Low TSH Symptoms: 5 Important Causes + Your Next Steps

Low TSH Symptoms: 5 Important Causes + Your Next Steps

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Have you been told that you have a low TSH?

Are you experiencing symptoms such as

It may surprise you to know that a low TSH can be associated with multiple conditions all of which present in different ways. 

This article will go into detail on how to interpret your TSH, how to determine the cause, the symptoms associated with each cause, and further instructions on how you should proceed

This article should be helpful if you have hyperthyroidism, hypothyroidism or pituitary issues (because all of these conditions can result in changes to your TSH level!). 

Let's jump in:


TSH as a Marker of Thyroid Function

Let's briefly discuss what the TSH actually stands for and what it is a marker of. 

TSH stands for thyroid stimulating hormone and it is a hormone which is produced by your pituitary gland in your brain. 

TSH is one of the main methods that your body uses to control and tightly regulate thyroid function and control of your body. 

The primary job of TSH, unsurprisingly, is to 'stimulate' your thyroid gland. 

This stimulation results in the production of thyroid hormones, primarily T3 and T4. 

Once these thyroid hormones are released into the bloodstream, they go through your body and interact with all of your cells to regulate your metabolism (1), help your body produce heat (2), help your heart beat, your hair grow (3) and so on. 

causes of low TSH

If you have a low amount of TSH in your body then your thyroid may not be getting the proper amount of 'stimulation' that it needs. 

As you might guess, this can lead to some serious downstream side effects and consequences that are felt by you as certain symptoms. 

There's only one problem:

There are many different causes of TSH dysregulation (4) and each condition is associated with a different set of symptoms!

Luckily, you can differentiate between these conditions with a little bit of knowledge and some thyroid lab tests. 

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5 Main Causes of Low TSH

As I mentioned previously, it's actually very important that you understand the primary cause of your issue. 

It's possible to have a low TSH and have either the symptoms of hypothyroidism or hyperthyroidism, all depending on the underlying cause. 

With that in mind, below you will find a list of the most common conditions that may result in a suppressed or low TSH. 

You should be able to identify where you fit in, but in case you can't, I've also included some follow up tips at the end to help you further stratify yourself. 

#1. Hyperthyroidism (Endogenous)

Perhaps the most common cause of a low TSH is caused by what is known as endogenous hyperthyroidism (5). 

The term hyperthyroidism refers to a state in which there is too much thyroid hormone floating around in the bloodstream. 

The most common cause of hyperthyroidism is the autoimmune disease Graves' disease in which your body autonomously (by itself) produces thyroid hormone without regard to the normal feedback loop. 

As thyroid hormone is produced your body will attempt to normalize the amount by lowering the TSH. 

But, if the thyroid gland is producing thyroid hormone through another stimulus (in this case through antibody stimulation) then it doesn't slow down in response to the low TSH.

This cycle continues until the TSH is close to zero or very suppressed. 

Endogenous hyperthyroidism should be differentiated from exogenous hyperthyroidism (6) which is caused by taking too much thyroid hormone medication and something we will discuss below. 

Endogenous hyperthyroidism is hard to miss because you will often experience very significant symptoms which will lead you to your Doctor's office. 

In addition, you will also see other findings on your lab tests such as an elevation of thyroid stimulating immunoglobulin (the autoimmune marker for Graves' disease) and elevated free T3. 

Symptoms associated with endogenous hyperthyroidism include:

  • Hot flashes
  • Weight loss
  • Diarrhea
  • Fatigue
  • Nervousness
  • Irritability
  • Bone loss
  • Heart palpitations
  • Rapid resting heart rate
  • Hair loss

These symptoms are hard to miss and they are often enough to identify the cause of your low TSH without further testing (but testing should still be used!). 

#2. Thyroid Medication

Here's where things can get a little bit tricky. 

Some people, perhaps you, suffer from changes to their TSH as the result of taking thyroid medication. 

Any thyroid medication that you take by mouth will influence your TSH level, provided that it is absorbed into your body. 

This includes medications like Synthroid, levothyroxine, Armour Thyroid, Nature-throid, liothyronine, and Cytomel

All thyroid medications have this effect. 

It stems from a feedback loop which exists in your brain designed to help control how much thyroid hormone is produced at any given time. 

Doctors take advantage of this feedback loop to help them determine how much thyroid hormone they should give to patients. 

The topic of the value of TSH in determining your medication dose is a something we can discuss in another place, but let me say here that the TSH isn't always the best marker to use (7). 

instances where the TSH is misleading

But back to the TSH and thyroid medication for a moment. 

As you take thyroid medication by mouth it will act to reduce your TSH. 

The more medication you take the lower your TSH will go. 

So, it's certainly possible to take enough thyroid medication that it will suppress or lower your TSH. 

But, does this mean you are hyperthyroid?

Does this mean that you have the same biologic condition as those patients who have endogenous hyperthyroidism?

The answer is both yes and no, and it depends on the patient and this is where it can get confusing. 

It's both possible to take an excessive amount of thyroid hormone, sufficient to reduce the dose and become hyperthyroid. 

It's also certainly possible to take thyroid hormone, enough to lower your TSH, but still remain clinically hypothyroid

These two conditions present clinically on opposite ends of the spectrum. 

If you have a low TSH due to taking thyroid medication and you are feeling hot, anxious, experiencing heart palpitations, feeling jittery or losing your hair, then you may be on the hyperthyroid spectrum

natural thyroid supplements version 2

On the other hand, if you have a low TSH while taking thyroid medication and you are gaining weight, feeling fatigued, experiencing hair loss, suffering from constipation, and experiencing depression, then you are most likely biochemically hypothyroid, despite what your TSH says

You can definitively differentiate between these two states by ordering free thyroid hormones which we will discuss later. 

Symptoms associated with a low TSH due to thyroid medication include:

  • Some patients experience hyperthyroid symptoms while others experience hypothyroid symptoms. Which set of symptoms you experience depends on what medication you are taking, the dose of that medication, and how well you are converting T4 to T3. 

#3. Pituitary Dysfunction

We know that you can have a low TSH from either taking too much thyroid hormone by mouth or because your body is producing too much thyroid hormone on its own. 

These two causes of low TSH occur due to the regulatory feedback loop that exists in your body. 

But what if the organ which produces TSH is damaged and cannot produce this hormone?

That's exactly what happens with pituitary dysfunction. 


Your pituitary gland (an organ in your brain) is the sole provider of TSH for the body. 

If it becomes damaged, or injured in any way, then you will not be able to produce TSH (8). 

If you don't produce TSH then obviously your levels will fall because your body can't get it from any other source. 

And, as you might suspect, this results in symptoms which are often much different than those previously listed. 

symptoms of low TSH due to pituitary damage

The reason for this has to do with the fact that your pituitary produces much more than just TSH. 

It also produces other stimulating hormones including FSH, LH, ACTH, Prolactin, and Growth hormone

If you have pituitary damage it's very likely that your pituitary will not be able to these other important hormones as well. 

If these stimulating hormones are not produced then they will not go around the body 'stimulating' the release of hormones and many of your normal hormone levels will drop. 

This happens with your thyroid as well. 

As TSH levels fall, your thyroid will no longer be stimulated and it will no longer produce sufficient levels of T4 and T3. 

As your free thyroid hormone levels fall, you will start to experience the symptoms of hypothyroidism

But, in addition, you may also experience symptoms associated with low testosterone, low estrogen, low progesterone, low growth hormone and so on. 

Pituitary damage can stem from trauma to the head, it can occur from tumors, and it can be caused by pregnancy due to lack of blood flow. 

Symptoms associated with a low TSH due to pituitary dysfunction include:

  • Symptoms of hypothyroidism: weight gain, hair loss, constipation, fatigue, depression, cold body temperature, cold intolerance and so on. 
  • Other symptoms associated with low sex hormones including decreased libido, changes to your menstrual cycle, appetite changes, painful intercourse, vaginal dryness, changes to breast size/volume, and hot flashes. 

#4. Lab Anomaly

Another important cause of low TSH is that of a lab anomaly. 

What do I mean?

Believe it or not, your lab tests are not always accurate. 

In fact, it's been estimated that up to 3-5% of lab results are inaccurate at any given time (9). 

What does this mean for you?

It means that, in some cases, your TSH may just be the result of a lab anomaly and there may not be any problems with it

You can identify this problem quite easily because, if you fall into this category, you will most likely not experience any symptoms. 

Furthermore, it's very likely that your low TSH was identified through routine testing and not because you went to the Doctor for any specific problem. 

If you fit into this problem then it's very important that you not jump into treatment right away. 

Instead, a better approach is to simply re-test your lab results after 6-8 week period and also look at other thyroid lab tests at that time. 

This approach will prevent you from starting treatment unnecessarily which can be associated with problems by itself. 

While this is not necessarily a common occurrence, it's still worth considering because some small fraction of people will fit into this category. 

Symptoms associated with a low TSH due to lab anomaly:

  • There should not be any symptoms with this condition. 

#5. Euthyroid Sick Syndrome

Another, relatively common, cause of low TSH is due to a condition known as euthyroid sick syndrome

Euthyroid sick syndrome, referred to as ESS, is more of a constellation of changes that occur due to a specific stimulus on the body. 

You can think of ESS as protective changes which occur when the body is under extreme stress. 

The stress can be from any cause including severe illness, chronic illness (10), extreme dieting (11), extreme social stress (12), environmental exposure (13) and so on. 

The theme that links all of these exposures is how the body reacts. 

When you put your body under these specific influences it responds with a few changes in your thyroid gland including:

All of these changes result in one major change:

A reduction in thyroid hormone production and function in the body. 

Sometimes this can be a good thing but sometimes it can work against your body and result in serious problems. 

ESS is becoming more and more common as people are exposed to repeated stressors and as the condition is coming into light due to more advanced testing. 

This condition is often missed unless tests beyond the TSH are ordered. 

Simply ordering the TSH by itself may lead to a false conclusion that you have excess thyroid hormone in the body, but can be differentiated from this state by checking for free thyroid hormones

The suppression or reduction in TSH that occurs in ESS stems from changes in the bloodstream picked up by your hypothalamus which directly influences TRH. 

As TRH drops the TSH will follow and then free thyroid hormones will soon after. 

Symptoms associated with a low TSH caused by euthyroid sick syndrome: 

  • This condition may or may not be associated with symptoms. Often, if it is associated with symptoms these symptoms will closely mimic those of hypothyroidism. 

Further Testing is Often Necessary

In almost every case of low TSH, you will need to get more advanced testing done. 

The TSH is the standard way physicians use to generally evaluate your thyroid, but there are many further tests that can and should be ordered. 

The TSH only gives you a specific set of information about your pituitary gland but it doesn't give you information about the amount of circulating free thyroid hormone in your body or about how well you are converting or utilizing thyroid hormone. 

These factors can easily be evaluated by adding a few extra tests. 

Tests that you will want to get beyond the TSH include:

  • Free T3
  • Total T3
  • Free T4
  • Reverse T3
  • Thyroid antibodies (TSI antibodies, TPO antibodies, and TgAB)

These lab tests will help differentiate the various causes of low TSH and will help you have a better idea as to what is happening in your body. 

Below you will find a list of lab patterns and how they match up with the conditions listed above:

  • Low TSH, low free T3, low free T4, high reverse T3 - This pattern is seen in euthyroid sick syndrome. 
  • Low TSH, very high free T3, low free T4 - This pattern is seen in cases of endogenous hyperthyroidism such as Graves' disease. 
  • Low TSH, high free T4, low free T3 - This pattern is usually seen with thyroid medication but doesn't necessarily mean that you are hyperthyroid. 
  • Low TSH, normal free T3, normal free T4 - This pattern is seen with a lab anomaly. 
  • Low TSH, low free T4, low free T3, low reverse T3 - This pattern is seen in pituitary dysfunction. 


This article highlights the importance of understanding thyroid physiology before jumping to conclusions, treatments, and diagnoses. 

While TSH is a potentially great marker for assessing thyroid function, it falls short in a number of ways and can be misleading unless it is also evaluated in the context of other thyroid lab tests. 

A low TSH can be caused by 5 main conditions, all of which are associated with various symptoms and can be differentiated from one another with further testing

You can identify these conditions by looking at various thyroid lab patterns and determining where you fit in. 

Now I want to hear from you:

Do you have a low TSH?

Do you know what is causing your TSH to drop or lower?

What other symptoms are you experiencing?

Are you undergoing treatment?

Leave your comments or questions below! 

References (Click to Expand)

low TSH causes and symptoms

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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.

P.S. Need more help? Check out my free thyroid downloads and resources.

40 thoughts on “Low TSH Symptoms: 5 Important Causes + Your Next Steps”

  1. Can you comment on what might be the physiology behind a postmenopausal women on synthroid and cytomel whose TSH is suppressed, <.1 but has optimal levels of FT4, FT3, good ratios of TT3 to RT3. Still feeling tired, no real symptoms of hyperthryoid. I can say that when her levels are optimized she isn't feel "great. Recent DEXA showed osteoporosis, but has had this in the past. Not sure if the suppressed TSH is a result of over medcation, but if the doses are reduced, FT3 and FT4 go down. Or is this a pituitary issue? NOrmally when a person has optimal levels of FT3 and FT4, their TSH is WNL. Just can't seem to figure this out. Thanks!

    • Hi Erin,

      Using thyroid medication does not exactly replicate the same physiologic state that exists when your thyroid produces sufficient thyroid hormone on its own. You’ll always need more thyroid medication to replicate near normal free T3 and free T4 levels in the body due to this. It’s rarely ever the case that a person taking thyroid medication to obtain optimal free t3/free t4 has a normal TSH.

      • I’m very ill and have been fighting this diagnoses of hashimoto’s for over 10 years. It has ruined my life. I have lots of questions and any info you could help me to understand would be greatly appreciated. I’ve had numerous ultrasounds and biopsies done. My thyroid gland is not visable its clusters of nodules on top of each other. My last 2 lab results have shown my tsh to be < 0.02 they were drawn 8 weeks apart and at different labs. My ft4 is wnl as well as my t3. I'm not seeing it say it's free t3. I've been on armour thyroid for almost 20 years. I've been on 240mg for over 10 of those years. I'm not well if I'm out of bed I start shaking and unable to hold my arms up legs start shaking and feel like going to collapse. Please help…

  2. In 2008 I was diagnosed by my primary care Dr. with TPO antibodies. My thyroid panel has usually been within “normal” range, although I have extreme symptoms from hypo and hyperthyroid, such as hearth palpitations, anxiety, irritability, every single symptom of PMDD, brain fog, weight gain, depression, low energy/flu-like fatigue and exhaustion.
    Most recent tests showed low TSH, high T3 & T4.
    Every doctor and specialist cannot or just does not know how to consider treatment. I am NOT on any medication, as I react negatively to thyroid hormone, even when lab results came in on the low range and I was experiencing severe “hypo” symptoms.
    On top of it all, I have herniated cervical discs, degenerative disc disease, unstable joints from injuries,and “fibromyalgia syndrome.
    I do not know how to find the ‘root cause” of my condition, nor how to treat it naturally, since the current medical system fails people who have autoimmune thyroid conditions.
    Any suggestions are welcome!
    Thank you for your consideration,

  3. Hi Dr Childs,

    I wondered if you can have “mild” ESS caused by PTSD and chronic stress?

    I have symptoms of hypo and have the following blood results:

    TSH: 1.41 mu/L (0.34-4.82)
    Free T4: 13.8 pmol/L (10-20)
    Free T3: 3.38 pmol/L (2.6-5.8)
    RT3: 21 ng/dL (ref range: 8-25).

    I’m not in hospital and don’t have a chronic illness. I just feel hypo and have had periods of extreme stress when younger (I’m 44 year old male).

    I’m trying to fix all underlying possible causes including microbiome and nutrients etc as well as lifestyle. I’m wondering whether a T3 medication would help or cause more harm?

    Thanks for any feedback you can give. 🙂

  4. Thanks for all you do, Dr. Childs. I bought your protocol and am feeling better. I have a question about TSH though. For years my TSH has been .01-.002 and doctors freak out even though my free T3 and free T4 are optimal (your optimal) but does it being that low indicate some kind of pituitary problem? Your optimal range is .5-1 so my TSH is far below that. Should I have further tests or is this okay?

    • Oh and I’ve been on bioidentical hormones for about 12 years. after a broken ankle last summer I also found out I have osteopenia. I’ve been struggling some with optimal thyroid levels since then because the pain and resulting cortisol problems made my reverse T3 shoot up to 33. So even when my free T3 is only 2.8 for example, my TSH is still only .01. Crazy!

    • Hi Colleen,

      Most people can get away with a low TSH without long-term complications, but it’s best to avoid a suppressed TSH if at all possible. If you are taking thyroid medication and your reverse T3 is that high and your TSH is that low then you are probably taking too much T4. If that’s the case then you’ll want to try and adjust how much T4 and T3 you are taking. Preference should be placed on optimizing free T3 over free T4 if necessary.

      • What testing is performed if one suspects Pituitary Disfunction? My TSH is very low to suppressed but I have below normal T4 and low T3. I currently take Synthroid and Cytomel and are trying to get the meds just right.

        I did have Graves and had RAI over 10 years ago but of course now, I am hypo.

        If one finds out that it is a Pituitary problem, how do they treat that? And, once that has been found to be the issue, is the suppressed TSH still damaging to your body?

        This is all a little confusing. Thank you for all you do. I am a subscriber and did pay for your video series, but haven’t come across the answers to these questions in particular.


        • Hi Annette,

          You’ll want to test both TRH and TSH (they test for hypothalamic and pituitary function). You’ll also want to look at the following: FSH, LH, ACTH, (TSH already mentioned), prolactin, and growth hormone – these are all of the pituitary hormones.

  5. Would you recommend lowering my dose of armour based on recent labs of a TSH at -0.01, but with optimal FT3 and FT4 but also having low T3 and T4 totals? I am having very hypo symptoms still. I have had Hashimotos for 12 years and have been on Armour for 5 years.

    • Hi Cece,

      I can’t give any personal medical advice or recommendations, but it would be worth looking at your reverse T3 and other hormones such as leptin to see if they are contributing to your symptoms. You should also be cautious of suppressing your TSH, you can learn more here: https://www.restartmed.com/suppressed-tsh/

  6. Hello Dr. Childs,

    I have been having hyperthyroid symptoms, rapid heart beat, pounding (palpations) fatigue, short of breathe, brain fog sometimes. I had recently seen my endo for a 2nd time and turns out my T3 and T4 were normal and no antibodies detected for graves. But my TSH is still low, when this 1st started it was 0.1 in the hospital, now around 0.3. it went up with out antithyroid medication in about 2 weeks. I am now on antithyroid medication and having TPO and all levels checked again in a month after being on methimazole. Could this be an acute onset of hyperthyroidism? I was working out too much without any rest days and working a lot. Im wondering if this is all stress induced and from skipping meals at times too. I am 32 years old. Thank you.

  7. Reverse T3 13
    Free T3 2.9
    Free T4 0.9
    TSH. 0.02
    Thyroid Globulin Antibodies ABOVE 2
    Thyroid Peroxidase Antibodies >900
    On Armour 1.5 grains
    Still have Hypo symptoms. Extreme Fatigue, depression, dry skin, inability to lose weight.
    My doctor recommended I get off of all Thyroid meds “For a while”, claiming they were causing the antibodies to increase. I think this is a bad idea. Am on Saxenda 0.6 qd, and found a site online where I can do a teleconference with a doc to get LDN. Also, supplementing for adrenal Fatigue. Workout out using HIIT and weights. Try to eat clean. Sex hormones were in normal range and periods still regular. At my wits end and don’t know what to do and can’t find a doctor who will listen to anything. Only want to look at TSH. Divorced, 47 and back in school and am about to lose everything. Any advice you can give would be so greatly appreciated.

  8. Hello Dr. Childs, Thank you for your web site. In 1996 I weighed 98 lbs. I had tremors. I won’t go into all the details that I was going through at the time. I met my endo at the hospital one morning and he gave me the I131 pill. The nurse had to hold the glass of water for me to take the pill. Very shaky. He slowly brought me up to a good level. 0.1mg Synthroid is what I have taken all these years. My TSH was low three months ago. I thought, what am I doing differently. I had started taking Biotin because I was losing my hair. I searched on the computer and yes, Biotin will lower your TSH. I stopped taking it. Two months later I went back to my endo and my TSH had dropped down even three more points. He said to take 1/2 a pill on Sunday and Mon thru Sat take a whole pill. LOL having bad hot flashes and once in a while heart palpitations. It’ hard sometimes to get in to see him. He stays booked up, seems like. What do you recommend? Very hot in Fl. lol

  9. Hi,
    I’ve been watching your lettuces and reading your posts. You say exactly what I’ve been learning lately. Thank you.
    As you asked here are my numbers from Aug 26th, 2019:
    TSH – 0.022 (0.450-4.500)
    Free T3 – 2.3 (2.0-4.4)
    Free T4 – 1.25 (0.82-1.77)
    Reverse T3 – 15.9 (9.2-24.1)
    I was on Tirosint 100 mcg and NP Thyroid 30mg and Cytomel 2.5mg. I was still symptomatic at this point. So I increased the NP thyroid slowly until reach (60mg), I stop the cytomel and I haven’t changed Tirosint dose. I’m feeling better now and I will have a blood work now in November. TSH will probably be lower or the same. Any thoughts?

    Thank you

  10. I like be your site and thank you for breaking apart hypothyroidism. I was diagnosed with hypo right after menopause. So, on top of the bio-identicals I was getting, now I had hypo to deal with. 10 yrs later, with doctor ok, I have taken myself off the estrodial+testosterone, take 200 mg of progesterone nightly, wake up to compounded look-alike “WP”, and eat handfuls of supplements daily. Sigh. I haven’t slept thru the night for over 5 yrs and my weight gain over the last 5 years is almost 20 lbs. I am now hypo glycemic and strongly suspect my leptin is out of town. then I discovered something: I sleep on the other side of my smart el chic power meter. I move into the guest bedroom and now sleep thru the night.
    Here is my question: by removing or reducing the RF and EMF waves in my house as much as possible, do you think I can get off all this stuff I am taking? Or, has being on thyroid and other medications now made my body dependent? I strong,y believe that these radio and other waves have compromised my system to the point where my body simply could keep up with the bombardments. I am hiring a biological engineer to asses my house, will do very back to an analogue meter, and “faraday cage” my WiFi router in the very near future. Still gathering data. Sorry for long letter. Thanks.

  11. do have many of the symptoms of Low thryoid. i go to the gym and I don’t seems to be getting stronger. TSH = 2.61. Is that okay? No, I am NOT on throid meds

  12. Hi, Thanks for your website. I am a 64 year old female with Hashimotos. The hypothyroidism started after my son’s birth 25 years ago. My yearly TSH showed 0.01 with a normal free T3 and normal free T4. I will ge a bone scan in December as I had a screening and it showed osteoporosis (Lifeline screening). Does long term use of Synthroid cause osteoporosis and should I worry about the TSH of 0.01? My nurse practitioner thinks if I feel ok the TSH doesn’t matter although she wants to monitor it more often. The TPO Ab test will be done the same day as the bone scan. It has run high (100-200) in the past. Please help. People tell me to take ndt but maybe I need to cut back on Synthroid from 100 to 50 mcg. Thanks for your help.

  13. Dr. Childs, Thank you very much. Do you think I should try Thyrovanz? My younger brother has Hashimoto’s with diabetes and he takes Thyrovanz from New Zealand. Otherwise I will get a bone scan and TPO Ab in mid December . My cousin has had thyroid eye disease and she emails me to see an endocrinologist ASAP. Currently I see a nurse practitioner who has hypothyroidism and she did the TPO Ab test for Hashimoto’s then increased my Synthroid from 50mcg to 100mcg. per day and therefore now with this 0.01 TSH I feel like I should try ndt or get back on the original Synthroid dose of 50 mcg. Your thoughts are appreciated!

  14. I’am attempting to determine what value can be determined with a recent blood test which indicated TSH <0.005 LOW Reference 0.450-4.500 uIU/mL T4, Free (Direct) 1.23 ng/dL 0.82-1.77

    • Hi Thomas,

      I’m not really sure what you mean by the value. You’ll want to look at your TSH in context with your symptoms and other thyroid lab tests.

  15. Hello Dr Childs,

    Thank you for this article, I read it but have some questions. I am 50 and have High Blood Pressure with Mitro Valve Prolapse. I have been in and out of the Emergency Room because like a switch I get goose bumps, my heart races, feel sick to
    My stomach and my blood pressure even on medication shots up to 250 over 150. Every time they tell me I am (heart wise) fine and probably stressing my self out Have had echos, brain scan, chest X-rays. I have been trying to figure out is this really in my head. Then I remembered that I have a cyst on one side of my thyroid. It’s a combo cyst They check my thyroid and say it’s fine. Recently I had a low TSH, 0.163. I have never taken any thyroid medication, I am skinny always have been. My skin is not dry, bloodwork spectacular, I do however feel tired and every so often will have a night sweat. What category should I focus on? My blood pressure on medication is usually acceptable, only when this episode happens does it shoot up. It usually takes 2 days for it to go back down.

    You for any guidance,

  16. I’ve been tracking my labs and medication adjustments in a spreadsheet for 10 years now and I always wonder what i need to do to get my TSH up to optimal. Since I had my thyroid totally removed 6 years ago, my TSH is always super suppressed at 0.01 – 0.04. (I know we want suppression to suppress cancer regrowth, but maybe not this much?)

    Meds: 125 Synth + 130 Naturethroid
    TSH 0.04 (high/hyper)
    FT4 1.47 (low side of optimal)
    T3 90 (low)
    FT3 3.1 (low)
    RT3 17 (high)

    This is always a problem when I see Endo for cancer follow up scans or I go to the GYN for annual exams. They always want to cut my meds in half (and they have, when I made the mistake of listening to them, I ended up severely hypo and hypothermic, it was literally hell). My TSH rose to 1.0 but i was on the verge of killing myself because I was so depressed I could not get out of bed or stop crying.

    – Curious if you see a greater TSH suppression when patients are on NDT’s?
    – If I took out the synthroid and just did 2 or 3 grains of NDT, and added T3 cytomel, my tsh might raise to optimal and also improve my T3 levels to optimal too?

    I know you can’t give medical advice, but is that the right direction or am I still not grasping this?

  17. Dr. Childs
    my endocrinologist will not approve a full thyroid panel blood test because she believes the T3 measurement is inaccurate. I plan to get one anyway because there appears to be value in these quantities. Do you have any guidance regarding the best time of day for getting the test done such as fasting in the morning? I have been taking Synthroid for many years with increasingly worse hypothyroid symptoms and believe there is more at play here I have been taking Synthroid for many years with increasingly worse hypothyroid symptoms and Would like to understand better what could be going on would like to understand better what could be going on


  18. Hi! I just found your page. I have been trying to find info that would help me better understand what I’m feeling. Over the last two years I’ve had my thyroid monitored. The TSH level was a roller coaster. 0.33 then recheck 2 months later was 0.98 then a year later 0.21 and the recheck 2 months after was 0.64. The thyroid ultrasound showed some very small cysts that shouldn’t be causing any problems. My symptoms though are all over the place. Very low energy/fatigue. Low libido, palpitations, tremors, anxiety and depression. Heat intolerance, dizziness (MRI normal) and brain fog. I’m going back in November for more labs and another ultrasound. I just hate feeling in this constant blah state. Have you heard of the tsh fluctuating so much? Thank you.

  19. What does it mean if you are not on meds and have low TSH 0.14, but Free T4 is 19.1 (11-21 range). Free T3 is 6.3 (3.1-6 range). My reverse T3 is 479 (230-540)?
    It it worthwhile getting a Graves antibodies test?

  20. These are the symptoms I have; low energy, cold intolerance, palpitations, hair loss, anxiety, breathing problems and head pressure. MD had my tsh checked 3 hours after taking nature-throid and it was .84. Taking 1 grain of nature-throid in AM. Your comments are greatly appreciated.

  21. Dr. Child’s, Thanks so much for this website and information. I am being told (yet again) that I need to see an endocrinologist. I really have NO symptoms. Lost half of my thyroid about 45 years ago to a benign tumor. Have never been on thyroid medication. My current TSH is .068 (prior .043), my T4 Free is 1.12 (prior 1.06) and my T3 Free is 3.4 for both years. Each year when I do my blood work, I am told I need to see a specialist. What other tests should I have done? Do I need to see an Endocrinologist?

    • Hi Elizabeth,

      It really depends on how you are feeling. If you are feeling 100% then there really isn’t a need. It just sounds as if your current provider is uncomfortable with your situation and doesn’t know what to do with you.

  22. Hi Dr. Childs!
    I am 18 years old and have been having terrible fatigue, panic attacks, anxiety and brain fog, among other debilitating symptoms.
    I’m undergoing therapy to manage my anxiety and my doctor just started me on 20mg Prozac to level things out.
    We just did a blood test for TSH and it came back at .77
    My doctor said it might indicate that my thyroid is slightly overactive.

    You say that my TSH wouldn’t be considered low unless it was <.00x

    Do you think I might benefit from some thyroid treatment with my TSH at .77??

    I’m so confused and need help here!

    • Hi Kristen,

      A low TSH may be an indicator of hyperthyroidism but it isn’t 100% accurate in assessing for the hyperthyroid state. Many people with low TSH’s are actually hypothyroid and not hyperthyroid but it’s still possible to be hyperthyroid with a low TSH. A TSH of .77 is still within the normal range of by most lab ranges, though, so it’s hard to believe that you are truly hyperthyroid. You could be someone who is more sensitive, though, so it could be a possibility.

  23. Hello,
    I am a 39 yo male,hypothyroidism for years,after years of being within range, tsh was 0.056 with normal ft4 and normal ft3,i then changed from euthyrox 150 every day to tirosint 150, 5 days per week and tirosint 125 two days per week ( didnt want to change to euthyrox new formula) ,now 7 weeks later tsh 0.01 with normal tsh 1.4 and t3 slightly low 0.9 nmol/L,i have been feeling good…
    I am to start on tirosint 125,6 days per week and 150 one day per week.
    Why the low tsh? Could be exacerbated by a better absorption of tirosint? Thank you

  24. Hi! I have CFS, Fibro,been on Armour most of my life-diagnosed by old family Dr no longer here by symptoms. Felt fine! Diagnosed w/hypo 4-5 yrs ago by blood work,& now I’m told I’m hyper—low tsh &free t4, high free t3–but only hypo symptoms-so exhausted I can barely make it to the kitchen! Live on the couch! On 2grains(120mcg)of NP Thyroid daily. Now she wants 60mcg M-F, none on the weekend. I have low blood pressure-95/65 yesterday,but it’s been low all my life! Am I hyper when I feel so hypo&don’t I need meds every day? No one knows how to treat thyroid-especially arrogant Endos! Med Schools have failed us! And I’m angry!


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