Low TSH vs Suppressed TSH on Thyroid Medication | Dr. Westin Childs

Low TSH vs Suppressed TSH on Thyroid Medication – What you Must Know

Does your TSH Test actually give you helpful information about your thyroid function?

As a thyroid patient, there is no doubt in my mind that you are already familiar with the thyroid lab test known as the TSH. 

It would be weird if you didn't. 

Doctors primarily use the TSH test as a way to measure how well your thyroid gland is working. 

But there's one big problem with that...

It doesn't work nearly as well as they think and probably not nearly as well as you think. 

If you are someone who is relying SOLELY upon the TSH as a means to determine whether or not your thyroid medication is 'adequate' then you are most likely making a huge mistake. 

Today we are going to talk about just that. 

We will be covering...

  • How your thyroid medication impacts your TSH
  • Why the TSH isn't the best measure of thyroid function in your body
  • The difference between a low TSH and a suppressed TSH 
  • Why lowering your TSH is probably not a big deal in the long-term
  • And more...

Let's jump in...

Before we do, though, you need to know that this information primarily applies to people who are taking thyroid medication

It does not necessarily apply to people who have a low or suppressed TSH without using these thyroid medications. 

Conditions in which your own body suppresses your TSH naturally are considered on the hyperthyroid spectrum

This information applies to people with LOW THYROID who are ALSO taking thyroid medication. 

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. 

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

Download more free resources on this page

What is a Suppressed TSH? 

For starters, we should talk about the exact definition of a suppressed TSH.

A suppressed TSH is the thing that your doctor is so afraid of when adjusting your thyroid medication. 

In fact, I'm sure you've experienced a situation similar to this:

Your doctor increases your dose of thyroid medication only to find that your TSH went down farther than expected. 

You feel great on this new dose of thyroid medication but your doctor is worried about your health and they say that having a low TSH is dangerous they lower your dose. 

All of your symptoms are back but you are told that you are now "safe". 

Does this sound familiar?

This is pretty standard for doctors, including endocrinologists

But, as I mentioned above, there's one huge problem with this method of thinking about the TSH.

It's just flat out wrong. 

But we will get to that more later. 

Doctors are afraid of giving you too much thyroid medication because they fear that you will become "suppressed". 

This idea refers to giving you enough thyroid medication that it lowers your TSH to a point that it is no longer detectable. 

In physiologic terms, it means that your brain is no longer sending signals to your thyroid gland to produce more thyroid hormone. 

When your TSH is suppressed, you are nearly 100% reliant upon thyroid medication to provide thyroid hormone to your body and cells. 

So what's the big deal with this state?

Doctors are afraid that suppressing your TSH will cause two major conditions: 

#1. Osteoporosis. 

And #2. Atrial fibrillation.

They also believe that if your TSH is suppressed or too low that this is an indication that you are "hyperthyroid". 

As you will soon see, none of these things are really true. 

A Suppressed TSH Does NOT Always mean that your thyroid is too high

On the contrary, it's actually quite possible for you to have a suppressed TSH and still have LOW THYROID symptoms

And you probably know what I am talking about if you've ever had a suppressed TSH. 

This is quite common by the way, with studies showing that at any given time as many as 30% of thyroid patients have been suppressed at some point in their life. 

But let me ask you a question...

When you had a low or suppressed TSH did you feel hyperthyroid? Did you suddenly lose a bunch of weight or find that you were jittery or that your hands wouldn't stop shaking?

Did you experience ANY of the symptoms of hyperthyroidism? 

Or did you continue to have low thyroid symptoms such as weight gain, fatigue, hair loss, constipation, and depression

I can almost guarantee that most of you experienced more of the latter. 

natural thyroid supplements version 2

And the reason is simple:

A suppressed TSH does NOT automatically mean that you are hyperthyroid (1)!

Let me make this as clear as possible:

It's not possible for you to magically be hyperthyroid but NOT notice it. 

You CANNOT be hyperthyroid without having the symptoms of that condition. 

If you do NOT have the symptoms then you are not hyperthyroid. 

I know this topic can be confusing because I see comments from thyroid patients on a daily basis. 

They are often quite confused because they are told they are hyperthyroid, due to their TSH level, while they experience nearly every hypothyroid symptom in the book

These two things are not compatible with one another. 

You are either hypothyroid or hyperthyroid, not both, and you can only be one. 

The best way to figure this out is by looking directly at your symptoms (and a complete range of lab tests which includes more than just the TSH). 

Degrees of TSH Suppression

Another important thing for you to understand is that not all flavors of TSH suppressed are created equal!

Let me give you an example. 

Consider a thyroid patient who is taking 100mcg of levothyroxine (the weakest thyroid medication available). 

With this dose, this hypothetical person has a TSH of 0.5 and is still not feeling well. 

Now let's suppose that we increase that dose of levothyroxine up to 200mcg per day. 

This person's TSH then drops down to an unnoticeable level and they are considered to have a suppressed TSH. 

Now let's take that same person and increase their dose by another 100mcg so now they are taking a total of 300mcg per day. 

Does the TSH go any lower than it already was?

No, because it's already suppressed.

But the impact that the 300mcg of levothyroxine has on the body is different from the impact that the 200mcg dose of levothyroxine does. 

And yet we consider both of these patients in the same "category". 

You can also apply this thought experiment using other thyroid medications such as Cytomel

The point here is that you can suppress the TSH using different types of medications and doses and they are NOT all the same. 

The risks associated with suppressing a TSH with 300mcg are much higher than those associated with 200mcg. 

And the risks associated with suppressing a TSH with 200mcg of Cytomel are much higher than those associated with 100mcg of Cytomel and so on. 

There are some real POTENTIAL risks when suppressing the TSH but they are certainly not guaranteed. 

What is a Low TSH? 

This next part is very important if you are a thyroid patient. 

I spent a lot of time talking about a suppressed TSH, and there are some risks involved if you fall into that category. 

But there are virtually NO downsides and no long-term consequences to only lowering your TSH. 

But here's the problem:

Doctors are just as afraid of a low TSH as they are a suppressed TSH even though there is no evidence to suggest that a low TSH is harmful to thyroid patients. 

In fact, there's actually evidence to suggest that a LOW TSH is necessary for most thyroid patients to feel better.

The reason is complicated but has to do with the fact that the body doesn't utilize thyroid medication the same way it uses thyroid hormone produced from a healthy thyroid gland. 

So you actually need more thyroid medication for the body to use compared to what your own thyroid gland would produce naturally. 

That's a topic for another day, though!

Let me first define a low TSH for you. 

I mentioned above that a low TSH is a TSH that is suppressed or non-detectable. 

A low TSH is a detectable TSH but one that falls outside of the normal range that most lab tests provide. 

Consider this example to help this sink in:

The standard range for a TSH test is usually somewhere between 0.5 and 4.5 uIU/mL. 

Abnormal TSH kathy

A low TSH would be any TSH which falls BELOW 0.5. 

So lab tests between 0.1 and 0.5 would be considered "low" but not suppressed because you can actually measure them. 

A suppressed TSH will show up as something like <0.001 (which means that the value is less than the smallest amount detectable by the lab test). 

A low TSH is not dangerous and does not mean that your thyroid medication is too high (necessarily)

A suppressed TSH does come with some associated risks. 

For instance, there is a small risk of developing osteoporosis (2) and atrial fibrillation (3) (in certain populations). 

But there are virtually no risks involved in simply LOWERING the TSH as described above. 

Most doctors are afraid to do this, however, because they wrongly believe that a low TSH is indicative of a state of hyperthyroidism. 

We already described why that isn't true at all (in a previous section) and in fact, it may be necessary for your TSH to be low in order for you to get enough thyroid hormone in your body. 

So when your doctor lowers your thyroid medication because your TSH is too low they are doing a disservice to you on several levels. 

The first is that you might actually feel amazing on that higher dose of thyroid medication and the second is that they have tricked you into thinking what you are doing is dangerous. 

What should your TSH "goal" be?

Is it possible to find the "perfect" TSH? 

Or put another way, what should your "goal" TSH be?

Unfortunately, there is no straightforward way to answer this question. 

I've seen thousands of thyroid lab tests from thyroid patients over the last 5 years and I've seen people feel GREAT with a TSH of 3.0 and I've seen people feel GREAT with a TSH of 0.2 and everything in between. 

If you are looking at the TSH as a way to measure how well your thyroid is working then you are using this lab test in the wrong way. 

The TSH is simply a measure of how much TSH is being produced by your pituitary gland. 

It is NOT a measure of total body thyroid function nor should it be used that way. 

If you are using it this way then you are using it incorrectly. 

And I don't blame you for this, it's most likely the fault of your doctor who has drilled the importance of this relatively unimportant thyroid lab test into your head. 

So what should you do instead?

I would strongly suggest that you get a complete thyroid lab panel done whenever you order a TSH. 

When you use both the TSH and other important thyroid lab tests such as free T3 and free T4, you get a much more clear picture of what is happening in your body. 

If your doctor is ONLY ordering the TSH as a way to measure your thyroid then it may be time to find a new doctor! 

Final Thoughts

There is a big difference between a low TSH and a suppressed TSH. 

A suppressed TSH does carry with it some risks to your health but these risks are relatively small and not guaranteed in all people. 

On the other hand, a low TSH may be necessary for many thyroid patients to actually feel better. 

And this state of TSH is NOT associated with any harm to your body long-term. 

A good goal to "aim" for would be a low but not suppressed TSH while adjusting your thyroid medication,

This will allow you to not only feel better but also mitigate or eliminate any risks involved in using too much thyroid medication. 

Now I want to hear from you:

What level is your TSH currently at?

Do you have a low TSH or a suppressed TSH?

Are you experiencing any symptoms or problems? 

If so, what issues are you having?

Is your doctor willing to order more than just the TSH or do you need to get a second opinion?

Leave your questions or comments below! 

References (Click to Expand)

dangers and benefits of a low TSH vs a suppressed TSH
Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

13 thoughts on “Low TSH vs Suppressed TSH on Thyroid Medication – What you Must Know”

  1. My Wife is taking Thyroxin-100 tab single in morning and today we did her Thyroid Test and result is as below:
    1) T3,Free:FT3 Result: 2.57
    2) T4,Free:FT4 Result: 1.20
    3) TSH, Ultrasensitive Result: 4.856
    What Medicin she can take for control her thyroid with regular medicin

    Reply
  2. Total thyroidectomy. Was on 125mcg yah level was 0.30, doctor changed meds to 112mcg TSH level 0.35 (Levothyroxine) how is this even possible.

    Reply
  3. Hi Dr. Childs,

    I am on a combo of NDT and T3 and my TSH is now suppressed at 0.02. My Free T3 and T4 are still at the lower end of the lab normal reference range.

    Should I focus more on the T3 and T4 values and my symptoms over the TSH, even though my TSH is quite low? I still have hypothyroid symptoms (fatigue, constipation, difficulty maintaining weight, dry skin, hair loss). Thank you for any insight

    Reply
  4. Hi -I’ve been loving all your books, website and info you have on Hashimoto and Thyroid. I have a TSH – .03, FT4- 1.08ng/dL,
    FT3- 2.8pg/ml. I still feel a little hypothyroid symptoms- hair dry and loss, weight gain, low heart rate, etc. I don’t have any hyperthyroid symptoms. My FT4 did decrease from 1.17 to 1.08 in less than 2 months. With my TSH being suppressed, do I need to be concerned? I was thinking to increase my NDT to my FT4 and FT3 can increase? I currently take 81.25mg of naturethroid. What are your thoughts?

    Reply
    • I had some issues with Nature throid. I also was on 81.25mg and it was simply too little. I switched to NP Thyroid and felt a little more relief. Have you tried to go up by 15mg for a few weeks to see if it helps?

      Reply
  5. Hi, I’m a bit frustrated with my thyroid. I’ve been dealing with it since I was 18, diagnosed with hypothyroidism at that time and put on synthroid – which seemed to help for a little bit. I’ve always had extreme debilitating fatigue despite being on medication, but I was always in “normal” range – very frustrating as a young adult. I just turned 35 and have experienced quite a bit of a change/increase in the already debilitating fatigue. I literally will sleep all day – not exaggerating.

    My labs were retested and a significant change in my numbers were noted (haven’t had a follow up yet, I have access to results)

    Let me preface this with stating I did start an adrenal “jump start” blend from a health food store (2 weeks prior to labs).

    TSH : 0.012
    Free T4: 1.90
    Cholesterol: 236 (first time ever)

    Both LDL and triglycerides “high” : 150/ 211

    I have been feeling in an insane amount of fatigue and a 30lbs increase over the last 8 months. What do I do with this???

    I’m planning on asking for a different medication as you mentioned in previous videos, armour or similar or a T3 + armour/symthroid. Is there anything else I can suggest. I’m worried my provider will slap a statin on me and only reduce the amount of synthroid without any changes to the actual medication. What can I do about the weight gain and severe fatigue.

    I have so many questions would love to consult with you.

    -Angie

    Reply
    • I think you should change Drs and get your Free T3 levels tested. I had a T4 level of 1.6 and my TSH had really dropped from 1.4 down to .74 for the first time ever yet my FT3 levels were at an all time low. Having higher levels of T4 isn’t necessarily going to help you if you’re not converting it. I was undiagnosed for a decade and my problems also started in my late teens and I started having problems with my thyroid meds around 36. I’m now 40. I’d have crushing fatigue and days when I couldn’t get out of bed. Since getting some direct T3 I haven’t had any mystery crashes.

      Reply
  6. I know I’ve probably commented about this on one of your other blogs but yes I’ve had to change my thinking when it comes to TSH. My first endo wanted my TSH closer to 1. My GP ordered TSH, FT3, FT4 and Total T3, not that he knew what to do with it all, as long as it fell with in “normal” limits. Most of my thyroid treatment has put my TSH in the mid 1 range sometimes close to 1.8 and other times 1.3, with FT4 ranging around 1.6-1.8. FT3 used to be around 3.5 to 3.8. My point is that I had a higher TSH but I didn’t feel hypo until the FT3 dropped. On NDT I didn’t feel hyper until my TSH was suppressed to 0.05. I was having symptoms like overheated tasks were difficult due to being hyper. At that point I didn’t need my TSH to tell me it was too much! However, looking back now to when I was on Levo only and my FT3 was optimal yet my Total T3 was always a low normal like 89 and I was having some hypo symptoms. My TSH did range on the higher side.

    Reply
    • also, after my partial thyroidectomy I didn’t take meds for two years and lived a normal life. I took ballroom lessons and even hiked around Europe, at that time my TSH was 5! The only symptom I had was slight fatigue, however I was thin as could be. I only got on meds because I was afraid I’d end up with another adenoma and lose the other side.

      Reply
  7. I’m still confused. I’ve been reading a number of your articles and so much of it makes sense. But I’m failing to find a response from you about really LOW TSH paired with LOW FT4 and FT3 on lower end of range.

    TSH 0.045
    FT4 0.75
    FT3 2.8
    (RT3 not measured in this lab but last time it was “low” at 8.4)
    *These values have been similar for several months now.

    From what you are saying above, my TSH is pretty much suppressed at 0.045. Can I still safely increase my med dosage? or should I be looking at a Pituitary problem. I’m on NP Thyroid 120mg daily (split dose).

    My doc is concerned that the FT4 and FT3 aren’t getting any higher after months of med support, and TSH is so low.

    Context: 43 years, female, Hashimotos, hypo symptoms, possibly adrenal symptoms, TPO antibodies have gone from 518 to 394, thyroglobulin high at 46.

    Also – Would low iron stores have anything to do with this?

    My fingers are crossed that you’ll answer! Thanks in advance!

    Anna

    Reply

Leave a Comment

Item added to cart.
0 items - $0.00
shares