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Mary Shomon

Low Thyroid, High Thyroid, Low TSH, High TSH: Making Sense of Tests and Dosages

By March 3, 2011

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Your Thyroid Stimulating Hormone (TSH) goes up and the dosage of thyroid medication goes... UP? Your TSH goes down, and dosage goes...down? You have "too much" or "too little thyroid," or "high thyroid" or "low thyroid." Overactive thyroid means less medicine? Underactive thyroid means more medicine? If you're confused, you're not alone. One of the most common questions I get on a regular basis here and at Facebook is "Please explain to me again why my doctor is lowering my medicine, even though my TSH is too low." Or "My thyroid TSH is too high, so how come they're giving me even more thyroid hormone?" Get off the TSH level-dosage seesaw, and find out the facts about the connection between TSH levels and increases and decreases in your thyroid hormone dosage.

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Comments
March 4, 2011 at 12:18 pm
(1) Dale says:

My doctor looks at the free T3 and free T4 and aims to keep those numbers in the middle of the normal ranges. If those numbers are okay he doesn’t care about the TSH being low (which mine usually is). My mother doesn’t have a thyroid, and her TSH is always 0.01 while her free T3 and free T4 are kept in the normal ranges. TSH = thyroid stimulating hormone. If you don’t have a thyroid to stimulate, it really serves no purpose as long as your T3 and T4 levels are okay. Doctors who “worship” the TSH as the be-all, end-all test for thyroid function are doing no one any favors.

March 4, 2011 at 12:58 pm
(2) Diane J. Marie says:

Dale,

How many more millions will now get diagnosed and will now get better treatment because the TSH range fiasco is finally, after all these years, being better set?

March 4, 2011 at 1:24 pm
(3) Dale says:

Diane,

I hope more, but I don’t hold out a lot of hope since so many doctors only look at the TSH. The TSH is a good screening test IF everything in the thyroid chain is working – the adrenals, the pituitary, the thyroid, conversion from T4 to T3, and absorption and tissue resistance. If there’s a problem with any one of those links in the chain, the TSH alone is a meaningless test. The last specialist I saw, an ENT who’s supposed to be “the best” thyroid doc in the city, had never heard of Armour thyroid.

March 4, 2011 at 1:27 pm
(4) Dale says:

And, I should add, my mother’s TSH of 0.01 still doesn’t fall within the new “normal” range, so for doctors who still go only by that, she’s still considered hyperthyroid. Sometimes I think when doctors go through medical school any common sense they may have had when they went in is sucked out of them before they’re allowed to graduate.

March 4, 2011 at 2:57 pm
(5) sal paradise says:

My TSH is now 3.8 on 100 umg of T4. My other (all T4, T3) levels are in the normal ranges.

However, I still have major issues with my mood, fatigue and weight. I was diagnosed in Aug 10.

My endo is rather conservative and had me on 8 50 umg T4 pills a week, but symptoms persisted and my GP knocked it up to 100 a day. As of now my TSH seems stuck at 3.8ish.

I wonder if I’m getting to that point where we need to discuss other options. Maybe T3. Does that sound like a proper approach given the called for range changes? Thanks.

March 4, 2011 at 3:40 pm
(6) Diane J Marie says:

Sal,

We’re all different. But as a fellow patient, I’d suggest adding T3, definately, to try it. Or maybe going with a dessicated thyroid product–they contain T3, along with T4.

But something is very wrong. Those amounts weekly and daily are way out of whack, unless the thyroid was removed or there is some other problem I’m not familiar with.

I’d suggest a doctor who knows thyroid care because by now, certainly, T3 should have been tried. Your current doctor won’t help you. Is an integrative doctor available on your insurance? Can you afford a very good PRIVATE integrative doc? Before making the appointment, you might ask if the doctor is willing to prescribe T3. Best to you.

March 4, 2011 at 3:45 pm
(7) Diane J Marie says:

Sal,

What Mimi says about getting informed is important. Gone are the days when we could trust what most doctors tell us. The best way to get informed is to go to your library and look for the book, Living Well With Hypothyroidism 2005 edition, by Mary J Shomon. Digest the book whole. Then you’ll be informed and you’ll know what you must do. That’s empowerment.

March 4, 2011 at 3:33 pm
(8) Mimi says:

My endo is from the Best Thyroid Doctor’s list. She looks at T3 and T4 and my antibodies for Hashimoto’s. She doesn’t even look at TSH because she said that because of taking Erfa it will be suppressed and that is normal. She also measures my reflexes because she believes that they are an even better measure of where I am. To an uninformed professional, I would appear hyperthyroid from test results. She is the third endo I went to because the first two never listened when I explained how tired and achy I was in spite of being on Synthroid. I have been seeing her for two years now. She gets it. We all need to be informed and then go out and find the doctor who is also informed.

October 12, 2011 at 12:20 pm
(9) Caroline says:

I take 60mg of Armour Thyroid. Test results are: TSH 1.012,
Total T3 .82 (range .35-4.94) and Total T4 is 4.5 (range 4.8-11.7). Why is the T4 always low? What should I take to increase the T4? Thank you

March 11, 2013 at 12:33 pm
(10) nidhika says:

hi i am patient of thyroid from past 12 years and have been taking 100mg thyronorm ever since, but lately i find my body very lazy and gaining weight
in my recent test my TSH in <0.01 and T3 is 137 and T4 is 11.8 ..how to interpret this result and what medicine should i take for proper functioning of thyroid gland…Please help..

March 11, 2013 at 12:33 pm
(11) nidhika says:

hi i am patient of thyroid from past 12 years and have been taking 100mg thyronorm ever since, but lately i find my body very lazy and gaining weight
in my recent test my TSH in <0.01 and T3 is 137 and T4 is 11.8 ..how to interpret this result and what medicine should i take for proper functioning of thyroid gland…Please help..

March 11, 2013 at 12:33 pm
(12) nidhika says:

hi i am patient of thyroid from past 12 years and have been taking 100mg thyronorm ever since, but lately i find my body very lazy and gaining weight
in my recent test my TSH in <0.01 and T3 is 137 and T4 is 11.8 ..how to interpret this result and what medicine should i take for proper functioning of thyroid gland…Please help..

January 27, 2014 at 5:03 pm
(13) w l hodge says:

I had a partial thyroidectomy 9/2010 due to non-cancerous tumors. (also had cancerous brain tumors that were removed 7/2010). The Dr. has decreased med because the tsh was chronically low. 0.01. Now, the tsh is .398, Free t4 1.11, cortisol 8.5 and acth 22, which are all in normal ranges, the tsh is on the low end (.36-3.74) I have been freezing half to death, body temp ranges from 95.9 to 97.2, and extremely tired since she lowered the dose in June 2013, 6 months ago. I have to keep my thermostat set at 80 to be even comfortable. They say everything is normal test wise, so nothing is done. Any solutions to this?

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