a certain time period, they could change drastically in just an hour or two. I’m going for blood work in about 2 weeks so we can compare it to the blood work I had earlier this month.

    I apologize for blabbing on and on…I just want some answers and honestly do not know where to turn at this point.


  101. Hello Doctor! My daughter (11yo) has Hashimoto’s and RA. She is on Euthyrox 75mcg daily. Her labs are a bit confusing: TSH 1.43; free T4- 2.2; total t3 – 2.22. TPOAb is up to 138 from 68 last year. Hemoglobin A1c is 5.2; IgA -91,5 and tgb an IgA – 3.3. Her cholesterol is 235 with ldl 170. Triglycerides are 99. She is on Kineret for RA (since 2014). She is been constantly gaining weight at a 2-3 lb/ month pace, which made her obese, is anxious, hungry all the time (this hunger makes her nauseous). She has a new endo who scratched her head to decide what tests to order. Meanwhile, my child has hypo symptoms, with hyper labs that alerted her pediatrician. I give her selenium, zinc, vit d3( she is constantly low), digestive enzymes, probiotics, fish oil, ca/mg. That is your opinion? Should I decrease the T4 a bit? What should I do? Thank you! Elena.

  102. I got my TSH T4 and T3 done on the 21st of August and I just got the results back. My TSH is actually going up since June. *My Tsh 1.86 my range is 0.35-5.50.
    *My T4(free)is 0.98 my range is 0.70-1.53.
    *My T3 is 100 my range is 76-181.

  103. Dr. Childs, did I miss the answer on what to do with high ft4, low tsh,low ft3, and high rt3?? That is exactly my scenario right now???

  104. Hi Dr. Childs,

    I am on Naturethroid 1 grain and 5 mcg of Cytomel, my TSH came in at 2.11, FT4 at .7 and FT3 at 2.10. I want to increase my FT3 but the doc is concerned about lower than lab range FT4. According to this article that is now irrelevant but if I can get her to increase Cytomel holding Naturethroid at current level, how low can the FT4 go down without there being issues? How much would you recommend going up in Cytomel?

  105. Hi, so I did the test and the results are:

    Serum Free T3: 1.29 (normal: 1.2 – 4.2)
    Serum Free T4: 0.86 (normal: 0.8 – 1.8)
    Serum T.S.H: 2.8 (normal: 0.3 – 4.5)

    My symptoms are constant fatigue, hair loss, joint pain, low blood pressure, headache, trouble concentrating, dizziness and constipation.

    Are those results normal? if so, What other tests should I do?

  106. Im learning a lot from your articles. Thank you!

    I have been having a lot of fatigue and body pain and weight gain. I had some blood work done and my thyroid tested and started on a compounded levothyroxine so I could keep it vegan. My MCV and MCH were both high and I wondered if they were connected to the thyroid issue.

    These were my numbers and then I started taking the level thyroxine at 50 mg. My doctor is raising it up to 75 mg

    TSH 4.1, 4.8, and then with meds 2.94
    Ft3 3.6 and with meds 3.3
    F t4 1.4 and then 1.2

    I think i have absorbtion issues. I take my medicine at five in the morning and then don’t eat or drink anything for at least an hour. I take my other supplements about six hours later. Thank you for any ideas you might have. I’m hoping with the increase in the level thyroxine that I’ll feel better.

  107. Hi Dr. Childs,

    About 20 years ago I had a total thyroidectomy (due to an inconclusive biopsy on a nodule which turned out to be benign).. I have been on oral contraceptives since then as well and have just gone off (three months ago). Around the time I went off my TSH was in normal range. Since then I have experienced higher than usual anxiety, less sleep, (though I am also cold but probably because its winter). I just had a full panel done and everything is in “normal range” with the exception of TSH, which is now .065. Is there a reason why my TSH would be low and rest of panel shows normal ? (other than the fear of pituitary tumors?) In other words, perhaps something more benign? Could I be over replaced even with t4 and t3 in normal range despite the thyroidectomy?

    • Hi Valerie,

      As far as I can tell, it’s simply not possible to correct all thyroid lab tests with one medication for patients without a thyroid. I’ll have to do a blog post in the future about this very topic.

    • Hi Pam,

      I will have to write a blog post on that particular topic, but it really depends on your situation. For instance, if you are taking thyroid medication then the answer would be to adjust your dose. On the other hand, the answer would be completely different if you are not taking thyroid medication.

  108. Hi Dr. Childs,
    I have a lot of respect for osteopathically-trained doctors/therapists; the best healthcare practitioner I ever had was a cranial osteopath, he used many different methods to diagnose illness and was so well-read, he moved to France and I really miss him! His name is Ivo van Gils.
    Your website is extraordinary, I used to have a private endocrinologist, Dr. Gordon Skinner, he, unfortunately, passed away some years ago, so now I have to rely on my GP, who although extremely sympathetic, is not so knowledgeable with this stuff and is on a very tight budget.
    I am on levothyroxine, just increased to 100 mcg. Dr. Skinner put it up to 200 mcg for a while, then reduced to a maintenance of 100 mcg, so I don’t think I have the optimum medication level yet.
    My free T4 is at the bottom of the normal range, TSH now down to 0.22.
    I have just started a supplement I bought called “Thyroid Complex” by SupplementsYou, from Jersey, UK (I live in SE England) and some berberine and turmeric, which is aimed at insulin/leptin resistance.
    I have all the symptoms listed under your “Low T3 Syndrome” in addition to many others, so I am thinking about the following course of action.
    I have some 25 mcg triiodothyronine which I bought some time ago, I haven’t taken it because I am due a repeat TSH/T4 test, and I was concerned that, although I am hoping the T3 will make me feel better, it will affect these lab results, leading to my GP reducing my dose of thyroxine.
    From what I now read, I am wondering, is it safe to take 25 mcg per day of this in addition to my thyroxine and supplements, and is it more likely to drive down the T4, so not causing the doctor any concerns with my medication?
    The Thyroid Complex is aimed at better conversion, I bought it after reading another website about this and ordered that from Amazon. This was before I came across your website, so that’s what I currently have.
    IMPORTANTLY, I have severe fluid retention, especially my lower legs and face. I have had this for 3 years, following a parasitic infection which was severe and widespread and I believe caused my thyroid to malfunction again. I have been hypothyroid before, from about the age of 35 when it was picked up and treated by Dr. Skinner, I came off the medication myself, which was probably not a good idea and have now been on levothyroxine again for about 2 years.
    Thanks for a fantastically informative website, it’s the best I have ever come across, including the book by Dr. Steven Langer.
    Daniella Stewart

    • Hi Daniella,

      Glad you find the information helpful! In regards to your question, yes, T3 will always drive down your free T4 level as well as the TSH and this effect is based on your dose. 25 mcg is enough, in most people, to both drop down the T4 and the TSH moderately to significantly. This may or may not freak out your current provider if they are unaware of T3’s impact on normal thyroid lab tests.

  109. Hi

    I take 132mcg. levothyroxine daily. My recent results are,

    TSH 0.011 mIU/L (Range: 0.27 – 4.2)

    Free T3 5.07 pmol/L (Range: 3.1 – 6.8)

    Free Thyroxine 23.000 pmol/L (Range: 12 – 22)

    Thyroglobulin Antibodies 115 kU/L (Range: < 115)
    Thyroid Peroxidase Antibodies 28.5 kIU/L (Range: < 34)

    For the past few moths I have started suffering with panic attacks and agrophobia.

    Could the high FT4 level be causing this?

    Also I have been told I do not have hashimoto's but as my anti body level is 115 does this in fact mean I do have it.

  110. Hello. Concerned about my 22 yr old daughter who has had symptoms of fatigue for years with depression. she’s seen psychologist and psychiatrist who have put her on antidepressants. She continually ask for thyroid studies, and the results always come back in “normal range” and no doctor addresses them. These are her latest results:
    TSH 1.71
    T4 7.3
    T3 125
    FT3 2.9
    I would love your thoughts on these clues. To me, her Ft4 and Ft3 seem low or at should I say at least not optimal. Also, NONE of the antidepressants have done a thing to address or help her with the extreme fatigue. she also has dry ichy skin periodically along with irregular and painful periods. also c/o request constipation.
    your thoughts would be so appreciated

    • not sure if you ever got that sorted out but it sounds a lot like my story. I was tired as a late teen and it progressed in my early twenties until I ended up with a goiter at 27, which led to a partial thyroidectomy. I also suffered from mysterious depression. At that time my TSH was only in the “2” ranges. If you haven’t already, try to seek out a Dr that’s a little more open minded, even an obgyn that treats hormone issues. It wouldn’t hurt to start her out on 25mcg of Levothyroxin for six weeks then test again. Every six weeks you move up to the next dose until she feels better. You have to keep an eye on nutritional stuff as well. Turns out I was low in iodine and B12 and more so my body wasn’t converting the Levothyroxin as well over time.

  111. This has been so helpful! I’ve been experiencing excessive weight gain on top of depression, hair growth, and acne. I’ve been trying to navigate a combination of PCOS/Depression/Hypothyroidism. I am also a short female and feel like “normal” levels aren’t scaled for someone as short as me.

    TSH – 1.8 and then retested at 1.94 mclU/mL (0.35 – 4)
    Free T3 – Ordered because of this article
    Free T4 -0.9 ng/dL (0.8 – 1.5)
    Reverse T3 – N/A
    Total T3 – N/A
    Thyroid Antibodies – N/A
    Sex hormone binding globulin – 25 nmol/L (12-137)

    I’ve had so many tests ordered, my testosterone is in the upper half and my DHEA-S is off the charts high. And my doctor’s can’t figure out what it is. I’m hoping it’s something with the T3 levels that they can figure out. But really struggling with advocating for my care – even with fellow female doctors!

  112. Hi! I’m so thankful to have stumbled upon your website. You described me perfectly in this article. I had the same experience with an endocrinologist 2 years and just knew she would help me find the missing pieces to this fatigue, brain fog, and weight gain…just to name a few. She gave me a complete thyroid panel but didn’t include Free T3 or Reverse T3!! She diagnosed me as Hyperthyroid (TSH was 0.06 and Free T4 was 0.68) reduced my dose of T4 (I was on 150 mcg). That was 2 years ago and I’ve been Hypothyroid for almost 10 years. I’m now working with my Internal medicine doctor since he has known me most of my life and telling him what I need tested and learning how to interpret. I just got these results while taking 50mcg of Levothyroxine.
    Free T4-0.94
    Free T3-2.97
    Reverse T3-16.2
    We are trying Cytomel and taking it slow. I sure hope this works! I’m a school teacher and it’s time to get busy.

    Thank you for sharing your experience and wisdom!

    Tired in Mississippi

    • Hi Stephanie,

      It looks like there is certainly room for improvement in your labs. Thanks for sharing and keep us updated on your progress!

  113. Hi, I am so glad I came across this article. I am trying to raise my T4 in order to do IVF. However, no matter what I do it’s always low. I’m on 1.5grains Naturethroid and 15mcg Cytomel. My T3 is 3.2, Tsh is 0.02, reverse T3 is 12 but free T4 is o.6. After reading this article it sounds like I’m never going to be able to get my T4 higher while on Cytomel. My RE is focused on T4 because that is what the fetus needs. Should I switch to something like Tirosint? I can’t find any answers and my Endo and RE have conflicting ideas. Thanks!

    • I have had Hashimoto’s for 20+ years, have gone through 10+ Dr’s. Finally found one that will test for Reverse T3. However, now she’s chasing the “optimal free t4”. I am taking 1 1/2 grain NP Thyroid and 105 of Liothyronine. My last blood work was
      Free T4 .071
      TSH .005
      Reverse T3 11.4
      (down from 27)
      T3 540
      Free T3 17.0
      I am feeling okay, though I am not losing weight and not feeling hyper. I think I need to back off the T3 and maybe up my T4 but afraid I am pooling.

  114. Sound optimal to you??
    tsh 0.45 (.32-4)
    ft3 3.2 (3.1-6.2)
    ft4 11 (9-19)
    Total t3 1.2 (1.2-2.7)
    TPO 13. (<35). Rt3 11. (8-20)
    Thyroxine Binding Globulin 270. (260-575
    TRAB <2 (<10). Anti-TG 11 (<40)
    B12 1500 (138-652) no supplements and no meat??
    Thyroglobulin 8.0 (<60)
    I’m hoping you can tell me if these are close to optimal. I feel terrible for about two years and seeing my second endocrinologist with no answers/diagnosis. I’m on zero medication for anything. Ty

  115. Interesting. I have been on a compounded T4/T3 (115 mcg/37.5 mcg) medication for over a year. I am one of those who has trouble converting T4 to T3. My energy levels are good, and I feel well BUT my latest lab tests are concerning. Free T4 is low (0.7 ng/dL), TSH is normal (1.69 mlU/L), Free T3 is in the low range of normal (2.5 pg/mL). Did not test for reverse T3. I have noticed that I am cold at night a lot. Pretty sure my doctor is going to adjust my meds next time I see her. What should we do? Increase the T4? Would appreciate any insight.

  116. Hi, I’ve had most hypothyroid symptoms for approx 30 years. Now that lab results are available online, I see that when doctors have said my thyroid was fine, maybe it wasn’t. I’ve had my T3, T4 and TSH tested 3 times in the past 18 or so months. My free T3 is middle of the range, but free T4 is at the bottom of the range. The lab reference range is 9-19, my result is 9. TSH lab range is o.32-4.00, my result is 0.81. My family doctor says my thyroid is perfectly fine. What?? I’ve asked her to do a full panel, she says no, there is no reason when my results are fine. I gave her a symptom checklist with almost everything checked off, she still says I’m fine. I’ve mentioned that it is odd that both T4 and TSH are right near the bottom and now she has decided to text those same 3 again. Since all my labs have been either 9 or 10 and .81, 1.1 and .9, what will these same tests show?
    Is it odd to have these results for free T4 and TSH, all these symptoms and be considered fine? I am a 53-year-old female.

  117. This web site is very informational however it is extremely hard to navigate. I have posted questions and can’t find where they were to get the answer. You tend to favor the people who do have thyroids and forget about those of us who don’t. Information is not specific to those who battle problems with NO THYROID. I will continue to find other sites who’s information is easier to obtain.

    • Hi Kathie,

      I do talk about both problems but what most people without a thyroid don’t realize is that the information for those who have hypothyroidism is nearly the exact same for those who don’t have a thyroid. Once your thyroid is removed, for any reason, you automatically have hypothyroidism and that’s what I talk about all the time. So if it applies to hypothyroidism it applies to you if you don’t have a thyroid. This is why you will never see a resource dedicated to those who don’t have a thyroid because it’s just not necessary. But you are welcome to continue your search!

  118. It’s been 2-3 years I have not felt “right” I had thyroid cancer so I have had a total ablation of my thyroid bed.
    Todays test
    TSH 4.89
    T3 0.98
    RT3 2.18
    T4 10.8
    My physician had mentioned testing the T4 and adding Cytomel (?)
    Your article did help to understand why I struggle with hyperthyroidism ailments even though the doctor seems to think everything is normal.
    Don’t you just love that when it comes to the Thyroid it IS the land of opposites? -Appreciated your posting on this subject and I understand my weight gain!
    If you can answer this question Id be so happy! I am looking to do Bio-Te a bio identical hormone replacement therapy. Will that at all interrupt my thyroid medication? I would guess not if its identical to what my body once produced?
    Thank you! Michelle

  119. Dear Dr. Westin,

    I would appreciate your input on the actual preparation/timeline for having thyroid panel bloodwork testing done. What criteria should I follow to receive the most accurate assessment of serum thyroid levels?

    What time in the morning? Why not in the afternoon.

    Fasting or not?

    Take T3 or T4 or combo T3/T4 meds prior, (2 hours?) to testing or wait on taking medication after blood is drawn.

    I am under the belief, perhaps misguided, that TSH half life is 7 days and T3 half life is 9 hours and peaks in 2 hours after ingestion.

    Thankyou for all the work that you do. Your work has been very helpful to me.

    The word “Doctor”, means, “Teacher”and you are a rare example of a Doctor that educates not only your paying patients but anyone that needs your help. You exceed and excel and surpass the definition of “Doctor”.

  120. Your articles have been helpful and I’ve enjoyed reading the comments and replies. My FT4 levels on generic 88mcg Levo were always on the higher end, anywhere from 1.6-1.88, anything lower and I was not functional. The only thing that made me feel terrible was the eventual decline of the conversion of T4 to T3. Never had the reverse T3 tested. TPO under 1 and TGA is 4, which was just recently tested.

    I’ve been experimenting with NP Thyroid for about 4 months and it makes sense that you’ll never have a high FT4 level, afterall you’re getting less T4. I took 90mg and my FT4 was 1.0, FT3 was 2.6, TSH .94 so I was quite tired with muscle aches. I bumped up to 120mg for two weeks and my FT4 was 1.2, FT3 was 3.6, and TSH was 0.05. I became very dizzy and started having blood pressure issues. I went back down to 90mg for two weeks but super tired again. I’m going to try something in the middle like 105mg.

    Do you think it’s okay to add on a little T4 to Np Thyroid instead of increasing the NP Thyroid? Seems like giving your body a little extra T4 to convert on its own while getting some T3 from the NP isn’t a bad idea. I can’t take too much more added T3. I’ve tried Cytomel in tiny doses but it makes me feel terrible.

    I agree, with natural desiccated you can’t chase these optimal levels of T4. From my experience you’ll end up overdosing yourself on T3 in the process. Currently I’m taking two supplements. One has iodine, zinc, selenium etc and the other is a B12/folate/intrinsic factor supplement, as my iodine was 50 and B12 was under 400. That’s what I’m doing so far.

  121. I’m confused about the t3 only medication vs. having a low t4.
    I have a functional doctor.
    All labs I have are optimal but I still struggle with weight going up and down regardless of being strict paleo for 3 years & im tired!.
    I am on mostly t3 meds… small doses of ndt ….
    My free t4 is super low and this is literally the only thing my doctor and I can find to pin point the fatigue…. I’m at a total loss and I’m frustrated…. any more info you can steer me toward?

    • from personal experience, yes, low T4 can keep you tired. You didn’t say how much T4 or T3 you’re getting. If you’re on T3 mostly then maybe you’re not getting enough of it to replace the missing T4? All you can do is either add more T3 or more T4 and see what helps. Mostly T4 regimen might keep you scraping by on T3 and you’ll be tired. Mostly T3 regimen will keep you tired if it’s not enough T3. Hope that helps. good luck

  122. Interesting being a male 67 years of age and taking levothyroxine of .75 mcg for 9 months and before that was .50 mcg levothyroxine. Noticed this past summer 2020, I started felling cold, chill and I live in the Phoenix area and had over 100 days of triple digit weather. However I was either wearing a sweater or jacket along with dry skin and hair dry even brittle in some cases. My last labs where as follows TSH- 1.80, T4 free 0.94, T3 3.0. Testosterone 601, in which I will say I do a weekly HRT treatment half a vial of 200mg. Im concerned that my dosage is still low. A year ago August 2019, my TSH was 0.646, T4 0.75, T3 3.1. How concern should I be or even be or am I overreacting??? I just do not feel the .75 mcg is enough, something not right.

  123. What are the optimal T4 levels for Levo and T3 combo? If the reference range for T4 is .89-1.76 and the T3 levels are low regardless of being at 1.4, 1.5, and 1.6 and the TSH isn’t suppressed below 1 then how does a Dr or patient know when to start adding T3? For example if your TSH is 1.5, FT4 is 1.6 and FT3 is 2.6 then do you bring the T4 down to 1.3-1.4 and then add T3? I think most people need T3 and would like to know what are the optimal ranges of T4 to start adding T3.

  124. I’ve been on Eutroxin(?) for about 8 years now. I test in the normal range but no reduction in symptoms, in fact they got worse.
    Checked, supposedly 3mths after correct dosage to get some reduction in symptoms.
    2 years ago it got to the point of looking like I had goiter.
    My response, stop taking the tablets the way they were supposed to be taken.
    My stomach doesn’t actually work well for the first 2 hours after I get up ,s o I may not have been absorbing them.
    I now take them with breakfast, including coffee and fibre powder. Which going on what I’ve read should screw up absorption.
    3mths after I started this, I had my yearly test and it again came back in the normal range. The difference was 1 which was normally on a 1-20 range(about 15 usually) was now 18.
    I had lots of reduction in symptoms and felt normal (for me) for the first time in a long while.
    Last year the same test was 13 but all others ok.
    This year I changed my diet and I’ve been losing weight without calorie counting or extra exercise. 7kgs in 2mths.
    no hunger, no sugar cravings, no fatigue.
    compared to 8kgs in 6mths before changing(with diet and daily aerobic exercise)which I gained straight back again.
    AS I kept telling the doctors at each yearly check, just because it’s in the normal range, doesn’t mean it’s normal for me.

  125. If I can stay awake long enough to type…. I feel asleep at 5:30pm and woke up at 7:30 am. And take about two hour naps almost daily…. I just had my NP to check my Thyroid levels and she said all was good. I asked for a copy of report and the levels are as follows:
    TSH 2.740 0.450-4.500
    T4 5.9 4.5-12.0
    T3 uptake 24 24-39
    Free Thyroxine index 1.4 1.2-4.9
    Reverse T3 12.4 9.2-24.1
    Thyroid Peroxidase 123 0-34
    Thyroglobulin Antibody 268.0 0.0-0.9
    I’m just not sure everything is so good like she is saying. Can you please help?


  126. My NMD just switched me to Tirosint from Armour. I have very low numbers altogether, My TSH is 1.95 up from 0.23, T4 is up a little 0.8 and t3 is 2.2. Have 10 pound weight gain despite carb free diet and exercise. Sleep 10 hours and can’t wake up! At 68 have been on thyroid meds for over 30 years. Have lowered A1C from 6.2 to 5.7 but just can’t seem to get thyroid under control. Told I’s hyperthyroid!

  127. Am I the only one who has a hard time understanding all of this? LOL

    Total T3 = 74L
    Reverse T3 = 8
    Thyroglobulin Antibodies = <1
    Thyroid Peroxidase Antibodies = <1
    Free T4 = 1.1
    TSH = 4.04
    Free T3 = 2.9

    Does any of this indicate Hashimoto's? I'm so confused. Desperately trying to figure out WHY I can't lose weight and feeling like garbage all the time.

  128. Hello,

    Im glad I came across your article. I’ve been diagnosed with hypo since 2019, but my pcp os the one who has been managing it and would never order a full thyroid panel. I went to an endocrinologist once for an assessment for cushings, and was sent back to my pcp. I am going to a different endo in March and kind of felt bad that I was pushing for testing so much. I don’t feel bad anymore after reading this article. My ft4 is 0.68 with a tsh 1.715, been on levothyroxine for at least 2 years, and have very mixed symptoms.

    • Hi Tracy,

      You should never stop advocating for your own health if you aren’t feeling 100%! Your doctor doesn’t know what it feels like to be you.


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