What Your Low TSH Means With Thyroid Medication & Without

What Your Low TSH Means With Thyroid Medication & Without

Would it surprise you to know that you can have a low TSH but still be hypothyroid? 

This situation is not uncommon and may be occurring in your body right now. 

On the flip side, a low TSH can also be an indicator of hyperthyroidism. 

Your TSH can be a helpful tool in evaluating thyroid function in the body but it certainly isn't the only tool (and it isn't even the best). 

This article will help you understand how to evaluate your TSH, what causes a low TSH, and what it means if you have a low TSH while taking thyroid medication: 


What Does your TSH Actually Mean?

First things first. 

We need to talk about what your TSH actually is and what causes it to change. 

Once we discuss these things it will be easier to understand the more complex aspects of this hormone. 

But first, let's start with some basics: 

TSH, which stands for thyroid stimulating hormone, is a hormone secreted by your pituitary gland and is a part of your endocrine system

the pituitary gland produces TSH

As the image above shows, TSH is only a part of the entire thyroid regulatory system. 

It's supposed to target your thyroid gland directly which results in the production of thyroid hormone (both T3 and T4) from the gland.

Basically, it does exactly as its name suggests: stimulates thyroid hormone from the thyroid gland.

So, why is this important?

If your TSH is low then it will not be stimulating your thyroid gland and you will have low levels of circulating thyroid hormone. 

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

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3 Main Causes of Low TSH

Now that you understand what the TSH does in the body we can discuss conditions which may cause your TSH to be lower than normal. 

When evaluating your TSH there are 3 primary conditions that can alter your TSH and lead to a low TSH: 

#1. Too much thyroid production (Endogenous Hyperthyroidism)

The most common cause of a low TSH is from the condition known as hyperthyroidism. 

Hyperthyroidism is a medical condition which causes abnormal production of thyroid hormone that exists outside of the normal feedback loops meant to protect this from happening. 

The most common cause of this condition is the autoimmune Graves' disease and is probably the main reason that you may experience a low TSH (1). 

If your body produces too much thyroid hormone then that thyroid hormone will feedback to your brain and it will naturally respond by reducing the TSH to try and protect against too much thyroid hormone. 

Identifying a low TSH caused by hyperthyroidism is quite easy because the TSH will be low and the free T3 will often be high (2).

In addition, you might also see the presence of thyroid stimulating immunoglobulin in the bloodstream. 

We won't focus too much on this today because the diagnosis and management of hyperthyroidism are relatively easy compared to the other conditions we will discuss. 

#2. Too much thyroid medication (Exogenous Hyperthyroidism)

Another increasingly common condition which may lead to a low TSH is from the use of prescription thyroid medications. 

If you take thyroid medication by mouth, it will be absorbed by the gastrointestinal tract and hit your bloodstream. 

From there it will circulate to your brain where it will tell your body to produce less TSH. 

As you take thyroid medication you are effectively shutting off the normal feedback loop which exists to produce thyroid hormone because your body doesn't need to produce it anymore. 

This is both a good and a bad thing. 

Good if your thyroid can't produce thyroid hormone, and bad because it can make interpreting your thyroid lab tests more confusing as you shut off the normal production of thyroid hormone. 

Even as you take thyroid medication your body will still be able to produce some natural thyroid hormone, but this amount will slowly decrease as you increase the amount of thyroid medication that you are taking. 

The idea that taking thyroid medication drops the TSH is incredibly important because it's how many Doctors determine if your dose is 'sufficient'. 

The problem with this approach is that newer studies have shown that the TSH doesn't always do a good job at predicting if you have enough thyroid hormone (3) in your body and that is one of the major reasons I am writing about this topic. 

T4 medication cannot acheive normal free T3 levels in patients without a thyroid

People who have a low TSH from taking thyroid medication may have low, normal, or high free T3/free T4 which differentiates this condition from low TSH (4) caused by overproduction of the body. 

Also, those with this condition may have variable symptoms ranging from those of hyperthyroidism to those of hypothyroidism. 

#3. Not Enough Production of TSH From the Pituitary Gland

Another reason you may have a low TSH is due to issues directly related to the pituitary gland itself (5). 

If your pituitary gland is unable to produce TSH then obviously your levels will fall because your body can't get it anywhere else. 

This condition will always result in both a decrease in TSH and a decrease in circulating thyroid hormones and it's best to think of this condition on the hypothyroid spectrum. 

Emerging information is also showing us that the pituitary gland and hypothalamus are increasingly sensitive to environmental triggers such as the foods that you eat and your weight. 

Both of these conditions can alter the amount of TSH and TRH that your brain is capable of producing which will then impact your free thyroid hormones. 

Consider this example:

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If you are someone who is under a significant amount of stress and you are a frequent dieter (both conditions known to lower the TSH and TRH) your TSH may be falsely low which will reduce 

If you didn't understand that a low TSH could be caused by stress and diet you might be inclined to believe that your thyroid is perfectly normal, even though it isn't. 

For this reason, and many others, it's important to have a complete understanding of conditions which impact the TSH and how they present. 

You can learn more about the way that each of these conditions, how they impact TSH and cause different symptoms here.

Using TSH to Diagnose Thyroid Problems

It may surprise you to know that there are no fewer than 5 different blood tests that you can run on your thyroid. 

Despite this, doctors tend to order only one of those tests. 

In fact, the current paradigm of thyroid treatment places a considerable amount of weight on this single test (6). 

In other words: 

Doctors use this test as a surrogate marker to evaluate thyroid function in your entire body. 

We will talk about why that isn't necessarily a good thing in a moment, but we need to stay on track.

So how does your TSH level alter your thyroid hormone?

This part can be a little confusing but I'm going to try and explain it in a way that makes sense. 

Assuming that you are not taking thyroid medication (this assumption is very important) a high TSH usually indicates that you are not producing enough thyroid hormone.

I know what you're thinking...

How can a high TSH mean that I have low thyroid hormone if TSH is supposed to make my thyroid gland produce more thyroid?

In order to understand this question, you have to understand the concept of feedback loops in the body. 

A feedback loop is designed to manage the concentrations of hormones in your body by telling your body to reduce or increase certain hormones based on specific signals. 

T3 hormone feedback loop and impact on TSH

In this case, thyroid hormones which are released from the thyroid circle back to your brain and tell your body that you have 'enough'. 

Your body then reacts by adjusting the TSH. 

If your TSH is high, it means that there is a low amount of thyroid hormone in the bloodstream which is coming into contact with your brain. 

If the concentration of thyroid hormone is low in the serum then your body will react by increasing TSH to try and force the thyroid to produce more thyroid hormone

The opposite is true when you have too much thyroid hormone in your body. 

As thyroid hormone increases (either because you are taking thyroid medication or because your body is producing it), your brain will react by lowering the TSH to try and reduce the stimulation of the thyroid gland. 

This is how a low TSH is often associated with hyperthyroidism and how a high TSH is often associated with hypothyroidism.

Instances Where the TSH can be Misleading

And, if this wasn't confusing enough, it gets even more interesting. 

Just because your TSH is low doesn't mean that your body is getting enough thyroid hormone. 

We often associate a low TSH with a state of hyperthyroidism, meaning too much thyroid hormone, but that isn't always the case. 

I want to spend a large portion of this article discussing states where there is discordance between the TSH and the thyroid status in your body. 

Discordance refers to a mismatch between what we expect to happen and what actually happens. 

So, when you have a low TSH, especially if you are taking thyroid medication, we expect that to mean that you have too much thyroid hormone in the body. 

But this isn't always true. 

There are several states which can cause your TSH to be lowered but where there is an insufficient amount of thyroid hormone in your cells. 

This has been shown in several studies (7) which highlight the difference between healthy individuals and their TSH and what happens to patients who take thyroid medication to normalize their TSH. 

Those who take thyroid medication have significantly lower free thyroid hormone levels than controls. 

is a normal TSH the same as having normal thyroid function

With that in mind, let's focus on understanding what happens to your TSH when you are taking thyroid hormone and why it doesn't always mean that you are 'healthy'. 

What Happens to your TSH When Taking Thyroid Hormone? 

It turns out that the TSH is a really good predictor of what is happening in the pituitary gland itself, but it doesn't necessarily tell you how much thyroid hormone is getting into your other tissues. 

And this is important because almost every cell in your body has a thyroid receptor.

So the TSH would be a great predictor of thyroid function in the body IF your pituitary gland was just like every other tissue in the body, but it isn't.

Your pituitary gland has special deiodinases which are different than other tissues in the body making it more sensitive to thyroid hormone than other tissues.

What does this mean?

It means that as you give someone thyroid hormone (especially T4) their pituitary gland will sense the thyroid hormone and drop the TSH in accordance.

But your other tissues may not get that thyroid hormone. 

This results in patients who have a normal or low TSH but still have symptoms of hypothyroidism.

Do all thyroid hormones alter the TSH equally?


And in order to understand this, we need to talk about basic thyroid physiology first. 

The two most important thyroid hormones in circulation include T4 and T3.

T4 is the inactive thyroid hormone in your body, but it has potential to be activated by deiodinases after cleaving off an iodine moiety turning it into T3. 

T3 is the ACTIVE thyroid hormone in your body. It turns on genetic transcription resulting in changes to your genes and the production of enzymes in your cells.

Why is this important?

Because most thyroid hormone that is used as a replacement is in the T4 form.

Meaning the thyroid hormone that doctors give you MUST be activated before your body can actually use it.

But here's where things get interesting:

Your pituitary gland has no problem activating T4 into T3, in fact, it does this quite well. 

But other tissues in your body have to compete with an inactive thyroid metabolite known as reverse T3.

Reverse T3 is the ugly stepsister of T3 and directly competes with T3 for binding and turning on genes.

Oh, and reverse T3 is created from T4 just like T3 can be.

So this means, in most tissues in your body, there is a tug-of-war going on between T3 binding and reverse T3 binding.

But this tug-of-war is not happening in your pituitary gland.

This is why basing your dosing decisions off of the TSH by itself is not necessarily a wise decision

So, how does taking thyroid hormone alter your TSH?

Taking either T4 or T3 will reduce your TSH, no question about it.

It turns out that T3 is about 3-4 times more powerful at reducing your TSH than T4 (8) is but they will both reduce it.

So if your TSH isn't the best way to evaluate thyroid function.... what is? 

Using Free T3, Free T4 and Reverse T3 for the Whole Picture

If you want to get a picture of what is actually happening in your thyroid gland then you really need to order more than just the basic TSH. 

Ordering and evaluating your free thyroid hormones (like free T3, free T4, and reverse T3) can help give you an idea of what kind of competition exists for binding in your cells.

For instance:

We know that T3 is the "good" thyroid hormone so we can conclude (under normal circumstances) we probably want more free T3 in our body than reverse T3. 


Because if they are both competing for binding in our cells, we probably want the good guy to win.

So it makes sense that if we test your thyroid hormone and you have low free T3 with high reverse T3 that probably isn't a good thing.

And this condition happens to have a name: Thyroid resistance

euthyroid sick syndrome lab values

But, what is the TSH doing in situations like this?

Your TSH may be normal in this type of condition making diagnosis difficult.

Because really what is happening is that you have tissue level hypothyroidism with "normal" blood levels of thyroid hormone.

Now your next question should be: is this common?

And the answer is that yes, it is more common than you think. 

Conditions and behaviors such as repeated exposure to stress, yo-yo dieting, fasting, taking certain medications, and exposure to endocrine disruptors can all impact how well your body converts T4 to T3

The presence of the conditions listed above promotes the conversion of T4 to reverse T3. 

You can easily identify the relative levels of each of these thyroid metabolites with the following tests: 

  • Free T3
  • Free T4
  • Reverse T3
  • Total T3
  • Bottom line: You need more than just your TSH to determine what is actually happening in your body. Make sure that you get a complete thyroid panel when evaluating your thyroid function. 

What is a Normal TSH?

Even though we know that the TSH isn't necessarily the best test to use to diagnose or manage hypothyroidism it still has some value. 

So what is the ideal TSH level?

Well, that depends on whether you are on thyroid medication or not.

Ideal TSH levels based on your condition:

What's interesting is that the reference range for the TSH ranges from 0.300 to 5.00 in most cases. 

But this represents the REFERENCE range, not necessarily the OPTIMAL range.

Focus on the optimal range I've listed above if you want to feel normal and you can read more about optimal ranges in this post.

high TSH and hypothyroidism

What does it mean if your TSH is low and you AREN'T taking thyroid medication?

If you are NOT taking thyroid medication and you have a low TSH then that truly might be a sign that you are hyperthyroid or have a condition known as subclinical hyperthyroidism. 

But this same concept doesn't necessarily hold true if you are taking thyroid hormone (although it may).

So let's talk about what can happen to your thyroid while on thyroid medication:

Low TSH but Normal T4 & T3

If you are taking thyroid medication is it possible to have a LOW TSH but normal T4 and T3?

Yes, you can definitely have a low TSH with normal free thyroid hormones.

But what does this actually mean?

If you fall into this category then you will need to use more than testing to determine what is happening in your body.

For instance:

If your TSH is low and your free T4/T3 levels are normal but your body temp is low, your resting heart rate is low and you have all the symptoms of hypothyroidism - are you really "normal"?

The answer is obviously not, and that's why you need more advanced measurements to determine what is happening in your body.

If, on the other hand, your TSH is low and your free T3/T4 levels are normal but you are having symptoms like heart palpitations or anxiety then it may simply be that your dose is TOO high. 

Yes, both conditions can and do happen which is why constant adjustments of thyroid dosing are necessary.

Some people are exquisitely sensitive to thyroid hormone (including even T4 thyroid doses) which can create strange symptoms that may include both a mix of hyperthyroidism and hypothyroidism. 

In these cases, it's best to determine if your symptoms coincide with changing your medication and if other factors (such as body temp, heart rate, etc.) imply your thyroid hormone is too high/low. 

  • Bottom line: A low TSH with normal T3 and T4 levels may indicate subclinical hyperthyroidism if you are not taking thyroid medication, or a hypothyroid state if you are taking thyroid medication. 

Low TSH with Symptoms of Hypothyroidism

Is it possible to have a low TSH but still have symptoms of hypothyroidism?


As I've mentioned previously your TSH only tells you how much thyroid hormone is influencing your pituitary.

It does NOT tell you how much thyroid hormone is influencing your hair follicles, cardiac tissue, skeletal muscles, insulin receptors etc.

If you don't have enough thyroid hormone hitting your hair follicles you will have hair loss.

If thyroid hormone doesn't hit your heart cells then your heart rate will slow and so will your metabolism

If it doesn't get into your skeletal muscles then you may present with chronic pain and muscular pain.

If it doesn't come into contact with your insulin receptors then you may develop insulin resistance.

The list goes on and on.

If you fall into this category then you may simply need more thyroid hormone or you may ultimately need to switch to a different type of thyroid hormone that contains T3. 

  • Bottom line: You can have a low TSH with symptoms of hypothyroidism. This occurs when your cells are not getting enough thyroid hormone but your pituitary is. 

Low TSH and Weight Gain

Is it possible to gain weight with a low TSH?

The answer is ABSOLUTELY.

In fact, this happens all the time.

If thyroid hormone actually made people lose weight don't you think there would be weight loss clinics pushing thyroid hormone like crazy?

Association between TSH and weight gain

Of course, they would, and the drug companies would be fumbling over themselves trying to patent a new thyroid medication that they could make money from. 

You don't see this happening because thyroid hormone (as a medication) is not a weight loss drug... necessarily. 

In most cases, people who are gaining weight with a low TSH usually have 1 of 2 problems (or both): 

The conversion problem refers to having issues turning T4 into the active thyroid hormone T3. 

If your body isn't good at converting thyroid hormone (from inflammation, infection, medical issues, etc.) then you will have plenty of T4 floating around in your system but very little T3.

The T4 floating around in your system can and will drop your TSH, but it doesn't mean that it's necessarily active in your cells.

You can test for this by looking at your free T3/free T4 levels and by evaluating your reverse T3 levels. 

If you are having issues with conversion then you can bypass the system by taking medications that contain T3 thyroid hormone like Cytomel, WP Thyroid, Armour Thyroid or Nature-throid.

  • Bottom line: High levels of reverse T3 can cause your TSH to drop and cause your metabolism to slow resulting in weight gain. To treat this condition you may need T3 containing medication. 


Remember that while the TSH can be helpful, it isn't the only (or necessarily the best) way to determine what is happening with your thyroid. 

Using a more comprehensive thyroid testing profile in conjunction with your subjective symptoms can help nail down what is actually happening to your body.

When talking about thyroid function it's important to remember how critical the conversion of T4 to T3 is in regards to how you are feeling.

High levels of reverse T3 with low levels of free T3 may indicate thyroid resistance.

In cases such as these, your TSH becomes less helpful and often is lower than normal. 

Now it's your turn:

Do you have a low TSH?

Are you still experiencing the symptoms of hypothyroidism?

Have you checked your free T3 or Free T4?

What TSH level do you feel "best" at?

Leave your comments or questions below! 

References (Click to Expand)

low tsh on thyroid meds? don't freak out yet

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.

309 thoughts on “What Your Low TSH Means With Thyroid Medication & Without”

  1. I’ve been waiting for an article like this…THANK YOU! This should be required reading for all doctors and health care professionals.

      • I am on synthroid, no thyroid gland. My tsh is .09. T3 and t4 perfect. My tsh dropped when I stopped hurt and had an abundance of estrogen and testosterone. Drank some peppermint tea and tsh dropped and estrogen began to leave body. How to get tsh back to where it should be can endocrinologist put it back some how. Miserable.

        • I must say this is the best breakdown of TSH that I have ever read online! Thanks.
          I m pregnant. Each pregnancy I have low TSH as low as .033 at times my T3 and T4 are normal. I dont experience any hyper or hypo symptoms that I can think of. I m not on medications. I dont eat as well as I should. I m not sure if this is due to my diet or something else. Both of my previous pregnancies my children have speech delays. Should i take thyroid medication to address the low TSH?

      • Hi,
        Taking 150mcg thyrax. Test result:
        TSH 0.153
        FT4 18.96
        FT3 2.65
        Total Thyroidectomy done year 2015 then radioactive therapy 2016. Now gaining weight from 54 kilos to 68 kilos. Help please. Thanks!

          • Thank you so much Doctor you are so kind to reply to my comment. My TSH almost 8 years was 0.01 so PTU wasn’t working? Same dose 300 mg a day! My free t3 and freet4 was up and down but not TSH level!

          • This is confused me more Doctor! How can be 8 years PTU Antithyroid medication not increase my TSH levels not even 2-3 times I checked my all blood tests results only once 2014 October my TSH was normal or almost normal TSH :1.3mU/L(0.35-4.94) before this blood tests 6 May 2014 :TSH 0.01 (0.35-4.94)
            Free t4 was 11.3pmol/L(9-19.1)
            Freet3 :5.04pmol/L (3.6-6.5 normal range) 30 June 2015 blood test results was TSH was 0.01 (0.35-4.94)freet4 was 14.4 pmol/L(9-19.1)
            Freet3 was :7.66pmol/L (3.6-6.5)TSH so quickly dropped again? strange

          • i believe im wrongly diagnosed or ignorant doctor not treate me well just watch me suffer for graves disease symptoms low libido ,anxiety,depression ,low mood ,easily get anger

      • I have hashimotos and am on compounded t4 /t3. I also take an additional t3 in the afternoon because I’m still symptomatic. I recently had blood work and I’m not sure what is going on because my TSH is low free t4 is low and free t3 is on the lowest side of normal. The doctor does not seem concerned so I am not sure where I should go from here.

    • Dear Dr. Childs, I have scanned your article and the posts for both very low TSH (.16) and low Free T4 ( .67) but normal or on the higher side of Free T3 (at 4.) These are my labs, over and over again, regardless of how many grains of thyroid I take, or the brand. My doctor has increased them and switched them faithfully but nothing changes. I feel better when I am in a warm, dry climate, not Chicago, but my job and family are here for now so that is where I am stuck. I am basically tired all of the time, cold, on migraine meds, and very low blood pressure and pulse. Thin but not in good shape because no energy to exercise. Any thoughts for why I have this combination of results and what can change it??
      Thanks, Martha M

      • Dr. Child’s
        Please help! My TSH 0.01 (never changes no matter what dose of synthroid or armour). Since the last year, my other labs are very high. T4 2.2, T3 5.8, T3 reverse 37
        I was taken off all thyroid medication several months ago then I was put on 50 mcg Synthriod because of heart palpitations and increased heart rate. Now my blood pressure is very high. What’s going on with me?

    • Hi Dr. Westin,
      I currently have a tsh of 3.12, t3 2.6 , t4 1.2. My doctor upped my dose 8 days ago and last night I was awake all night, sweating on and off and a lot of anxiety. What really concerns me is I have developed high blood pressure with high heart rate. How soon could I re test to see if my tsh is now too low? I am taking synthroid as I tried to use amour, nature throid and np with no luck. Always had high heart rate and lots of anxiety. Thanks.

  2. Dr Childs, I just got back my results and I have a low .038 TSH, t4 5.9, t3 uptake 28, free thyoxine index 1.7, rev t3 18.0. I have been on natur throid 130mg.for hypothyroid. I was on on Armour 135 and switched 6 months ago. Little concerned because I have been on clean, gluten & dairy free, Keto diet and Im in the 4th month and only lost 10lbs with exercise. If I cheat I gain. I don’t even like sugar Im only 5’1 and gain gain gain I have gone from 135lbs to 170. A glucose serum of 104,231 cholesteral,140 LDL cholesterol, ferritn serum 201,alkaline phosphatase 119.not good….help I’m also woman 59 years old.

      • Will I benefit from your 60 day diet plan if I’m already eating a low carb? also if I eat pretzels 1 hour later I’m in hypoglycemic state as I was since I was as my whole life with sugar swings. I need to lose 15 more lbs to be healthy

  3. Low TSH, sub level free t4, just below mid level of ft3.
    2.25 grains of naturethyroid. Have tried taking more but felt jittery so dropped back – regardless the free t’s never really move? thoughts?

  4. Thank you for this article!!! I will be taking it to my Dr. visit tomorrow. I was feeling OK on Levothyroxine 112 for 8 years and my T4 was always in range but my TSH was .3 so my doctor said I had to take a lower dose of 100, otherwise I would “burn out” and get osteoporosis. The result is hell: Low energy, cold intolerance, hair loss, joint pain, head aches, weird sleep (like I can’t wake up), depressed thoughts for no reason and so on. AND guess what? Now my TSH is a .1 after rising briefly to a .7 back in Dec. I cannot live like this and now want to try ND Thyroid for sure. I also want more testing-they never have checked my free T3 or free T4 since thyroidectomy 16 years ago. I am otherwise healthy and weight 129 at age 53–have always eaten whole foods, mainly vegan with a little dairy and occasional egg. I have educated myself and searched and you are the ONLY doctor I have found that I have total confidence in! You deserve a gold medal for all the wonderful info you are providing to people like me who cannot see you personally. Please accept a HUGE thanks for me, as I now feel that, for the first time in 16 years, I have the knowledge to take my thyroid replacement care into my own hands. As a patient, you have to, sadly, because no one else will.

  5. Thank you–fantastic information. I will bring it to my doctor. I need it desperately as I am an under medicated T4 patient with a total thyroidectomy. You deserve a gold star for all you are doing to help people like me!

      • Presented your post to my NP today. She was very impressed and ordered all tests for the first time. Also agreed to try to put me on ND Thyroid which she has never prescribed in 30 years of practice. She was going to “call Walmart” to get a conversion table, but fortunately I already had the conversion table from you:) I am so excited to finally see my free T3 and reverse T3 scores after 16 years of feeling not that great on levo, and even more excited to see how I will finally feel on NDT, which my mom always told me years ago she felt great on. I honestly believe I am one of those people who does not convert T4 to T3 all that quickly. Although my T4 is high and my TSH very low I still have low body tem, cold hands, and pulse of 62 right now during the middle of the day. My blood pressure was only 90/70 to day as well. NP had to admit that this was not 100% normal. Also, I’m glad I also know to raise the NDT dose slowly, because the NP knows nothing about all this–it’s SO important to take responsibility for your own health! Thanks again–will keep you posted.

        • Thank you so much for this article. It is extremely helpful to me. I am in remission from Graves, was diagnosed 8 years ago. I went into remission when I did “block and replace” on my own. The treatment my endocrinologist was doing, of just the anti-thyroid medication, was not working and she wanted me to have my thyroid removed (I also have graves eye disease although things have resolved). I can’t seem to find a doctor in San Diego who supports me and who will treat me properly. I have had to finagle and be very savvy myself with my medication by doing my own labs personally and making my own dosing decisions. I went hypothyroid a couple of years after going into remission and I now have to take a high dose of Levoxyl (250mcg) and Cytomel (30mcg) but my TSH is still suppressed and basically has never come back from when I was diagnosed with Graves’ disease. My free T4 and free T3 levels are always in the normal range even though my TSH was suppressed. Doctors get very concerned and want me to cut way back on my doses. When I do that I become very symptomatic and I will not live like that again. I live in San Diego and I am looking for a good doctor to treat me and allow me to be treated by my symptoms while keeping my free T4 and free T3 in the upper and of the “normal range” even if I have no TSH. My heart rate is very low 40-55 bpm) very healthy and I’m an athlete. Am I being reasonable? Do you know of any doctors near me who I could see? Thank you so much for any help at all and please please feel free to email me.

      • Thyroid removed 5/11/15
        Was suffering from IBS became pre diabetic a1c 6.0 was on synthroid brand 75 until 8/22/17 TSH jumped from 2.70 to 6.25 so PCP raise dose to 100 and I dropped to .01. Stared seeing ENDO and she dropped me to 100 3 days a week and 75 4 days a week TSH moved to4.25. But still had symptoms of hypo fatigue jitter weight gain or unable to loose weight has continued since the surgery from 160 to 188. Bloating constantly leaky gut. Changed to Tirosint 88 lost all hypo symptoms and felt great stomach problems changed lots of energy checked TSH now back to .01. ENDO is looking to adjust but I really think because of my stomach issues and non ANA lupus that I may not be converting T3 and may need a T3 drug Tirosint seems to have help me the most except for weight gain or unable to lose weight I wish the doctor will suggest that the cytomel may be a good trial because I really thought I was on my way to recovery but it lasted 4 weeks Every person that I meet that does not have a weight problem with no thyroid takes a t4 and a T3 and everyone that is over weight is on a cheap t4 only. I had to make the first doctor put me on the brand synthroid and I pay for it because I stayed at .01 no matter what dose I was on

  6. My gyno requested blood work because of weight gain/stress/anxiety symptoms. The stress is probably because I’ve steadily gained 40 pounds in 12 months. #stillgaining I exercise 4 x per week and eat a balanced diet. I’ve been on 1 grain of Nature Throid for about 6 months with relief of cold hands/temp and joint pain but now my blood work came back TSH .009 and T4 is .9. She told me I am very HYPERthyroid and to go see an endocrinologist (who cant see me for 3 weeks). What could be going on? I went on NDT due to hypo and weight gain and now I’m told i’m hyper with weight gain. Any insight would be appreciated.

    • Hi Michelle,

      You are most likely not hyperthyroid, she just thinks you are because your TSH is slightly suppressed. It’s still very possible to have hypothyroid symptoms with a suppressed TSH.

    • I agree with Westin Childs (I don’t know what your free t3 is, but that free t4 is NOT elevated at all)! I cannot tell you how many times a doctor has freaked out over my TSH that is exactly your number (totally suppressed). I always retort with, “there is NO WAY I am hyperthyroid with a heart rate of 68, BP of 110/65, normal body temp and free t’s inside the normal range”. These doctors have totally moved away from physical examination and have unfortunately relied on labs only. Sometimes you have to listen to your own body, and what it is telling you, and continue your search for a doctor who is well versed. We need more Westin Childs’!

  7. Dr- Childs, I am so glad I found your web site, your articles are great!
    My problem is that my TSH was suppressed at 0.006 with borderline normal low T4 and T3 in May 2016 when I was on Armour Thyroid 135mcg.
    In September my new endocrinologist lowered Armour to 120 and added 25mcg Tirosint. Nothing changed and I knew he would want to lower the dose, so I asked him to switch me to Tirosint only. I was on 175mcg Tirosint and 7.5 Cytomel. TSH stayed at 0.006 and T4 went to 1.76 on a scale .82- 1.77 and T3 3.6 on a scale 2.0 – 4.4. In December 2016 we removed Cytomel and I was on Tirosint 175 for two months. TSH didn’t budge T4 and T3 were 1.83 and 3.7 respectively.
    In Feb. 2017 we lowered Tirosint to 150mcg and May 2017 results were, unchanged TSH at 0.006, T4 at 1.35 and T3 at 2.7. I feel great, I am not cold, I have no palpitations, I have decent energy for my age of 55, I exercise regulary, doing cardio and weight lifting.
    My endo is worried about me getting accelerated osteoporosis (i was diagnosed with osteopenia last year) and possibly heart problems. I’ve been on AIP since I was first diagnosed with Hashimotos in March 2016 and I put it in remission 4 months later by sticking to the diet.
    My next lab is in the beginning of July and I will ask for Reverse T3 test.
    I have two questions: if my TSH is suppressed, will I really get accelerated osteoporosis? And secondly, What would you do to get TSH to more normal numbers, closer to 0.4.
    I would greatly appreciate your suggestions.

      • I am so tired of this osteoporosis line! My TSH was on zero for 7 years when I was hyperthyroid due to Graves. After TT the highest number I ever got was .7, even though I went through a ton of hypo symptoms and a miserable life just to get that:( After a dexa-scan of my hip, they tell me my bones are five years younger than my age (53). And FYI, I haven’t drunk milk since I was 10 years old.

        • Sheriann,that’s what he said. No data to support low TSH causes osteoporosis to happen any faster than normal.
          Drinking milk is not a good way to get calcium.Milk promotes mucus buildup in your lower gut and prevents nutrients such as calcium to aborb into your system. Ionic Fizz Cal/Mag is the best.

    • Hi Pica-was inspired when I read your story because mine is the same. I had radiation on my thyroid for Graves’ disease two years ago. Now my tsh is low and my T4 and T3 are falling in normal range but I have hypothyroid symptoms. My endo said the symptoms I’m having are not thyroid related. Went to get another opinion at another endo and she suggested I come off my Stmor Thyroid and take Tirosint. She said I may not be absorbing the armor properly and Tirosint is more easily absorbed because it is in s gel form and has only 4 ingredients. I am considering the switch and was glad to hear that you found improvement on it. Thank you for sharing your story.

  8. Dr. Childs,
    Apologies in advance for what is sure to be a long winded comment. I just want to share my experience and hopefully give some others who are seeking help some hope that there is a way out of what they’re going through.

    Most of all, thank you for your informative website and for talking about the things that thyroid patients such as myself can’t ask their doctors. My endocrinologist runs a specialty thyroid practice at a major academic medical center, and from what I’m told a renowned name when it comes to thyroid care. That said, he did not help me feel better. A very nice man, but also old school. Before turning 40 I never had thyroid issues (i.e. out out of range labs), although had been feeling cruddy since about age 37. Honestly the only reason they paid me any attention this time was because I developed a very rapidly growing nodule and a TSH of 42. After numerous ultrasounds and a couple of biopsies, it was determined I had a benign adenoma. I was also told Hashimoto’s based on the ultrasounds (negative antibodies). I was started on T4 only, which did bring down my TSH to within “reference range”.The nodule shrank somewhat, but was still very, very visible on my neck. I’m a healthy weight (5’8″ ~137 lbs) but my bone structure is such that i have a long scrawny neck of someone much thinner. I elected to have a partial thyroidectomy because I couldn’t deal with walking around looking like I’d swallowed half a tennis ball. The surgical path was reviewed by the hospital’s tumor board, and stated findings “consistent with Graves”. When I questioned the surgeon (after downloading the report myself), he told me not to worry about it and that it was likely just a mistake. What could I say? He was the head of endocrine surgery. Never got an answer on that particular issue.

    This was a couple of years ago, and I’ve since relieved my endo of his duties, and found a clinical nurse specialist who has been very open to treating me according to what is hopefully become a more accepted paradigm. I tried Armour which unfortunately didn’t work and now take T4, and generic Cytomel. I’ve also struggled a great deal to get my Ft3 and Ft4 as high as the low end of the references range. After getting even more discouraged after my most recent results I found your website. Thanks to the additional information you provided I had some other labs tested. My iron saturation is 15%, Ferritin is 14, B12 and D also at lower ends of their ranges. I think you get the idea. Additionally, even even though I was taking my thyroid meds 30-45 minutes before food, I often took them with black coffee (whoops!). I’ve forwarded sections of your website and various posts to the nurse specialist that prescribes my meds and for the first time in a long time I have hope that making some concrete changes regarding supplementation and how I take my meds, might help me to feel better.
    Apologies again for the long post, but too often we are discounted by physicians, and I can’t tell you how much I appreciate your efforts to help those of us who live too far away to see you in person.

    • Hi Melissa,

      Thanks for your comment and I’m glad you found it helpful. I hope you are able to start feeling better with this information.

  9. Hello Dr. Childs! I have been watching your videos on Youtube as well as reading the articles on the website. Moreover, this is the first time I ran into such good attitude towards the patients, because many doctors do not pay attention to their feelings.
    I think you’re doing great job out there! 🙂

    However, I do have a question; I understood the main point of doing the physical examination first, to do the hormone tests. Unfortunately, right now I do not have the opportunity to do the tests (long story).
    So the question – Is there any possible way to lose up to 6-7 kilograms in 2 weeks? Because there is nothing I tried and it worked…e.g. Intermittent Fasting, HIIT..etc

    I have been struggling with my weight for really long time. Apparently, I am on the medication – Euthyrox 125 mg, still feel tired, sleepy and didn’t return to my normal weight( I do not eat much). The dose of Euthyrox is set by the doctors (in the last 3-4 years doctors increased it from 75 mg to 125 mg). The last I went to the doctors, they said that the T3 & T4 were in the norm.

    • Hi Kamiki,

      It will probably be impossible and unhealthy to lose 6-7 kgs in 2 weeks. Any diet that you find that will result in that kind of weight loss in that amount of time will ultimately cause metabolic damage and you will regain the weight back over a few months. You can find more information about how to lose weight safely and effectively in my weight loss program here: https://www.restartmed.com/hormone-mastery/

  10. I believe that’s typically my case , am hypothyroidism and am on levo 150 …my levels were ok but am always tired and hv mood swings ,cant loose weight no matter how hard i diet and exercise,my T3 and ft3 were low so i tried to get cytomel from canda ,uk or usa or thybon henning from germany as all T3 medications are not available in the middle east but wasnt able to get without prescription,
    Lately i hv been facing extreme pain in my muscle it is spasmed all the time am extremely tired ,getting up a couple of stairs is a challenge for me,i gained weight and my body is bloating and full of water although(was diagnosed with fibromyalgia)i dont eat that much
    So my last lab test was as follows
    TSH 0.005
    T3 96.28
    FT3 3.04
    FT4 1.91
    Anti TPO 62.6
    Anti TG less than 2.4
    My doctor lowered my dose to 100 levo ,what is your tips/recommendations for me ?! Should a try to get Cytomel or not?!

    • Hi Soha,

      You really need to get your reverse T3 checked in addition to SHBG to determine what is happening with thyroid hormone in your tissues.

      • Actually those 2 tests are not done here in EGypt?! Any other recommendations?! Should i go for cytomel or stick wz that lower dose 100 levo?! Thanks for all ur great tips and replies, i really do appreciate

        • Hi Soha,

          Those tests can be done if you live in Egypt, I know because I have at least 2 patients from Egypt and they were able to get them done.

          • Ok thanks may be i should ask in another lab. ,do u hv online appointments?! How much i should i pay your good self to get a full diagnosis and recommendations?!

  11. I am about 35lbs over weight, age 49.female. A couple of months ago the weight just started adding on and isn’t stopping.
    I was prescribed 90mg of Armour twice a day last year and taken off cytomel.
    I’ve recently seen a nurse practitioner in an Interogative Hormone practice. I’m not happy with her follow up and I’m not feeling any better. She told me to cut my Armour in half so take it once a day. Also, not a thyroid problem but an adrenal problem.
    I think it looks like thyroid resistance and I’ve never been able to convert my T3’s properly.
    But what to do?
    Ultra sound findings, right thyroid lobe measures 4.3×1.6×1.5 cm and left lobe 3.9 x 1.7 x 1cm. Isthmus measures up to 0.2 cm AP.
    Moderate diffuse heterogeneity of the thyroid parenchyma without discreetly lesion or any definite hypervascularity. No lymphadenopathy.
    Impression: Moderately atrophic and heterogeneous thyroid likely sequela of chronic thyroiditis, without discrete nodule or hypervascularity.
    Here are my labs…
    TSH .006
    T4 10.3
    Free T4 1.61
    Reverse T3 31.5
    Free T3 8.5
    Sex Hormone binding glob, serum 185.4
    Leptin 26.1
    Thyroid antibodies
    Peroxidase 102
    Thyroiglobulin antibodies 39.3
    Saliva DHEAS 1.7
    Saliva cortisol 5.7 morning, 1.4 afternoon, .9 evening, .7 before going to sleep
    Saliva Estradiol .9
    Progesterone 29
    Ratio: Pg/E2 32
    Testosterone 15

    • Hi Sarah,

      I would be evaluated for peri menopause/menopause with FSH and LH testing, it’s also likely that you have thyroidal damage due to chronic inflammation from hashimoto’s. In cases of chronic damage to the thyroid gland thyroid serum levels seem to be relatively preserved but these patients stand to benefit significantly from thyroid hormone replacement.

      • My Lh was 20.1
        And my FSH was 33.6
        Aren’t those normal levels.?
        What is thyroid hormone replacement?
        Thank you so much for responding.
        My medical doctor said I was to complicated so she is sending me to an endocrinologist on the 22 of this month.

      • Sarah, The same thing happened to me years ago. I went from being a normal weight to 45 lbs overweight! It turned out I was peri-menopause AND Estrogen Dominant. One of the symptoms is also weight gain and very tender bloated breasts. My breasts almost felt like when I first began breastfeeding my daughter they were that swollen and sensitive. Anyway, I know your comment is 1.5 yrs old, i just wanted to reach out to you. My NP put me on Natural Hormone Replacement Therapy. It changed my life! Bio-identical Progesterone Oil that you rub on areas of your body with low fat(inner forearms,behind the knees etc) It was a life changer for me! I also went on DHEA as I was extremely low. I really hope you feel better 🙂

  12. When you discuss high RT3 – how high is high? I went to see an endo a couple of weeks ago….and as you can imagine it didn’t go very well. She didn’t even want hear anything about RT3, nor my left-over symptoms of HPA axis dis-regulation. I’m certain that my hypothyroidism was driven by my adrenal crash 2 years ago. My sex hormones are still low (I’m working on it). I’m still on 48.75 mg of Nature-Throid, but I’ve been watching my RT3 and it has historically been over 15 ng/dL (ranging from 15 – 19.3). But at the same time my FT3 to RT3 ratio was over 20 in 2015 and was under in 2016. I do not want to be or become thyroid hormone (T3) resistant. How do I reverse this? Is it recommended to titrate down my Nature-Throid, and get off?

  13. Hi,been attending endo because concerned re cognitive issues/fatigue/aches/low mood.Long term Hashimotos. Have been taking t4 long term, 100mcg
    Now also 15mcg t3 per day. If I stop t3 I become even more forgetful.
    Latest blood tests- tsh 0.145 free t4 19.1 tt3 1.3
    temp very low without t3. Mood & energy/motivation better with t3 but as it’s quick release I take several small doses.Not due appointment for 3 months.

  14. I would like to know if all my hair follicles are dead can my hair grow back with treatment as I am going bald and wear wigs and scarfs to hide it


  15. I take t4 and t3, but I still have trouble loosing weight. I recently had blood test on my progress which also included my Estrogen and Testerone . My Estrogen was 130 and Tesrterone was zero. I understand once you have been Menopause, I am 68, Estrogen levels usual drops to 75. Do you consider 130 to high and if so, could this be causing me to hold onto weight around my middle and hips.

    • Hi Rosemary,

      The hormone changes associated with menopause do contribute to both weight gain and weight loss resistance, so it is possible.

  16. Dr. Westin
    I am a walking thyroid problem. I was diagnosed with my thyroid prob in 2006, and just in these recent weeks I have learned so much from you. So much that these doctors at Palo Alto Medical Foundation do not know. I need help, YOUR help. Your view and guidance on what I am missing or what I need to do to help me feel better and help me with my weight problem. At PAMF I just get the run around and all they say is take your medication(levothyroxine)but nobody understands exactly how horrible I am feeling. Initially I was diagnosed w Graves’ disease, I had the radioactive iodine tx, but my TSH levels are rarely ever stable they fluctuate, so I never feel good/normal/stable. I am now considered hypothyroid. I just need some guidance and help from u(if in any way by phone consult or in person) I am in San Jose California, but I would totally fly to Az to seek your help. I know your practice is closed and I could see why(you are great)but pls I ask for you to consider my case and pls pls pls make an exemption. I would forever be grateful. Please help me…..I’ve searched for help here in Ca but we aren’t as lucky as Az…we don’t seem to have someone like you here.

  17. I am 49 years old and I have graves disease. I am gaining weight and very miserly. How or what should I be doing to stop the weight gain, I am taking thyroid medication 10 mg. 2 pills a day.

  18. Hi Dr Childs

    I am on WP thyroid 81.25mg since December 2016 and just had my blood test done about 2 weeks ago and my test results are as follow:
    TSH : 0.12/L (low)
    Free T4: 0.9 ng/dl
    Free T3: 2.9 pg/ml
    Prior to December i was on WP 65mg and my TSH was also suppressed (0.18 L) and my free Ts were still same (low normal) as what they are now. I would really appreciate if you can tell me the possible reasons why i am not able to improve my free Ts even when my doctor increased the dosage from 65mg to 81.25 mg? Any suggestions to what i can do to help increase my free Ts as i am still having hypo symptoms?
    Thank you

  19. Hi Dr. Childs:
    I had the left side of my thyroid removed on 3/13/17. I was taking armour 30mg in the am, 45 in the pm. Felt very tired. lab work numbers are below six weeks after sugery.(Ive always had a very low free T3) which is the reason I don’t take synthroid.

    TSH: .83 range (.400-4.500)
    FT4: .6 range (.7-2.0) – Low
    FT3: 2.4 range (2.6-4.4) – low

    Switched me to WP thyroid 81.25mg a day. still tired, cant lose weight. Want to try cytomel. Dr says increasing my meds would be malpractice because my TSH is to low. what are your thoughts? Thanks! Kelly

    • Hi Kelly,

      The current standard of care is to treat based on the TSH, so your doctor isn’t completely incorrect in his assertion that it will be malpractice. That being said the TSH is a rather poor predictor of tissue levels of thyroid hormone and so dosing really shouldn’t depend upon the test in isolation. The best thing to do is find a physician more willing to work with you.

  20. Hi, i am 30old,man,For years I have symptoms like; Hair loss, chronic fatigue, keratoconus, sleeplessness , waking sleep rhythm alterations. Mental tiredness, anxiety or depressive sensations, feelings similar to depersonalization! I did the blood tests for the thyroid and the result was; Tsh 3.88, ft4 1.20, ft3 3.87. No autoimmune disease. Thyroid morphologically normal but i have a nodule of 1.7cm. The doctor says I have subclinical hypothyroidism and I have to take 50mcg levothyroxine right away.i have tryed to take tiche50mcg (t4only) ut i was very bad with fatigue,anxiety, depressed mood. So I took for 21 days 33mcg of naturethroid, for a few days I felt more energy and not tired! But I felt a bit nervous inside. I did not have palpation or tachycardia. After 7 days I did not feel nervous and slept better, I had an increase in energy and well being on alternate days! I used 250mg of rodhiola for adrenal fatigue and I felt weak and fatigued and sedated! I stopped the rodhiola. I also passed to 25mcg of synthetic t4 / t3 (ibsa 33mcg), I felt much better physically and mentally! !!! Serene stable and positive mood. I increased the dosage from 33 to 66mcg t4 / t3 synthetics and I started to feel very bad! Extreme fatigue, weakness, depressed mood. The physician has returned me to the 33-mg dose for 2 days, but I’m still sick and I’m afraid not to go back as before. What can be the cause? Thank you very much for your site. I graduated in chemistry and pharmaceutical technologies. i write from Italy.

  21. Thank you very much for this and similar articles you wrote. They helps to understand what is going on with our thyroid. Is there any article about high TSH but normal fT3 and fT4 (according with your info that should be in the last third of range). Taking 63mg of Thiche (only syntetic T4), feeling is terrible, very fatigue. Also my ferritine level is at the bottom (22, but since is higher than recommended minimum -20- there is no additional Ferrum prescribted). Any way taking New Iron (medicinalis) one tbl per day for 4 months already but the situation is not better. Thanks for recommendation!

    • Hi Janja,

      I don’t really understand your question. A high TSH would indicate that your thyroid is sub optimal, so there really wouldn’t be a need to write an article about this because you are by definition hypothyroid. The low TSH state is more confusing to patients than a high TSH state.

  22. Hi Dr Childs and thank you. I am working with a doctor and he thinks the reason that even 5 mcg of liothyronine added to my 88 mcg of levothyroxine makes my rt3 come down, ft3 comes up but I have hyperreflexes and symptoms of hyperthyroid. Very low tsh
    But antibodies very high tpo 178 TgAb 2100. And we cannot get them down. So we’re addressing my exhausted adrenals, yeast, inflammation in my gut. So no more liothyronine for now until these other things are addressed. But only 1 month off liothyronine I am severely hypothyroid. Would just a very small amount of liothyronine help while addressing these other issues. I believe he’s on the right track but my situation is very complex. He is very open to my research, what I have learned from all of your information on Facebook, Pinterest and my gmail updates. I wonder if you could help by suggesting some other areas to address.

  23. Hello Dr. Childs,
    I am a little confused about TSH levels. I had thyroid CA in 2000, and had a total thyroidectomy and followed by I131. Never been able to loss weight until this past year. Changed my died and workouts. I only each chicken, fish, veggies and very limit carbs. I also work out 5-6 times a week with 1 of the workout being a 4-6 hour hike.
    Lost about 70 lbs. Blood work always good until April. My blood work came back with a TSH of 3.7 and T4 1.78. Dr. lowered my medication and now my blood work is TSH 5.8 and T4 1.8. I always thought that my TSH should be lower a suppressed.Can you tell me what my TSH should be. I am now having a very hard time working out. Fatigue, muscle and joint aches, and over all not my normal self. Second question can a diet and workout change the way you absorb your medication or the amount you may need?

    Thank you,

    • Hi VC,

      The higher the TSH the lower the thyroid hormone is in your body. It seems odd to me that your physician would lower your thyroid medication with a TSH in the 3 range, I’m not sure what the logic behind that decision is. In regards to your other question, yes it’s felt to be protected to suppress TSH levels post thyroidectomy for thyroid cancer in most cases. The reason is that we are always unable to remove the complete thyroid and the nature of thyroid stimulating hormone is to stimulate thyroid tissue, so TSH would theoretically be adding fire if some thyroid tissue had cancer in it.

  24. Hello !Doctor Childs I want to share to you that my mother is suffering a thyroid disease which she already consulting to the doctor almost 6 month already but her thyroid has no changes .Again the doctor requesting another Tsh and t4 this is already the 3rd time request of her doctor. I want to know what does it mean. And doctor said if she willing to be have operations , but my mother want to take only medicine because she is afraid of operation.

  25. Dr Childs – thank you for the information in your article and the clear way in which it was written. After radiation therapy on my thyroid two years ago for Graves’ disease, I find myself with a low tsh, normal t3 and t4 but terrible hypothyroid symptoms which fluctuate but never go away. After my last lab, my endo basically told me my symptoms can’t be thyroid related because the numbers do not indicate that. I did go see another endo who suggested I switch from Armor thyroid (120 mg) that I’m on to Tirosint. She believes I may have an absorption issue and would do better on this. She did agree that my tsh is not going to be a good indicator in my case. I don’t think they have checked my reverse T3 and I would like to ask you if that is something I should have checked or would that not play a part in my case since I’m presently on Armor thyroid which includes the T3. Could reverse T3 still play a part or no, since I’m on Armor with T3. Thank you.

    • Hi Donna, like you I’ve had a super low TSH (.1) while having “normal” T3 and T4 and I always feeling very hypothyroid (cold, tired, etc.) I’ve gone through lots of switches and they don’t change much, but one thing did seriously change from levo to armour and that was that RT3 went from 34 (real bad!) to 16 (normal). That was a big improvement. But you are already on armour or T3, I realize. I wish I knew like people like us have such low TSHs with everything else normal and we still don’t feel good.

  26. I’ve had hashimoto’s for a number of years and have been relatively stable on 50ug t4 and 5ug t3. Tried Armour 15 and did very poorly both mentally and physically(under-dosed in my opinion). Improved immediately by going back on prior t3/t4 dose. New doc doesn’t approve of t3 and I’ve tried to go to t4 only but each time I develop joint/muscle/tendon issues and dr. says there is no correlation, although she agreed to keep me on t3 unless my tsh numbers dropped too low. And now they have (0.16, 0.27-4.2 range). I agreed to try lowering t4 to 25ug and a week later I’m noticing increased joint pain, muscle weakness etc. This Dr won’t run any labs but tsh. Can you give me any logical explanation why my tsh might crash without any medication changes?
    rT3 was high when I first started t3/t4 and was low a year ago; thyroid antibodies were also high in the beginning and within normal a year ago. Total t3 was low (.76, .80-2 range) about 6 months ago. Tsh used to be a fairly constant 2ish until I tried the Armour but has been steadily dropping after going back to my “old” routine.

  27. Hello. My TSH has been rising over the past year, it went from .8 to 4.5. Even at .8 I’m still just really fatigued and gaining weight. Now I’m at 4.5 and they just want to shove saxenda and contravene down me. They say if I just lost weight my synthroid would work better. I’m 5’3″ and 176 lbs. I have asked over and over about T3 and reverse T3 and they say that has nothing to do with hashimoto. They see hashimoto as an autoimmune disease that you just have to treat with synthroid and that antibodies never go down and is something you will just have for the rest of your life. I go to Oklahoma Heart Institute! The endocrinologist I see there even teaches endocrinology at OU. Why do they not see that T3 is part of the thyroid?

    • Hi Kassia,

      Using T3 just isn’t in the current treatment paradigm. It doesn’t matter if your endocrinologist is Harvard trained, teaches at Hopkins or does cutting edge research – they don’t believe T3 should be part of thyroid treatment so they simply won’t prescribe it. It’s difficult for patients to understand, but that is just how endocrinologists practice thyroid management.

  28. I have an upcoming appointment with my Endo doctor but they will not allow me to get the blood test you recommend (says insurance will decline it), only a partial listing of the ones you mentioned. I would like to go out and purchase all the suggested labs myself, what website do you recommend that has the ability for the patient to select and purchase their own labs. All of my thyroid was removed about 12 years ago so I rely completely upon medication. I have never had some of the suggested levels mentioned checked so definitely want to after reading your article.

  29. Hi,

    I’m always hesitant to write about my thyroid issues, because I tend to fall outside of the norm on most things. For one thing, I’m very underweight. I have a body mass index of 16.8. I’m 5’3″ tall and weigh 95 pounds. In that I eliminated wheat gluten and grains, my diet is restrictive, but the fact is I’m not dieting. I simply am not hungry most of the time.

    Typically, I have been able to sleep at night after Chinese herbs, some supplements, low dose naltrexone was used for my autoimmune issues, and multiple infectious agents were discovered/treated naturally. I’m still in treatment though.

    However, last year, I begin having nightmares, waking with panic, and eventually, I started waking at all hours of the morning. I generally can’t sleep until 1:45 am or 2 am. Trust me when I say that forcing the issue makes it worse.

    I always have my doctors test for most of what you recommended except the leptins. That’s new to me. Here are my current results with the range listed first and my results in parenthesis. By the way, my thyroid was fully destroyed in 2003. I had them check via ultrasound to see if there might still be tissue. I was told no. Although I don’t think ultrasound is definitive, nothing could be observed through scan.

    I’m about to go crazy, because I’ve tried Cytomel when my free T4 was a lot lower and I had “normal” TSH but high reverse T3 levels. Doses much lower than 5 mcg caused me to have twilight sleep for two months before I called it good.

    What can you recommend? My doctor isn’t knowledgeable about how to deal with reverse t3–she said that to me directly. I have never met one endocrinologist that could help me either, and because I asked questions, seeing one in town is now impossible anyway. Do you have thoughts? Anyone like me on your blog? I added selenium. Zinc made me sick so I’m trying to add that through juicing. Effectively, I’m force feeding right now. I have both hypo and hyper symptoms. Not much hair loss though, but the fatigue is unreal. Normally, I can escape through sleep and avoid this type of anxiety. I felt like this when I was told I had autoimmune Graves’ disease. I was later told it might have been Hashi’s also. Sorry for the long post!

    T3, Total
    60 – 181 ng/dL (102 ng/dL)

    Free T4
    0.89 – 1.76 ng/dL (2.09 ng/dL)

    Free T4 (Ref)
    0.89 – 1.76 ng/dL (1.93 ng/dL)

    T3, Reverse
    9.0 – 27.0 ng/dL (26.8 ng/dL)

    0.33 – 4.70 uIU/mL (0.04 uIU/mL)

  30. What if you have no TSH, a normal T4 but a high T3? No one ever seems to cover this combination. Everytime my doctor say it’s because I have too much T3 medicine but any time they reduce it I can’t function and my cycle is HORRIBLE! It’s bad no matter what but it’s a nightmare when my medicine is lowered. I’m taking Liothyronine at 25 mcg and levothyroxine at 0.125 Mg. There’s more but I’ll just leave it at that. Any tips are welcomed.

  31. Dr. Child’s,
    I have a free T3 of 2.5, a TSH of 3.0 and all the symptoms of hypothyroid. I was put on the teeniest dose possible of naturethroid and within a week it sent me hyper with terrible heart palps and racing pulse. Does this mean I am probably not a candidate for the meds if such a tiny amount did this?
    Thank you!

  32. Hi I’m on 137.5 levothyroxine and 15 liothyronine. My levels are TSH .01, FT4 .7, FT3 3.3. Where do I go from here‍♀️

  33. Dr. Childs,
    Thank you for the information.
    Is there any risk with having low TSH, if T4 and T3 levels are almost normal? I take NDT and would like to continue to raise my free T4 and T3 levels, but the TSH looks low.
    Free T3: 2.86
    Free T4: .69
    TSH: .091

  34. Everytime I open up something on the web site I found something different to think about. I have hyperthyroidism but after 8 mo on Methamizole I stopped taking it. I got a severe rash and itch on my entire body. Lost a lot of hair after 3 months on medication. Extreme heat intolerance and weight gain on a under 5 foot woman’s frame. I switched doctors now and am going to Winthrop hospital for a 3rd opinion. I found out that if you have a hot nodule you can have half of your thyroid removed without taking Synthroid. I don’t tolerate medication very well since I had parts of my intestines and bladder removed. Any suggestions. My T3 range was 200, and my T4 tange was 1.1 My TSH came back as a 0.03 out of range. What does this mean?

  35. I’m confused. So it is possible to have a low TSH and a normal Ft4 after medication, but still you have symptoms that indicate hypothyroidism? That seems to be happening to me. After medication switch (because of production failure of the old medicine) my TsH dropped to 0,29, while my FT4 is still 23. But my body tells me my thyroid is working to slow. Weight gain, feeling down, hair loss, tired, etc. What to do? I just decided to go back to my old brand and dosis, because it became available again. I don’t feel like my practitioner takes my problems serious. Last time I talked to her about my weight struggles she referred me to the hospital for a gastric bypass. Not only is my BMI to low to be considered for such an operation (but to high to be considered not obese), but also my kcal intake hardly exceeds 1750 on a daily basis 🙁

    • Hi Martine,

      Yes, it is very possible to have a low TSH (or normal TSH) and still be hypothyroid. The general idea is that the TSH gives you a marker of thyroid status in the pituitary but does NOT give you information about other tissues in the body.

      So your pituitary may be getting the feedback that there is sufficient thyroid hormone reaching your pituitary gland, but that doesn’t mean there is sufficient in other tissues in the body.

  36. Daughter diagnosed with hashimotos and put on .75mcg Levo, recent labs

    FT4 .84
    TSH .11
    FT3 2.8
    D3 31

    She is cold, tired, gaining weight, fatigues easily, pale in coloring. Has mthfr gene mutation one copy

  37. I had thyroid cancer and had both of my thyroids removed in Aug ’15, my levels have not balanced out since then. First my T4 and TSH was too high. Now my TSH is 0.006 and my T4 is 3.45. My medication (Unithroid and Synthroid) have been adjusted 6 times. My endocrinologist suggests a body scan next if my levels are still LOW.

    • Hi Nette,

      Your situation is not uncommon, it may take some time to find the right balance for you (but remember medication is never as good as the “real deal”).

  38. Thank you great article!!!

    I just started going to a new doctor because I have new employer paid insurance.They tested my TSH only, not T3&4. Even though I asked for all three.Then made the assumption that I need less thyroid medication. I know I will have symptoms of hair falling out, cold hands cold feet and fatigue if they lower my dose. I have been dealing with this for 20 years and my last doctor understood what you are saying that the TSH is not a good indicator and was giving me a slightly higher dose of thyroid which made my TSH .03.

    How can I explain what you are saying to this new doctor without upsetting her because in my past experience doctors do not like being told they are wrong! 🙂

    • Hi Jenn,

      You won’t have much luck trying to explain any of this to a conventional physician. You will have the most luck looking outside of the insurance model and searching for a physician who specializes in hormone management. Conventional physicians are set in their ways and have very little to no interest in changing how they practice.

  39. Thank you for your informative site. I have been on thyroid med for more than 15 years… Armour years ago switched to compounded T3/4. Since moving to AZ (2 years ago) I have had lab and symptoms all over the board… long story short prescribed various WP/Nature Thyroid and now back 90 days on compounded time release veg cap Avicel filler… the Nature Thyroid suppressed my TSH to .006… Hence put back on compounded T3/4 ~ 27/140… 90 days later now my TSH remains .006 Free T4 1.28, Free T3 3.6. My doctor is taking me off ALL medication for a month to “reset and retest” concerned about the abnormal suppression of TSH… I do not have Hyper symptoms… I too am concerned about the severe suppression but T3/4 are the best ever! I have researched over many years… am well versed but am at a complete loss! I do not want to feel so bad again due to no meds. I am 59 y/o menopausal on Bioidentical HRT (troches and Progesterone). Thank you for all that you do!

    • Hi Susan,

      I can’t imagine a scenario where you suddenly feel great after stopping all medications, but that is between you and your current physician. I think you will likely find that you will always feel better with a somewhat suppressed TSH but they won’t want you to be there so they will constantly switch your medications around.

  40. Hi there, I am in the U.K. Diagnosed in 2001 in February my doctor said my blood tests were too high and had to go down to 100mg of Thyroxine. Results were
    T4. 24.1. Range (8.0-19.9)
    TSH. 0.02. Range (0.30-5.50)
    T3. 3.9. Range (2.5-5.7)
    It’s now 23rd September and I am so tired, headaches, arms aches difficult to lift tendons sore, back aches and leg pains swelling behind right knee. My brain does not get things right and my eyes are sore I fall asleep during the day even when taking to someone.
    Today I saw my doctor and told him how
    I was feeling and could I gave a test. He said no, I did one in May. But I have been on the lower dise since February. In 2001 they same thing happened and he put me up to 125mg. Afterwards I felt better again. He didn’t bother to test me to see my levels then. Don’t know why he refuses to follow either now.
    I am not sure what to do, do you think it is the thyroid or some other depletion?
    Thank you I found your above article very enlightening.

    • Hi Gail,

      Most likely your symptoms are related to thyroid function, especially if they began after you lowered your dose. The hard part is getting your Doctor to keep you on a dose that improves your symptoms.

      • So how can I make him understand that my body is not functioning on the lower thyroxine?
        I realise it’s not getting into my tissues. My tendons in arms and legs are catching and painful as well. I find I can do the exercises I could six months ago as my body has become stiff! I have now bee injuring myself when previously I had been fine! Feeling helpless!

        • Hi Gail,

          It will be very difficult to convince your physician to change your management or treatment, most patients find that it’s instead easier to look for a new physician or another specialist.

          • Thanks for the reply. So in other words they want us unable to function so they can dish out more pills by saying you are depressed, or physcotic and put you on those drugs.

            I get the picture Agenda 21 rings a bell!

  41. Hi!!
    I have been telling my doctors allll of this for years. It is so hard for me to FEEL “therapeutic” my numbers can say whatever they want but I know my body. I usually feel good at 1.0 or below. I was pregnant and they increased my meds and now I delivered and was out of my meds and I am all screwed up. Its so annoying. Insurance has also forced me to try generic even though when I had my thyroid removed I tried and failed on them and have been on brand since..

  42. I increased my cytomel from 10 to 15. My tsh went down (suppressed as expected) but my t3 also went down (from 3.2 to 2.8). Any ideas why t3 went down? Thank you for your time. Greatly appreciate it.

  43. I am 72 year old women with total thyroidectomy for non-cancer reason. I have been on 88 microgram of Synthroid for a while. I have excessive sweating for a while, also. However, thyroid function tests have been alright until now, when TSH (not-reflexed) is low at 0.22 (reference range of 0.47-4.68), T3 is low at 72 (reference range of 76-181) and free T4 is low normal at 1.1 (reference range of 0.8-2.2). Do I have to adjust the dose of Synthroid ? If yes, lower or higher dose ? I’d appreciate it greatly if you answer these questions to my e-mail address.

  44. Had more labs done. Confused at my doctors office calling and saying they are good.

    TSH was at 2.21 in 2015, 1.55 8-’17, is now .52 9-’17.
    (Range .53-5.65, optimal .53-1.5)

    FreeT4 was at 1.46 in 2015, 1.2 8-’17, is now 1.2 9-’17.
    (Range .68-1.92, optimal 1.3-1.92)

    FreeT3 was 3.0 in 2015, 2.5 8-’17, is now 2.9 9-’17.
    (Range 2.2-3.9, optimal 3.475-3.9)

    My doctor had me on 75 Levo raised to 88. Put me on 5 Cytomel and raised it to 2 x’s per day. I still am feeling very fatigued, brain fogged, and have had a few heart flutters. Any suggestions?

  45. I have pretty much felt absolutely miserable and have gotten worse over the last 8 years. I have been on Levo. The whole time I have Hashimoto and my doctor has never tested my reverse T3 and basically she told me that my TSH was a normal range so there was nothing else she could do for me. I am wondering if I have a issue With my adrenal glans.I have been to 2 endocrinologist and my GP in the last 8yrs how is it possible for an endo to be so unaware. Why do most endo so unwilling to order these test and to prescribe t3. While on levo i felt horrible it effected my memory and all sorts of other issues the only thing it seemed to help was my inlarged goiters and my hair loss. If I have a super stressful busy day I spend the next day on the couch paying for it. Help

    • Hi Angela,

      The good news is that you can start right away with some basic therapies to help. I would recommend that you sign up for my email list to get the 3 day meal plan, and then start with at least 1-2 supplements designed to either increase adrenal function or improve T4 to T3 conversion. From there you can ask for a complete thyroid panel and further understand what is happening in your body.

  46. Hi Dr child’s. I really need some advice. My sistuation at the moment is this. I was diagnosed with Hypo 4 years ago. My TSH was 39.5 Gp started me on 50 levothyroxine did not explain the condition just take this and all your symptoms will be sorted. However non of my stmymotoms have changed and I am at this point severely fatiguiged daily migraines. Hair loss ( excessive) eye twitches leg spasams back problems pains also in my back when my kidneys are I have bouts of constipation then bouts of diareaha. I have feeling of something pressing on my throat. And my voice is very deep and only yesterday my voice totally disappeared. (It is back today) my body aches and I feel as though I have weights on my legs and arms.i have vision problems which I had before diagnosis but seem to get worse once starting on the Levo. I can not focus properly and vision is blur and I have flashing lights. The week before my period my body feels 100% worse! I can not focus mthe migraines are so bad I throw up! I feel and this is no exaggeration like I’m dying! Following the inictial 39.5 TSH all other TSH were coming back in range. However 5 months ago week before my period I noticed the symptoms I’ve just explain above are worse and I wasn’t recovering once my period had finished. So this is 5 months on to the day of those symptoms and I went to see GO he again ran TSH and said the hair loss was probably anemia. Results came back after just two days and No anemia but TSH was 28.5 he called to say he was upping my meds to 150 and I’ve been taking them as unstructured. I have asked repeatedly for FT3 FT4 RV T3 bloods to be done and he refuses. Keeps telling me it’s my Thyriod I just need to see how I go on higher dose of Levo. I have read your above article and watched listened to the video and it makes perfect sense about the limitation with TSH testing only. I have also watched your video concerning suppliments and found it amazingly in lightening about deficiencies not only causing these symptoms built making patients worse if the are lacking in those you stated. Please could you advice me further on how I can get some help. I am in the UK and its such a struggle as I have found most GP’s here are all of the same thinking!! Thank you for such honest and open information. This has given me a clear understanding and some hope!

  47. So good to read this article. I have been chronically ill since 2011 and am bed bound, hardly able to walk, severe fatigue, dizzy, headaches, muscle, bone and joint pain, gut issues – the list goes on. I have been trying to get my FT4 and FT3 into range since 2011. I was diagnosed with Hashis in 2007. I do not convert T4 very well. However, I cannot tolerate T3 either and have tried everything suggested to improve but to no avail. I do have inflammation and infections from a tick bite (Lyme and co-infections). I’m at my wits end trying to figure why I can’t utilise my thyroid meds. I’m curretnly taking 75mcg and 100 mcg of Levo alternatively. I add in just 1mcg of T3 twice per day. However, I’m not well on it. My labs always come back with FT3 below range. I can’t tolerate NDT’s and don’t know how I can overcome this problem. My entire skeleton hurts and I wonder if my thyroid issues are contributing to my osteoporisis – is that possible. I know that my lyme is making me ill too so I get very confused. I live in the UK and there are no doctors who understand my thyroid or lyme – there are no lyme doctors and thyroid doctors just look at the TSH and T4 and do not take much notice of the FT3 as they believe that the pituitary and TSH are all that is required. So relieved to read an article like this but regular doc will not accept it so I have a battle to try and get well. Any ideas?

    • Cherie, I don’t know if I’m suppose to comment, but if there’s a chance that I can help another struggling with thyroid issues, I have to try.

      Two things could be happening.
      The T4 that your taking could be unable to convert into T3, or it could be converting into RT3.

      I understand that taking T3 medication can make you feel unwell, but in my experience, if you stick with it your body will adjust and what you feel as negative side effects from the T3 will diminish.
      (If you have high blood pressure and/a high resting pulse, keep a close eye on them while taking T3).

      Personally, I would highly suggest getting your vitamin D levels and calcium levels tested. If they come back with low vitamin D, and high calcium, definitely get your PTH levels checked, as this presentation could lead to a diagnosis of hyperparathyroidism, (which isn’t that difficult to cure, and could make you feel much better, especially regarding the bone pain. My thoughts are with you. -London

  48. Dr. Child’s, I don’t think my Nature Thyroid is working for me. Do I just need to increase the dose or change to a different medication? I’m exhausted, my muscles hurt and I’ve gained 15 lbs. I had my thyroid removed in 2009. Thank you.

    TSH – .9
    FT3 – 2.5
    FT4 – .69
    130mg of Nature Thyroid

    TSH – .238
    FT3 – 2.5
    FT4 – .77
    162.5 mg of Nature Thyroid

  49. My thyroid was surgically removed a couple of years ago. I am taking synthroid. My TSH was 0.24.I am 5’2″ and weigh 111lbs. Can the synthroid cause me to be slender because I have lost weight?

  50. I have been taking synthroid for 19 years since my thyroid was removed when I was 12 due to a benign nodule. Recently, my free T3 and free T4 have been normal but my TSH has been 22-25. My endocrinologist thinks I should start taking T3 (cytomel*). I am wondering if I may have a pituitary problem. I feel great, no symptoms. Do you have any thoughts on this? Thanks in advance.

  51. I take a t4 and t3 combo Med. My tsh is almost 0 but my t4 is still low, t3 is normal but still very very hypo feeling! No reverse t3 or antibodies to anything. What is going on!?

  52. My levels are in the low range of normal after taking armour thyroid..but I’m feeling anxious,and have pain..dr says I need to increase my Zoloft…

  53. Hello.
    I started synthoid about 6 weeks ago. My tsh is almost 6 and t3 was 82. After 6 weeks my tsh went down to 1.5 but t3 went down to 70. What does that mean?
    Thank you in advance

  54. On Armour Thyroid for several years. Can’t find a physician who really understands thyroid function. My last TSH level was 0.006. Doc said that’s too low & reduced my dose. How low can TSH be and not be too low?

  55. Having difficulty getting my medications right. I felt better when my TSH was higher around 2.32 and my T3 and T4 though continued to be too low. My Dr. Put me on Synthroid 0.50mcg and took me off of the Levothyroxine 0.25mcg and I was on a compounded T3 15mcg and I felt better then but now I feel like I am dying. I feel like i need to go back on the Levothyroxine I dont think the Synthroid is my drug I am having double vision and diarrhea with this and things are going down hill.
    My last numbers TSH 0.55, T3 3.7 and T4 3.6 Any suggestions

  56. I feel best when my TSH IS 3. When it drops to 1, I can barely function, gaining 3+lbs of fluid, depression, extremely dry skin, hot & cold temps, flushing of face when active, cold nose, hands & feet. I’m barely functional. Yet many say I should not be taking so much Synthroid (250 mcc daily) & I’d be healthier if Tsk is 1. I’m confused.

  57. Have been experiencing Thyroid disfunction for past couple of years. First diagnosed with Hashimoto’s and then re-diagnosed not having Hashimoto’s. I do have food sensitivity and food triggers. I calculated my T3 and RT3 ratio from blood draw on 08/08/2017 indicating 22 from a Ft3 2.8 pg/mL and RT3 12.7 ng/dL. My TSH 1.830 uIU/mL. My Ft4 0.69 (LOW) ng/dL. TBG 19 ug/mL and (TPO) AB 10 IU/ml.Thyroglobulin <1.0 IU/mL. My FT4 0.69 ng/dL (LOW). My medication: Generic T4 75mcg once daily and Generic T3, 5mcg two tablets in morning and two tablets at lunch. I like my FT3 and RT3 ratio above 20 and my TSH between 1.0 and no higher than 2.0 uIU/ml.
    My current lab work as of 12/21/2017 after increasing my T4 medication to 100 mcg. daily and same does of T3 5mcg, 2 tablets twice a day is as follows: TSH dropped LOW to 0.030. I am concerned! My ratio of T3 and RT3 dropped as well to 17.9. I am concerned with that drop as well. My FT4 has gone up to 1.30 ng/dL. I am pleased with FT4 indicator going up. My TBG is same as last lab work 19 ug/mL. My physician is very good and understands that I may have difficulty converting T4 to T3 medication as my liver experienced Hepatitis C when I was young. I am a practicing vegan dietetic measures and prefer not to go Paleo dietetic measures (I understand that Paleo might be better for my thyroid health challenge. I will see my physician in a few days and am confident with outcome. I will ask if we might bump up T3 meds regarding RT3 FT3 ratio dropping under 20 and discuss his opinion on big drop of TSH. I am functioning well on medication and observe I am not tired and sleepy and yawning as prior to medication., Thank you for your concern.

  58. Great article – very informative.

    My wife has had hypothyroidism for 20+ years. She has been on T4 with gradually increasing doses over the years. Recently her FNP checked her TSH and it was too low and she dropped her from 112 to 100 and then down to 88. She is constantly tired, takes multiple naps every day – IMHO is depressed, and just generally not feeling well. We tried to convince our FNP that her TSH may be low, but she was feeling better at the higher dose. She wouldn’t budge, but I was able to get her to order all the tests you recommended. All the numbers are “normal” but if I read your article correctly, I think maybe she is thyroid resistant. I believe the “right” choice for her would be to add T3 to her prescription, but our FNP is “happy” with her results (regardless of her symptoms). What is your opinion?

    TSH – 0.672
    T4 – 7.5
    T3 Uptake – 26
    Free T4 – 2.0
    RT3 – 20.4
    TPO Ab – 9
    Antibody <1.0

  59. Hi Dr. Childs,
    I have been on Armoid Tyroid for years. This past Nov my blood test came back with TSH of 3.55. 2016 is was 343, and 2015 2.81. I started with 30mg, then got bumped to 45, now my doctor bumped it up to 60. I was feeling great before the bump to 60 but since then I have lost weight, having hot/cold sweats day and night, my heart is palpating, I’m having trouble sleeping, which is very rare for me and I get out of breath doing the simplest things. What’s going on?

  60. I was diagnosed with Hypothyroidism about 9 years ago and have had TSH levels as low as .002. Over the years, I have been prescribed Nature Thyroid and Armour Thyroid. My Endocrinologist and GP have never tested me for T3, Reverse T3 or Free T4. Nor have they tested me for Tgab to test for Hashimoto’s. I am a 52 year old male and struggle to maintain my weight. My BMI is 23, I am 5’10 and weight 170. I eat over 3,000 calories a day, all day long. I cannot eat enough and still never gain weight. If I miss a work out, I actually lose a pound or two.

    Over the last two years I have had a terrible time remembering things, my anxiety is quite high, trouble concentrating, trouble sleeping. These symptoms have started to affect my work performance and relationships. I am currently prescribed 90 mg of Armour Thyroid which I take in the AM on an empty stomach. My last TSH level was at .005. I seem to have the symptoms of Hyperthyroidism but my Dr. says I have Hypothyroidism (I assume because of my low TSH).

    My GP recently diagnosed me with early dementia based on just the symptoms I described above and my wife and I were devastated. No blood tests were ordered, no scans, no neurological evals, just a quick diagnosis of dementia of a 52 year old able bodied man with a family. Pretty awful situation that has left us feeling sad and scared. At this point we are taking my thyroid situation into our own hands because we have yet to find a Dr willing to do the tests and work through this with us. Thank you for your article and the work you are doing Dr. Childs. If you can offer any advice, my family would be grateful. At this point, we have requested a complete thyroid panel be ordered. Anything else we should be requesting?

    • Hi Cass,

      It would also be worth evaluating various other factors such as inflammatory markers, insulin levels and testosterone. You might even consider looking at genetic markers which may predispose you to developing early onset dementia. In general I would probably probe a little bit deeper into your diagnosis to determine if that is truly the cause perhaps with further testing.

    Hi Dr. Childs, I so appreciate you taking the time to read and answer questions.
    My thyroid test results are unlike any results I have read or heard of.
    I am taking 112mcg of Synthroid and 75mcg of Cytomel… (gradually increased over two years to reach those doses)
    I’ve been basically the same weight, (around 120lbs) my whole life, then about two years ago I went up to 130lbs and no matter what I did I could not lose any weight. That’s when the doctor noticed the loss of the outsides of my eyebrows, did thyroid test, and told me I had hypothyroidism, (which both my mother and sister have). It took awhile, however after about 8 months of taking/adjusting my thyroid meds my weight dropped back to normal and I felt alive again, though that only lasted for about 8 months, (for the past 8 months) my weight has been increasing rapidly and much higher, (150lbs), and number and severity of my hypothyroid symptoms have increased dramatically.
    However, ALL MY THYROID TESTS ARE LOW… (and have been decreasing over the past two years despite the thyroid medications).
    Below my thyroid test results while on Synthroid and Cytomel.
    TSH = 1.60 –>0.22 –>0.01 –>0.05 –> 0.01
    Free T4 = 0.89 –> 0.67 –> 0.71 –> 0.7
    Free T3 = 2.6 –> 2.5 –> 1.8 –> 1.6
    RT3 = 9.7ng/dl
    TPA= <10.0
    Cortisol= 12.3ug/dL
    Antibody test for autoimmune thyroidists is negative.
    Two years ago I was also in the middle of the summer, (I literally work out in the sun the entire day) I was diagnosed with a vitamin D deficiency and put on 50,000 units of vitamin D monthly for the past two years. My doctor rechecked it a month ago and it is even worse, 10ng/ml. Yet my calcium levels have been slowly increasing and have reach 10.0, I don't take any vitamin supplements nor anti-acids and there is very little calcium in my diet. My potassium levels have also been increasing, from 3.4mmol/L to 4.7mmol/L.
    Decreasing lab values over the past two years.
    Glucose= 92mg/dl to 64mg/dl Bilirubin= 0.5mg/dl to 0.1mg/dl
    There was nothing else remarkable on any of my test.
    Though, I should note that I've had more than several head injuries in my lifetime, the most recent being 3 months ago when traveling at 65mph someone clipped my bumper which sent my car spinning, repeatedly slamming my head into the window. I also fell off the roof about 4 months ago but I don't remember hitting my head, however recently my memory fails me more often than not. I also noticed about 2 months ago a knot (?) on the left side of my neck at the base of my skull a bit larger than a marble, very hard, painless and unmovable. Oh, and I had carpal tunnel surgery sometime in the middle of this.
    Me nor my GP could make sense of my lab results. I saw the Endocrinologist a week ago and he had me stop taking both thyroid medications, but literally would not talk to me, just said to have labs for TSH and FT4 done in two weeks and then to see him in a month. And my GP increased my vitamin D to 50,000 every 7 days.
    I felt like my normal level of unwell, until day 4 off my thyroid medications, which was two days ago when unwell went to much worse.
    Can you tell me what if anything you conclude from this strange constellation of lab results, vitals and my state of being? I pray you have some idea, because I'm in a very dark place and I am losing my grip. Thank~you so much for reading this…
    With Gratitude ~Tigger turn to Eeyore desperate to be Tigger again…

    I look in the mirror and don't recognize my own body, I can't recall basic things like how to spell words, I kept trying to write the word 'only' the other day but I kept spelling it 'alonely', I knew it was wrong but I could not figure out how to spell it correctly, I forget everyday things the other day I spent 5 mi

    • I look in the mirror and don’t recognize my own body, I can’t recall basic things like how to spell words, I kept trying to write the word ‘only’ the other day but I kept spelling it ‘alonely’, I knew it was wrong but I could not figure out how to spell it correctly, I forget everyday things the other day I spent 5 minutes with my house key in my hand trying to figure out where the ignition switch was in the car, (my car doesn’t use a key and starts by pushing the button). I’m literally losing my mind. I sleep more hours than I am awake a day, and during the hours I am awake I feel exhausted… I’m sorry I’m rambling, because no one seems to get how far I am from okay. -London

  62. Hi Dr. Childs,
    I’m a 58yr old women, My labs are TSH 0.08 and my Free T4 Reflexive is 1.90 and I take 100mcg of Levothyroxine. I was diagnosed with Hashimoto 38 yrs ago. I have gained 20 lbs and my muscles ache, dry skin, very cold. Should my medication be changed? Also my thyroid is assymetrical. Having US this week. Suggestions???

  63. Dr. Childs –

    Thank you for this article. I have had a suppressed TSH for 8 years (0.02mlU/L), with normal T3 and T4 (free or total) while taking Cytomel 25mcg, and Synthroid 100mcg. I’m active (run, bike, hike, walk, etc.) 53yo female. I describe the way I felt prior to medication as “hitting a wall”, I couldn’t get a good deep breath, constantly cold, and my legs felt like lead. These meds were a lifesaver! I felt normal, I gained weight when I wasn’t paying attention, and lost it when I worked at it. My BMI floated between 23 and 25.

    Fast forward to today.

    I had the same doctor for 20 years, but she moved on and my new PCP was alarmed at the TSH. I knew that Cytomel suppressed the TSH, but she didn’t. So she referred me to an endocrinologist.

    The Endo adjusted the Cytomel from 25mcg once a day to 20mcg (10 am 10 pm) Sept 2017. I felt horrible the first 30 days of this change. Not “hitting” the wall, but maybe slapping it pretty hard.

    The Feb 2018 test were: TSH (0.02mlU/L), TT3 (121ng/dL) and FT4 (1.4ng/dL). No change, but I have also gained weight.

    After reading your article, I feel like I can ask better questions to my Endo to get a better understanding as to what happens. I do have one comment, and three questions for you:

    First, thank you for providing the complete thyroid panel, which I will ask for at my next appoint in April.

    Questions –
    *Will Total T3 include reverse T3?
    *If I’m taking Cytomel, and my T3 numbers are normal, can RT3 still be a problem?
    *After this test in Feb above, the Endo wants to lower the Cytomel from 20mcg to 10mcg. I am reluctant to do this in one shot because of the experience of lowered from 25 mcg once a day, to 20mcg twice a day (10 am 10 pm). Is it prudent to be cautious about cutting my dose?

    Thank you for your time.


  64. Was taking 100 Synthroid last fall….many symptoms of hypothyroid. Started 5 of cytomel along with morning dose of Synthroid….began to feel like a new person again. Two months later added 2.5 cytomel in afternoon. Now 2 months later I am having fullness in my head and feeling off balance/intermittent dizziness, but only starts in early evening for about 4 hours. Could this be from the addition of the extra 2.5 cytomel I take about 2:30 in the afternoon everyday?

  65. I had a T4 of 1.7 in January on 100 levothyroxine.

    Doctor cut me down to 50.

    6 weeks later T4 1.5 on 50 levo, but <0.01 TSH.

    Now Doctor wants me to go off levothyroxine.

    I'm confused. Is it safe to go off completely?

  66. Great information. I’ve been trying to get my doctor to run the tests you listed but I’m told it isn’t necessary! I insist I want to know! Exploring getting new doctor.

  67. Hello

    I know this is an old post and I hope you can help. I really am at a loss of how to help myself.

    I was diagnosed with an underactive thyroid 6 years ago. I have been taking Eltroxin ever since. I am currently taking 150 micrograms daily.

    For the past 6 weeks, I have been feeling like the walking dead. I have every symptom of an interactive thyroid so I went to see an endocrinologist. He sent me for a panel of blood tests. The results are as follows:
    TSH 0.03 uIU/ml
    FT4 14.6 pmol/Leigh
    Anti TG Antibody 1.76 IU/ml
    Anti TPO Antibody 0.16 IU/ml

    My doctor has asked me to decrease my Eltroxin from 150 to 125 micrograms per day. I don’t understand this. Why would he decrease my Eltroxin when my thyroid is underactive?

    Please help!

  68. Always told I have an underactive thyroid. Prescribed 50mg new blood are showing fish 0.01 and t3 23.1. Am I on the correct dosage. I feel that my symptoms have heightened and have developed new symptoms that weren’t present before.

  69. Hi Dr. Childs: I have antibodies for both Graves disease and Hashimoto’s Disease. I am just now recovering from my latest bout of hyperthyroid. My levels are T4 Free 1.54 and T3 150 and TSH .006. I was taking 20 mg. Methimazole. My endo says I need to stay on 10 mg Methimazole because I could swing back into hyperthyroid. The problem is, I have all of the symptoms of hypothyroid. I am not eating more than 800-1000 calories per day, I work out 4 days a week and I am stuck at the same weight for 3 weeks. I stopped taking my Methimazole because I do not want to go to full-blown Hypo. This has happened to me before and I had to go on Synthroid to get back to normal.

  70. Hi Dr. Childs! This is the best explanation of the various thyroid blood tests and interactions I’ve ever seen – and I’ve seen a lot.

    I’ve had something odd happen – and would love to know if you’ve ever heard or seen anything like it.

    History: Had half my thyroid taken out due to nodules 40 years ago. Currently 58, and moved from synthyroid to NDT 20 years ago. Durig a shortage of Armour (my pharmacy couldn’t get it) I grew some nodules – but those have been static over 15 years. I’ve been vegetarian for the past 5-6 years, and have lost over 100 pounds putting me into a normal weight range (female, 150 lbs, 5’7″). I frequently(2-4x/week) do 3-mile hikes, do some strength exercises, and swim sometimes to keep me healthy.

    Have been stuck at 150 lbs (my goal weight is 140) for over a year, and decided to try a “fast”. My fast consisted of less than 200 calories a day with things like a hard-boiled egg, half an avocado, or a couple macadamia nuts.

    I used keto urine strips, and the third day of the fast, I went out for an easy tempo walk. But when I came back I didn’t recover. Pulse stayed high, and I couldn’t sleep that night. The following morning I was almost at the top of the keto range for the strips (nothing prior). Went to the doctor that morning and my T4 was crazy high (which prompted her to do an antibody test, which came back normal – not elevated).

    Anyway, could fasting or ketosis cause a sudden change in thyroid function? My doctor didn’t seem to believe me when I said it was a sudden onset. Is it possible the cortisol uptick from fasting triggered my own thyroid on top of the desiccated thyroid?

    Broke the fast that day and have all but quit (taking 20% of normal) the thyroid. I don’t want my thyroid to start making nodules again :-/

    The TSH was 0 on the test, the T4 was 2.69 (and I felt horrible). I’ve used how I feel to manage my thyroid levels and have a good feel for what’s right with no issues for 15 years. Any ideas or suggestions on what to research?

  71. Hi Dr. Childs, I am grateful for your thyroid facts and opinions. My new PCP 12/17 wants me to reduce Armour (90 mg) to 6 days a week from 7 after 3-month blood test TSH 0.08, T3 to 119, Free t4 1.0, no other thyroid tests. Cancerous thyroid removed 12/2014, on levo, hair fell out, low temp and jittery 125 mcg, then 100 then 75 mcg for 2 years until new PCP 12/2017 asked to change to Armour 90 mg). 3 months later I am hesitant to reduce from 7 days to 6 as I feel well, not freezing all the time even in 65 deg F days, my hair is GROWING BACK! I am 60 years old, usually 100 lbs, now 102-105 lbs, 4’11’, osteoporosis diag in 2011. Please advise me. Thank you, God Bless, Alicia Harris

  72. Good morning;

    Thank you for a wonderfully written article! I have had Hashimoto’s for almost 40 years and I’m still learning new things every day! I take both T4 (currently 50 mcgs) and T3 (50 mcgs) daily. For about the past year my TSH has been between .008 and .045. We have tested approximately every 6 weeks and have adjusted my T4 down – we have not touched the T3 dosage as it is for depression and it works!

    I have never had a full panel as you suggest – but will be bringing that up to my doctor today. I made an appointment to see an endocrinologist (my primary has been taking care of my thyroid with no difficulties for years) but what suggestions would you have in the meantime?

    For the past 18 months, I have completely changed my diet and exercise habits and have seen great success in weight loss, stamina, and pain. I know that the meds needed to adjust down because of the weight loss, however, I am stumped as to why my TSH is still so high!

    I would value your input greatly, thank you.

  73. Hello Dr. Childs,

    I’d appreciate your thoughts on the following labs results. TSH has been extremely suppressed, yet free T4 levels remain low and T3 levels are lower than optimal. The doctor had me run additional tests to look for potential pituitary and/or hypothalamus disorders. Your thoughts, please? Thank you in advance!

    * Female, age 43
    * Been taking thyroid meds for Hypo since my early 20s
    * Currently taking 2 pills of 5mcg liothyronine (10 mcg total) along with 1.75G WP Thyroid upon waking
    * Labs just taken 3/30/18:
    – TSH = .006 (it’s been this low for 3+ years)
    – Free T4 = .79 ng/dL (it’s been dropping in the last 2 years)
    – Free T3 = 2.5 pg/mL
    – T3 = 85 ng/dL
    – Reverse T3 = 13.7 ng/dL
    – Thyrotropin Receptor Ab, Serum = <0.50 IU/L
    – LH = 7.8 mIU/mL (day 12 of cycle; average cycle 27 days)
    – FSH = 6.0 mIU/mL (day 12 of cycle; average cycle 27 days)
    – Prolactin = 9.0 ng/mL
    – Iodine, Random Urine 45.9 ug/L
    – Growth Hormone, Serum = 1.8 ng/mL

    • hi stacie,
      my TSH, FT4 and FT3 are IDENTICAL to yours…and they don’t make sense….as a low TSH while on thyroid meds with a sl LOW FT4 and a nl FT3.

      as you know a low TSH is associated with HIGH FT3 and FT4….i will look for another post from you.
      feel free to email me…

      • Hi Lauren,

        A low TSH is not necessarily associated with a high free T3 or high free T4. You can very easily suppress the TSH with levothyroxine and have a low free T3 level and it happens frequently.

      • Hi
        A low TSH is not always associated with a high FT3 or FT4 and sometimes a low TSH can be the result of taking Armour Thyroid or combination of T4/T3 meds.

  74. I go to an internist doctor, not a specialist. My Tsh is .63. I am tired all the time. I take Synthroid .88. I feel my best around 2 to 2.5.

  75. I am currently on 50mcg of levothyroxine and 50mcg of Cytomel. My recent bloodwork: TSH: 0.01,
    T4: 4.90, T3: 2.39. Still, have hypo symptoms and weight gain. My PCP reduced my Levo to 25mg. and wants to do bloodwork in 6mo. What should I do or suggest to her?

  76. My TSH has been dropping every 6 mos. I had a thyroidectomy 6 years ago and take Synthroid every day. My TSH is now 0.038. I have been on a strict diet and work out every day, and the weight is just not coming off. I see my doc next week to go over my results. Any ideas to help with the weight loss?

    • Hi
      I had thyroidectomy in 2016 and my labs are always low. I have been on a combo of T3/T4 (100mcg synthyroid and 10mcg Cytomel)

      I found its best to make sure your Vitamin levels are optimized (not just at the low end of the normal range) as many doctors think this is good… it’s not. VitD3 should always be taken with Vit K2.

      Looking for a good support group for thyroid disease go to Healthlock thyroid UK …great group.

  77. Hi,
    My thyroid was obliterated 15 years ago for Graves’ disease and a goiter after trying one year of back and forth medicines. I have been to several endocrinologists and until my recent one never felt like myself. But now I am on 137mg levothyroxine feel good except I now have a hyper parathyroid tumor. But my TSH level is 0.07 every blood test. I also still show signs of hypothyroidism such as fatigue and very intolerant of cold. I guess my question would be what else can help me?

  78. More than 15 years ago I was diagnosed with hypothyroid. I was put on medication. My ENT was trying to help me feel better and raised the amount to 225 mg. He also put me on Cytomel. Two years ago I was looking to figure out why I am so tired all the time. I went to a diabetes doctor to help with insulin resistance and he checks my thyroid and said I was on too much thyroid medication because of the low TSH. My last levels a week ago were free t4 1.64, free t3 3.6, and tsh, .01. I do not feel like I have symptoms of hypo. I crash at about 2 pm and do not feel any energy until later in the evening, if at all. Can a person go from hyper to hypo? What does the low tsh really tell me? I am tired of being so tired.

    • Go to Endocrinologist for your thyroid issues. The ENT is not capable of handling thyroid disease as your finding out!

  79. I am almost 60 years old and have been on various thyroid medications for about 20 years. My levels seem to fluctuate excessively. I am currently of Tirosint. My TSH W/REFLEX TO FT4 is low at 1.7, but my T4 FREE is 1.7. I am having major issues with cramping and wonder if it is related to my Hashimoto diagnosis. I am in good physical condition. I ran a mountain trail run a half marathon a few days ago and ended up having extreme cramping in my calves and thighs for the last 7 miles. My doctor does not seem to think there is a correlation between the muscle cramping and my thyroid issues. Is there any test, etc you can recommend to see if there is something else going on that is related?

  80. I have had hypothyroid for the last 19 years. I am currently taking Synthroid and liothyronine Sodium. My doctor does check my t3 and t4 levels on a regular basis but recently my TSH was setting at .09 so she adjusted my Synthroid only (cut it back to 1/2 a pill 3 days a week). after 6 weeks I had it retested and now it is set at .05. She is very strict about checking all aspects of the thyroid. I did read all your documentation and from what I gather from your information is that my body is having a tug of war with the t3s. My question is this…my thyroid seems to be VERY sensitive to constant changes…why don’t they just rip the sucker out (not that I want any surgery)? Wouldn’t that help regulate things a bit better?

    • Hi Marlene,

      Typically people who have their thyroid out find it much more difficult to titrate medications after the procedure. I can’t imagine a scenario in which it would be easier to remove the thyroid than play around with medication dosages, etc.

  81. Dr.Childs,

    My endo keeps telling me I must lower my Synthyroid from (100mcg)to(88mcg) and I’m to keep taking the 15mcg cytomel. She keeps telling me Im hyper and that im going to develope heart disease and this all comes from my DEXA Scan that says I have osteopenia (low risk). I don’t have any hyper symptoms at all and Im just not understanding and they don’t explain why.

    I had thyroidectomy (cancer) 16 months ago and all my test have pretty similar (TSH) results.

    MARCH 2018:

    FT3 (2.0 – 4.4) 2.980

    FT4 (0.93 – 1.7) 1.23

    TSH (0.27-4.20) ……0.076 (L)

    Reverse T3 (9.2 – 24.1) 19.3

    Thanks Grace

  82. I’m on Armour at 180 mgs. I’ve been on Armour for several years. My free T3 and 4 are normal. My Tsh is very low. I have no hyper symptoms except a high heart rate. But I had a high heart rate before ever being diagnosed hyperthyroid and taking Armour. I believe I have a high heart rate due to being anemic. I feel good on 180 mgs and my hypo symptoms have gone away. I didn’t have a hard time or an easy time losing weight. My new dr want to lower my dose until my TSH goes to the normal range. I know that my symptoms will come back at a lower dose as they didn’t go away until my previous dr increased it to 180 mgs. My previous dr left the state and so closed his practice. My new dr doesn’t believe in desiccated thyroid, says it doesn’t work and wants me to switch to synthetic thyroid. I don’t want to take synthetic and I don’t want to go below 180 mgs. What can I say to convince my new dr to keep me on Armour and to not lower my dose. She seems fixated on the high heart rate that I’ve had before being on thyroid medicine. She says that my high heart rate proves I’m over medicated. If she took away my Armour and I was not on any thyroid medication I would still have a high heart rate.

  83. At the present time/ HYPO? Hashi? Have been on (increasing dose of Levo/then Synthroid 125 MCH presently. I am at the end of my rope. I can hardly function. (I have told the ENDO this. and he continues to up the dose) Even those I’m feeling worse and worse. I went to a functional med Doc. We did some blood work (RT3 28)H (Thyro Antibodies 362)H (TPO 350)H (T4F 1.49 and TSH .55)*Both in the normal range (T3f 3.4) also within range. *I’m now stopping Synthroid slowly . and going to start Cytomel. Is this what you would say will work???. I’m 53. Hysterectomy. left ovaries. 30 years of Crones. (MANY years on Prednisone and other Biologics) Have not medicated for 10 years for the crones.* I believe these created my autoimmune issue to begin with

  84. Hi,

    I have been on levothyroxine for about 10/11 years. I was diagnosed with Hashimoto’s disease in 2010. I recently had a new test done done to check my levels because I felt really off and my Doctor didn’t change my meds or really tell me anything about what I was seeing so maybe you could help me?
    My TSH was <0.006, my T4 was 16.8, and my T3 was 4.5. I'm just really confused about what is happening to my body right now; with all my levels being that way. I have never seen my TSH level that low.

    • Hi Ashley,

      In Hashimoto’s, the amount of thyroid hormone that your body is capable of producing can vary based on the severity of the disease. If your thyroid pumps out more than normal, plus you are taking some medication, then you will likely see your TSH drop.

  85. Multi-nodular goiter removed years ago. Other lobe shrunk significantly, yet dr. thinks I don’t have Hashimoto’s due to my blood test. She thinks Central Hypothyroidism. FT3/4 levels perfect, but she thinks with my TSH at .006 is way too low. She wants to cut Naturethyroid 1.95 mg. down to 90 mg. I have suffered significant hair loss, muscle pain, etc. Yet she now believes I could be Hyper. I’m on bio-identical creams via doctor, so I don’t think it’s my age (65). Looking for a new doctor.

  86. Hi Dr. Childs, I have been struggling to find the right treatment for my Hypothyroid. I’m 19 yrs old and live an extremely clean life style. I run everyday and eat a very clean diet of wild caught salmon, veggies, egg whites and a whole egg. I also have guacamole at times with veggies. I never had a weight issue. I am 5ft3 and normally weigh 117 until lately. I was eating this way and working out etc. I noticed hair loss and weight gain so I changed my workouts to more cardio. I found a doctor who was listening to my symptoms of always being tired and cold, hair loss and weight gain. She had diagnose me with Hypothyroidism. I had full panel of test and at the time I had low T3 normal TSH and T4. I went on a compound for my T3 and saw results even though I had low T3. Fast forward I was referred to an endocrinologist because my Testosterone was elevated and the thought was PCOS I have delayed menstral cycle and no acne and no facial or body hair ever.
    Ever since I started the endocrinologist I went on birth control and that was awful tried it for a couple of months and blew up. Now off of the birth control for a month and half now and I’m have been on Tirosent and Cytomel since January with normal range free T4 and T3 but now have low TSH. I am at my heaviest at 126. I am eating and exercising as I always have. Why am I gaining weight?? What should I be doing next? Also, my cortisol levels have double since March. I am in college and have lots of stress. I don’t believe I have Cushings Disease. Welcome your feed back Please!!!


  87. At The End Of My Rope
    hypo diagnosed at age 22 a year after pregnancy. TSH was controlled with levothyroxine at 150mcg. After two years thyroids normalizes a year later I was back on meds. Symptoms were tolerated well enough. fast forward to the past three years. I went 6 months without insurance and no couldn’t get a doctor to prescribe me meds without being seen. I got sick all the hypo symptoms you can name I had it. when I finally got in to be seen My TSH was <0.01 in r.r
    0.36-3.74ulU/mL instead of looking into what could be going on they accused me of taking thyroid meds and put me on amour thyroid at 60mg. And my thyroid started to swing ever 6 weeks it was something different it would go hypo TSH 14.6 they back to hyper about 8 months ago the swings stopped and 6 months ago I switched back to Levo 150 and it has been lowered at my last labs down to 125. My last two labs are 2/16/2018 Before switching off amour
    TSH <0.02
    Thyroglobulin AB <0.9
    TPOAb 124.0
    Free T4 .96
    TSI <=122% my are 98
    T3, free 6.0
    T4 6.59
    After medicine switch
    TSH <0.02
    T3, Free 3.0
    T3,Total 124
    I have been given a Hashimoto’s diagnosis but I'm worried I might have Graves disease as well. Please help me My doctors won't run test I as for. I've asked her to run reverse t3 and a full thyroid panel everytime she tests and her nurse said she's going by textbook because she is in over her head. I had to get a new doctor after not having insurance because my old one retired and he was good. What test should I demand and how do I get her to do it? I have been experiencing a mix of hypo and hyper symptoms and as of late more hyper than anything.

  88. HI There,

    I am very discouraged over my sudden weight gain, fatigue and irritability. I have been on Synthroid to treat my hypothyroidism for the last 23 years. I can usually tell when my dosage is “off” and after testing it usually is. I am currently taking 112 micrograms after a new Doctor had lowered my dosage from the 125 I had been on for many years, even after my “hypo” symptoms. Fast forward 1 year and I am feeling fatigue,irritability, body aches, depression, and have gained 20 lbs in the past 2 weeks. I had a blood draw last week with no Doc to help with a dosage change. ( due to an out of state move and 4-5 week wait to see an endocrinologist). Again, I take 112 of Synthroid daily. My TSH is .015, with a T4 of 1.93. What dosage do you think I should be on given my symptoms and test results. I am 45 and most likely in menopause but I shouldn’t be symptomatic because of hormones my IUD is providing. I’d appreciate any help you can give, I am so discouraged.

    • Hi Jenel,

      I usually look at much more than just labs/symptoms to determine dosing so I can’t really provide that type of information. I would suggest that you take into account other hormones such as leptin/insulin when considering dosing adjustments, however, as these may play a role in some of your struggles.

  89. So I was suspicious of hypothyroidism but my TSH has always been low normal (<1) but have had hair fall brittle hair, low resting heart rate (53) and I’m not that fit right now and feel like I easily put on weight, (though I am not overweight at all.) so I went to a lab and paid for my own thyroid panel.
    TSH- 0.86 (normal)
    Free T4 – 1.12 ng/dL (in normal)
    Free t3 – 1.6 pg/ml (low)

    Any insight/way forward from here would be much appreciated.
    I’m a 28 y/o female with no other real issues that I’m aware of. Pretty healthy lifestyle.

    • Hi Jane,

      In order to get a better idea you really need to get the following tests: cortisol, thyroid panel (complete panel, what you have currently is not complete), estradiol, progesterone, free & total testosterone, leptin and insulin. This would be the best starting point to really put together the whole picture.

  90. I had my thyroid removed in January of 2016 for graves and TED. My TSH remains at less than .01 and my free t3 and t4 are in normal range. I take 137 Synthroid a day. at 125 a day I felt tired cold etc. I have gained 15 lbs and cannot lose weight. I am 70 and weigh more than I have ever weighed, almost 150. My TED dr is concerned about the low TSH. My endocrinologist has checked pituitary hormones and HAMA but all are normal. What is going on and what should I do?

  91. Excellent article. I have suffered with thyroid issues for probably most of my life. I can tell the doctor what tests and what meds to give me! I am taking Armour right now and they lowered the dosage again but everything seems to be functioning better now. I still don’t have a TSH but all my levels are fine. Never, and I mean never was inflammation explained to me as a problem with thyroid. I almost had hip surgery last year my pain was so severe. My hair is still falling out but I am going to give it time to catch up to the new dosage. I will be watching this site and I hope you still monitor it because you are doing a great job!

    • Hi Georgianne,

      Glad you like it! I check the site every day and publish at least 2-3 blog posts each week 🙂

  92. I had a total thyroidectomy 1.5years ago due to the medicine I was on affecting my kidneys. Since then, I have gained 40 lbs. I started out on 150 Levo, but my endo has added t3 and reduced my Levo to 112, all in hopes of getting my tsh to rise. It has been between. 001 and. 02 since surgery. She has concluded my tsh is just never going to go up and that I’m one of “those people”. Do you have any thoughts. I have no energy and I can’t stop gaining weight in spite of working on lifestyle changes.

  93. Blood tests show low TSH (.14) and High T3,free (1.14) but t4 (4.6), T4 free (1.14), T3 )156_ and Reverse T3 (9) are all in range. I take 90 mg Armour. Should I be concerned that TSH and Free T3 out of range. I still have low body temp and occasional shaky hands and anxiety, but energy levels are typically good. Sleep very poor (under 5 hrs) in spite of poor sleep. Been on Armour for 5 years. Male 71 yrs, lost 40 pounds over past 5 years but diet changed to low carb, gluten and dairy free, low sugar.

  94. I’ve had Hashimoto’s for 22 years. I have been on 237mcg of Levo for the last 2 years. All of a sudden I had 2 regular thyroid tests done and the TSH was .06 and .09, over the last 4 months. My dose is now down to 175mcg. And I have another test coming up in 3 weeks to recheck again. Why after 22 years is it doing this (looking hyper in blood work) but I still feel like crap.

    • Hi April,

      With Hashimoto’s, the amount of thyroid hormone that your thyroid can produce varies over time. It’s very possible that your thyroid gland is producing more thyroid hormone than normal and now with your added medication it’s enough to suppress your TSH. The amount of thyroid hormone that people need changes over time, just like any other hormone in the body, so you’ll never stay on a “static” dose forever.

  95. Hello Dr Childs. I am 50. 136 pounds. Had a full thyroidectomy. Gaining weight. Eye sight deteriorating. My TSH just came back at 4.4. My new doctor says this is normal. My old doctor never let it go above 3. Going with the first doctor’s wisdom, Does this mean I’m on too much or too little meds? thanks

  96. I am not on any thyroid medications. Two years ago, I had really bad hyperthyroid symptoms–shaking, anxiety, high energy (like a 5 year old with ADHD), heart palps, rapid weight loss (I loved it!) I actually felt like my old self except for the shaking and anxiety. Then I got really, really ill–like close to dying ill–that no doctor could figure out. They diagnosed it as fever of unknown origin (104 for 12 days straight). After that, I felt very hypo, gained back all the weight, felt like a slug with severe brain fog. Two years later I’ve fought my way back with diet, supplements, and iodine. My latest labs show my TSH is still 0.007, my FT3 and FT4 are optimal, but my reverse T3 is at the very top of range at 24. My symptoms aren’t too bad except for low heart rate, low temperature, an enlarged thyroid (I have Hashimoto’s and nodules), and can’t lose a pound. How can I bring the RT3/FT3 back into balance without meds? No doctor will give me anything.

  97. Hello,
    I am a 71 yr old woman, about 160 lbs, 5’8″. I have been taking synthroid for decades. For many years I took a dose of 2 MCG. Then 10 yrs ago it was lowered to 125.
    My blood test indicated a tsh level of 0.04 L. The other thyroid markers were within normal range.
    I believe I may be having breathing difficulties – worse when I am standing still – due in part to too much thyroid. I suspect that because when I’ve forgotten to take the medication I now believe my breathing problems are not as bad. I am also very intolerant of heat. Very! But other symptoms would point to low thyroid? However, I need to address the breathing, heart, problems first! I think with age my body does not handle the replacement hormone as well, at least when it comes to the heart.
    I’ve also been taking a weight loss pill, Tenuate Dospan. I am going to reduce that dosage too.
    What confuses me is I don’t have bulging eyes or unexplained weight loss – much the opposite. It seems that 2 worlds exist in my aging body – hyper and hypo thyroid.
    Any information would be helpful. Meanwhile, I am going to reduce the dosage and get another blood test and possibly see a specialist.
    Also, with the low tsh reading I have had much more hair loss and very dry skin – that doesn’t make sense?

    • Hi Beverly,

      You can suppress the TSH with T4 only medication no problem, but that doesn’t mean that your body is properly converting T4 into T3. You’ll need to check your free T3 and total T3 to determine if that is happening.

  98. I have been hypothyroid off and on since my second child was born. During my last pregnancy I was on levothyroxine and I started to cut back my meds because I felt hyperthyroid. After a month of being off the meds, I had a 0.2 tsh level but didn’t test for t3 or t4. I have never had a low tsh result before. If I test for t3 or t4 I’m not sure what I would do with the results, especially since I don’t feel hyperthyroid. What would you recommend?

    • Hi Rachel,

      The best place to start is with a complete thyroid panel because this can help you understand what is actually happening and help you plan your next move. Without this information you would simply be guessing.

  99. I was taking methimazole for hyperthyroidism but I stopped taking the medication when I found out that my free t3 and free t4 were normal. When off medication my TSH is 0.01. You indicated in your video that a TSH level of less than 1 is optimal for a healthy person. Does this mean that I am ok and have gone into remission?

    • Hi Elva,

      No, it sounds like your hyperthyroidism is back or never went away. A TSH of 0.01 is not a healthy normal range.

  100. Hi, Dr Child’s,
    I am currently taking dedicated thyroid(Etta) 135. I changed from Synthroid to Erfa because myt3 was 3.2 even after my Synthroid was raised to 150. I have been on Erfa now for 9 weeks and it has actually lowered my t3. This has confused my doctors as the Erfa contains t3 and should raise my t3 Numbers. Do you have any idea why this would be happening? I Also have Hashimotos with tpo antibodies at 1600. Thanks

  101. I am 64 years old woman who had the thyroid gland removed over 10 years ago. For a long time I have been suffering from strong feeling of internal shaking that is destoying my life. My Endo just puts this down to anxiety!

    My latest test results are: TSH 0.31 (0.4 – 4.9mU/L); FT3 3.6 (2.6 – 5.7pmoL); FT4 11.6 (9 – 19pmoL).

    Currently taking Levo 100 & T3 10mcg.

    Should I increase or decrease meds?

    • Hi Carol,

      Unfortunately, I can’t give you medical advice but you should look at your labs in conjunction with your symptoms when evaluating whether or not you should adjust your medication.

  102. I am diagnosed hashimotos hypothyroid. I had a baby 3 months ago. They upped my levothyroxine during pregnancy, and lowered it back to my normal dose at 6 weeks post partum bc my tsh was .08. Now, 14 weeks post partum my tsh is .01 with a normal t3 free and normal t4. Experiencing muscle aches, numbness in my fingers, hair loss, low body temp, and anxiety. What should I do?

  103. Can you help? TSH has ranged from .008 to .012 on
    120 mg of Armour.
    T4 between .80-1.15 and
    T3 5.3 to 4.2.

    I fight weight gain, fatigue, low stamina, and hair loss. Endocrinologist just now weaning me down to 90 mg. after being these levels over a year. What are the risks of this low TSH and What do you recommend to get to normal healthy levels?

  104. Thank you for all the detailed info. What would cause the TSH to be low (.006), T4 mid-range normal, but T3 very high (8.37)? I’ve been on Naturethroid for 2 years, my dose has been all over the place from 1 grain to 4 grains. Was diagnosed based on symptoms only (all labs were normal). After many months of bizarre symptoms that mimic hypo, I found I had iron overload. I donate blood every 3 months. Symptoms began to dissipate, however I started having hyperthyroid symptoms (palpitations, hot, insomnia, ect, but with a bit of weight gain). Could you please explain why one would have low TSH, normal T4, but really high T3? Thank you so much.

  105. Thank you for the article. It looks like I have a low TSH with symptoms of hypothyroidism, so my cells are not getting enough thyroid hormone but my pituitary is! I am on T4+ T3 therapy and my labs came back like this:

    Total T4) 81 nmol/ L 59 – 154
    FREE THYROXINE 17.2 pmol/l 12.0 – 22.0
    FREE T3 5.0 pmol/L 3.1 – 6.8

    How can I get enough thyroid hormone into my cells? Should I worried about the low TSH as I have low bone density? thank you 🙂

  106. Very informative article. Thank you!
    In my case just wondering if it is better to have a low TSH 0.04 or a low FT4 (just under the range) and lowish FT3. Because as soon as I reduce my dosage my TSH goes into range and my FT4 and FT3 lower too much..what do do? I am postmenopausal and have a low bone density, osteopenia. It seems very difficult 🙁 a bit hopeless

  107. I found this article very helpful and interesting, however, I just received a unique blood test result for thyroid function and I’m concerned about it…My T4 free is 0.75, TSH is 0.081 and T3 free is 2.7
    I have been struggling to regulate my thyroid for 3-4 yrs and I’m discouraged about the weight I’ve gained, dry skin, hair loss and fatigue. I’ve been taking 81.25 naturethroid and 5mcg of liothyronine, so confused as to why my TSH is low? Saw doc today and she increased the liothyronine to 10mcg and advised me to take it morning and night. I am also on Gaia adrenal support, fish oil, CoQ10, multivitamin, and magnesium/calcium/zinc, and as of today will start taking HPTP (pituitary homeopathic) and beta-sitosterol. Any suggestions? I am at my wit’s end and my doc probably is too, as she says these results are not typical! Can’t wait to hear from you! Thank you in advance, Teri

  108. Great article Dr. Childs. I’ve been on 45mg nature thyroid for years and felt ok, but severely sleepy to the point that I actually had been falling asleep at the drop of a hat in work meetings, working at my desk, etc. Some days I would have to go out to my car at work and take a nap-TWICE! I talked my doc into adding .5 mg of Cytomel. I feel much better, but now my labs are slightly out of range. I’m worried that she might not let me continue on the Cytomel.
    Free T3—2.8
    I take other hormones as well. I have Hashimoto’s and to make things more complicated, I have an immune deficiency (CVID) which affects my hormones, including adrenals. I wish that I could come to see you!
    What is your opinion of my lab results? Thanks much, Anna B.

  109. Do you have a low TSH but symptoms of hypothyroidism? yes, I do:
    – Weight gain:5kg in the last 2 months
    – I am most all the time cold
    – I wake up tired
    – muscle pain
    – dry skin
    TSH -0.071( ref 0.05-4.4)

    What about your free t3 and free t4 levels?
    T4 – 18.9 ( ref 10.0-20.0)
    What TSH level do you feel “best” at?
    Vitamin D – 54 ( ref 50-125), currently on medication with eutyrx 75mg
    hdl 2.0 ( ref 0.2-1.6)
    ldl 2.6( ref 1-2.6)

  110. Hi Dr. Childs! Thank you for your knowledge that you put on your website, it has helped me understand many things over these years of my fight!

    Have you ever seen someone start out as a classic Primary Hypothyroid and then once medicated they develop Secondary Hypo? My new Dr seems stumped but leaning towards that I have Secondary due to the blood work that I’ve been having and STILL having symptoms…

    No Meds:
    TSH- 5.25 (.45-4.5)
    FT4- 1.07 (0.82-1.77)
    FT3- 2.5 (2.0-4.4)
    RT3- 16.0 (9.2-24.1)

    2 Grains NDT:
    TSH- 0.014 (.45-4.5)
    FT4- 1.09 (0.82-1.77)
    FT3- 3.4 (2.0-4.4)
    RT3- none

    50mg Synthroid (NIGHTMARE)
    TSH: 3.51

    New Dr 1 grain NDT:
    TSH- 2.21 (.45-4.5)
    FT4- 0.81 (0.82-1.77)
    FT3- 2.6 (2.0-4.4)
    RT3- None

    1.5 grains NDT:
    TSH- 0.078 (.45-4.5)
    FT4- 1.00 (0.82-1.77)
    FT3- 2.9 (2.0-4.4)
    RT3- None

    My new Dr upped my Nature Throid to 1.75 and I am having a slew of Blood Work (including RT3) to confirm his suspicions that I may have Secondary Hypothyroid (I also always have high Prolactin and sometimes High Iron). From everything I read it’s not clear that if Medication can induce Secondary and I am so confused! Thank you for any and all advice.

  111. Hi Dr. Child’s,
    I appreciate how you respond so thoroughly to comments on here. I am 4.5 months postpartum and having my thyroid monitored, but haven’t yet started medication. My blood has been drawn four times. The first three times, I had elevated TSH (5.45 at it’s highest) and low FT4 (from 1.2 down to 0.9) along with low FT3 (2.2 down to 1.7). Last time I had my blood drawn, my TSH plummeted to 0.05, but my FT4 was also low (0.8) and my FT3 was low too (2.1). My symptoms are hypothyroid, not hyper. Any insight to what is going on? Or further tests I should request? My naturopath thinks the low TSH could be from the thyroid supplement (not a prescribed hormone) that I switched to but I’m not sure.
    I have had my TPO tested twice. It was 39 a few weeks after birth, then went up to 240 about four months postpartum.
    Thanks in advance!

  112. I’m hoping for some direction. 17 yrs ago I was diagnosed with Graves disease and had radioactive iodine done. I’ve struggled with hypo symptoms ever since. This was compounded by my irregular taking of meds. A year ago I got serious. Dr. prescribed 180 mg (3 grains) of Armour for 3 months and I felt great. Lost 50 lbs. TSH came back .012 Dr then alternated 180 mg and 120 mg. I felt ok – weight loss was harder but still modest results. 3 months later TSH was .032. I’ve been on Armour 120 for 4 months and have felt awful. I can’t make it through the day without a nap. My hair is falling out. I’ve gained 20 lbs and I have no energy to prepare healthy meals so I know I’m cheating. I had another lab for TSH today and an appointment in 3 days to discuss the results. I need a reason to convince my Dr. (internist) to look further. Suggestions?

  113. WOW! Wonderful info! Easy to understand because while i was reading this,I felt like i was having a conversation with a Dr..
    Anyway,Im on NDT.My blood test result brought me here:

    TSH is extremely low* 0.02 (yes!that low)
    T3 uptake – 30
    Free T4 Index – 1.7
    T4 Thyroxine -5.5
    TPO – 1
    TGA – <1
    I have an appt with my NP in 2 wks but meanwhile Im freaking out over the TSH. I was diagnosed with Hypo and have been taking Nature-Throid. I think my dose is too high maybe that's the problem but I also think I may have an RT3 problem–even though my T3 is in range? Im a size 8 should be sz 5/6.. But i still have outer eyebrows missing but have heart palps (is that strange?)
    AND my energy and brain fog is brutal sometimes.. any links or advice would be SO greatly appreciated! Thanks 😀

  114. Thank you for your article, I found it very interesting and informative. I have hypothyroidism. I have taken synthroid for over 25 years. Recently my doctor switched me to Armour Thyroid because my T4 was not converting into T3. Now my tsh is low and my free T3 is high. I still have symptoms of low thyroid and have put on a few lbs which I haven’t done in years. Is this Armour thyroid causing my issues or what could it be? My doctor has just lowered my dose of Armour Thyroid to bring my TSH up but I am afraid I will gain more weight and get more tired. Any thoughts or advice I would really appreciate it. Thank you so much

    • Hi Elizabeth,

      Not everyone does well on NDT formulations because they are “static” in dosing. You may be someone who needed just slightly more T3 but got too much with the transition or some scenario similar to that.

  115. Hi, so pleased I found this article! I’m in the UK and both me and my sister suffer all the symptoms, my sister has a resting heart rate of 45 and is not an athlete! Problem is UK doctors will not treat unless your TSH is over 5 (my sisters is steadily rising and now over 3). They won’t do full thyroid panel either. Do you have any suggestions? We were thinking of doing the private test and then taking results to gp. Concerned they have tunnel vision and no matter what will only treat if you’re TSH is over 5! I was thinking of buying armour privately! Any suggestions would be greatly appreciated!

    • Hi Tracey,

      As far as I can tell, the best way to get treatment in the UK is to find and pay out of pocket for a private doctor. There have been others who comment here and have told me that that has worked for them.

  116. Dear Dr. Child’s, I really appreciate your post. Currently I take both cytomegalovirus and tirosint. My latest labs are at- T-SHIRT 1.260/ T4 7.5/ T3 Uptake 24/ Free Thyroxine Index 1.8. My nurse practitioner says it is all great. However, I am not feeling well at all. Shortly after I take my meds in the am, I get this tremendous amount of nervous energy. I literally shake. I can barely focus or hold down a conversation. This is embarrassing. I’m 45 by the way.

    By the evening, I’m so exhausted all I want to do is lay on the couch. Please give me some advice. Sincerely, Selena

  117. Dr.Childs,
    I have been on 50mcg of Levothyroxine and my TSH was low so dose was reduced to 25mcg. Lab redrawn after 8 weeks showed low TSH. Then instructed to omit dose 2 days a week for 8 weeks. Lab draw still showing low TSH. I am now instructed to taper dose down gradually then stop altogether. Does this sound like the right plan?

    • Hi Carol,

      When I treat patients I am usually more interested in free thyroid hormone concentrations as opposed to the TSH. Without this information, I can’t offer much help.

  118. I was diagnosed with hypothyroidism back in 2012 and put on synthroid, it took a while for dosage adjustments but my TSH finally normalized. In 2015 I had my left thyroid removed due to A-typical nodules growing on it and my synthroid dosage was increased to 150mcg due to a spike in my TSH prior to surgery. A biopsy of my left thyroid after removed had me diagnosed with Hoshimoto’s (still in 2015). Now between September 2017 to November 2018 my TSH levels have rollercoastered from 1.98 in September 2017, 7.89 in January 2018, .045 in May 2018, .027 in August 2018, and .028 in November 2018. I am always fatigued, my body temperature is always elevated to the point I will break a sweat wearing a t-shirt and shorts when everyone else is wearing sweatshirts and pants at a state of rest, and my heart goes into rapid rates (up to over 200 bpm) without me feeling it. I am under the care of a cardiologist for the heart issues. Constantly have chronic skeletal and muscle cramps and pain. So what are the questions I need to be asking my doctor?

  119. Hi Dr. Childs. Due to my symptoms, my physician told me I had hypo (Juli.2018). With the same results, an endocrinologist said that my thyroid panel was perfectly normal and that I didn´t had hypo but just slow metabolism. But in any case, both said I should start on levothyroxine 50mg. With this dose, most of my symptoms disappear, so my physician increased my dose to 75 (August 2018). With this dose, I´ve felt great until the last couple of days that I started to feel tired again, with muscle pain, cold hands, and feet (Dec 2018).

    These are my results:
    TSH – 1.8 mUl/L
    T4 – 8.7 ug/dL
    T3 – 0.99 ng/mL
    Free T4 – 0.78 ng/dL

    TSH – 0.15 mUl/L
    T4 – 8.07 ug/dL
    T3 – 1.01 ng/mL
    Free T4 – 0.89 ng/dL
    Free T3 – 4.08 pg/ml

    TSH – 0.09 mUl/L
    T4 – 9.91 ug/dL
    T3 – 1.17 ng/mL
    Free T4 – 0.95 ng/dL
    Free T3 – 3.74 pg/ml

    Any insight/way forward from here would be much appreciated. I really don´t feel hyper and don´t understand how my levels are moving.
    I’m a 28, female with no other real issues. Pretty healthy lifestyle.

  120. Hello. I was diagnosed with Hashimoto’s a little over 2 years ago, and got pregnant a little over 1 year ago. I have never taken thyroid medication because I prefer to try to manage it naturally, but I was extremely disciplined with eating, exercising, and taking herbal supplements during pregnancy and my TPO actually got a lot lower during that time (from 293 down to 120.) My thyroid tests over the past 2 years have consistently shown normal to high TSH (never higher than about 7.0), always normal T4, and normal T3 except for 2 tests when I was pregnant that showed T3 getting lower. My TPO, as I mentioned, went from the first test of 293 down to 120 at 8 months pregnant, then it went back up to 243 about 2 months postpartum. Now, at 4.5 months postpartum, my T3 and T4 are normal but my TSH is low for the first time ever (0.34) and my TPO is alarmingly high (499.) What in the world does that mean?! Forgive me if the answer is in your article– I read it but I don’t have a scientifically wired mind so I may have misunderstood, and what’s really confusing me is not just my blood work numbers, but the progression– the combination of high TPO and low TSH. All my symptoms are still hypothyroidism, if that helps. Thank you!

  121. Thank you for this! I have VERY low TSH (like .3) but my T3 and T4 look ok right now, and I’m not producing any anti-thyroid antibodies. I’m 16 weeks pregnant and they keep doing tests. I still have many hypothyroid symptoms. I take 60 mg of Armour Thyroid and have for 10 years- since my second child turned 1. I was likely hypothyroid for a long time before that. And I’ve felt that there is a missing piece for many, many years. About 4 years before the hypothyroid diagnosis, I was in a severe car accident, which included head trauma. However, at the time, saving my life was more important than worrying about my pituitary gland and such. I strongly suspect that your suggestion about head trauma and the pituitary gland and hypothalmus might be at least part of the missing puzzle piece. I will be asking my midwife about that next week. Thank you! I’m off to keep reading.

  122. Hi Dr. Childs! Thank you for your knowledge that you put on your website, it has helped me understand many things over these years of my fight!

    Have you ever seen someone start out as a classic Primary Hypothyroid and then once medicated they develop Secondary Hypo? My new Dr seems stumped but leaning towards that I have Secondary due to the blood work that I’ve been having and STILL having symptoms…

    No Meds:
    TSH- 5.25 (.45-4.5)
    FT4- 1.07 (0.82-1.77)
    FT3- 2.5 (2.0-4.4)
    RT3- 16.0 (9.2-24.1)

    2 Grains NDT:
    TSH- 0.014 (.45-4.5)
    FT4- 1.09 (0.82-1.77)
    FT3- 3.4 (2.0-4.4)
    RT3- none

    50mg Synthroid (NIGHTMARE)
    TSH: 3.51

    New Dr 1 grain NDT:
    TSH- 2.21 (.45-4.5)
    FT4- 0.81 (0.82-1.77)
    FT3- 2.6 (2.0-4.4)
    RT3- None

    1.5 grains NDT:
    TSH- 0.078 (.45-4.5)
    FT4- 1.00 (0.82-1.77)
    FT3- 2.9 (2.0-4.4)
    RT3- None

    My new is suspicions that I may have Secondary Hypothyroid due to severe blood loss from my accident (I also always have high Prolactin and sometimes High or low Iron). But this new Endo cut me off before I could even explain! Thank you for any and all advice.

    • Hi Kristina,

      The short answer is that yes, many people have a combination of primary + secondary or primary + tertiary and so on.

  123. Hi Dr. Child’s
    I found your articles very helpful.
    I have been on amour thyroid 190 mg a day from 2010 to 2015. My new dr lowered my amour to 120 mg a day and added liothyothrine 5mcg 2times a day.
    I have been gaining weight and have noticed depression. Also I have been battling kidney infections. I get one or two a year.
    My TSH has always been low. .015. I wasn’t educated enough to know their were other tests.
    August 2018. FT4 was 1.54
    TSH .010 I don’t know about FT3.
    I was having heart palpitations and trembling.
    So they took me off my liothyronine and lowered my thyroid to 60 mg. Still having trouble with my heart.
    Retested 12-6-2018
    FT3. 5.3 high
    FT4. .86
    TSH. .005 low

    He didn’t believe the test so I had it redone on 12-14-2018
    FT 3 4.9 High
    FT4 .73 low
    Tsh .005
    What the heck
    I am so confused on what’s going on.
    I haven’t seen an endocrinologist. I believe I better.
    I don’t feel good.
    Gaining weight
    Hair is thinning
    My heart palatations have decreased.
    I need a little advice.
    To make matters worse I’m from Alaska and spend my winters in Az. We call that a snow bird.
    Thank you

    • Hi Debra,

      Your sensitivity to thyroid medication can change over time and depending on various factors in your life. You may need a temporarily lower dose for now which may go back to normal in a few months to a year. I’ve seen this happen with my patients before as well.

  124. Hi Dr. Childs,

    I am a 67 year old female that has been on 125 mg of Synthroid for years due to hypothroidism. During the past year my TSH has dropped in the last 3 labs from 1.92 down to .40. (also lost 5 lbs.) My endocrinologist and my GP only test TSH. I exercise quite frequently and from October to December I had a pinched nerve in my C4 and had to take mega doses of Ibuprofen to get past the pain. Strange thing is that I have no symptoms of being hypo and I feel wonderful except for having periodic muscle fascinations and this started when my tsh dropped. Do you think I should insist that my endo does more tests to determine why my tsh is dropping? Would the stress of that pinched nerve have anything to do with the low numbers? I read that stress can affect the results. Thank you in advance.

    • Hi Connie,

      Stress affects your thyroid lab tests negatively which is not what is happening here. You’re basically experiencing what happens to thyroid patients when they are treated adequately without relying upon the TSH. What will most likely happen is that your doctors will insist that you drop your dose and you will start to experience worsening symptoms (weight gain, fatigue, hair loss, etc.). This has to do with how current physicians treat thyroid diseases and this is part of the reason that my entire blog exists, to try and debunk this method of treatment. The best thing you can do is try to not drop your dose if possible.

  125. Hi Dr.Childs
    I have no thyroid and I take 2 grains of Armour Thyroid and I also have Psoriatic Arthritis and currently in a 2 year flare that makes movement a nightmare at times.

    Can you tell me if my immunosuppressive drugs I take for psoriatic arthritis can cause my TSH,FT4,FT3 and T3 to be in the low end of normal? No matter what i do my Endo wants to drop my ARMOUR dose I mean come on I have no thyroid I gained 50lbs and developed Psoriatic Arthritis believed to be brought on by thyroidectomy.

    Any idea why my tsh,t3,Ft3 and FT4 would be bottoming out I’ve been on 2grains since Aug 2018 and my numbers drop every time? I’m tired of reducing my meds soon I will be on no meds without a thyroid at this rate as I fought the past 3 reductions in the past few months and now I’m looking to fight again.

  126. Since turning 40 it seems things have been downhill for me. I am 48 and use to be happy healthy and full of energy and all of this had changed since having conditions requiring meds and I feel being a female and hitting this phase of life has made it more difficult. My mother has suffered from thyroid throughout her life and I have been on levothyroxine 5-6 yrs with it being increased regularly but recent thyroid panel with TSH tach showed low TSH and normal t4 t3 uptake and free thyroxine index so she has reduced my med to 88 instead of 100 and says repeat test in 4 months. Also says my blood sugar was showing too high for the first time. I have high blood pressure, high cholesterol, thyroid and now signs of diabetes coming on. I feel I just want to stop taking everything and be drug-free. My hair had thinned and falls out and I drag around like I am depressed. Thank you for taking this time to fill us with understandable information and breaking things down so we can get a clearer picture. This helps and it is appreciated. Wish you were in Va.

  127. Hi Doc Childs
    I am about one and 1/2 years post radioactive iodine for Graves. In Dec I was on 112mcg levothyroxine. Dec labs were:

    T4, FREE
    T4, FREE 1.9 HIGH 0.8-1.8 ng/dL 01
    TSH 0.02 LOW 0.40-4.50 mIU/L 01
    T3, FREE
    T3, FREE 3.7 2.3-4.2 pg/mL 01

    So meds were reduced to 100mcg
    My most recent results were:
    T4, FREE
    T4, FREE 1.3 NORMAL 0.8-1.8 ng/dL 01
    TSH 0.07 LOW 0.40-4.50 mIU/L 01
    T3, FREE
    T3, FREE 2.9 NORMAL 2.3-4.2 pg/mL 0
    I feel just fine and my weight is good. Do you think I should stay on this dose, reduce meds again or have more comprehensive testing such as reverse t3’s?
    Thanks, Ann.

    • Hi Ann,

      Unfortunately, I can’t give medical advice to you unless you are an existing patient but you can take your lab results to your current doctor for further help. If your doctor isn’t willing to work with you, you can use this resource to find a thyroid-specific doctor: https://www.restartmed.com/thyroid-doctor/

  128. How would you explain normal range FT3 in the presence of below range FT4 with TSH of 1.01 while taking 60mg Armour? Perhaps the pituitary recognizes the normal level of FT3 and decreases TSH? But how can you have adequate FT3 when FT4 is decreased? What about pooling of FT3? RT3 was drawn as well but results are not yet back.

    • Hi Angie,

      Any thyroid medication will drop the TSH, and how well you convert will determine the approximate ranges of fT3 and fT4. In addition, some people are more sensitive to medications which contain T3 which drops the T4 level due to pituitary feedback.

  129. Hello,

    I have been taking 90 mg Armour Thyroid for years. I started on Synthroid and was later given Cytomel which I was allergic to. It landed me in the E.R. with hives everywhere.

    Fast forward to January 2019, I went for my annual labs. My FT4 has been Here are my labs:
    FT4: 0.8 (0.9 – 1.7) which has been at this level for years
    FT3: 3.1 (2.3 – 4.1)
    TSH: 0.441 (0.400 – 5.500) – A year ago it was 0.98.

    My doctor recommended lowering my Armour and possibly adding back Synthroid to help my TSH levels. All I know is I want to feel normal and lose weight.

    What are your thoughts on the labs?

  130. I’m a 60-year-old female that started thyroid replacement with NP Thyroid about 3 years ago at 60 mg. I’m currently on 90 mg and I can’t get optimal because every doctor I’ve tried chases my TSH which is low (just below range). If I drop my dose my terrible body-wide pain starts up again. In spite of the low TSH, my free T4 is the bottom number in the range (0.9) and my free T3 is low at 2.0 (range 2.4-4.2 pg/mL). RT3 is 14. How can I explain to my doctor what I need? She’s willing to try Cytomel, but she wants me to drop to 60 – 75 mg of NP Thyroid and add in only 7.5 mcg of Cytomel for 6 weeks. Is this reasonable when I’m obviously so hypo? Thanks for any insight.

  131. Thank you so much for this article. I am, however still pretty confused as to what is going on with me. I have have had and been treated for hypothyroid since my 20’s. I have been through quite a bit of stress with work and a death in our family and really had not been taking care of myself. I really thought I was exhausted because of all of these factors and the fact that I had not been taking my medication regularly for diabetes and thyroid. I scheduled a doctor’s appointment expecting my blood sugar to be high and thyroid way off. My sugars were high but my thyroid was .019. My doctor said that I was taking too much medication and reduced it. I told him I had not been taking my medication. How could I have too much thyroid hormone if I am hypo and have not been taking my meds. Is it normal for someone to go from hypo for over 25 years to now hyper? Or could there be something more serious going on? Thanks for any insight!

    • Hi Lisa,

      I wouldn’t say it’s normal but it can absolutely happen. You need to get a full set of labs off your medication to determine what is going on.

  132. I’m happy to have found your site, but still a bit confused after reading several articles concerning TSH.

    I had my ND check my thyroid levels recently, but she only did TSH. It came back as .22, so she said she wanted to reduce my 50mcg dose of Synthroid to 25mcg. I asked her to let me take a month to see if anything changed, as I went through some really major emotional stress in January and February, had lost my appetite as a result and had stopped eating much, losing nine pounds. I was also taking herbal supplements via tinctures created for me, such as white peony and ashwaghanda. I’ve been lethargic the whole time, very sleepy and I was still exercising 2-3 times a week, downhill skiing 4-6 hours each time. I’m not losing my hair, I have no tremors. I’ve not gained back the weight (and note that this was my weight most of the last 30 years; it fluctuates every so often due to thyroid and other hormonal issues. An OBGYN put me on three different permanent birth controls post endometrial ablation surgery in 2015 before I finally said “no” to synthetic hormones for good in spring 2017-that weight took forever to lose.

    I was diagnosed with Hashimoto’s in 2008 amongst a few other major health issues at the time and I was showing up on and off as ANA+ as a result. I also have endometriosis and am estrogen dominant. It took years to get things back to more “normal.” Hashis is in my family: a cousin was recently diagnosed on the maternal side, but on the paternal side, my grandmother had a goiter and my aunt was on thyroid meds for much of her adult life.

    The ND retested me last week and it was .26, so still too low in her mind. I have now requested an appointment with my endocrinologist, who is the only one I want messing with my meds.

    I’m new to where I live, so this endo has known me less than two years and I just started with this ND in the fall. I don’t understand why only TSH was done when I know T3 and T4 should be taken into account.

    Per last ultrasound in the fall, I have a suspicious nodule on my thyroid and others that are not. It seems feasible to me that this could be affecting things.

    I worry that neither doctor really knows my case well enough and are just going by “Golden standard.”

    I eat a very healthy diet, minimal to no processed foods, mostly organic and free ranges, grass fed. I do IF, so I wonder if that affects thyroid hormones at all.

    What else should I be asking for? Am I on the right track? I feel like no one knows my body like I do, and I’m worried that messing around too much with medications is going to make things worse and take longer to recover from.

    Thank you for any suggestions.

  133. Hello Dr. Childs, I am taking levothyroxine for hypothyroid 50 mcg daily and had my blood test done recently. My TSH is .094
    T4,Free(Direct) is 1.58 ng/dL ,
    Reverse T3, Serum A 32.2
    T3 Uptake 29 %
    Triiodothyronine (T3) 105 ng/dL .
    So, looks like my TSH is low now and reverse T3 is high. Please advise.

  134. This website has been life-changing. I had my thyroid removed 18 months ago. I was diagnosed with Graves 13 years ago and have always been able to manage things with ATD’s. The last time it came back however I was not responding to the Methimazole and it was not bringing my levels down much and I hated how the beta blockers made me feel to control my heart rate, so we decided it was best to remove my thyroid. I felt so much better after! The anxiety and crazy fast heart rate were gone within just a few days of surgery.

    However, now I’m dealing with the never-ending battle of trying to find my perfect balance of medication. My TSH has been and is still super suppressed but I do not have any symptoms of a hyperactive thyroid. My endo office (I just see the PA’s for medication adjustment) has been so fixated on my low TSH and they keep lowering my doses which is causing my t3 and t4 to drop too. My personal belief is that you should look at the whole picture and this is what it seems you say too. My tsh bumped up a tiny bit this last draw but I honestly feel like in order to get my TSH to a “normal level” I’m going to have to let my T3 and T4 drop to below normal levels. I have symptoms of hypothyroid currently but I feel like they do not listen and just focus on the tsh. My hair is very brittle and is literally breaking off, I’m sluggish, my BBT is consistently low, and I’m gaining weight even though I’ve had no changes to my diet or activity level.

    I’ve never had my RT3 tested. Could this be affecting things? I just had my antibodies tested and they came back in the normal range.

    Here are a few of my lab draws to show how thing have been since surgery:

    Started 100mg Levo 2 weeks post total thyroidectomy 12/20/17

    Increased to 112mg of Levo after this draw.

    FT4- .99
    Then she thought I was being over medicated because my tsh was still low so she had me drop my Sunday pill to half a pill

    TSH- 0.017
    I reported feeling sluggish so she added 10mg of cytomel to my 112mg Levo with keeping Sunday as a half pill.

    TSH- 0.005
    We bumped up my Levo back to 7 days at 112mg and 10mg cytomel.

    TSH- 0.005
    TT3- 95
    FT4- .94
    She had me drop my Sunday Levo back down to a half pill because my T3 and T4 dropped suspecting I was just being sensitive to the medication. ???

    TSH- 0.005
    TT3- 104
    FT4- 1.05
    She had me drop my cytomel to 5mg suspecting sensitivity to that and then had me increase to 112 mg for 7 days of Levo.

    TT3- 99
    FT4- 1.02
    She had me drop my Sunday pill again to half 112 mg tablet and stick with 5 mg cytomel.

    At this point, I began getting frustrated with the jumping back and forth with my meds and being so fixated on my tsh that I asked if we could start looking into why my TSH is still suppressed. She still is insistent that is is that I am just sensitive to the meds.

    I did some reading online and found a lot of information about how elevated antibodies can be a cause of suppressed TSH so I asked that we check them at my next draw.

    TSH- 0.022
    TT3- .90
    FT4- .83
    Anti-TPO- 24 IU/mil
    TSI- .55
    I was so bummed because I thought for sure my antibodies were the answer.

    So what else could it be? My tsh is finally climbing a little but I feel like in order to get it up any more my T3 and T4 are going to have to plummet super low.

    What are your recommendations! Should I have my RT3 checked? They’ve never checked? Are there any other reasons? I don’t feel great and would love my levels to be above mid-range normal, not rock bottom normal!

    HELP! Any advice you could give would be so appreciated! I’m depressed and feel like I’m at a total loss and feel like the PA is so fixated on my TSH and is not treating me based on symptoms or on the whole picture of my thyroid panel.

    Any advice you could give would mean the world to me! Thank you!

    • Hi Missy,

      The single best thing you can/should do is look for a knowledgable doctor who is more willing to work with you and help you figure out what therapies are necessary for your situation. That includes someone who is willing to order more advanced tests and consider using T4/T3 combinations. You can learn how to find someone who fits this profile here: https://www.restartmed.com/thyroid-doctor/

  135. Hello Dr Childs, I love your website and have learned a lot from it. I have been on desiccated thyroid for a few years, and recently my GP said he didn’t like that my TSH has been suppressed for a while (I’m talking 0.00something). However I have no hyper symptoms, but he still made me cut out my dose by 30 mgs every few months. As a result I have been gaining weight, developed carpal tunnel syndrome and I feel very tired. My free t3 is within the normal range but reverse t3 is high, what could be going on with me ?

    • Hi Samantha,

      It sounds like you dropped your dose and you are now experiencing the symptoms of hypothyroidism. Your labs should level out probably within a few months and you will probably have a low free t3/low free t3 at that time as your TSH increases.

  136. Hello Dr. Childs
    I’m writing this letter because I have been completely frustrated with my local doctors and my thyroid issue.
    I will turn 74 in July. Other than my thyroid issues, I am very healthy. My biggest problem is the lack of energy that I have. I’ve had this problem for at least the last 18 years or so and it seems to be getting worse. I know at my age I’m not going to have the energy of a 60-year-old but most of my friends in my age range have an incredible amount of energy compared to me.
    I was born hypothyroid, and after being diagnosed around 6 yrs I was treated by a specialist in San Francisco. I have a letter from him stating that I was taking five grains of Armour thyroid in 1956. I had been taking that same amount of for approximately 30 years or so. I had a normal level. I was not hyper I did not have any of the symptoms I’ve seen written in medical journals of being hyperthyroid.
    The following numbers are from the last thyroid test I had in April 2019.
    T4 1.25 TSH .012 T3 9.3 these numbers represent my daily amount of 3 grains of armor thyroid per day for approximately three months. After my last visit, my doctor (endocrinologist) told me my TSH was extremely low, and my T3 was extremely high. She suggested I try 2.5 grains and come back for another test in July. In the past year or so I have had approximately 30 other blood tests and they all came in normal, so I don’t think I have any other health issues going on. In 2006 I was diagnosed with ADD. I was given a stimulant Adderall to help my concentration. What I also found out to my surprise was that it helped me out a lot with my energy problem. When I was younger I never had a problem with concentration, so I’m not really sure if I am ADD or not. I would rather not take any medication I don’t need.

    Now for the big question I have for you. Is there any way that I could be hypothyroid with the pass lab test numbers. I know there are all kinds of opinions from doctors they specialize in the thyroid gland.
    When I was a kid, and taking five grains of Armour Thyroid there was no such thing as the TSH test. Doctors at that time used how the patient felt. I’m just guessing that’s when doctors started using the TSH test where is the beginning of the end of my energy level.
    Hopefully, to get in your opinion I can put an end to my quest for taking more thyroid. If you have the same opinion as they, I will most likely accept I have some other problem going on.

    I want to thank you very much for all the time you spend helping the people on this blog.

    • Hi Larry,

      Yes, you are correct in that in the ’50s and ’60’s thyroid medication was dosed based on symptomatology and other metrics such as metabolism and body temperature. Once the TSH was ‘discovered’ that’s when doctors cut all thyroid dosing basically in half which sparked a number of issues among patients such as yourself. It appears that it didn’t catch up with you until now for some reason.

      In your case, it would seem that if a low TSH was going to cause a problem it would have caused one by now as you’ve probably had a suppressed TSH for 3-4 decades or more. It doesn’t make logical sense to lower your dose, especially if you were fine.

      And yes, it’s possible to be hypothyroid with a suppressed TSH because the status of thyroid function in your body is better represented by other metrics such as free T3, the free t3:reverse T3 ratio, and total T3. Doctors are not trained to measure these lab tests, however, which is essentially the reason why I have this blog and do the work that I do.

  137. Hi Dr. Childs

    I had Graves’ disease 33 years ago, had RAI and became hypo for 33 years. I’m 56 years old now and my TSH is at .16. My doctor has lowered the dosage of my Levothyroxine 4 times now and it makes it worse by lowering my TSH My Free T4 is 16. My doctor has lowered dosage about every 50-60 days. I’m achy and I’d say I have insomnia, heart palpitations and a bit of eye discomfort but also sensitive to cold. Because of my age, I have been experiencing symptoms related to menopause so I think it’s difficult to decipher what’s related to that and to my thyroid. I’m going to see my GP in a few days and will ask for a referral to Endocrinologist. Any suggestions or insight would be appreciated. I want to know what I should be asking for or expecting of them. I understand it’s rare to become hyperthyroid after 33 years but not impossible. Is there any indication it could be a pituitary or hypothalamus problem? Also, right side of my neck is slightly swollen but not tender.
    I appreciate your time.

    • Hi Patti,

      It’s possible to become hyperthyroid after RAI but very unlikely considering RAI is supposed to destroy your thyroid gland. Instead, it’s much more likely you are experiencing hypothyroid symptoms because your dose is too low while also experiencing menopausal vasomotor symptoms which appear to be thyroid related but are not. The only way to figure it out is with the assistance of a physician and some basic lab tests.

      • Hi Dr. Childs

        I just wanted clarification on my dosage of Levothyroxine. My TSH had been 0.2 so my doctor reduced my last dosage, re-tested my TSH and it was 0.16 So is this not what he’s supposed to do given my TSH levels? Does this mean I have too much TSH? I was confused when you said my dose was possibly too low. Thank you again, very much.

  138. Hello DR, thank you for your great articles. I am feeling worse than ever.
    My Dr said that I am stable. No change in med. Taking 2 grains Np Thyroid and 5mcg T3… Pressure in my head off balance, can’t function, BP went from 100/70 my whole life to 136/70. I’m in NY and been suffering for years. Dr refused further testing and doesn’t want to know about any symptoms. Thanks.

    Tsh 0.187, range 0.358-3.741
    reverse T3 11.3, range 9.2-24.1
    FT4 0.61, range 0.76-1.46
    T4 5.7. range 4.8-13.9
    FT3 2.7 range 2.0-4.4
    TT3 112, range 60-180

  139. Hello, Dr. Childs, I am 47 female I have Hashimoto’s recently my blood pressure has been quite high 169/110 pulse 115 my EKG was abnormal had cardiac test everything looked good… I feel like crap… So doctor checked my levels and the T3 and T 4 were in range but my TSH was 0.01… I get the results sent to my email… My dr. calls and says “everything” looks great… I feel like crap 8 months ago my TSH was 6.0 Is this normal? I take 75 mcg levothyroxine and my weight is out of control! Thank you for any help…

    • Hi Shannon,

      It sounds like your results are certainly abnormal and should be evaluated more closely by a physician who better understands thyroid management.

  140. Hello Dr.,

    I am very confused, as is my doctor. I am 57. Live in Phx, AZ. I always have all the blood tests that you mention. My numbers are crazy. My TSH is less than o.o1 (extremely low), FT3: 2.6, FT4: 0.7 (below normal), T4 Total: 5.1, T3 Total: 107, RT3: 7. So everything is super low, but I still feel hypothyroid. I am on NP Thyroid 120 mgs. and Liothyronine 45 mcgs. per day in split doses. My TPO antibody is normal. What is going on and what do I do now? Both me & my doctor is very confused. I have a great diet but am celiac.

  141. I have a question: my TSH level is low again as of 7/2019 and I am not on medication, I am planning on having the sleeve surgery 8/3/2019 however do I need to be on medication before the surgery and how will my thyroid affect my VSG Surgery?

    Also 5 years ago I was diagnosed as having Graves and diagnosed as hyperthyroid, I was put on medicine however three years later I was diagnosed as euthyroid and taken off medication and have been off medication up until this new testing and just received results as of 7/2019…. what is your recommendation about taking meds before during and after?

    • Hi Charisse,

      It would be wise to undergo a complete thyroid lab test prior to your surgery to see if any changes are necessary. Hyperthyroidism can lead to complications such as hypertension and other issues related to your heart that you should be aware of prior to surgery.

  142. Wow, what a wealth of information, my brain is trying to catch up to everything. I began searching the web for answers because my NEW primary care physician wants to lower my levothyroxine dose from 100 mcg to 88 mcg after 7 years of the same dose. I had Graves disease and had the RAI treatment done so even though my T3 (3.3) and T4 (1.1) results are normal, my TSH is .06 which is why she says I’m on too high a dose. I feel fine but have always had occasional palpitations during high stress and recently a little weight gain after an injury from which I lost a little weight. I’m an otherwise healthy 35 year old female. Should I get a 2nd opinion from an endocrinologist?

    • Hi Brandie,

      You are certainly welcome to get a second opinion but just be aware that most endocrinologists do not think the way that you see outlined on this website. The majority are stuck in a different treatment paradigm and unwilling to accept new treatments even though the studies suggest that they are beneficial.

  143. Dear Dr. Childs,
    My wife is 80 years old and has symptoms of hypothyroid. She has probably been this way for decades but her doctors either never tested for thyroid status or tested only TSH and FT4. I only have a useful measure back to 2016. Her TSH has been consistently in the range of 1.0 to 2.3 uIU w/o thyroid medication. Her FT4 was .79 to .96 ng/dl – low end of normal. Her FT3 was .21 to .25 ng/dl slightly below the low end of ref range but way below optimum. Her rT3/FT3 was 41 to 70 – normal, and her FT$/FT# was 3.3 – normal.
    Her diagnosis was all is OK. But her body temperature has been 96.3 to 97.1, and she has several symptoms of hypothyroid, especially cold extremities and cold sensitivity. I finally found a doctor who would prescribe T4 (50 ug), and more recently T3 (5 ug), both at very low dosage. Her TSH dropped sharply (to 0.6-0.7 uIU), but FT3 and FT4 hardly budged. I recently increased the T3 to 10 ug and TSH really tumbled (to 0.22 uIU), her T4 dropped to 0.64 ng/dl, but her rT3 also dropped (from 12 to 7 ng/dl). Her body temp came up about 0.5 degrees.
    These results are inconsistent with anything I read about. In Aug 2018 her TGAB and TPAB were < 1, so no Hashimotos. However, in April 2019 her Thyroglobulin QN was measured as 1.4 ng/ml vs a ref range of 2.8-41. What is TGQN? My doctor hasn't commented and may not have noticed, and I never checked all of this before I read a lot of your posts.
    Any comment you can provide will be useful. Thanks, Murray

  144. Hi Dr. Childs,
    I have been on 20 mg of Armour Thyroid for my hypothyroidism now for a few years. Up until this last year, all my lab results have been great. But this past year my TSH levels have dropped to 0.14 while my T4 Free is still normal at 0.9 and my T3 Free is normal at 4.0. I feel fine. My blood pressure is 105/50 which is normal for me. I sleep well, haven’t lost or gained weight and have no hair loss. My doctor is still very concerned. I would truly appreciate your opinion on this, please.

  145. I’ve been on Levothyroxine for 20 years at a dose of 150 or 175. Is there any way to make my thyroid work without the meds? Thank you.

  146. Hi Doctor!

    Great web site and article, it’s very difficult to find much information at all on low tsh on the web! I am 50/M and never went to the Doctor much because really always heard it was not necessary without symptoms until 50. Just went since I turned 50 and the doctor did a lot of blood tests. Lipid/metabolic panel/complete blood count/vit D and B12, PSA and TSH. Everything was normal except I had a .04tsh. I am obese with a 31.64bmi but always chalked that up just to poor diet and not enough exercise. I pretty easily lose weight if I eat under 1800 calories and gain it if I eat over 2200 calories. I have yoyo’ed quite a bit during my 40’s dieting and then gaining it back by getting lazy with my diet, I just love sloppy food lol. I think now that I’m 50 I need to adopt permanent changes to lose weight, and have lost 15lbs by being pretty strict since I saw the GP 2 weeks ago. I always feel great, I might add. I don’t seem to have any symptoms of a thyroid problem, in my uneducated opinion. Do you think I should be concerned with this low tsh? I also read, maybe here/maybe not, that 60-80% of people with low tsh had a normal result when tested a year later. Thanks again for your information and the opportunity to comment. Good stuff! Regards, Tom.

  147. Hello dr. Child,

    Thank you very much for all your articles. I need your help too.
    On the same doze of liquid Tirosint ( T4 only, 5x 100mg and 2x 125mg) the TSH has been reduced for the second time in 4 months.
    Low TSH ( 0,42 mIU/L, ref 0,35-4,94) and high free T4 (19,39 pmol/L, ref 9,01-19,05).
    Free T3 is 5,24 pmol/L (ref. 2,63-5,70).
    Hypo symptoms: fatigue, hair loss, weakness.
    When in July TSH was 0,60 mIU/L, I reduced Tirosint for 25mg per week, but I felt worse so I increased it again. Without dairy and gluten, soy, eggs, corn. A lot of vegetables and fruits. What to do to feel better? Your opinion will be very much appreciated.

  148. Hi Doctor
    I was diagnosed with hypothyroidism about 10 years ago I think, currently on 75m of levothyroxine.
    Recent test show low TSH Level of 0.11 mu/L
    T4 level 21.2 pmol/L
    I currently feel anxious and insomnia has worsened.
    What do you advise
    Many Thanks

  149. Hello! I was currently tested and have low TSH but t3 & t4 are normal, however, I have fairly severe symptoms of hypothyroidism. My doctor wants to run several more tests to figure out why my TSH is suppressed, but after reading your article I’m thinking that this a fairly common, so I’m not worried. I’m wondering if you have a supplement that would could help get my TSH back within normal limits and help alleviate my hypothyroid symptoms? And if so, how long would it take before the supplement impacted my labs? I would much rather spend $100 on supplements than hundreds on various tests!
    Thank you!

    • Hi Tracy,

      Are you currently taking any thyroid medication? If so, that could easily explain your low TSH. If you aren’t then it might be more serious but I wouldn’t do anything unless you retest it to confirm that it’s a real value and not a spurious result. In terms of what supplements you would want to use, I would probably recommend Thyroid Adrenal Reset Complex for now until I have more info: https://www.restartmed.com/product/thyroid-adrenal-reset-complex/

  150. Hello and thanks for this article. I was diagnosed with Hashimoto’s about 25 years ago and have been taking T4 replacement. My recent blood test results are:

    Serum free T3: 3.8 pmol/L
    Serum free T4: 26.5 pmol/L
    Serum TSH: 0.05

    Do these results indicate that I’m taking too much T4 replacement? Also, do they indicate that my body is not converting T4 to T3 very well?

    Thanks for your help.

  151. My TSH is .51, my free T4 is 1.1. Im on 25 mcg of unithroid and and 500mg Metformain ER. I am loosing hair, brain fog and fatigue? That means not enough T4 hormone right? I have Hashimotos.

  152. wow, very eye opening article here. Luckily, I started seeing a clinic that believes in testing reverseT3 so I’ll have that done this week. I’m starting to find that the lab results don’t seem to correlate with how I feel because they fluctuate slightly each time I’m tested however I still have hypo symptoms no matter what. My most recent test had the lowest TSH numbers I’ve ever had over the past ten years at .76 and T4 was 1.74. My TSH usually ranges from 1.43-1.88 but the T4 stays anywhere from 1.6-1.88. I take generic so that could explain the fluctuations. When the TSH dropped to 0.76 I started having muscle spasms in my trap area of my neck, pain in lower back, neck and spine, as well tenderness in those areas. I felt super tired and my muscles were weak. I was actually diagnosed with Fibromyalgia by my GP and orthopedic Dr. I thought that was ridiculous because I may have been tired before going on thyroid meds but I didn’t have all these other symptoms so I decided to try functional medicine. I’ve been on Np Thyroid for 5 days and although I’m not 100% when it comes to energy I’ve been feeling more calm. I know I’m probably not on the right dose but the neck pain and tenderness has subsided and the muscle weakness isn’t as bad. Thanks for the article and hopefully I’ll start feeling normal on NP. I can relate to these stories and know what a nightmare it is to have thyroid problems.

  153. I have never been in compliance with my thyroid Med because I was frustrated that I am loosing hair no matter what. When I was not complaint my TSH was in range and now since few months I was complaint and took 75 mcg synthroid almost every single day. Now my TSH is low (0.26), my t3 and t4 normal but reverse t3 higher than normal. Did I shift from hypothyroid patient to hyperthyroid patient ? Please advise . Am loosing close to 150 strands a day. Am I over dosing ? None of the doctors I have been going to since few years don’t know about t3/t4 etc. all they do is order TSH. I requested other tests after I saw your blog.

  154. Working on a diagnosis with my PCP. So far, I have:

    TSH .044
    T4 Free .77
    T3Free 2.67
    Thyroglobulin 14.7
    TgAb <1
    TPO 2
    just had thyroid uptake and scan and waiting on results. I have hypothyroid symptoms. Especially fatigue and the inability to ever get warm.
    Any thought on these results? And any suggestions for tests to run?

  155. Hi,
    I was diagnosed with hypothyroid in Oct 2018 and started NP thyroid which lead to low TSH low FT3 and low FT4 normal RT3. Still had symptoms and my liver enzymes had doubled along with macrocytic anemia so at the end of January 2020 I started Tirosint 50mcg and
    Liothyronine 15mcg. the most recent labs show this:
    TSH 0.136
    FT4 o.65 (0.77-1.5)
    FT3 2.58 (2.52-4.34)
    RT3 11.4 (9-27)
    I’m still feeling shaky, nauseous, dizzy, fatigue and very bloated but wondering if part of the symptoms are due to inflamed liver. I am underweight with very low BP and HR. Had eating disorder when I was young but now eating very healthy. My question is why is my TSH low along with FT3 and Ft4?? Should I increase meds – I’m afraid that will cause the tremors to get worse. Do you offer one on one consultations?

  156. Hi again,
    I just realized after reading the suggested guidelines for posting questions that I probably broke every single one!
    I apologize and will use your extensive resources on here for guidance, thank you for devoting your time and energy to help people on their healing journey it is deeply appreciated.
    God bless,

  157. I posted this on another article but didnt know if this article was more appropriate for my question. I am currently being treated for Hypothyroidism. Last year at this time my TSH was 0.01 ulU/Ml and my Free T4 was 2.35 ng/dl. My endo did not change my medication dosage. I tested again today and my TSH is still 0.01 ulU/Ml and my Free T4 is 2.22 ng/dl. Is this considered acceptable lab levels? I’m trying to decide if I need to switch physicians. I am currently taking Synthroid 200mcg. My TSH could actually be lower than that, it may just be that 0.01 is the lowest my office’s lab will detect. Would levels like this cause long term effects after a year? I have also gained some weight. I’m just concerned damage has already been done. Thanks in advance

  158. It started out my TSH was normal but both my totalT3 and freeT4 was not. Now, after being put on 60mcg armour thyroid and 50mcg levothyroxine I am at a normal totalT3 and freeT4 but my TSH is very low and almost non-existent, and I am still experiencing hypothyroid symptoms. What would the next step be?

  159. I’m on 90mg of NP Thyroid and 5mg of Cytomel. Only the TSH looks good! The other labs make no sense. It’s as though I’m not taking any thyroid medicine and I feel extremely hypo. Can you tell me what’s going on?

    TSH 0.734 (0.450-4.500)
    Thyroxine (T4) 4.1 (4.5-12.0)
    Triiodothyronine (T3), Free 2.6 (2.0-4.4)
    T4,Free(Direct) 0.71 (0.82-1.77)

  160. I feel like the odd man out. All blogs are usually about a low TSH on Levothyroxine but mine is always 1.3 to 1.8 with FT4 levels anywhere from 1.7-1.94 but TT3 is always low. Levo does lower my TSH but always still cold, hoarse voice and hypoglycemia problems and no appetite. Looks like my TSH is still showing I’m hypo.

  161. It looks like taking any thyroid medication for hyper/hypo thyroid decease is worthless because it never regulates your hormones and the more you try the worse it can get so why not just leave it alone I understand it effects your endocrine system and all kinds of things in your body but it sounds like its worse to take medication then to not So what is the long term of not taking any medication if a dry warm climate can help regulate the hormone levels why not just move to AZ or Florida or GA or the Texas or CA areas and see what happens I had a normal TSH until I moved to KS and wow low TSH normal T3 and T4 is it the climate when I lived all my life in New England and never had a problem and felt great till I got to KS I lived in Phx AZ for 8 years and felt great so what is the difference I am getting to the point I am really worried about taking any medication with all the sensitivities and reactions to medications to take any medication more so having my thyroid taken out and having a reaction to medication that could kill me because I no longer have a thyroid the pro’s and con’s are really scary I have loss 46 pounds which is good for me since moving to KS but not good for my heart rate I had a mitral valve repair in 2017 and was doing great till I moved to KS now I really am going to hell in a head basket since moving here I think I am going to move to AZ again and she what happens because I am scared to death to keep living here I see to many sick people and not from the virus here So explain to me why I should take medication when I may just get worse instead of better Thank you Pat

  162. For several years now, I have had undetectably low levels of TSH but normal T3 and T4. I have never taken any medication. I am a healthy 45 year old woman. It seems that perhaps that means subclinical hyperthyroid but I have having a hard time knowing what steps to take to promote balance.

    • Hi Kelly,

      Yes, that is most likely the case but if you are asymptomatic then you don’t need to do anything about it. It would, however, be a good idea to make sure that you are eating clean and exercising regularly to prevent the onset of true hyperthyroidism.

  163. The way I am reading the study you reference
    (about LT4 and euthyroid) is different!
    They are not just talking of levels of T4 and T3. I believe they are referring to the fact that LT4 supplementation does not fix the T3:T4 ratio. This is an important difference. And not surprising at all in my viw: why would giving synthetic T4 necessarily improve T3 levels?

    Disappointed you didn’t want to talk about Graves or temporary episodes of hyperthyroidism / thyroxicosis but will go and find your article that does.

  164. Recent TSH level was 0.09, Free T4 was 1.37. Have been taking 0.50mcg levothyroxine for years. Began taking thyroid medication over ten years ago when levels indicated a need and my eyebrows fell out. At this time, I noticed eyebrows again are thinner than ever, I am exhausted all of the time, and have gained weight that will NOT come off regardless of how well I eat and exercise. I am middle-aged, but quite active and very healthy. Advice? I wonder if it would hurt to suggest to my physician to switch up medication dose (less) to make TSH higher but keeping Free T4 in normal range.

    • Hi Kelly,

      You will probably need to play around with your dose to determine if you are taking too much as excessive thyroid hormone may be contributing to your symptoms. Having said that, it is still also possible that even with your low TSH you are not getting enough thyroid hormone which is why you will need to play around with it to determine.


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