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. 

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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

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 45,000+ people have used them over the last 4.5 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

85 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
    • The tests are not perfect and never have been. Also, many things can interfere with lab testing including supplements, the time of day that you take it, illness, etc.

      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
  8. Hi, I had my thyroid totally removed in 2014………I have been on Armour thyroid since then…….In August 2020 my tsh was at 3.66 and is now at 1.55 and my free t4 is at 1…….was just recently put on Trazodone which is an anti depressant medication…….I feel as though I have hyperthyroidism……..didn’t know if I’m still hypo or now hyper……once the thyroid is removed will I always be hypo no matter my tsh levels or will I become hyper?

    Reply
    • Hi Susan,

      You can always become hyperthyroid if you take too much medicine but that is very rare as most people are underdosed. Once your thyroid is removed it’s better to think of yourself as hypothyroid due to these reasons.

      Reply
      • Hi, I had thyroid bloodwork done again yesterday……..My TSH is now 2.80 my Free T4 is still at 1 and my Total T3 is at 180………still having hyperthyroid symptoms……..could this be due to the Total T3 levels?

        Reply
  9. Dr. Childs:
    I had a total thyroidectomy in 6/25/20, after a hyperthyroid condition resulting from a severe thyroid infection that left the thyroid gland toxic. I am on Synthroid 100 mcg/day. We cannot seem to raise my FT3 with latest lab. results TSH=0.18, FT3=2.4, Ft4=1.63. I am taking your thyroid essentials (3 months) now. Is there any way to increase FT3 into optimal range without TSH becoming suppressed? Would a supplement of liothyronine be possible or perhaps change to Armour? Please reply

    Reply
  10. I’ve got a large thyroid per US. You can see it just looking at me. Sister with Hashimoto’s. I’ve got same sx (cold intolerance, sluggish, difficulty losing weight, dry skin, constipation, etc)But my TSH is usually 2-2.5, TPO ab negative, FT3 3. My doc wants me at 4. But now even on 90 mg of NDT my T3 is still only 3.4 and I am so symptomatic—even more weight gain, low energy—even with active lifestyle and regular exercise including cardio, good diet. Perplexed as to why I’m feeling worse.

    Reply
  11. Hello, I have spoken with two doctors her in Scottsdale, AZ with 2 different answers to the TSH versus FT3/FT4. My TSH was 6.5 with abnormally low FT3 & FT4. Now on Liothyronine 50 mcgs. & Tirosint 100 mgs. FT3 is 2.7 and FT4 is .6 with suppressed TSH less than 0.01. RT3 is 15 and no antibodies. This has been going on for 7 years. I have symptoms of hypo still. One doc said I’m over medicated because of the suppressed TSH, so I cut the Lio to 40 mcgs. and started having hypo symptoms of severe hair loss, weight gain, puffy face, etc. It only dropped my FT3 to 2.6 and did nothing to TSH (still suppressed). Any suggestions, as the doctors I see in Arizona don’t even agree with each other. I have absolutely NO symptoms of hyper at all whatsoever, only hypo. When I try to drop to lower doses my symptoms are horrible for hypo. I feel I even need more Lio but was told that was crazy.

    Reply
    • Your reverse T3 is high, you might have to clear it to go forward. Some patients call this pooling, but it’s in medical literature as tissue hypothyroidism.

      Reply
  12. Hello Dr Childs,
    When does one look for a pituitary problem with a suppressed tsh? Mine is suppressed but always has been even when diagnosed hypo. Dexa scan was a 2 .4…2.5 is osteoporosis. I’m concerned!

    Reply
    • Hi Lori,

      If you are taking thyroid medication then your dose would probably explain the issue. If not, then you could look at pituitary function.

      Reply
  13. When first tested my Thyroid…..My TSH was normal, my Free T 4 was normal, but my Free T3 was a little low…..after first taking the Cytomel 25Mcg for 6 weeks, I had high Free T 3 and my T4 went lower, I lowered the Cytomel medication, it seems after a year of lowering or raising my Cytomel medication, my T4 levels go lower and lower. My T3 is either too high or too low.

    What should I do? Do I really need medication? Or was it the tooth infection I had at the time of my Low Free T 3 test, that gave me the Low Free T3 in the beginning. I also exercise a couple hours a day, I am very athletic. Does that have anything to do with my Free T 3 labs?

    Can I take no medication for a month and see where my levels go? I already have osteoporosis.
    I want a plan to get off that medication.
    Thank you Doc.

    Reply
  14. Hello,

    I had Graves disease 40 years ago and had RIA. It has been a battle ever since. My thyroid was suppressed for about two years and a Naturalist Endo lowered my meds to 30mg of naturethroid. I had a TSH of 13 after that. They gradually increased my meds as I have AFIB. I am now on 90MG of NP Thyroid. My TSH is 0.063 T3 2.44 T4 1.04. So now they want to lower the meds again. Yet I still haven’t lost the weight I put on when they made me hypo. I’m so frustrated with this whole thing. I was seeing them through telemed but recently our state laws changed on Florida and I can no longer use them. I need some advice.

    Reply
  15. Would you suggest that cholesterol, A1C, and lipid panel be done when evaluating thyroid function? I read (in your blog?) that high cholesterol can be a sign of hypothyroidism. My thyroid is in normal range and I take generic Synthroid and generic Cytomel. I have some circulation symptoms, very cold hands and feet. Also, I get more colds and have allergy symptoms when my thyroid medication is too low, which I think it is. I an conditionally thin and at age 68 have arrhythmia; however, I don’t feel those are a result of my thyroid medication. I don’t believe I am hyperthyroid as I am not shakey, not nervous or agitated. I moved and will be meeting with new endocrinologist soon. Should I request the cholesterol levels and advocate for small increase in my low thyroid medication?

    Reply
  16. My recent TSH was .01 and free T4 1.4
    triglycerides 187 HDL 155 LDL 118 Cholesterol 190 A1C 5.8
    Dr would not order free T3 or reverse T3 or T4
    I was on Levothyroxine 100 mcg and Cytomel 12.5
    Earlier in year I was on Levo at 125 mcg and cytomel 25. Had heart racing at night but otherwise felt pretty good ie functional energy level. Cannot lose wt hair falling out splitting nails and very dry skin.
    Dr is very concerned about low TSH. On my own a few days ago I increased Levo to 125mcg and no Cytomel. Cant evaluate if any improvement this early. I’m 74 and had COVID late Dec with lingering fatigue. Will it hurt to increase Levo higher than 125 mcg? Does Cytomel help or hinder? Incidentally the increased Levo and added Cytomel were ordered by a naturopath who wasn’t concerned so much about lab but how I felt. Bad news he died last May and I’m back to arguing with FP.

    Reply
  17. Hi! I have a suppressed thyroid as I am on 45mcg of armour and dosed cytomel at 25 mcg in the morning and 15 mcg in the afternoon. My tsh is .006 but my free t4 is low at .54. My free t3 is also on the lower side at 2.7.
    I still feel tired, depressed, have some weight gain and occasional arm aching. I also have Hashimotos. Could low t4 be causing me problems and should that be raised to be in range ? And how what medication would make that happen? Help!

    Reply
  18. So I take np thyroid 1.25 grain. I also take 1/4 of liothyronine both 1x/day. I get my labs early am before meds or breakfast.
    Results: free t4. – .77
    free t3. – 2.2
    Tsh – .743
    Tpo. – 184
    Rt3. – 9.0
    My iodine is 22.1.
    I feel joint pain and have very dry skin and I am off and on tired. I do have Lyme as well, so sometimes I’m not sure what the symptoms are from.

    Also my shbg is high. I take replacement hormones for menopause too.

    I’m a little nervous to take more thyroid hormone but know I need to do something. Any recommendations??

    Reply
  19. Dr. Childs, I have Hashimoto’s Thyroiditis and Secondary Hypothyroidism. On the later, I am told this results in low TSH (mine results vary from .009 to 0.02) while my latest FT4 and FT3 results are 20.25 and 4.80 respectively. I am on Levothyroxine 137.5 and Cytomel 10mcg. I suggested taking Cytomel to increase my FT3 and perhaps lower my Cholesterol and my doctor was agreeable. I still have a Cholesterol of around 240 which has not changed appreciably with my thyroid medication and have tried different food restrictions (no dairy, gluten free, no eggs) to try and reduce it but it seems stuck at that level. My diet is very good with little to no processed or fried foods and minimal sugar intake (no sugary drinks at all) although I’ve a bit of an ice cream fetish but am disciplined. I am 175 pounds and 6’0″ so weight does not seem to be an issue. Any way I can get my cholesterol lower and even my LDL? Thank you, Bob

    Reply
  20. Hi Dr Childs

    Gayle from Australia (have posted before). Thyroid surgery in my teens (70s) (Graves Disease) – triggered I believe by being over-medicated with iodine in late primary school and through food sources. Appalling follow-up.. by the time I diagnosed myself 4 years later, had myxedema.

    Since being put on thyroxine/levothyroxine my TSH has been below zero. It remains at 0.01 no matter how hypothyroid I have been or how much my Free T4 and Free T3 alter. Doctors used to panic of course and reduce my medication, resulting in my becoming very hypothyroid and unwell – eventually I stopped taking that advice.

    It has taken me a lifetime to find a well-informed doctor – fortunately who thinks exactly the same way that you do! I have finally (after many years of asking) been put on Tertroxin (Liothyronine) 20mcg, in combination at the moment with 100mcg Levothyroxine (reducing the amount I was taking). My reverse T3 was the highest my doctor has ever seen in his life. It has started going down and I am feeling a lot better.

    My TSH is still 0.01. Is 0.01 suppressed? I have no concerning symptoms and am certainly not hyperthyroid. My doctor is not concerned about it (which makes a change).

    (Can I just say too that I am deeply sorry to see on the news the terrible time the US is experiencing.)

    Reply
  21. Thank you for this distinction! I appreciate the way you clarify these crazy complicated issues.

    I would like to mention that osteoporosis can be from other causes too–hyperparathyroidism, for instance. So if your serum calcium is repeatedly over 10, even if it is in normal range, ask to have your parathyroid (PTH) tested. My doctor was always blaming my thyroid dose, but when we finally tested my parathyroid levels they were high.

    Reply
    • Hi JS,

      Agreed. The mantra from your doctor will be that a low TSH results in bone loss and heart problems but it’s not always as clear cut as it may seem.

      Reply
  22. My blood test given to me by my pc was 0.20 my T4 free was 1.2. I was then sent to see an Endocrinologist. Then another time it was 0.21. Then, I started Tapazole and it went up to 0.32. MyT4 was 1.1. At that time my RDW went up to 15.5 , which I was told was ok, it should was in the red zone on my bloodwork. Then up to 0.62 T4 free 1.0. I kinda stopped taking it just because I shoved it somewhere and forgot all about it went down to 0.37 but T4 free was 1.0. Now I’m on it consistently and it up to 1.74 and my T4 free is 1.0. Then after quite sometime on this med I was told I have Graves’ Disease. In my younger days I was super slim (size 0 or 1). Up until I hit 42 I started to put on weight a little more all the time. Now I’m 57 and a big girl. I had no other symptoms other than weight gain brittle hair. My Dr said the brittle hair and hair loss had nothing to do with my thyroid. I do have Osteoporosis as well as High Cholesterol, and prediabetes.

    Reply
  23. Hello Dr. Childs and all,
    I’ve been reading your posts but so far this one for me is one of the best. Now I got the difference between low and suppressed. As you mentioned very clearly I’m one of this patients that has a low or (now last blood work) suppressed and not having any hyper symptoms. And I’ve never seem my TSH on the “range” and I’m feeling well or not having any other symptoms. There’s no way for me to have optimal levels of FT4 and FT3 (never had) and a TSH “on the range”. I still have symptoms and hair fall although I think it’s getting a bit better but hair never stop falling. I wonder if it is because my FT3 in not optimal. I’m also peri menopausal what does not help. But honestly I think it’s a t3 issue, once looking back I’ve never had a optimal ft3. I’m trying to increase the T3 slowly and see if it will work. Thank you for you website

    Reply
  24. My TSH has been low for at least 10 years. Dr’s say I am hyperthyroid. I have 3 nodules Stable and have not grown in 5 years. My sypmtoms are hypothyroid. I have gained 30lbs, so tired, cold alot, feet and hands cold, slight hairloss, dry skin, lack of motivation, apathy, memory problems, numb and dry lips, some brain fog. I do not feel hyper. I have been to many Dr’s, all say the samething. So I do not dare try things for hypo. This was last blood work.
    Range
    TSH .203 ulu/ml .380-5.330
    FT3 2.97 pg/ml 2.-4.40
    RT3 20. ng/dl 9.-27
    FT4 1.06 ng/dl .93-1.70
    TPO <9.0 iu/ml

    Look forward to your opinion!

    Thanks!

    Reply
  25. Dr Childs
    Thank you for this site and the information you provide. I was totally sure I was hypo with all the symptoms I am having.
    T4 1.13
    T3 3.83
    TSH 0.022 ( prior test 0.001)
    TSI <89

    After Nuclear Test was put on methimazole 10 mg for 30 days. Now 5 mg once a day. I have been taking for about 45 days. I do have some days I feel better. But still no weight loss seems it just stopped when I hit the 0.001.
    I am just confused that I am hyper not hypo with my symptoms.
    What do you think about the numbers?
    Thank you

    Reply
  26. I am on NDT and have been for the past eight years. After struggling for years with lots of hypo symptoms on levothyroxine to have an in-range TSH, I found a doctor who put me on NDT and allowed me to raise the dose until my SYMPTOMS resolved. Once they did, my TSH had dropped to below 0.01 where it has stayed. I never had a single hyper symptom. My doctor is obviously unique because he told me that TSH suppression the standard treatment goal in thyroid cancer patients, so if it´s not dangerous for them why would it be for someone with end-stage Hashimoto´s totally dependent on exogenous thyroid hormone…?!

    Reply
    • Hi Anna,

      I tend to agree with the logic but it’s still a good idea to keep an eye on bone density and cardiovascular function!

      Reply
  27. I have a supressed TSH – am taking a combination T4 + T3 medication. However, I feel really good on the medication – I am no longer extremely tired, although my other symptoms remain. My ft3 and ft4 within two hours of taking the medication are also relatively high but according to my doctor this is normal directly after taking the medication. I am now worried that I am doing harm to my body but like I said – I experience no symptoms of an overactive thyroid – do I lower my dosage to decrease the risk of osteoporosis?

    Reply
    • Hi Marie,

      It would be a good idea to get a DEXA scan to see if you need to worry about osteoporosis before making any changes 🙂

      Reply
  28. Hi
    Yes, all this is great info, but you overestimate the ability of people in the UK to determine what tests they get done. That is determined by the GP and there are very very few who will test for anything else other than TSH. And your comment about getting a new GP – this won’t necessarily solve the problem, as virtually ALL GPS in the UK agree that they only need to test TSH. It would be useful if you could provide some clinical evidence (i.e. studies in respected peer reviewed journals) that I could show my GP to back up what you’re saying. Thanks

    Reply
    • Hi Barbara,

      You could get a private doctor 🙂 You’ll find plenty of people here who have used private doctors with variable success in the UK. Also, you can download my PDF list of clinical studies to take to your doctor here if you wish to go that route: https://www.restartmed.com/start-here/

      I’m told that the doctors in the UK are particularly obstinate, however, so the use of clinical studies may provide little help. Usually, it’s better and easier to just pay out of pocket or find a new doctor entirely. The chances of your doctor “seeing the light” exist but tend to be slim.

      Reply
    • Hi Barbara, I feel your frustration as I am in Ireland and equally difficult to find a good Doctor for Thyroid. Your best bet is to go to https://thyroiduk.org and request a list of practitioners in your area, I found a wonderful functional Thyroid specialist in Ireland through them after 20 years of misery. You can also get a better range of blood tests here https://medichecks.com/collections/thyroid. I hope this helps and Best of luck with it all.

      Reply
  29. I’ve needed levothyroxine for 40 years. For over 5 years I’ve been adjusted to 200 mcg per day. A new doctor decided my TSH was too low and my total thyroxine T4 so high that I was being overdosed, so reduced levothyroxine tablets to 175 mcg per day. I showed absolutely no symptoms of being hyperthyroidal, though. After 3 months shoulder pain started so couldn’t use a knife and fork or dress without great pain. The doctor believed T4 was the main thyroid hormone and knew nothing of T3 or T4 to T3 conversion. Got worst constipation ever.
    Persuaded doctor to return dosage to 200 mcg/day. She says Coventry hospital’s lab doesn’t do FT3 tests. I think the basic problem is the doctor’s lack of knowledge, and totally relies on lab tests, rather than listening to how patient feels. I am now getting back to my previous good health. All this ignorance despite levothyroxine being the 3rd most widely prescribed medication in the UK!

    Reply
    • Hi David,

      Unfortunately, this seems to be the norm right now. I’m hopeful it will change in the coming decade, though.

      Reply
  30. First of all; thank you for all your information! WE NEED MORE DOCTORS LIKE YOU!!
    I have printed out this one about low TSH to give to my doctor. Almost every doctor here in Norway should learn about this!! Many thyroid patiens would have a better life, only by not having to fight with their doctor!
    My TSH has almost always been low, but I don`t care as long as I FEEL alright.
    My TSH is between 0,001 and 0,002, T4 round 10/11 – and T3 5,5 to 6,0. The most important test for me is my T3 level.
    I take my medication at bedtime, and my vitamins/minerals in the morning.
    Since I started taking 20 mcg T3 in addition to 45 mg Armour two years ago, I have got my life back! I feel just fine now!!!
    …. and I have been struggeling the last 25 years.

    Yours sincerely,
    Britt Fremstad, Norway

    Reply
  31. TSH – 0.25 (0.27 – 4.2)
    T4 – 17.6 (12 – 22)
    T3 4.6 (3.1 – 6.8)

    My GP tried to lower my Levo but I refused and my Endo told the GP to leave my Levo where it is. I don’t feel hyper and still have hypo symptoms.

    Reply
  32. Hi Dr. Childs:

    I have been dealing with Hypothyroidism for over 30 years. My GP tried hard to help me, but only looked at results of bloodwork. He sent me to an Endocrinologist and I just feel she doesn’t have the knowledge about what Hypo patients deal with. She did add Liothyronine SOD 5 mcg 2xs a day along with my Levothroxine 75 mcg 6 days per week and 1.2 tablet once a week. At first the addition to the T3 helped alot, but in the last 3 yrs I have gained another 20 lbs. Here are my last test results in
    July 2020:
    TSH – 0.70
    Free T4 – 0.8
    FT3 – 267

    February 2020:
    TSH – 0.53
    Free T4 – 0.8
    FT3 – 353

    September 2019:
    TSH – 0.14
    Free T4 – 1.0
    FT3 – 283

    Thank in advance for any advice your have! ‘
    Lisa

    Reply
  33. Hi Dr. Childs, after THYROIDECTOMY for the beginning of graves (was Lon. 25mg for 9 years, then had graves symptoms, and choose surgery). My TSH has been .001 since surgery. I am taking cytomel 20mg and 100 thyroxine, and feel; pretty good. But many docs say its not ok. I am in Germany too, so get frustrated with people just looking at TSH. It has been 2.5 years since my surgery and it is the same. I am 51, end of menopause as well. Any advice?

    Reply
    • Hi Jennifer,

      Many doctors prefer to suppress the TSH post thyroidectomy for thyroid cancer and view the risks vs benefits to be favorable in this situation. While your situation is different the idea that the risks vs the benefits may be favorable still may apply.

      Reply
  34. How does high cortisol morning, afternoon and night time affect the function of Thyroid meds? Also if you are taking too much thyroid meds shouldn’t your FT3 and FT4 be too high?? I have suppressed TSH but low free T3 and T4, no Hashimoto. Current symptoms are insomnia, fatigue, shakiness, weakness, hair loss, constipation and brain fog. When increasing the meds a while ago I developed heart palpitations and shortness of breath.

    Reply
    • Hi Susanne,

      I rarely ever see elevated free T4 levels from levothyroxine. Though it can happen to free T3 levels with T3 medications such as liothyronine.

      Reply
      • Thank you and if you have any thoughts on how high cortisol affects how the body absorbs thyroid meds I would deeply appreciate it.
        Thank you so much for your time.

        Reply
  35. I had a total thyroidectomy 10 years ago. After many poor experiences with GPs and Endo’s, I now self treat. It’s the only way I’ve been able to get to feeling even close to normal again. Started having RT3 issues with all the reformulations and changes in NDT, so 6 months ago I switched to straight T3. I started out slow, and increased incrementally. I am currently up to 75 mcg of Cynomel (mexican) a day. I do feel much better, but still have a few nagging hypo symptoms. I plan to increase just a little more (starting with 1/2 of a 25mcg pill) to try to get rid of remaining symptoms, and then test again.

    The ONLY times I have ever felt really good again (post thyroidectomy) were when my TSH was fully suppressed. What I want to know is: if I continue keeping it suppressed in order to feel human and have a good quality of life:

    HOW do I detect when it might be causing issues with Osteoporosis or Atrial fibrillation (without expensive testing I don’t have access to – just the basic labs I can order myself)?

    AND most importantly – if either of these conditions do become an issue – WHAT CAN I DO TO COUNTERACT IT WITHOUT LOWERING MY MEDS AND FEELING CRAPPY AGAIN?

    If you’re going to warn us about the possibility of these becoming issues with suppressed TSH, I feel it is important that you should also offer us some alternative solutions (other than not suppressing TSH) as well.

    Reply
    • Hi Julie,

      It’s always a game of risks vs rewards. Do the benefits of suppressing your TSH outweigh the potential downsides in your specific situation? If yes, then you can continue doing it while keeping an eye on your bone density and cardiac function. A DEXA scan and an EKG will do the trick in checking for both.

      Reply
  36. Hi Dr. Childs,
    I have Hashi’s and am on Synthroid and Cytomel. My TSH goes between low and suppressed and my FT3 and FT4 are both low. I have every EXTREME symptom of hypo and absolutely no signs of hyper. In fact, I had the best visit with cardiologist in years and have low temp., HR and BP. My primary sent me to Endo who insisted I was hyper and she wanted to take me off all meds! My primary is now afraid to treat me, since Endo said he is doing me harm. I fired the Endo and am seeing a new integrative doc on Thursday. I appreciate this post, as this scenario is rarely discussed and I know that many others suffer greatly as I have been for years. I have never felt so unwell in my life! Feeling such despair and am hoping that new doc will be able to help me become optimal. Thanks, again for post. Please wish me luck!

    Reply
    • Hi Diane,

      Well, if you really wanted to increase your TSH all you need to do is lower your dose of NP thyroid. But whether or not that makes sense in your situation is a different question entirely!

      Reply
      • Thank you, Dr Childs. I may try to lower it since I believe my dose is too high and need to supplement with an adaptogenic like ashwaganda.

        Reply
  37. Hi, my current doc wont check all my labs, just wont do it. I only have 3 labs they’ll check. My TSH in Aug was 1.67, this week it was 2.92, My FREE T4 in August was 0.75, and this week it was 0.80. And my TPOab in August was 13 iu/mL and this week it was 18 iu/mL. That’s it! I even stopped everything a week before these labs, including all of the supplements of yours that I take. So frustrating. Still on the hunt for a new doc. Thanks for your input & all you put out to educate us!

    Reply
  38. My TSH was 4.98 ui/ml, T3 was 4.9 pg/ml, T4 was 0.81 ng/dl. Endo put me on 137 mcg of Synthroid. I don’t understand how T3 and TSH are both high – that seems contradicting. Also, one thing to mention, high dose of biotin has totally messed up my thyroid panels, so be aware if your taking this supplement to go off of it for at least 3 days before blood work. I still don’t know what’s going on with my thyroid, but continue to not feel well and gaining weight like crazy.

    Reply
  39. Previously had Graves, entered trial to see if they could measure, weigh etc individuals to give exact amount of radioactive Iodine to achieve euthyroid state. It didn’t work and now hypothyroid for past 20 years. One size definitely does not fit all. Twenty years ago I kept asking my doctor to adjust my thyroxine but he refused saying TSH within normal range. Normal range back then was anywhere from 1.5 to 6.0. At 4.2 I was barely functioning. I found another doctor who was willing to work with me and we developed a diary and started experimenting with levels of medication, noting how I felt. I am optimal in the range 0.5-1.5, anything above that and I am lethargic, emotional, depressed and my kidney function goes down. Yes, that’s right. I recently had a full blood test which showed my kidney function low at 55 mL/min/1.73m2. When I looked at my TSH it was 2.8 mIU/L FT3 4.6 pmol/L FT4 18 pmol/L (normal) Reverse T3 582 pmol/L which doesn’t make sense as I FT4 is not high. Ignoring Reverse T3 it is more important I address my current symptoms and improve kidney function. So I have increased thyroxin slightly from 100 mcg to 125mcg p/d (dr trusts me to do this myself) and will get retest in 4 week. My emotions, energy levels back to normal and depression and lethargy gone. The retest for estimated glomuler filtration rate for my kidneys will be of interest.

    Reply
  40. Hi Dr Childs, for me to have a readable TSH means heavy hypo-symptoms. As soon as I add T3 in any form, my TSH plummets. I have to choose between being hypo and really sick – with a readable TSH OR suppressed TSH and feeling much better. A difficult choise – NO 🙂

    Reply
  41. Hi Dr childs,
    Recently i did thyroid test. Which shows TSH is 11.93.
    I never took any thyroid medication before. Could you please advice me what should I do to lower my TSH.

    Reply
  42. Hello. I had my thyroid removed 6 mos ago because of medullary thyroid cancer (it was not due to hereditary reasons) My levels were just 2.5 for T3. TSH was at 0.198 and my T4 was 1.02. I am on .88 of levo and .5 of liothyronine for the T3 levels. I feel pretty good at these levels. My Dr now wants to lower my levothyroxine to .88 only 6 days a week instead of 7 days because she thinks my TSH is too low…? (Which the low number really means it’s high & she’s afraid I will become hyperthyroid instead. She said that because of the type of cancer I had (medullary) we don’t want my Tsh to be too low of a number. Does this make sense? Any feedback would be greatly appreciated:)

    Reply
  43. Aloha,
    I am currently taking 137mcg of levothyroxine and 25mcg of cytomel. I finally am feeling “normal” in my own body. I am able to maintain my weight. My hair loss has slowed. I sleep well at night (still maybe a bit too much) and my anxiety has subsided. My TSH fluctuates between .2-.1. My only concern is that I do have a constant tremble in my hands. Minimal in the left but more so in the right. Should I be concerned at this point? I’m not sure it is related to my medications or just a coincidence. Like I mentioned above, otherwise, I feel good…finally.

    Reply
    • Hi Melinda,

      The tremor in the hands could be an indication that you are taking too much. It would be a good idea to check your thyroid hormone levels including free T3.

      Reply
      • Thank you, Dr. Childs. The last labs I had done were the ones I included above. My Free T3 at that point was at 2.8. From what I recall, the optimal range is between 3.8-4.4. This number seems to be “lower” than this range. Is the Free T3 the biggest factor when it comes to hand tremors or overall number combined?

        Reply
  44. I have had fluctuating thyroid for years. I feel best at the low end of the range and actually feel best under 1. My doctor lets me stay at the low end and adjusts dosage I felt the best when it was 2.8 but she changed the dose and it went to 1.8. I am having it retested next week. If I hit 3 I know it for sure because I have severe symptoms. I did not have hyperthyroid symptoms when the TSH was .28. I have had all the thyroid tests at least three times and they have been okay so they just do the TSH.

    Reply
  45. Last TSH test was 0.054 and taking 112 mg Synthroid. I never feel good…always tired…had Hyperthyroidism/Graves disease and Radioactive Iodine for thyroid leaving me Hypo 12 years ago…my body does not tolerate hormones, but ended up with Synthroid to live.

    Reply
  46. My last results were FT3 :3.1, FT4: 1.52, TSH < 0.01

    I have had a suppressed TSH for years,( less than 0.01) and at one time was taking 25 or even 50 mcg of Cytomel, but felt fine. Usually have FT3 in upper quadrant, and FT4 about where it is. don’t feel that great, with 90/50 BP in am, temp in hi 96’s, but told the usual that I’ll get osteoporosis etc. Thing is, I take 175 T4, and 15mcg T3, and endo. wants to STOP all thyroid meds cold turkey!

    Reply
    • Hi Tina,

      Just keep an eye on your bone mass with periodic DEXA scans. It’s not likely to just sneak up on you if you watch for it 🙂

      Reply

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