5 Thyroid Patterns That Won’t Show Up On Standard Lab Tests

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

In medicine, the key to choosing the best treatment is an accurate diagnosis. If the diagnosis isn’t correct, the treatment will be ineffective – or even cause harm.

Unfortunately misdiagnosis is common in the management of hypothyroidism. If you go to a doctor with hypothyroid symptoms, you’ll simply be given replacement hormones without any further inquiry into the cause of your condition.

Even worse, if you have hypothyroid symptoms but your lab tests are normal, you’ll be told you’re “fine”. If you insist you’re not, you might be sent home with an antidepressant, but no further clue about the cause of your symptoms.

The problem with this approach is that thyroid physiology is complex. The production, conversion and uptake of thyroid hormone in the body involves several steps. A malfunction in any of these steps can cause hypothyroid symptoms, but may not show up on standard lab tests. It’s incorrect and even negligent to assume that all cases of hypothyroidism share the same cause and require the same treatment. Yet that’s exactly what the standard of care for hypothyroidism delivers.

In this article I’ll present five patterns of thyroid dysfunction that won’t show up on standard lab tests. If you have one of these patterns, your thyroid isn’t functioning properly and you will have symptoms. But if you go to your conventional doctor, you’ll be told there’s nothing wrong with your thyroid.

A standard thyroid panel usually includes TSH and T4 only. The ranges for these markers vary from lab to lab, which is one of two main problems with standard lab ranges. The other problem is that lab ranges are not based on research that tells us what a healthy range might be, but on a bell curve of values obtained from people who come to the labs for testing.

Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health? (For more on the problems with standard lab ranges, watch this great presentation by Dr. Bryan Walsh)

The five thyroid patterns

  1. Hypothyroidism caused by pituitary dysfunction

This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance. These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough thyroid hormone. There may be nothing wrong with the thyroid gland itself. The pituitary isn’t sending it the right messages.

With this pattern, you’ll have hypothyroid symptoms and a TSH below the functional range (1.8 – 3.0) but within the standard range (0.5 – 5.0). The T4 will be low in the functional range (and possibly the lab range too).

  1. Under-conversion of T4 to T3

T4 is the inactive form of thyroid hormone. It must be converted to T3 before the body can use it. More than 90% of thyroid hormone produced is T4.

This common pattern is caused by inflammation and elevated cortisol levels. T4 to T3 conversion happens in cell membranes. Inflammatory cytokines damage cell membranes and impair the body’s ability to convert T4 to T3. High cortisol also suppresses the conversion of T4 to T3.

With this pattern you’ll have hypothyroid symptoms, but your TSH and T4 will be normal. If you have your T3 tested, which it rarely is in conventional settings, it will be low.

  1. Hypothyroidism caused by elevated TBG

Thyroid binding globulin (TBG) is the protein that transports thyroid hormone through the blood. When thyroid hormone is bound to TBG, it is inactive and unavailable to the tissues. When TBG levels are high, levels of unbound (free) thyroid hormone will be low, leading to hypothyroid symptoms.

With this pattern, TSH and T4 will be normal. If tested, T3 will be low, and T3 uptake and TBG will be high.

Elevated TBG is caused by high estrogen levels, which are often often associated with birth control pills or estrogen replacement (i.e. Premarin or estrogen creams). To treat this pattern, excess estrogen must be cleared from the body.

  1. Hypothyroidism caused by decreased TBG

This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid – not hyperthyroid – symptoms.

With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.

Decreased TBG is caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.

  1. Thyroid resistance

In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms.

Note that all lab test markers will be normal in this pattern, because we don’t have a way to test the function of cellular receptors directly.

Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors.

Conclusion

The five patterns above are only a partial list. Several others also cause hypothyroid symptoms and don’t show up on standard lab tests. If you have hypothyroid symptoms, but your lab tests are normal, it’s likely you have one of them.

Not only do these patterns fail to show up on standard lab work, they don’t respond well to conventional thyroid hormone replacement. If your body can’t convert T4 to T3, or you have too much thyroid binding protein, or your cells are resistant, it doesn’t matter how much T4 you take; you won’t be able to use it.

Unfortunately, if you have one of these patterns and tell your doctor your medication isn’t working, all too often the doctor’s response is to simply increase the dose. When that doesn’t work, the doctor increases it yet again.

As I said at the beginning of this article, the key to a successful treatment is an accurate diagnosis. The reason the conventional approach fails is that it skips this step and gives the same treatment to everyone, regardless of the cause of their problem.

The good news is that, once the correct diagnosis is made, patients respond very well to treatment.

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Comments Join the Conversation

  1. says

    “These stressors fatigue the pituitary gland at the base of the brain so that it can no longer signal the thyroid to release enough TSH”

    I think you need to edit this misleading wording  - the thyroid doesn’t release TSH, the pituitary gland releases TSH to stimulate the thyroid to release thyroid hormones (not TSH).  I’m pretty sure you know this, but some might not.

    • Chris Kresser says

      Thanks for catching that. I changed it to what it should have been in the first place (“thyroid hormone”, instead of TSH) I think my brain is melting down from too much studying. 4 weeks until the licensing exam, and I’m feeling it.

      I need a proofreader.

      • Cait says

        Just to let you know, I have been studying anatomy and patterns of disease around adrenals and thyroid for about 4 year. You BY FAR are the most knowledgeable, articulate, and thorough source I have come across. Thank God for your brain. I wish all doctors were like you.

        • jim says

          I just come across your article and am very impressed by it I have had fatigue weight gain small amounts of weight loss neck pain shoulder pain that comes and goes and periodic pain right where my thyroid is just had blood work all normal did not see t3 checked just tsh and t4 like u spoke about my dad had thyroid issues as well as my oldest boy if my ct scan comes back normal I know where to go from here hoping for the best and thanks for sharing your info

            • says

              What you do is fire the doctor and go find one that will listen to you. YOU are the customer. The doctor should take orders from you. Unfortunately that is the way it goes and people don’t realize the power they have.

              • Christy says

                Foolish Rebecca. People die waiting to be seen by Endocrinologists and you callously give advice to fire a doctor and wait even longer for treatment and another appointment. In some areas “firing” a doctor may not be an option. For many socioeconomic classes either. The best advice is to work with your physician. Take in your research. Doctors want to help their patients. Be prepared. Be informed. Be persistent. Be in charge of your health but don’t give orders to a physician. You did not go to med school. Rebecca advice is very bad.

                • Sherry says

                  Naive Christy. Not only do many doctors have 0 interest in truly helping their patients, even the ones who do want to help are annoyed by what they call WebMD MD’s. When you go in with a lot of web research to try to make them listen, they tune you out even more. The original question was about a doctor who won’t listen. The correct answer is: fire the doctor. Many times, you can do this simply by requesting a referral to specialist. This solution makes everyone happy. You get to leave the doc who won’t help in favor of someone more likely to have the knowledge to help, and s/he gets “the problem patient” out of the office so the the next $$ – er, I mean, patient can have the room. This may sound cynical, but it’s absolutely true. After 15 years in the healthcare industry, I can tell you with certainty that capitalism and healthcare go together as well as water and electricity.

                • G C says

                  LMAO at “fire the doctor” and “YOU are the customer”.

                  If you want people to take your opinion seriously, don’t make it ignorantly. I believe the correct terms are “leave” instead of “fire” (because really, only their employer can fire them, and you are NOT their employer, as much as you wish to believe you are), and “patient” instead of “customer”. Oh the customer one freaking hilarious! Hahaha…just. ..come on! Hahahaha!

                  And if you honestly believe doctors are there to take orders from uneducated, unintelligent people who know nothing about what is happening themselves (which is why they are at the doctor), I’m afraid your medical life is going to be full of struggle and unnecessary stress if you honestly believe that.

                  I’m not saying be a slave to any doctor you meet because you have no choice, but don’t kid yourselves about “the power you have” over your doctors.

                • Jennifer says

                  I agree with “firing” the Dr just because you didn’t choose to be a Dr doesn’t mean you are uneducated or don’t know what type of care you need. There may be things in your medical history that your Dr is unaware of and they need to take the time to listen. Also they may be annoyed by Web MD or people doing their own research but science is constantly changing and evolving not to mention that they have been out of school for some time and have numerous amounts patients they can make mistakes it’s your life not there’s you are already stressed enough your relationship with your Dr matters you need to feel comfortable talking to them about everything. Why do you think they go over sensitivity and how to relate in medical school? I “fired” an Endocrinologist and within a week found one that was better. No one knows your body better then you and you are not a generic make up where they can just come in and slap the “normal” diagnostic on you and collect their Co pay and never give you a second thought If you feel you are rushed or unheard by your Dr feel free to find someone better even if you have to drive a little distance the inconvenience is worth your time. You have more power then you think you can take you money else where and write reviews on the medical board. Don’t use slander but give other people insight about your experience and let them decide if they want that type of care

      • says

        My name is pauline long i have had Thyriod resistance disorder problems for 10yrs now, and still feel very tired lerthergick sorry but im also dyslexic so my spelling wont be upto date,i am at present on 125mgs per day of Levothyroxine, and feel worse every day, with no energy what so ever im also depressed and cant think properly, the thyriod problems run through my dad who is no longer with us, not only that but ive found out theres thyriod problems on my mothers side but have never youfound out if she had any cos she was never tested please could you help me sort this medical problem out once and for all so i can get on with the rest of my feeling much better in myself thank .

        • laura says

          Maybe your doc should try a different medication if you aren’t responding to the Levothyroxine. Perhaps Armour or Nature-Throid will work better for you.

          • Mary Price says

            I have been suffering for years. One Dr finally put my on Armour and it worked but then one day the pharmacy said they could no longer get it. I also have recently found out I have a cyst on my adrenal gland. I just saw another Dr. and she said they dont do Armour only synthroid. She gave me some tests. One is anti-throglobutin which was high at 1046. The lab normal here is <40 She also did an anti-tpoab which came in at 868,0 She has also done an utltrasound of my thyroid results are pending. My blood sugars get elevated at times as well. i had a cortisol test done which was negative .How can i find a dr that prescribs Armour?

            • Missy says

              Nature-throid is what you want. Armour has corn fillers in it and some folks don’t tolerate corn well. Be persistent with your physicians. I don’t know what part of the country you are in, but here in Indiana, Walgreens and CVS will get Nature-throid. It is not what the Doc usually prescribe, so I had to check with the pharmacies myself and then tell my physician that was what I wanted. It took a 45 minute conversation but we got it done and it is working well for my daughter who has Down syndrome.

              • Sasha says

                Armour stopped working for me and many other people couple of years ago; I think the technology was changed. Nature-Throid is working well, and regular Walgreens can order it for you, even if they do not have it in stock. Mail-order pharmacies also carry it, and it is usually covered by insurance. The thing is to find a doctor who is willing to prescribe it. Normally, endocrinologists prescribe synthetic T4, expecting it to convert to T3 (according to their theory) which does not work for many patients. So go to naturopathic doctor instead. Insurance usually does not cover the visit but on a long run, it will be a very wise investment, because your health is precious.

            • martie says

              I was recently on Armour. I was getting it from CVS. I live in Northern California. I just got diagnosed with Hashimoto. So right now I got off of Armour.

            • Katie says

              You have got to find yourself a Holistic doctor. Any regular doctor will HATE and refuse to give you the less filler more natural Thyroid medicines.

        • Lisa says

          I felt the same way. I did not respond to the synthetic thyroid medication. I need to take armour instead. Also there may be other issues that resemble thyroidal symptoms. On my own, I figured out that I can not eat Rye bread…. So no longer may I have a Ruben sandwich. my tongue immediately thickens and I feel lethargic. You need to see a good general physician. and Endocrinologist will only look at what they are knowledgeable, and not the overall big picture. Armour may also be needed as it is the only one I am aware of that inherently converts T 3 – T 4. Because it is natural. It made all the difference. Best of luck.

        • Anea says

          I don’t know anything about Thyroid but I have an 11 year old with dyslexia…. never apologize for that … you are a very special person and have a very special gift from God… you posses skills that others can never have… do some research and don’t think of Dyslexia as a bad thing … consider it a gift A wise man once said ” if you judged a fish by how well he could climb a tree…he will spend his whole life thinking he is stupid”

          • Janelle says

            Hi!

            My husband thought he was dyslexic for years until a behavioural optometrist diagnosed our daughter with a convergence dysfunction. She got multifocals and went from the bottom of the class to the top with reading. My husband then was diagnosed with it. Behavioural optometrists diagnose plenty of things normal optometrists don’t.

            • DA says

              my daughter was dyslexic until I took her out of school and retaught phonics. She shows no signs of dyslexia now.
              Don Potter has an excellent page with information and a test to give the student to see if they were taught whole language or phonics.

        • Maria says

          Need to also test adrenals (cortisol) if in some state of adrenal fatigue, the thyroid will not improve. Also see 23andme for genetic tests and doesn’t hurt to do heavy metal test as toxicity can negatively affect many things. If Dr will not do these tests, go to another one who does, even if you have to go out of network and pay out of pocket. This is an investment in your health and more important than other expenses.

          • Lea says

            Maria – you hit it spot on. I have been tested in the past by my PCP and everything comes back “normal”. My younger sister had thyroid cancer in both lobes; my father had goiter and removal of one lobe; I have several nieces and nephews with thyroid issues as well. Do you suggest I see an endocrinologist? or just another PCP? What specific tests should I have done?

            • Maria says

              Neither, I had cortisol saliva test through naturopath. Allopathic Drs are generally not good at these tests. You can do a mail away test unless you live in NY state where mail away laboratory tests are not allowed. Have you read Dr. David Brownstein’s books or seen his youtube on thyroid and iodine?

              • Jan Marie says

                I want to talk about the comment on Dr. Brownstein and iodine. I discovered thyroid cysts in 2006. I had several ultrasounds and the doctors said to leave the cysts at that time. I was deemed to be euthyroid even though I WAS indeed hypothyroid, but with a TSH of .4 and sometimes lower (notice I said POINT 4). I suffered for years with hypo symptoms, and finally made my way to an endocrinologist. Good thing there are practitioners like Chris out there because I was told I needed to get my thyroid removed!!! The cysts are not that big nor do they cause any issues for me other than I was coughing a little as they were growing slightly. SO, instead of telling me to take iodine, the endocrinologist warned me over and over NOT to take iodine as it would make matters worse as she said. So, I found this wonderful ENT at the university of MN. She is not holistic by name but by practice she is an inquiring mind and is alternative. She told me to find ‘an old fashioned’ doctor and have her/him guide me with iodine. I told her that I had finally found a functional doctor but that I still needed guidance. She then told me to take 550 mcg of Iodine daily and guess what? My cysts have GONE DOWN in size. And they have stayed down. If Iodine has competition from other halides, i.e. bromide, chloride, fluoride, then it cannot do its job with the thyroid. So, DO watch that youtube video and educate yourself. My doctors have told me not to take as much as he advocates. I had a reaction to 6 mg that I took, a very bad one. So, I just stick with 550 mcg and I think the upper tolerable limit is 1100 per day, but not positive. I hope this helps. I feel wonderful now and interestingly to note, that when I started taking T-3 which was FINALLY prescribed to me my TSH went UP not DOWN as all other practitioners said it would. I was low and the T-3 (liothyronine compounded) did not make me hyperthyroid as they all (but one) said it would. And when I began using Iodine concurrently with the T-3 RX I then found that the energy was better and the RX worked better. I still have thyroid issues and weight gain and testosterone levels that are either really high or really immeasurably low. I am going to contact Chris about this and hope that he can help me work on this and see why that happens. Jan

                • Lisa says

                  I realize this is an old story but I am seeing it just now. I have been told for years I was just fat and lazy. I would work out like crazy on a daily basis and my weight wouldn’t budge. My sizes would sometimes go up or down but my weight always went up. I was able to work out a system of eating 800-1300 calories a day. It makes you super tired and hungry and probably sounds crazy but it was the only way I could lose weight. I finally went to the doctor this year and HE made the suggestion to test my thyroid and pituitary hormones. I told him I had been tested before when I was pregnant and they told me I was just morbidly obese. I also have had horrible side pains around my liver area. I thought it was my gall bladder and the doctors I saw during my pregnancy told me I was stupid and it was probably gas. Turns out I have an enlarged fatty liver and the pain was from it stretching its casing. So I have been wondering if the two are related somehow other than me being overweight….

                  And to Jan, my close friend has PCOS and that causes her hormones to be wonky. She grows facial hair really bad almost like a man would and has heavy weight in her midsection. There’s different treatments for it including surgery and hormone therapies. Maybe get tested for that?

                • AHH says

                  Could you tell me the name of the holistic doc in MN that you see for your thyroid/iodine?
                  Thanks

                • AHH says

                  Jan, Could you tell me the name of the functional doc in MN that you see for your thyroid/iodine?
                  Thanks

            • Maria says

              A good Dr. would treat the symptoms and not necessarily the test results. A full thyroid panel is a great start. If Dr. refuses then you know they are not the right Dr. for you.

              • Joan says

                I started on thyroid medication about 10 years ago. At the time I did not want to start medication because I had no symptoms other than the blood test that said my tsh level was low. I felt good, had energy, hair was healthy, skin good. My Dr. just kept after me until I finally gave in. After about 2 years on medication, I had symptoms. Hair falling out and dry, low energy, dry skin. My hair has stopped falling out, but still have dry skin and do not have the energy I should have. I feel like I should not have started taking meds. Is there anything I should do now to maybe get off medication or change what I am taking?

                • Kathy says

                  Joan, I feel that I am in the same boat as you! I started on synthroid at age 40 (19 years ago) after the birth of my second child – he was 1 year old. A blood test showed that my thyroid level was low, but I had no symptoms except being tired from 2 toddlers and working and weight still to lose. I felt great the first 5 years, but have gradually developed symptoms of low thyroid. My present doctor has been adjusting my levothyroxine according to TSH and T4 levels. I recently got my free T4 and T3 uptake included and they all “look normal” on blood tests (in range) but symptoms persist. I went to an endo about 8 years ago when my Dr. couldn’t understand some of my numbers (like high calcium) to have my parathyroid checked but it was normal. I also went to a Bioidentical Hormone Doctor to have hormone levels tested but costs were getting prohibitive (not covered by insurance of course) so I quit. I would like be able to afford a doctor that will test my hormones for the “big picture” but being retired, I cannot afford it. My doctor and I’m sure my insurance will not cover Armore or Nature-throid – not made by Big Pharma.

              • Maria says

                Joan, what type of labs is your Dr. running? Need to do full thyroid panel including free T3 &T4 & reverse T3 (RT3) several times a year and explain results to you at a minimum. If you’re over 40-45 then other hormones may have started to change. What does your Dr. say when you tell him about numerous low Thyroid symptoms? If he does not address them, go to another Dr. even if you have to pay out of pocket. Your well being is worth it. Without good health, you can’t really enjoy much of anything else.

                • Teresa says

                  I just got my blood tests back:

                  July 2014:
                  TSH: 3.530
                  T4: 0.88
                  Reverse T3: 13.6
                  T3: 70
                  TPO: negative 6
                  Thyroglobulin Antibodies: Negative 1.0

                  Can someone help me interpret them? Teresa
                  my email is teresa_michael@ymail.com

          • Maria says

            I have a thyriod problem and I take 88mg of Levothyroxin a day. I also havae adreanal insufficiency and addisons disease. I take Hydroquartisone everyday just to stay alive. I also have to eat salt because the Addisons disease make my kidneys spew salt.
            I feel like a walking hypocondriack, but I am not. Now I just discovered I have diverticulos and colitis. I take no medication for the colitis and the diverticulosis. I know how you people feel. Sometime I get so weak and tired but I cant sleep. Outside of that I feel great. Its very hard to find a Dr. who doesn t think just in main stream medicine terms. Its a catch 22, if you find a natural health dr your insurance won t cover it and they are to expensive to pay out of pocket. I try to eat clean food and do not eat fried food or fats. Its not perfect. Oh well.

      • athena says

        hi ive been having hypo symptoms for at least 3 yrs now all the tests the dr’s have ran says im in the normal range what kind of dr do you think i should see besides a thyroid dr for much deeper tests . they said i have fibromyalgia after diagnosing me with mixed connective tissue desease and polyarthritis i think it was im frustrated help please

        • laura says

          If you are on a PPO, you should go see an endocrinologist. If you are on an HMO, you will need a referral which may be a pain in the butt to get from your GP. If you cannot get a referral, you can always try a holistic (natural) medicine doctor in your area too, although it will be an out of pocket expense and you can expect to pay upwards of $100 just for the appointment, plus whatever they charge for the blood tests on top of that.

          • athena says

            hi laura i went to get a second oppinion on the fibromyalgia and he ran a vitamin d test and ultra sound for pcos the ultra sound came back ok but the vit d came back low they put me on 1000 iu dose of vit d theres been some inprovement on the pain but still feel theres a thyroid issue as the weight just wont budge im going to ask to be sent to a endocrinologist

            • Wendy says

              Funny, I have 13 symptoms of hypothyroidism but my doc tells me I’m just vitamin d deficient. I feel like crap every day and it is really starting to affect my lifestyle. So depressed that he won’t even TRY to consider anything else. Looking for a new doc as we speak as I am tired of feeling this way, but being brushed off if I complain.

              • Kelly says

                I also have the fatigue chronic pain Vitamin D deficiency migraines for years now The depression is overwhelming most days I hurt so bad everywhere I don’t get out of bed I have had two primary Dr’s that ran blood tests The first one was totally uneducated saying my vitamin d was so low that I had Ricketts I’m 50 years old I thought that was for kids So I switched Dr’s the second told me my thyroid levels were fine so it’s not a thyroid issue I don’t believe trust that because it was my gastrointestinal and my respiratory therapist and my pain mgmt dr that said they think it’s fibromayalgia What kind of Dr will confirm this?? My primary is no help but I will demand a referral if you tell me for what kind of Dr Please help I’m going insane Thank you

                • Laurie says

                  Do an online searchfor “MARY SHOMON DOCTOR LIST”. You will find doctors listed by state. Also, read her site and Gina Nolin site to get list of labs to run.

          • Jennifer-Anne says

            I had a nuclear scan and a biopsy I was diagnosed with cold nodules of the thyroid .iwas told that it cold be cancerous and should be operated on,and that they would have a pathologist in the theatre
            To check and see if they have got it all out.but I have been delaying
            Can one advise

            • Maria says

              Misdiagnosed and untreated thyroid disease can cause nodules on thyroid. I had small one and when properly treated with Armor or Naturethroid & iodine they went away. Did you get full 6 panel (hormone) thyroid test? This is essential for proper diagnosis. If Dr. is not willing to run proper tests complain to medical board and go to another one who can properly diagnose you. Only have surgery as last resort when other proper protocols have failed and its clear (get 2nd 3rd opinion) that surgery is needed and would benefit your condition.

              • Jennifer says

                I just had a 2nd visit with new doc…I was told to go off medication so doc can see thyroid panel clean..I went off for 5 weeks and felt like crap..all symptoms came back as soon as got back on after new blood work within 4 days I began to feel better and goiter began to shrink. when I kept asking questions about why with the medication my hypothyroid symptoms go away plus my large thyroid goiter begins to shrink I was told there is no possible way that the medicine could be making me feel better or have an effect on goiter since my tsh t4 and t3 are all normal. When I challenged this I was told by doc I’m not going to argue with you about this. This is my 5th endo who is unwilling to be cooperative!

                • Molly says

                  I am so sorry you are having such a hard time finding a doctor who can help you. All of my blood tests always come back in the “normal” range but I have severe symptoms and a huge goiter. My endocrinologist has been great and by treating my goiter and symptoms with thyroid medicine, my symptoms have improved and my goiter has gotten smaller. I had three nodules and they all disappeared within 6 months of being on the medicine. It’s been nearly 4 years now, I still have a goiter but it’s much smaller. Symptoms are very mild but I have had to have my medication increased 5 times in the past 4 years. My endocrinologist says that my thyroid doesn’t work well unless my TSH is at a 1 (or a little lower). The blood tests and the “normal” range are not accurate for my thyroid. It has changed my life in the past 4 years and I am so sorry to hear that no doctors are willing to look past the numbers to help you.

        • Jan Marie says

          I had fibromyalgia in the 90s when diagnosed with CFS. I got relief from B-12 injections (methylcobalamin only) and eating an anti-inflammatory diet. It is so so so important to eat foods that won’t inflame us and especially if we have fibro. Check out http://www.nutritiondata.com and see which foods are appropriate. Try to balance the Omega 3′s with the Omega 6′s to help with inflammation. That is what my husband and I have been doing. He had an extremely high Ferritin test results, high CRP, both markers of inflammation. We cleaned up the diet and he no longer uses insulin (which is also very inflammatory). I had fibro so bad that I could hardly move. I now job and walk every day, work from 6:00 to 10:00 and am a senior. I hope this helps you.

      • robyn says

        So I have glassy eyes severe weight loss fast heart rythm symptoms started after pregnancy. What do I do to find a doc to treat this and listen to my symptoms not just bloodwork? In nj area

        • Jan Marie says

          check out lists of functional doctors, holistic doctors, and alternative. There is Institute for Functional Medicine and I have been told there is a list of names on there, state by state.

          Good luck!!!

        • RenegadeRN says

          You could have pregnancy induced Graves’ disease. Gives same symptoms you listed.

          I had it 25+ years ago after a pregnancy.

      • Annie says

        Hi there, very interesting article and almost sounds like there’s hope for me somewhere in there. I did have a very high-profile, high-stress job and slowly but surely found my hair falling out, my nails became very brittle, irrespective of how many supplements i was taking. I also started gaining weight, initially not because of overeating, just gaining around my belly. And my weight had been stable and between 68 and 72kgs all my life. i could no longer sleep without a sleeping tablet and became depressed, could not concentrate and lost confidence in myself completely. This was 6years ago. Since then, i have gained 30kgs! i have tried 4 dietitians, to no success. They put me on extremely low calorie diets and the weight-loss was truly minimal. I could see they thought i was just cheating and that made me feel so bad i stopped seeing them. I cycle every second day for 30minutes minimum, do my own housework, ie vacuum, mop, sweep, dust, polish, dishes, washing and ironing for the sole reason to stay supple. I have seen an endocrinologist who did plenty blood tests (unfortunately i do not have the results, he has) and he claimed my thyroid, pituitary functions etc were normal. The only abnormalities that i can recall was a slightly elevated liver count and my pancreas was checked twice, if that means anything to you?? I do not drink alcohol at all and i don’t smoke at all. The only chronic medication im on is degranol 2 pd and nexiam 20mg 1x pd. i do not take anti-depressants, however i realize and recognize that i still suffer from depression and have become a bit of a recluse. I have tried several appetite suppressants, no success there either. The doctors talk about insulin resistance, i tried antagolin, no luck. i am desperate, so desperate, im ready to slit my wrists. Please tell me what treatments you would suggest for these 5 Thyroid patterns you’ve identified so i can discuss it with my doctor. Lastly, i live in South Africa,am 51years old, height – 1m 71cm and now weigh 97kgs. Please help me! Thanks and regards. I hope to hear from you soon!

        • Maria says

          This is for Annie:
          You have a right to ask for a copy of all your blood work and x rays and any otheer test The labs due. Go to your Dr. and tell him you want a copy of your blood results. Just ask the girl at the window in your Drs office and she should give them to you.

      • Lisa says

        Chris,

        Can your column be shortened to the most current comments? Also, is there a thryoid treatment for “Dummies” available?
        Just asking.

        Lisa

      • Rhonda says

        Chris, I am a 47 yr old female who had routine blood work done in Feb 2013 whereby my TSH was 2.47..I was having chronic yeast infections. I felt horrible six months later and my primary ordered more blood work and my TSH was 10.2. Went to endo and more blood work showing no antibodies. Also, thyroid not enlarged. She diagnosed me with Hashi’s gave me synthroid 112 mcg and said see you in 6 mo’s. Medicine worked the first two weeks then nothing. How can I have Hashi’s without antibodies? Why has the medicine stopped working? I am very confused.

      • Tricia says

        Hi,
        I loved your article.
        My question is, where can I go to get an accurate diagnosis. My primary care would only do a TSH.
        I live in Boston. Can you advise on reputable resources.
        Thank you

        • Carrie says

          I had bloodwork for this done by my chiropractor, who ordered a full thyroid panel. I came back as TSH 2.86 with slightly low T3, but my ob/gyn had ordered a simple TSH and told me I was normal. Good luck.

      • Lynsey Chinnery says

        What happens when your TSH level is 1.78 and protein level is 8.1 and you’ve gained 20 pounds in five months and the doctor basically tells you it’s your fault? What then? I can’t afford to go to multiple doctors to find one that’s willing to listen to me and help me.

        • Amanda says

          Hi Lynsey, through the help of a naturopath and the right tests and meds, we have found that my perfect TSH is more in the range of 0.05, which is pretty low for most people. Perhaps the 1.78 is just still too high for you.

      • Lindsey says

        You say conventional doctors won’t go into detail or maybe misdiagnose/mistreat or not help you fix whats really wrong with your thyroid. What type of doctor do you recommend me going to if I’m having some trouble?

        • Maria says

          Lindsey,

          Not sure who you are replying to. I wish these articles had comment set up similar to mercola.com articles where its much easier to read, and respond to comments. 3 generations of my family have repeatedly been medically mistreated, misdiagnosed for many ailments. It was not until I went to nathropath who can look at the entire body, vs. many Drs. looking at one little part and not seeing the big picture, that I was properly diagnosed and we began healing. It is well worth it even if insurance doesn’t cover appointments. Its a totally different way of health care and the process of healing takes time vs. just medicating one symptom. What price do you put on good health. I know many people who practically live in Drs. offices not only not getting better, but actually sicker as they experience negative side effects of their prescriptions.

      • eckmama says

        Can you elaborate on what treatment would look like for these? And what tests do I ask my doctor for? I have every single symptom of hypothyroidism but always test *normal*.

      • Angelina says

        Mr. Kessar, I’m 35 years old and I had a nodule in my thyroid that caused for a right lobe ectomy when I was 25 years old. I’m a mother of five and I struggle with low energy level which I never had issues before as I was very active and push hard to remain. l have weight gain, joint pain and constant skin rashes and hair loss…The list goes on. I had two endocrinologist test my T3, Tsh , T4, and prescribe me 125 mg of synthroid they say that my numbers are two to three points higher than what is “normal” and technically I’m hyper. I’m exhausted constantly not feeling well, can you please give me advice as to what I can do to get back on a healthy level please!!!

        • Nona Famous says

          I want to add this piece of information for Angelina, May 6:
          Thyroid/TSH, Free T4, Free T3, Thyroid Peroxidase Antibody/TPO,Thyroid Antibody/Anti-thyroid AB

          and want to say that youtube searches:
          ” dr. kent holtorf hypothyroidism ”
          will lead you to brief explanations, info and insight. best, Nona

          • Jan Marie says

            I will also comment that Dr. Kent Holtorf has clinics in the east and west of the U.S. and there is a book named “Stop The Thyroid Madness” that he is connected with and his premises are quoted through the book. I have found more thyroid information in this book than anywhere else on the internet or in a doctor’s office.

      • Nona Famous says

        Watching women in my geographic area living but not thriving; one of these is my daughter. I want to take part in this conversation because maybe I have come across resources that can help here.

      • Sarah R says

        Wow I think this is one of the best articles I have read. You should get a knighthood for the amount of people you have probably helped as a result of this page… My only wish is that you were in Scotland. I have been displaying signs of hypothyroid and similarities to hashimotos for years (I’m only 34 now but been back and forward to doctors for over 10 years). I also have PCOS and hormone stuff which doesn’t help but I have been feeling like a hypochondriac even though I know there is something wrong. Blood tests are always in “normal” range but I have had a goiter since I was 13. My grandma and mum had hypothyroid. The doctor keeps asking if I’m depressed and I say no, although moods all over the place but I have a fantastic 2 year old son who is my world and a great job etc. I had a thyroid ultrasound scan last week and they said there’s chronic inflammation of thyroid. I spoke to doctors again and he said That my thyroid is fine as bloods are fine…. Argghhh so frustrating. He said there’s probably a autoimmune thingy there but won’t treat it as don’t know what it is. I am worried, I get back leg cramps now too and my veins are bad on my legs. I have also been getting pains in my chest but doctor thinks it’s gallstones. It just all seems connected but until I find out the cause and doctors believe me I won’t get treatment. Symptoms, weight, hair growth, freezing feet and hands, purple legs, varicose veins, swollen ankles, acne, sleep problems, moods, no sex drive, dry hair, itchy legs, cramps, skin tags, goiter, weak nails, bits of eyebrows missing, facial hair, indecisive, chest pains, occasional abscesses when run down, strange stretch marks on shoulders, high blood pressure, a pulsing feeling in belly, constipation followed by bouts of the other, constant aches and pains which I don’t even think about now as I just live with it. Feet always hurt, no energy… My get up and go has got up and gone. Feel like I’m always so moany like this post (sorry!) but I used to be carefree and happy. My nickname was smiler. My mum committee suicide a few years ago so I guess that doesn’t help. What else can I do to get doctor to listen or who can I speak to ? Thank you and sorry x

      • Ann says

        Chris~ I wish there was a thyroid expert who lives in Richmond VA. For the past 16 years I have been taking synthroid in gradually increasing doses and I feel awful.
        I am a nurse and have just enough info to get me in trouble. I have read your book and kept up w/ other experts…but what do you do about joint pain-specifically shoulder and knee pain-weakness? I am unable to play tennis and am feeling like an 80 year old. I am 55. YIKES!!!

        • Wayne says

          Ann. I am in Richmond and just recently diagnosed with enlarged thyroid lobes. Can’t believe how hard to get an appt with an endo.

          I have terrible burning mouth syndrome as well. Ruining my life.

      • Jpf says

        I am suspicious that I have some sort of thyroid disorder but currently am not on health insurance. Where should I go to get accurately tested if I don’t have a primary care physician? Thank you!

      • mercy says

        My life changed 1 1/2 ago….I have been constantly fighting a cold, alergies or infections…gained 35 pounds…can sleep at night..or wake up every other hour…my day are a marathon were I have to convince my self I ll make it to the end ( I have three kids…3,5.10)….sometimes I even feel my heartgoes to fast…or way to slow..I am always tires…no energy…I push my self to go to the gym…have not lose a pound and no matter how much I stop wating or doing healty diets…I do not loose weight…recently talk to my obg..she said I was been dramatic..and my carsiologiest..test me just yesterday and toldme I was fine…this are the results…can you help me to understand…can you please help me?
        This are my test results…
        T3 uptake 30
        T4(thyroxine), total 7.3
        free T4 index(T7) 2.2
        Globulina 3.0
        TSH .91

    • Gina says

      Hi Chris
      I read your article and it was very interesting. I have a son with special needs who I am taking him in to be tested. Can you please tell me exactly what tests need to be done. He is 18 years old and has Down Syndrome.

      Thank you!

    • kate says

      Hello Chris,What do you do when your thyroid is not functioning because of elevated cortisol?I have has adrenal fatigue for decades..cut out all problem foods, do chi gong, meditate, only eat real organic and grassfed food..but am tired and cold all the time. My doctor put me on armour thyroid 30, but it made my loose stool worse, so stopped.I felt tired again right away..really not sure where to turn to get my leaky gut healed, my adrenals back and my thyroid working again! Help!

      • Richard says

        kate – leaky gut, follow a SCD/GAPS diet for a few months, lots of bone broth/stock and fermented foods, won’t take too long. If it does take a while, supplement with raw camel milk. Google this stuff and check it out, you’ll be fine!

      • Rita Hodges says

        Here is an idea for all but you mentioned leaky gut and it made me think about the “virgin diet” by J.J. Virgin and she uses that term “Leaky Gut” to explain about food sensitivities that can cause symptoms that look like many diseases I have a lot of the same problems as many of you I take generic Synthriod but I have no energy etc. I would suggest having your vitamin levels checked low D3 can make you depressed low B12 can make you tired I am still learning about other vitamins. Many of our health problems will have multiple origins and all need to be looked at because they are usually a combination and for those with Fybromyalgia you can do all of these steps and still be tired all of the time believe me I know as I have that as well. I would suggest having a sense of humor about your health problems. Not ignore them or make fun of them but to not let them get you down and to realize that

        • Sally says

          Hypothyroidism is associated with low Vitamin D levels but most people in the first world these days have low Vitamin D levels. Further Hypothyroidism causes low B12 levels due to the low levels of Stomach Hydrochloric acid and Intrinsic Factor being produced. Injections of Vitamin B12 are appropriate.
          These are problems have one origin and that is Hypothyroidism.
          In the 1970′s when there was a swing to using levothyroxine and testing for TSH became the vogue, as predicted by the fab Drs around at the time, many Hypothyroid patients were left undiagnosed. Over a number of years there have been different ‘new’ disorders which all describe Hypothyroidism by another name; fibromyalgia, M.E., C.F.S. and so on. Dr Gordon Skinner (UK) demonstrated that those people who present with these so called ‘new’ disorders will be relieved of symptoms if given thyroid hormone treatment.
          Check out the history of Hypothyroidism – its fascinating and will open up another world.

      • Sally says

        Low Adrenals must be treated before your thyroid med will work well enough. Check adrenal gland function with salivary test – Cortisol and DHEA. Also check with temperature at 3hourly intervals through the day; if they are labile then its adrenals; if they are simply persistently low then thyroid; if low and labile then likely adrenals and thyroid and often the two go hand in hand.
        Hair analysis may help identify if you are low in certain elements. You may need to supplement either DHEA or Cortisol (at physiological doses) BUT there are a number of vitamins and minerals which also support the adrenals:
        Magnesium taken at night don’t take calcium too.
        You may need Phosphorus too but you will need a multimineral tablet or powder too.
        Vitamin B complex plus additional Vitamin B3, B5 and B6. Its likely you’re low in B12 too(due to hypothyroidism)
        Vitamin C dose to Bowel tolerance.
        Vitamin E 400iu daily.
        Adaptogenic herbs such as Ashwagandha support low adrenal function. Take these regardless…..then check DHEA and Cortisol too.
        Always support adrenals before taking thyroid medication.

    • leah says

      I’ve had hypothyroid symptoms for years….Im angry I’ve been getting just tsh tests but I found out that can come back normal and drs say I’m ok….told my Dr to do the full t3 and t4 I feel I’m not bipolar I have bladder problems high liver enzymes high cholesterol weight gain and loads of other symptoms….my t4 was 0.8 and t3 4.1 my tsh was 1.75. Can this still be possible?

      • Sally says

        Yes it can still be possible: All tissues, organs and cells require thyroid hormone mainly T3.
        It appears that many hypothyroid sufferers cannot easily convert T4 to T3; this is not revealed by the TSH, T4 tests. Further the Pituitary gland which secretes
        TSH is a special tissue compared to those others around the body; it will be saturated with thyroid hormone when all other tissues, organs and cells around the body have very little. So we can be hypothyroid at the cellular level and yet the pituitary gland will be oblivious to this fact since it soakes up thyroid hormone like a sponge; so pituitary gland is soaked with thyroid hormone = no TSH gets released.
        If conversion is also a problem the thyroid may be producing its hormone mainly T4 with a little T3 some bound by proteins which make it unaccessible to the cells tissues and organs. Further, if it is not converted it remains in circulation; HAHA – yes the levels of T4 circulating in the serum may be at NORMAL levels!
        So we have low TSH levels (‘normal’ or within range) and T4 levels within range too. However, you ARE hypothyroid and your body is displaying all the symptoms of the disorder – infact often it is screaming out.

    • Scarrillo says

      How do I figure out why I am having all of the hypothyroid symptoms: brittle nails/hair, tired all of the time, light headed, freezing cold hands and feet, short of breath.
      Labs are as follows:
      T3 uptake 27.6
      T4 total 6.7
      Tsh 1.75
      Drs keep saying I’m borderline? I’m not understanding!
      Any help would be appreciated. Please and thank you

      • Sally says

        Ask for a 3 month trial of thyroid hormones: if you feel better and some symptoms resolve then the trial should continue as permanent treatment. If however, whilst taking the hormones you may experience some palpitations and signs of HYPERthyroidism it may be one of two things: (1) you are not HYPOthyroid and the additional hormones are tipping you over into hyperthyroidism. (2) You need to treat your adrenal glands and have a second trial or better still treat your adrenal glands prior to the thyroid hormone trial.

    • Debi says

      I have fibromyalgia but believe I may also have hypothyroidism. I have severely swollen glands under my chin. I am cold all the time. I the last six months I have developed a chronic vomiting problem. Whatever I eat it seems to come back up. I cough incessantly and choke while drink eating or jist swallowing saliva. My cough is continual. Of course I am always tired but can’t sleep at night without sleeping pills. The nausea seems constant. My GP seems to think I am a hypochondriac and my rheumatologist was annoyed when I brought in a list of 19 symptoms to be addressed. I know my body better than they do and I KNOW something is wrong other than the fibromyalgia. Can anyone help me? Give me suggestions? Thank you

      • Maria says

        Go to different Dr. I did not start to get properly tested and feel better until I tried naturopathic Dr. They are trained to look at the whole complete person not just specialize in a little part of the body, so they save you time and money that way. Unfortunately many do not participate in ins. plans but what price and priority do you put on your health?

  2. Julia says

    Great post thanks Chris!  It’s great to know there are reasons thyroid tests come back ‘normal’ when they don’t feel normal at all.  Do you know much about using basal body temperature as a means of testing thyroid function?

    • Chris Kresser says

      It’s not a reliable indicator. Too many different factors affect BBT for it to be conclusive.

      • Sally says

        If you have signs and symptoms of hypothyroidism and you also have repeatedly low basal temperatures then Dr Barnes (who used/’invented’ the test) thought it was reliable. Barnes compared the basal temperature with the basal metabolic test outcomes and they compared favourably; however, if a detailed history is taken and a clinical examination is also carried out and the basal test and all of these other indicators agree the liklihood of hypothyroidism then it is as good a test/reliable as any other and better in the case of TSH.
        When making a diagnosis for any disorder/disease all factors should be taken into acccount and history, and aclinical examination must be given a great deal of credence. Basal Temperature test is part of the clinical picture.
        A Trial of thyroid hormone is acceptable and can be the final piece of the jigsaw if there is any doubt. A trial of hormone can rule out hypothyroidism for some patients if done properly. A trial of thyroid hormone is not dangerous and has been carried out for around 100years without being problematic.

  3. Elizabeth says

    Wow, just wow. 55 years of Synthroid, several doctors including endocrinologists, and not one tested me for anything except TSH and free T4 and T3. I went through misery after misery, fought with those doctors, changed doctors. NOT ONE mentioned a possibility of any other problem with my endocrine system. I’m floored.

    This is depressing me since I don’t think I can find the kind of doctor I need in my area, At age 80, perhaps I will just have to do the best I can with my present situation. Outside of my hypothyroidism, and skin itching the dermatologists can’t find a reason for, I’m very healthy.

    Perhaps when I started Synthroid in 1955, there were no tests? I was just trying to get pregnant, at age 26, and my doctor tried the low dosage of Synthroid. It worked.

    Thank you, Chris, for your enlightenment. I’m sure that if I take this article to my endocrinologist, he will just pooh pooh it and tell me to stop reading junk science on the internet. :(

    • Sally says

      Yes there were tests in ’55 but they have changed over the years; indeed rising serum cholesterol levels were probably the test of choice in those days; (and more reliable than TSH, T4 in my opnion)
      Itching skin is likely due to a fungal infection. Look on the net for antifungal diets/foods etc. Further I have used a product called Lufenuron – I am not associated with this proudct in any way but found it very effective in treating my life long fungal infection AND without side effects unlike the drugs given to you by the medics..

    • Maria says

      Find another Dr. that will take you seriously. At 80 you don’t have much time. My dad just passed at 85 and he went to the same type of idiot Dr.s that just prescribed useless drugs causing more side effects than his original symptoms. Your kids would rather see you healthy and happy. You don’t need to leave a large inheritance to anybody and you certainly can’t take it with you.

  4. Angus says

    This article displays  lack of understanding of basic thoiroid function. Taking the points above in order:
    1. T4 will be low in hypothyroidism secondary to pituitary dysfunction
    2. Control of TSH is dependant on feedback from T4 and T3 levels acting on the hypothalamus and pituitary. The action of T4 and T3 on inhibiting TSH production is proportional to peripheral activity (ie T3 has more peripheral activity  and more feedback (for a given concentration). Therefore if you are poor at converting T3 to T4 you will secrete excess TSH until the combined action of T4 and T3 is at a physiological level (T4 may be above ‘normal’ and T3 lower but overall activity will be unchanged.
    3. Assays which measured total thyroid hormone went out in the 1980′s. All assays used now measure free hormones therefore changes in TBG are irrelevent.
    4. Now I’m completely lost. Tempting to say you couldn’t make this stuff up but of course you have. High levels cause thyroid underactivity? Well obvoiusly thats why all those people with thyroid overactivity have symptoms of underactivity. Except they don’t they have symptoms of overactivity (sweats/palpitations/weight loss etc). Can you produce any evidence for this? Thought not.
    Also, for your information I expect the testosterone levels seen in female to male transexuals are rather (about 10 times) than the slight increases seen in PCOS.
    5. Untrue. Usually Thyroid hormone resistance (which is mainly inherited) affects the receptors in the pituitary and hypothalamus in a similar way to to those in the rest of the body. The end result is elevated TSH levels and T4/T3 but the peron with the condition has no symptoms.
    Sadly the symptoms seen with underactive thyroid are very non specific, really common, usually not caused by thyroid problems and often caused by complex factors with no simple cure. In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thryoid hormone over placebo. Unnecessary thyroid hormone treatment carries a risk of side effects including osteoporosis and changes in heart rythm. There are good reasons why UK doctors who prescribe thyroid hormones to people without any evidence of deficiency are struck off and national guidelines are explicit in advising against (http://www.british-thyroid-association.org/news/Docs/hypothyroidism_statement.pdf).


    • Chris Kresser says

      Sorry it has taken me so long to respond to this. As some of you know, I was preparing for the acupuncture licensing exam in early August, and then on vacation until last Sunday night.

      1. T4 will be low in hypothyroidism secondary to pituitary dysfunction

      That depends what you mean by low. It’s possible in this pattern for T4 to appear within the normal lab range, but below the functional range. Lab ranges are not based on scientific studies, but instead on bell curve analyses of patients who get tested in labs. Who gets tested in labs? Sick people. Therefore standard lab ranges represent what is “normal” for sick people, not what is normal for healthy people.

      What’s more, many people who have their TSH & T4 tested are taking supplemental hormones, which further skews the lab ranges.

      Finally, as much a we’d like to think that these feedback loops work in a textbook manner, they don’t. For example, I have a patient with confirmed Graves’ disease. According to the textbook, she should have low TSH (she does) and elevated T4 and/or T3 (which she never has). In fact, it’s not at all uncommon to have patients that don’t fit the expected patterns.

      2. Control of TSH is dependent on feedback from T4 and T3 levels acting on the hypothalamus and pituitary. The action of T4 and T3 on inhibiting TSH production is proportional to peripheral activity (ie T3 has more peripheral activity and more feedback (for a given concentration). Therefore if you are poor at converting T3 to T4 you will secrete excess TSH until the combined action of T4 and T3 is at a physiological level (T4 may be above ‘normal’ and T3 lower but overall activity will be unchanged.

      There is some controversy on this issue. But I can tell you that I’ve seen lab work on patients with normal TSH, normal T4 and low T3. If it were always true that low T3 would increase TSH, then such a result shouldn’t be possible. But as I mentioned above, patients very often don’t present with the textbook pattern.

      I’ve also seen and heard of patients improving when treated for T4 to T3 conversion problems even when their TSH is normal.

      3. Assays which measured total thyroid hormone went out in the 1980′s. All assays used now measure free hormones therefore changes in TBG are irrelevent.

      I don’t know what it’s like in the UK, but here in the US the standard measurement is total thyroid hormone (which includes free and protein bound). Few doctors order free T4 or free T3 routinely. Therefore TBG is not at all irrelevant. This is why T3 uptake is still included on standard thyroid lab panels.

      4. Now I’m completely lost. Tempting to say you couldn’t make this stuff up but of course you have. High levels cause thyroid underactivity? Well obviously thats why all those people with thyroid overactivity have symptoms of underactivity. Except they don’t they have symptoms of overactivity (sweats/palpitations/weight loss etc). Can you produce any evidence for this? Thought not.

      It is well-known that receptor site expression and sensitivity are both down-regulated in the presence of excess hormones – whether thyroid, insulin, leptin or other.

      It’s true that a large excess of thyroid hormone will produce hyperthyroid symptoms. But it’s a question of scale. To illustrate this, let’s look at a similar pattern that occurs with another hormone: insulin resistance. Chronic elevations of insulin cause insulin resistance. The cells are less sensitive to circulating insulin and hyperglycemia results. However, what happens if you give a hyperglycemic an insulin shot? They become hypoglycemic. Even though their cells are insulin resistant, they still have some receptor site activity, and the flood of insulin from the shot is enough to activate the receptors – whereas the smaller amounts of insulin produced from eating food is not.

      Thyroid hormone resistance with decreased TBG is similar to what I described above. The elevations in free thyroid hormone are enough to down-regulate receptor site activity, resulting in decreased proteonomic response. However, in hyperthyroidism, the level of circulating free hormones is more analogous to the levels of insulin after a shot. These much higher levels are still able to activate the receptors and increase proteonomic response.

      5. Untrue. Usually Thyroid hormone resistance (which is mainly inherited) affects the receptors in the pituitary and hypothalamus in a similar way to to those in the rest of the body. The end result is elevated TSH levels and T4/T3 but the person with the condition has no symptoms.

      Sadly the symptoms seen with under-active thyroid are very non specific, really common, usually not caused by thyroid problems and often caused by complex factors with no simple cure. In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thyroid hormone over placebo.

      My answer to #4 above addresses this. Of course there would be no benefit to giving thyroid hormone to people with resistance. Their cells can’t use it. The factors causing resistance in the first place must be addressed for these people to improve.

      This is one reason why people on supplemental thyroid hormone continue to need larger and larger doses.

      • anna says

        “But I can tell you that I’ve seen lab work on patients with normal TSH, normal T4 and low T3.”
        Well, such lab work is the reason I am here. Haven’t been officially diagnosed with anything, but I had my tests last week, saw the results and now I am educating myself.
        Thank you, Chris.

        • Natalie says

          I am suffering from almost all of the symptoms of Hashimoto’s Thyroiditis and my THS & T4 levels are normal. I asked to take the TPO & TG tests!

        • Sally says

          You can have ‘normal’ TSH levels and ‘normal’ T4 levels and low T3 levels and be hypothyroid. How? The pituitary gland soaks up huge amounts of thyroid hormone and may be adequately supplied with thyroid hormone even though the rest of your body’s tissues, cells and organs are depleted of thyroid hormone….probably due to poor conversion of T4 to T3 – at this point normal levels to high normal levels of T4 can circulate whilst T3 levels may be low. The individual will display signs and symptoms of hypothyroidism and this must not be ignored.
          There may also be something such as oestrogens or high/low Cortisol or High/Low Iron levels which block thyroid hormone gaining access into the cells.
          Further no one has mentioned reverse T3 (rT3). If there is an abundance of T4 circulating and in some other circumstances T4 and only T4 is converted to rT3 and not T3; hence low T3 serum blood levels, normal/normal high levels of T4 and ‘normal’ levels of TSH. If the rT3 levels are measured it is possible to work out whether the body is (and not the pituitary) is low in thyroid hormone or not by working out the ratio of T3 to rT3.
          Further, if you are all confused it is easy to measure exactly how much thyroid hormone the body has been able to use – or not as the case may be. There is a 24hr urine thyroid hormone profile test; which measures T4 and T3 metabolites; that is what exactly the body has used and the remains of which (metabolite) is expelled by the kidneys.

      • Angela says

        Hi Chris, I have had hyperthyroid a few times in my life. It came after childbirth and a few more times after that. I take medication for a few months till the thyroid becomes hypothyroid and I ween off the medication and I go back to normal. I am 45 and had a partial hysterectomy which now has put me in menopause . What has been happening now is that I have had major heart pounding that went straight through a week long period and now I have palpitations and tremors . My muscles are very fatigued and I have no energy and my blood pressure gets high at times( I never have high blood pressure) . It feel very much like how I felt with hyperthyroidism but the blood work is showing up fine. I have went for 3 tests and there is nothing. They checked the tsh and the free t3 and t4. I feel horrible and I am so frustrated because I am a very healthy active person. Can you let me know what you think. Thank you

        • Sally says

          I would say check your adrenal gland function and iron profile too…also ask for rT3 and T3 ratio lood test.
          If you are hypothyroidi it is very unusual for someone to remain euthyroid once they stop their thyroid meds….there are transient cases but they are not too common. If you have to take thyroid meds of and on and off and on then one might suspect you should stay on the meds and stop coming off them to stay well.

      • Brenda says

        Bc,
        I have a Downs daughter, she is now 32, and even though her blood tests show her thyroid only a little low, her doctor has upped her strength of meds on two occasions.
        From what I observe from watching her day to day, I believe she does not metabolize her food properly and in turn has upset stomach more than should be, she has gained weight more than should be, she sleeps to much, and is content to set to much. In short to tire, to much weight gain, always tired, and sleeps as soon as se exerts any energy over active work. Just shopping for an hour or two will send he off for a long a long nap.
        Does this sound like a thyroid that needs a more in depth testing? Or should I look into another area?
        Thank you for any help.b

        • Sally says

          It sounds as though she is on the wrong meds; likely she needs some T3 such as Armour or ERFA Thyroid or she may need T3 only meds. This might be necessary on a temporary basis to get rid of any rT3; but you need someone who has an understanding of the issues around low thyroid hormone.
          If she converts T4 to rT3 then it is of no use giving her more T4 meds since she will convert her meds to rT3 and remain hypothyroid. The symptoms you describe are hypothyroid symptoms; find a Dr who knows more than you; and in the mean time educate yourself to get the best deal.

    • sherrie says

      I have FDH as do 3 other female members of my family, we all have normal thyroid function tests but symotoms of both elevated and low thyroid. We have been told by doctors that cant see past black and white that FDH does not cause symptoms. Well i would like them and you, who is adament that people couldnt possibly have symptoms, live with this thing!!

    • Sally says

      I agree with much of what you said in your post but the last bit is incorrect; Before a study can be considered valid it must be repeated and the same outcomes must also be repeated….so the test with placebo vs thyroid hormones has not been replicated…one also has to consider how the test was carried out and on whom; as we know low thyroid hormone/hypothyroidism is a complex subject.
      A trial of thyroid hormone is a valid thing to do and is not dangerous; your statement is scaremongering. I am based in Europe and the European Union Guidelines support the use of thyroid hormone trials when diagnosis is uncertain. The use of a trial of hormones has been carried out safely through many decades and should still be a valid option when doubt exists.
      Firstly, patients should be tested for Adrenal function and iron profile testings and also in my experience fungal infections, and treated accordingly, prior to a trial commencing. If the patient complains of symptoms associated with hyperthyroidism then the trial can be stopped and no harm is done; only if thyroid hormone is continued whilst the fpatient experiences these hyperthyroid symptoms and this has to continue for a very long time, before any damage is done.
      Osteoporosis is associated with long-term untreated hysiological hyperthyroidism and not with thyroid hormone treatment; this is another scare tactic Drs use against patients receiving adequate thyroid hormone treatment.
      Drs who prescribe thyroid hormone treatments do not prescribe them with no good reason; and I am unaware of any UK Dr being struck off as a result of treating hypothyroidism. I am however, of Drs being persecuted by the GMC as a result of prescribing thyroid hormone which has made their patient ‘better’ relieving their hypothyroid symptoms – that is due to ignorance on the part of the GMC and the BTA and nothing more; they have not though been struck off.
      If you have read the Guidelines and you have any knowledge of studies and evidence relating to hypothyroidism you will note that it is possible to blow Bonny and Clyde bullet holes right through the guidelines. The are not scientific they are prejudicial in favour of pharmaceutical companies and most definately not the patients. It is due to these pathetic and entirely wrong guidelines that patients remain hypothyroid, with and without treatment.
      Please stop scaremongering; hypothyroid patients have enough to contend with as it is.

    • karen says

      The british thyroid association no damn all,clowns all of them.

      I have checked the stop the thyroid madness website ,the information they provide makes much more sense to me.

  5. says

    FYi, it isn’t always necessary to go through a doc to get the tests you need (though it is great to have a good doc to help with test result interpretation – so I’m not knocking consulting with a good doctor).  In many, if not most cases, patients CAN order the tests themselves, without having to hurdle a gate-keeper doctor, pay unnecessarily for an office visit, or share the results (except in NYS where the legislature seems to think the residents are too feeble-minded to mind their own health).
    If you are willing to pay out-of-pocket instead of billing your insurance co, have a good PPO plan which will reimburse fees for any accredited lab, or if you already are paying out-of-pocket for lab tests, consider using a service that will allow patients to order their own tests.
    There are numerous labs that will take a lab order direct from patients, such as MyMedLab.com (no affiliation other than as a customer).  The test fees are often discounted, especially when “bundled” with other tests typically ordered for common conditions, and include the doctor’s order necessary to run the tests (except NYS, where this arrangement is specifically prohibited by law).  Test samples are collected at many convenient locations, including the widespread Lab Corp network.  Results are usually speedy and communicated directly to the patient, though can be also copied to a physician if desired.
    I couldn’t get my endo to run thyroid tests for thyroid antibodies (he said it wouldn’t make any difference in my treatment) so I ordered the test my self from MyMedlab.com and had the blood draw done at LabCorp.  I received an email the next day that my results were in (avail via secure log-in at the website).  The fee was very reasonable.
    I also have ordered my own tests at Enterolab.com to check for gluten sensitivity.

    • Eli Renwick says

      I totally agree with this! I think its so so important to get the advice of medical professionals, but when you know you need some tests, its ok (and sometimes cheaper) to just order them yourself. I went way way too long without knowing this, so I am glad that someone has already posted about it here. I found a helpful site for me to find info about ordering my own blood work at http://PrivateHealthNetwork.net

      I really hope that Chris does/did well on any exams he has- This is one of THE BEST sites that I have seen for Thyroid information. It really has helped me- I have been scouring the web trying to find info about my condition, and this is one of the few sites that has helped!
      Thank you!

    • Maria says

      I’m one of those in NYS. What can we do about getting the same rights as other states to order our own tests? Why do New Yorkers pay so much in taxes and have so few medical rights? This alone makes me want to move!

    • Julie says

      But how do you fund someone to help you when you have the results and don’t know what to do now??

    • Chris Kresser says

      I don’t have time to answer in the detail I’d like to right now because of my upcoming exam. So I’m going to wait until I do.

      • Kate says

        I have a nodule on my thyroid, persistence of both hypo and hyperthyroidism, and yet every doctor I have been to trying to resolve this has given me a blood test and told me my levels are fine. I have hairloss, brittle nails, anxiety and depression, and huge fluctuations in my weight for seemingly no reason. Not to mention lots of family history. Could you reccomend a doctor that would properly diagnose me? I would be more than willing to travel to get proper care. Help!

        • Jonna Yager says

          Hi Kate,

          I also have nodules on my thyroid. However, I do not have symptoms thus my doctor said I’m fine because my TSH is normal. I insisted that I get my T3 and T4 tested and they both were well within the normal range. I’m wondering what I should do next?

  6. Lynn says

    Something tells me Angus is from the BTA or the BTF, with his talk of good doctors being struck off. He seems obsessed with the TSH, which is a pituitary hormone for a start!

  7. Chris Kresser says

    Sorry it took so long to approve that comment, againstthegrain.  It got caught in my spam filter.

    I like directlabs.com for ordering labs w/o a prescription.

  8. Jin says

    Hi Chris, I noticed in this article about thyroid testing you didn’t mention Free T4 or Free T3.
    My MD has always ordered TSH, FT4, FT3, TPO & TgAb when checking my thyroid, stressing the importance of measuring the Free’s.
     
     

    • Chris Kresser says

      T3 uptake gives a rough idea of free thyroid hormone status, is included on most standard lab panels, and is cheaper than running FT3 and FT4. But yes, if I am particularly concerned about the free hormones I’d probably run them too.

        • says

          My thyroid goes up and down. I have autoimmun problems from rheumatoid arthritis. I gained weight, got alopecia in my eye lashes, splitting nails and fall asleep all the time. My doctor has been checking my blood for three years. He can’t give me any medicine because it’s turning out my lab tests are normal.

          • Sally says

            Your Doc should not be treating the lab tests he should be treating you and your history and your symptoms and your signs that includes basal temperature test. Don’t be put off – change your Dr if necessary.

      • Annette says

        You mentioned for one scenario with high estrogen to clear some out of the body. How is that done?
        Love this article! Most helpful I have found!

  9. ben nguyen says

    Low thyroid hormone supposedly can cause high cholesterol…
     
    Unfortunately, my doctor says all my thyroid numbers (t3, t4, etc) are normal.. so i’m on statins to keep my cholesterol on check (otherwise it shoots up to above 400!!))
     
    There’s a book by David Brownstein, that I’ve heard covers how to step by step diagnose thyroid issues!   In the meantime I’m minimizing my pufa intake, and increasing the number of antioxidants!

    • chimonger says

      Please, anyone using Statin drugs to control cholesterol, PLEASE also be taking SIGNIFICANT amounts of CoQ10!
      In Japan, as far back as the early 1990′s, Docs understood clearly, Statins strip critically necessary CoQ10 from muscles–especially from heart muscles where it’s so greatly needed.
      They’ve been dosing Statin takers with -several hundred milligrams- CoQ10 daily.

    • Ginny says

      Statins can be very dangerous – I won’t use them. I am using niacin at 500mg at night(you must use the flushing kind and it is a bit like hives so I take it at night). Brought my cholesterol down from 280 to 220. You can also try fish oil – 3g per day or policosanol. All these work to lower cholesterol altho like a statin the policosanol should be used with CoQ10. Niacin was what was used before stains came on the market – very cheap.

    • Sally says

      Rising cholesterol used to be the diagnostic test for hypothyroidism due to the fact that hypothyroidism causes rising blood cholesterol levels. Why? Low thyroid hormone affects the liver as much as it affects other aspects/organs of our body. The Liver is unable to process cholesterol; you will also find it cannot process Vitamin A either, etc., etc.
      Statins will cause more problems and are contraindicated in hypothyroidism; further are you taking CoQ10 at the same time?
      Have a 24hour urine thyroid profile test done this measures how much thyroid hormone your body has actually used. Do some basal temperature tests over several days too. Write a list of your symptoms and any other signs of hypothyroidism and also write a detailed history including family/medical history; these should take precidence over TSH testing; oh and get some studies which demonstrate TSH testing is rubbish, read them and understand them so you can argue your point.

  10. Elizabeth says

    I don’t see the connection between thyroid hormones and cholesterol. I have hypothyroidism, have had for 55 years, and normal cholesterol. Ben, I’m really sorry you have to use statins. The only time I would recommend statins is in a case like yours becaue they can have deleterious effects.

    • Chris Kresser says

      There is indeed a connection between hypothyroidism and high cholesterol. Thyroid hormone is needed to activate the LDL receptors. So when thyroid hormone is low, there will be a larger amount of LDL floating around in the bloodstream.

      • Ashley says

        My blood work came back with that very thing (elevated/high cholesterol and low t3 uptake). My TSH was at the low end of normal (well below functional levels) and my T4 was mid range, I think. (I’m going off memory for the latter stuff). Haven’t been able to speak with my Dr yet (phone tag) but with the results coupled with the symptoms (cold hands/feet, fatigue, aching joints, mood swings, etc) I’m hoping the Dr will be amenable to exploring if medication might be beneficial. What do you think?
        And are there any books that are recommended for further education about thyroid?
        Thank you!!

      • ucgp says

        My last lipid panel (a few years ago) also showed crazy high LDL. My doctor recommended medication (statins, I assume.) I insisted on an LDL particle test and a CRP test. The LDL particle test came back normal and the CRP test was lower than they could measure. I would never take statins based on an LDL number alone. From a standard lipid panel, the Triglyceride to HDL ratio is the best indicator of heart disease risk. My ratio was excellent, which accurately predicted that the particle count and CRP would be fine too.

  11. Kathleen says

    Can you please state which tests to order for a full thyroid evaluation  —name them in order in a way the lab will understand and/or I can take to my doctor.
    thanks for the great information.

    • Chris Kresser says

      The problem is not what tests to order, but finding a doctor that knows how to do a proper thyroid evaluation. You can order the right tests, but if your doctor doesn’t know how to interpret them, it’s not much use. The standard tests I order for each patient are TSH, TT4, TT3 and T3 Uptake. If I suspect autoimmune involvement (almost always the case if TSH is elevated), then I’ll order thyroid antibodies as well.

      • Jennifer K says

        So, even if I order the TSH, TT4, TT3, and T3 Update as well as the Thyroid Antibodies… the doctor may not realize if something is wrong looking at the tests? So far they only order the T3 and TSH (I believe)… But since my cholesterol is high and my Vitamin D is low and I have other symptoms of what could be Thyroid issues (sure, they are symptoms of other things as well)… I’d like to truly rule out the Thyroid. I do also have recurrent Iritis (an autoimmune disease), so I am relatively sure that my other non-eye symptoms are autoimmune in nature… just can’t pin them down.

      • n king says

        i have had underactive thryoid for a year now, i am on 125mg levothyroxine. Recent blood test shows my t3 and t4 are ok but TSH is high. My doctor has advised me to go to 100mg and then re-test in a month. My joints ache at the moment and feeling very tired. Do you think I have thryoid resistance? What is the best way to treat this. I have never felt 100% since being diagnosed and long to feel like the old me :(

      • Ro Ro says

        So T4 Free (1.1), T3 Uptake (31), & T3 Total (86), will not paint the complete picture? What else should I take? Is TSH necessary?

      • Mark Flynn says

        I am starting to feel like there is a link between my son’s mental health and his Thyroid.

        My son has been diagnosed ADHD and we tried every type of stimulant. They did not even touch the problem. In fact they made things worse (very out of control mood swings).

        My son is 8 years old. Off the medicine he is incredibly active can literally run all day (I have 5 children and my wife is a school teacher… his activity level stands out). He also has emotional outbursts when he is off the medicine, getting very upset, and then eventually crying and coming back down to normal. During his outbursts he says things like, “I wish I was never born.” and other very sad/ low self-esteem things (This is odd for someone so young).

        All the ADHD stimulants made his outbursts worse. At some point he was prescribed a small dose of risperidol and it seemed to help, but he started to gain a lot of weight, so we took him off of it. His weight normalized and then we tried Abilify, that definitely helped, but again weight has started to creep up.

        One of his doctors actually did a thorough blood work on him. I noticed that his TSH level was 7.34. (I have other blood info if useful)

        Do you have any recommendations? What type of a Doctor should I see to get to the bottom of this. Psychiatrists are not the right answer…

        Thanks
        Mark

        • Kathy says

          Mark, I would strongly consider getting your son evaluated for Bipolar disorder. That sounds like a better description of his symptoms than ADHD and explains quite well why stimulants make things worse and why Abilify helped. Abilify is a mood-stabilizer and is used with people who are bipolar.

          Note: I am not a doctor nor a therapist. I do, however, have a masters in exp. psychology and used to own and run a counseling office with my then-husband who was a clinical psychologist. I am not diagnosing your son as bipolar. Just suggesting that it is a possibility and if that is what he has, then treatment might be able to be better geared toward that than adhd. It is not unusual for kids to be diagnosed adhd when they are really bipolar. Here’s a quick link about the two: http://www.webmd.com/bipolar-disorder/guide/bipolar_disorder_or_adhd.

          Good luck!

          • Saska says

            If I were you Mark, I would have your son taken to a endoctrin specialist..your sun has obvious hypothyroidism. Insanity…above 7????? He needs treatment. Psychologists or psychiatrists do sometimes more harm than good…as they do not understand the hormonal connection and your body’s needs. A friend of mine had tsh 4.90 and used to be deeply depressed with severe anxiety. When they found out here levels, she received treatment and feels much better now.

        • Sally says

          The brain must have adequate supplies of T3 to function well. Certainly the TSH levels appear high but interpretation of TSH levels is so variable. I would persue the thyroid issue since it is well known that hypothyroidism causes mental health issues amongst a myriad of other symptoms.
          Whether he has Bi-polar or ADHD it is likely whatever he has is due to low thyroid hormone.

        • Maria says

          Mark, my kindergarten son would have emotional outbursts like yours everyday after school. In 1st grade diagnosed ADHD combined. For him the meds seemed to help but I was never comfortable putting such a young and underweight child on Ritalin. I researched and went to different Drs. Finally when he was in 4th grade found a naturopath to do neurotransmitter tests (way off!) and food allergy tests. Once child had his food allergies removed which for him were gluten, dairy, eggs, bananas and 3 different types of beans, he was like a totally different child. He was able to totally come off the meds and do even better in school. When originally diagnosed I was concerned about him getting through the 1st grade and now he’s shooting for the honor society in middle school. Also remove any known GMO (genetically modified ) foods from the diet as there is concern that the BT toxin engineered into the plant, along with the pesticide residues can lead to leaky gut, causing the food allergies in the 1st place.

          • Mark Flynn says

            I am headed to the Dr. with my son tomorrow. This Dr. specializes in Pandas (which I don’t think my son has), but I think this Dr. may lead me down the right path.

            I have heard from several different sources that food allergies/inflamation may be to blame. I want to make sure I suggest the right tests… Is there a food allergy test that is more accurate/revealing than another?

            Also, I had his neurotransmitter levels tested (urine test), and they were all over the map. Almost none of them fell into the “normal” range… I have some Drs. say that the test is not a useful indicator of anything.

            I am trying to avoid quackery while not just settling for the easy answer. Either way nothing has really worked yet.

            Thanks for the help.

            • Maria says

              Mark, in response to your original post, there’s a great book “Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD” by Daniel Amen and one of the 6 types does not respond well to stimulant meds. Not sure where you live. Here’s naturopath web site for neurotransmitter testing http://stevenenninger.com/ I would no longer go to the Drs who say that neurotransmitters do not mean anything because they most certainly do especially to a Dr skilled in analyzing them and knowegable in correcting any inbalances by removing food allergies and using corrective supplements. Unfortunately such a Dr will most likely be a nathropath and may not participate in your ins. plan. There’s various food allergy tests IGG, IGA testing across 96 foods. Its impossible to have normal neurotransmitters when there’s hidden inflammation because the body is reacting to unknown food allergens. My 10 YO on ritalin for 3 yrs, was so allergic to gluten,dairy, eggs that whole digestive tract and neurological system was inflamed causing ADHD sym. and stunted growth. Diet + supplements- ritalin and w/in 1 month child became new person. Was able to avoid ritalin with younger son, using these techniques.

  12. Carina says

    “In trials where people with normal blood tests but symptoms of low thyroid are given thyroid hormone or placebo (inactive pill, e.g. sugar pill) (e.g. BMJ 2001;323:891-895) there was no benefit in giving thyroid hormone over placebo.”

    I´m curios how these trials can possibly work, since you have to raise your thyroid hormone until symptoms are relieved and the sufficient amount is so individual. For me it took 100 mcg of tyroxin to get any real benefits, but even that wasn´t enough. I did feel a little better on 50 mcg than on nothing but I was still sick as a dog. I would have probably been written off as one that didn´t respond better than placebo. How high a dose do test patients get in such studies? And do they raise the dose every 6-8 weeks as a normal thyroid patient would?

  13. Chris Kresser says

    Carina,

    The point of this article is that there are physiological mechanisms which depress thyroid function that won’t respond to standard thyroid hormone replacement.

    For example, if your cells are resistant to thyroid hormone, supplemental thyroid hormone will have a limited effect. If you underconvert T4 to T3, taking Levothyroxine or another T4 replacement won’t help much.

    The reason thyroid patients have to continually increase their dose is that these underlying mechanisms aren’t being addressed. It’s not “normal” to have to raise the dose every 6-8 weeks. It might be common, but it’s not normal.

    • Sally says

      I’m not sure I agree with what you are saying here Chris. You place a lot on thyroid resistance when it is more likely hypothyroid symptoms whilst taking thyroid meds is due to other matters such as low/high Iron and low/high cortisol, poor functioning adrenals etc. These are easy things to test and sort out and should be so. There are also other things such as high flouride/bromide levels, high toxic metals such as mercury or lead etc. These too are things which must e addressed but may cause someone to eed higher doses of thyroid hormone meds.
      Of course for most people who are put on levothyroxine they may suffer the problem of poor conversion and rT3 conversion and so their meds must be changed otherwise they will always be hypothyroid and no matte how much Levothyroxine they receive their symptoms will not abate.
      It is normal to raise your thyroid hormone meds every 6-8 weeks but only until the best dose is attained and that is the dose which relieves your symptoms – and not lowers your TSH to whatever level.
      So I agree with Carina that study is not a study to base any treatment on, since the hypothyroid issue is too complex and should not be affected by that one study; I’m not sure what the point of the study was to be honest, if you need thyroid hormone then a placebo will not do -simples!

  14. lynn says

    I assume Carina meant that when you first start treatment you increase the dose every 6-8 weeks until optimised. Not that you change the dose every six weeks for the rest of one’s life. This is very common when the above mechanisms are not addressed or a person is on T4 only though.

  15. Carina says

    Chris,
    I guess I digressed there from your article, but these questions always pop into my head when I hear of trials like the one mentioned.

    I really thought it was normal to raise the dose quite a bit. But even so, if some of the test persons had one of the underlying dysfunctions, then that would skew the results, so I would still say that there are problems with trials trying to determine whether or not patients with “normal” labs would benefit from thyroid meds.

  16. Chris Kresser says

    But that’s exactly my point, Carina: that “normal” thyroid labs don’t necessarily equate “normal” thyroid function. This is the argument I’m making in the article.
    These 5 mechanisms I listed here can suppress thyroid function, but they won’t necessarily show up on lab tests and they won’t necessarily respond to replacement. The value of those trials is that they confirm that replacement won’t work for patients when their underlying mechanisms haven’t been addressed.

  17. lynn says

    Hi Carina

    It is normal to raise the dose quite often when you first add thyroid hormone. You do this until you reach your sweet spot. Then, some need to increase slightly in winter and decrease a bit in summer. Otherwise, if you need to constantly tweak your dosage there is something wrong. Check out all the things Chris mentioned in his series as well as ferritin, B12, electrolyte and adrenals.

    Also, T3 or natural thyroid works better for most.

    • Steinalder (Norway) says

      If you need to increase your thyroid medication in winter, you probably want to think of getting some D-vitamin instead….. My underlying issue with hypothyroidism was gluten and dairy intolerances and vitamin and mineral defciencies as well as a gut infection.
      2 months after I went paleo I had to get off all thyroid medication (I have been taking Levaxin for more than 15 years!). The thyroid medication never worked for me, all the low thyroid symptoms were there all these years despite the medication. My doctor said “everything is OK” year after year – he trusted the results from the blood work…..
      Thank you Chris for all your hard work informing and educating us all!

  18. Carina says

    Lynn,
    Yes, I meant raising the dose until optimised.

    Chris,
    I´m with you. I was just pondering the accuracy of such trials. I guess I should have directed my question to Angus who was the one mentioning it in his comment.

  19. says

    Hey Chris

    I am hoping you can help me. I have many of the thyroid symptoms, but all my levels check out:

    TSH 1.27, FT4 1.1 and FT3 3.7

    Negative or “normal” for antibodies. TSH was tested separately and I was on “the raw milk diet”for both the tests.

    Testosterone was 306 on the first test, on the second it was 438. I was not fasting during any of these tests which I now have read could screw up results.

    I have been gluten-free, Primal type diet, no cheats with any grains whatsoever, since December. Unless there was gluten in something I ate at a restaraunt, although I was very persistant about being “gluten intolerant.

    I have had folliculitis caused by gram negative organisms, usually Enterobacter Aerogenes for 3 years, it waxes and wanes. It’s not “horrible”, but it definitely has ruined my face.

    I have been on Tetracycline in 2003 for Acne. Then nothing till 2007, where since I have been Doxycycline twice, Amoxicillion, Erythromiycin, and Clarithyromycn. Never for more than a month at a time.

    Obviously my gut flora is screwed. I did the raw milk diet and am now taking Theralac and Ohhiras. The condition has improved and definitely improved when I let go of topical therapy (a huge waste).

    But now my thyroid symptoms are really showing up, and I can’t tell if my folliculitis is flaring from the very dry skin from thyroid, or if the Enterobacter is still going strong. I wanna say it’s both.

    I was VERY underweight for about a whole year (all of 2007, some of 2008)due to being an overzealous cross country athelete who could not recognize when my overly competitive attitude was doing me wrong. I restored my weight with a junk food-binge type diet quickly by 2008.

    Found Primal in 2009. Many health problems left. But now things are much much worse. Did Zero carb for a bit, Very low carb for a few months.

    Never had thyroid symptoms till now, but clearly I had them coming.

    I am guessing my pituatary, adrenals, and thyroid are just fed up with me.

    I have been overfeeding, at least 2500-3500 calories a day for about two months now. There have been days when I feel and look great. But then days where I feel horrible, my eyes get puffy and baggy, skin flaring.

    Really don’t know where to go. I really just want that fecal therapy done to correct my gut flora, and then address the rest of the issues. I am afraid to go on antibiotics again unless I can get fecal therapy right after. Folliculitis get’s worse after each antibiotic and I really don;t need any other immune issues.

    I am ruling out Hashimoto’s for now. Just because for years I ate gluten and never had any thyroid symptoms. I gained and lost weight like a normal person, slept alright, didn’t really display any food intolerance symptoms besides acne and ADD, some anxiety sometimes about sleep.

    Too long of a comment, I am sorry. Hopefully I can get some advice. I have a doctor at Whitaker Wellness.. but so far that is going no where.

    • Sally says

      You have several other people commenting on your post but one thing to think about due to high amounts of antibiotic therapy is fungal infection. It is highly likely you have fungal infections which are causing some of your symptoms.
      I have used Lufenurone to good effect and without side effects which has to be a bonus with everything else you have. You will need to take Lufenurone for around 6 months and then repeat it again next year and so on until those symptoms resolve. It will then enable you to work on your gut dysbiosis and then the other things including thyroid. It is a long and windy road but its possible to get there; be patient; though I understand that is frustrating when you feel so Sh*t. Best of luck

  20. Chris Kresser says

    Bill,

    I wish there was an easy answer I could offer you. As you have no doubt gathered, thyroid physiology is complex and multi-factorial. From reading your story, I suspect (as you do) that it’s your HPA axis that’s driving your symptoms. This isn’t uncommon – I have several patients with normal thyroid labs, but still have weak thyroid function secondary to pituitary or adrenal dysfunction.

    There’s really no way to know more without doing a full work-up. If you’re interested in that, please visit my professional site to learn more about how I work with people and schedule a free, 15-minute phone consultation.

  21. Chris Kresser says

    Lynn: I disagree that TSH isn’t useful. I think it’s very useful. It tells us what hormone levels are feeding back on the pituitary, and whether the pituitary is functioning properly.

    Bill’s FT3 and FT4 levels are within both the functional and lab ranges.

  22. Lynn says

    I should have phrased that more clearly. I meant that that the FT4 and FT3 are more important than the TSH, and that just because his TSH is low does not mean he is euthyroid.

    Without ranges, it is hard to tell where Bill’s numbers are though. Ranges differ from lab to lab and they don’t all use the same units.

  23. Chris Kresser says

    Ranges don’t differ that greatly, in my experience, for FT3 & FT4. He’s at the high end for FT3, though he is towards the low end for FT4. It’s more likely he has thyroid receptor site resistance secondary to dysregulated cortisol rhythms. It’s perfectly possible for people to have normal thyroid labs and still have symptoms.

  24. Lynn says

    Well some labs use the range 2.0 – 4.4 for FT3 and other labs use the range 4.0-6.8 for example. People who are doing well (absence of thyroid symptoms) on their thyroid meds tend to have their FT3 at the very top or slightly over the range. This observation comes from years of interaction at patient groups. Apparently the ranges used to be higher, which explains this.

  25. Lynn says

    Nope, he isn’t, but the point of thyroid replacement is to mimic normal phsyiology. So, if thyroid patients do best at the top of the FT3 range; I would venture that healthy people should be there too.

    I also FIRMLY believe in fixing underlying causes low thyroid such as low adrenals, low iron/ferritin, low B12, gluten intolerance etc.

  26. says

    I forgot to add that at the moment (as of yesturday) I have started to supplement Betaine HCL, as I also have some symptoms of low stomach acid. Not sure if I will get any results from that.

    I have scheduled a phone consultation. Thank you Chris.

  27. says

    What about when labs indicate Hashimoto’s but I felt healthy with no hypo symptoms to report (I had a TSH of 10, FT4 of 1.0, and FT3 of 297, TPO >1000, ATA 1268)? I went off gluten for 5 months and now my TSH is 2.08 and all of a sudden I feel terrible — brain fog, fatigue, mild depression (FT4 of 1.2, TPO 447, and ATA 260). I started a dose of Armour Thryroid a week ago and am hoping this will help alleviate these unpleasant symptoms!

  28. Elizabeth Strong says

    Once again, no high cholesterol, but I am hypothyroid. I’m getting far too much thyroid medication according to my primary doctor, but my endocrinologist lets me stay on the present dose because I don’t have high cholesterol, or heart probems, and bone density is fine. And no diarrhea.

  29. Mark says

    I’ve got another one for you. A friend of mine was recently diagnosed hypothyroid do to a medication side effect (carbamezapine). This manifests as normal TSH, low T4, and low T3 – but in the early stages, T4 (and possibly T3) are depressed but not out of range. This develops over time. It’s unclear if this is acting through the pituitary or something else entirely. Troublesome for anyone on continuous treatment with these sorts of drugs, as the TSH remains normal, and many doctors test only that. In our case, we discovered the change due to a sudden and rapid increase in cholesterol.

  30. Kimm says

    Hi,
    I came across this forum trying to figure out what my doctors apparently are not able to. While I do not expect you to provide a proper diagnosis simply based on what I write here, I was hoping you could possible point me in the right direction. I have been suffering from insomnia for the past (at least) 3 years. About the same time I started having difficulty sleeping, I had an abdominal surgery (2009) (I have Crohn’s disease, which currently appears to be in remission as of my last colonoscopy a month ago) and put on 30 pounds following the surgery for no apparent reason. I did not change my eating habits at all, I did not change my exercise routine at all and my stress level really did not change either.

    The following summer, we went to take our first annual bike ride (we are avid riders and would ride 15-20 miles every weekend with the kids) and by the time I got to the corner of our street, I was literally crying because my legs burned and hurt so badly, I ended up walking my bike back because I could not pedal it home. I went to my doctor, again complained of being exhausted by this point, still from lack of sleep and the burning in my legs. He ran a bunch of tests, of which I cannot recall, I was told all levels were normal except my triglycerides, which were over 500 or something crazy high like that. None of my other cholesterol levels were above normal, just my triglycerides. I did not want to start statins because my legs were already hurting, so I modified my already relatively healthy diet to exclude the small amount of occasional fried foods. Of note, prior to the surgery, my weight fluctuated between 125 and 130 and I am 5’2″ tall.

    Fast forward to a bunch of normal tests and I end up at a rheumatologists office who tells me I have fibromyalgia and prescribes Lyrica, which is in addition to the Ambien my doctor has prescribed for sleep (or lack thereof), neither of which did much of anything for either of my issues (sleep or leg burning).

    About 5 months ago or so, the insomnia was getting worse and started to affect my cognitive function….. forgetfulness……so badly, I actually forgot to go to work on two separate occasions (who does that right?), inability to follow along in simple conversations, excessive daytime sleepiness to the point that I would lie down and take a nap for 3-4 hours every afternoon or I could not get through school.

    I went back to my doctor because one afternoon last week, it took me 7 hours to answer 15 simple questions in my psychopharmacology class, which happens to be a subject I excel in…..my GPA is 3.98 on a 4 point scale and I have never in my life ever struggled with school and rarely have to study. So, for me, this is a new symptom or I should say worsening symptom. I am also working on my supervised hours for addiction counselor and “forgot” a very important court date I had to appear at for one of my clients.

    My doctor has now added a low dose of Adderall (10 mg) as a “temporary fix” until they can figure out what is going on with me and it has greatly improved my energy level and clarity. I easily recall things I need to, do not have a need to take a nap, and for the first time in 3 years feel “normal”.

    I had a sleep study performed a few weeks ago (prior to the addition of Adderall)….This showed no evidence of sleep apnea. With taking 3 mg of Lunesta (changed from Ambien because of no improvement) prior to retiring for the night, I only entered REM sleep for 7% of my total sleep time and woke up or cycled back to stage I sleep 29 times. I feel asleep in 11 minutes, the study lasted for 371 minutes and it took me 271 minutes to get to REM sleep, where I spent approximately 26 minutes. Of most clinical significance, it was noted that my O2 saturation dropped to 84% and it was suggested I have an overnight O2 saturation study. I had that study performed immediately after and in a 6 hour period, my O2 saturation dropped 31 times to between 80.4% and 80.8% and staying that low for between 21 seconds to 5 minutes. Restless leg symptoms were not noted, nor was there any evidence of snoring.

    In addition, TSH was normal (using that term loosely), CRP was normal, B12 was low (I was given a B12 injection), WBC normal, CBC normal, triglycerides still elevated, but decreased to 282, all pulmonary function studies were normal and I have no evidence of asthma nor do I have any shortness of breath while awake or during exercise.

    My doctor sent me to an ENT thinking my tonsils may have something to do with my O2 sat dropping. ENT thought I was crazy and asked if I was depressed…..went to a second ENT (since I thought it was impossible for a proper diagnosis from the first one when he did not even take the time to look at my tonsils or examine me in any way) who informed me I had tonsiloliths, but not significant enough to cause O2 desaturation and this one also asked if I am depressed. By this time, I am frustrated, exhausted and don’t really care if they call it the chicken pox, I just want it to stop so I can get some quality sleep. I calmly told him that since my profession is to recognize signs of depression and provide counseling services to my clients, I am pretty sure I could recognize if I myself was experiencing depression. I went on to tell him I had a very happy childhood, was never sexually abused, have a pretty good relationship with my mother, am involved very happily in a relationship and we are planning on getting married when I graduate in the spring, I absolutely love my job and while I occasionally get a day when I feel like life is treating me like its own personal toilet bowl, for the most part, I am very happy and not very dysfunctional. I also wondered out loud, in an inquisitive tone, when depression started to cause ones O2 saturation to decrease as I have been taught that it can cause difficulties sleeping or excessive tiredness, but have never heard that oxygen desaturation can be caused by depression. I suspected, again out loud, that if my oxygen saturation issue was solved, that likely my sleep issue would also be solved.

    So, now that I have taken up a great deal of your time, my question is this……how possible is it that my issue with O2 sats dropping as low as they are is caused by either my thyroid or my adrenal gland? The ENT wants to perform yet another sleep study, which I think is a tremendous waste of my time since I have already had one done only a few weeks ago. Should I be seeking an opinion from an endocrinologist to explore a thyroid or adrenal issue? I feel like I am going out of my mind because even simple tasks like remembering to take something out for dinner is incredibly cumbersome. I struggle to do even basic activities throughout my day and my legs are still burning so bad I cannot even go grocery shopping because of the walking involved. I should also mention that I did have ABI testing performed to rule out any clots or arterial/venous issues and I have had a complete cardiac work up, also normal.

    I would appreciate any direction you might be able to lend.
    Thank you
    Kimm

    • liverock says

      Kimm

      People with Chron’s Disease tend to have low selenium, low zinc levels and high copper levels.

      http://www.ncbi.nlm.nih.gov/pubmed/8362213

      The high copper can affect women with Chron’s especially as most women already have higher copper levels due to such things as copper IUD’s and birth control pills. Copper also rises as estrogen levels rise. and it needs very good adrenals and liver function to eliminate excess copper. which sress will deplete.

      High copper can cause a lot of your stated symptoms including insomnia and muscle problems. The low selenium and zinc could also cause
      thyroid problems. To reduce your triglycerides google” fish oil reduces triglcerides”

      I have found this site to be helpful for those with excess copper problems and she will answer any questions.

      http://www.tvernonlac.com/copper-toxicity.html

    • sally says

      I am sorry you are having a tough time. It might be helpful to have a hair analysis; this will tell you what is happening in your tissues – often different to what is happening in your blood – and the hair analysis I use here in Europe will also give advise on diet and supplements but more importantly will diagnose low adrenal output and low thyroid hormone too. The feedback is specific to you and you would inform them of Chron’s.
      Certainly insomnia is a symptom of low adrenal output and low thyroid hormone since I suffered with it for around 28years. Insomnia where you wake around 2-3am is due to hypoglycaemia and that in turn is due to low adrenal output, low thyroid hormone and resulting low liver funcion. Sometimes I couldnt even get to sleep let alone wake up.
      Hair analysis gave me information and a determination to get the right diagnosis; this came after 33years. Since treating my adrenals with vitamins, minerals, trace elements and herbs plus DHEA and also getting the right thyroid meds, I USUALLY now sleep like a baby. Best of luck.

      • Tina says

        Sally – where can you get the hair analysis? I am in Germany and having a horrendous time finding a doctor that will listen to my *symptoms* despite normal results.

        General question here…I am getting a bit confused as my “normal” levels use the German names:

        Free “trijodthyronin” (FT3?): 4.2
        Free “thyroxin” (FT4?): 14.2
        “Thyreoidea-stimulierendes Hormon” (TSH): 1.69
        “Thyreoidea-Peroxidase” Antibodies (???): 312
        “TSH Rezeptor”, Antibodies (???): negative

        But, despite my “normal” levels, I feel like hell. I have a long history of PMDD that no doctor will do anything to help so I was already running with about 50% of a ‘normal’ existence (pmdd for me always sucked all the life and energy I had out of me plus made my moods and emotions uncontrollable, my appetite rage out of control, my concentration disappear completely – for two full weeks every.single.month.) But then I returned to normal. Happy, with energy, focus, PATIENCE, normal appetite.

        Within the last 3 months, my energy level has vanished completely. My hair has been breaking for a long time, I am fully exhausted, if I do anything (do the shopping on Saturday afternoon) it takes hours to recover. My appetite has gone crazy, I crave sugar and salt, I am short of breath, I get really cold (i freeze), I have serious brain fog, I am irritable and NOW I am depressed. This is a major change to “just” the PMDD. This is horrible for me and my little boy. I have no energy to do things with him. I feel hopeless of ever getting to the bottom of this.

        My iron levels were a bit low. I have been taking iron pills for the last 4 weeks, but there is no major change there. I do have a lot of stress though, but in general, have a lot of positive things happening. I was feeling pretty darn good on my non-PMDD days) It’s just a lot in for a long time. My cortisone level is 127.

        My mother, father and sister all are hypothyroid. My gynecologist (from an Endocrinology practice) thinks I am just depressed and prescribed Zoely which is a birth control pill with “natural hormone replacement”. The pill was a nightmare for the PMDD when I tried it before. I have not started this.

        But I have several other Hypo symptoms. These are just the ones that are truly making my life miserable right now.

        Does anyone have any ideas? Sorry, I started with just general questions and just kept going. ;)

        Thanks for any thoughts. I wish us all the help we’re looking for.

        Tina

    • RenegadeRN says

      Kimm, I know yours was an older post, but parathyroid adenoma comes to mind. Did anyone run a serum calcium on you? Better yet, an ionized calcium.

      If you are over about 30-33 years old ,your calcium should be in the nines, anything over 10, on a regular basis or climbing, coupled with insomnia and fatigue points to primary hyperparathyroidism.

      • RenegadeRN says

        Forgot to add, check out parathyroid.com for a complete list if symptoms. This condition is grossly under diagnosed , and many providers do not have an accurate picture of clinical HPT. Most have outdated information.

  31. Crystal says

    Chris,
    In 2010 i went for my phy due to being tired (excessively) and weight fluctuation. I was had maintained 120 lbs w/ no weight fluctation. I was and am highly active workout daily and was eating semi healthy. My prim dr discovered a nodule on my right side of my thyroid. Long story short the TSH came back saying i was hyper. But none of that made sense as i was exhaused and gaining weight. I tried for almost 2 years to manage my healthy w/o pills but in Feb of 2012 after putting myself on a high protein diet, prenatal pills and using every nail growth nail polish when my nails split putting on a necklas (and w/ my weight then and now at 130-133 desiptie my working out and caloire watching and prioir they were long and strong!!) i went and was tested and put on 50 mg of lthyrxine 6 weeks later up to 100 then 3 months later back to 75). It seemed to help some of my symptoms (better sleeping no excessive sweating on my armpits) but now 8 months later my nails are not growing (i have never bitten my nails and they look like i chew on them) I am training for NPC competition and eating the same clean diet no soda no junk and my body isn’t responding ( i am 135 lbs @ 28%fat). I was tested for the anit bodies and that was positive and yet my TSH levels reflect i am hyper but my T4 and T3 are normal. I am at the point of going crazy. I am at a loss what to do!! i am at the point of having the nodule removed as since it came to be is when all this has changed and impacted me. I am looking for direction on what i should ask my dr and i feel like my body isn’t converting things correclty in my body based of my nails (hair dry skin …low engery) and weight etc. ? can you recomend anything to me?

    • SoccerMomTeri says

      Crystal, I had many of your health issues and was dx with Graves. I told my Endo I felt like I had Hashimotos. He insisted it was Graves and quickly scheduled me for RAI, which I declined and went on 3 surgery consults instead. After my total thyroidectomy June 2011, the biopsy showed I did indeed have Hashimotos… My suggestion to you is to get ALL the antibody tests to see if you are like me and have BOTH Graves AND Hashis. The tests I had done were: TG-AB, TPO and TSIG. My antibodies were high for all of them. Have you had your ANA labs done, with the ANA Pattern? I did, and my ANA was positive, with a speckled pattern, with a positive SSA antibody, so I also have Sjogrens. My point is, if we have one autoimmune disorder diagnosed, often times, we will also have a second autoimmune (or even 3rd, like me). Over half the battle is getting an accurate dx. Good luck to you.

      • crystal says

        Hey thanks for the heads up! I guess my results in Feb were suppressed tsh and t3 &t4.. thus the l thyroine but w no weight loss and now my tsh ar. 01 i went off (& i am training for npc comp..so clean eating 2 a days and no fat loss). Went on hypo meds and i gained 5lbs in a week!! Now am seeing a sports metabolic dr specialist.. she thinks there is something bigger going on so testing all ny # hormones tsh etc ) hoping they can find out what i will let u know and willask about alk that

        • crystal says

          So after labs and all have been done .. am being treated for insulin..and leptin resistance…will see how this pans out but fingers crossed

          • Nena says

            Your case sounds so similar to mine regarding all the symptoms and body weight issues…the only thing different is that my dietitian was actually the one that told me to do all these tests again, eventhough I had been doing it for 3 years in a row, and all doctors (neurologist, alergologist and gynecologist would say everything is normal). I am currently waiting for TPO and TG-AB results, my TSH is low and T3 and T4 are normal. How did your experience ended?.

            • sally says

              Have they checked your pituitary gland output? Also it isnt totally uncommon to have both HYPER and HYPOthyroidism simultaneously. You need a new Doc perhaps; someone who fully understand thyroid issues. How about Dr Brownstein?

  32. Jennifer says

    Chris,
    I need your help!!!! I had my thyroid removed a year and 1/2 ago and was put on levo 100 mcg after surgery. I have had many of the hypo symptoms since even though all labs were normal. The worst symptom light headed very low heart rate (40′s) and blood pressure sent me to the ER. Had tons of tests in ER for heart and lung and all came back normal. After having every test under the sun and all came back normal I decided to take it upon myself to increase my levo to 125 mcg with my internal med doc’s approval. Gradually my symptoms subsided.

    I had been feeling good for 5 months and woke up one day with breast pain and went to doc for exam and he found breast discharge. Had mamo and ultrasound and they said ducts were a little off but normal. I had my doc test for prolactin levels and they came back very high 107. My doc ordered a pituatary MRI and found a 7mm tumor.
    I’m now on cabergoline to stop prolactin and shrink tumor.
    After all of this my endo doc also decreased my levo to 88 mcg because he said my TSH levels were hyperthyroid (even though I had no symptoms).
    I expressed my concerns in changing the dose because of the hypo symptoms i might experience again but he would not listen and said I had to lower it because of the pituatary problem.

    It has been 7 weeks since he lowered my dosage and I have the hypo symptoms back (low heart rate, feeling faint, cold hands, chest pains etc)
    HELP!!!

    • sally says

      No Dr should titrate your thyroid meds with your TSH levels. Also when taking meds most people feel ‘well’ when they have a suppressed TSH. It is not appropriate to compare someone taking thyroid meds TSH with someone who isnt taking thyroid meds – apples and oranges.
      There are studies and articles out there which describe in detail the reasons why TSH levels are not a good way of measuring hypothyroidism both on and off meds; so I would check them out. (Sorry dont have any details to hand.)
      I can though tell you that your pituitary gland has a very strong affinity to thyroid hormone and this is many times greater than all other tissues around the body. There is plenty of evidence to suggest that the TSH can be suppressed due to the pituitary gland being soaked in thyroid hormone, when actually the peripheral cells including CNS and the brain and heart can be depleted. Your endo is wrong and you are right; after all is he treating you or the blood results?

  33. Camille says

    Hi Chris,
    I was wondering if you could help address my questions. I am 35 and suffering from painful, heavy periods due to a large uterine fibroid. I went to a “natural approach” doctor who checked my Thyroid (TSH, antibodies, T4/T3, etc). My TSH was 2.8 and she said my T3 was 2.4. She also noted that I had some antibodies (she said the range is 0-60 and mine was 45). She prescribed Armour Thyroid (30 once a day) and Prometrium (to get my progesterone up to help fibroid issue) and Iodoral iodine. I have been too nervous to take the Armour meds or the Iodoral for fear that it will do damage rather than help? According to another Dr., my thyroid is in the “normal” range, but to her I need Armour (she seems to think it will help with the bleeding, but my ultrasounds show that it’s the large fibroid causing it). My only “hypo” symptoms are hair loss, fatigue, and constipation (but then again those could be from being on iron supplements due to losing so much blood each month?). What would you advise? Take the Armour and Iodoral or will it do more harm? I’m 5’7 and 120lbs so weight loss is not an issue for me. Thank you:)!

    • sally says

      Taking Armour thyroid is not dangerous; at the very worst you will experience palpitations and then you stop taking the Armour Thyroid and the palpitations will stop within 12 hours or less.
      Fibroids and heavy periods can be due to untreated or undertreated hypothyroidism; you are lucky to have someone who is willing to take that route.
      You appear to be suffering a number of symptoms of hypothyroidism and I bet if you thought about it you are suffering many more; in which case taking Armour thyroid is not dangerous. You are being offered a very small dose, 1/2 grain is 30mgs so dont worry about that.
      I would though avoid taking the Iodine for now, take one thing at a time then if you experience any changes you know what it is due to.
      The TSH blood test is open to debate and certainly determining whether the result is high or low is very much open to interpretation; in my opinion yours is slightly high but definately higher than you would wish for. Many people experience hypothyroid symptoms when the TSH is greater than 2.0; just as you are.

  34. Ann says

    Hi Chris, Don’t know exactly where to start but will try to put everything together quickly. In 1983 I ended up with Thyroid Cancer and had a thyroidectomy and also lost my parathyroid glands. So I currently take Levothyroxine and Vit D replacement. Slowly but surely I have been losing my battle with weight gain, fatigue, depression, insomnia…you name it. My labs show hypothyroidism most of the time, and in the last 5 years I have developed high blood pressure and extreme fatigue and was diagnosed with fibhromyalsia. I have elevated TBG and show signs of anemia, all tests for sugar levels have been normal. I have started taking B-12 and increasing my Calcium intake. It really sounds like the iodine and selenium could also be involved in this picture. I have always questioned the normal levels on the bloodwork especially since I am
    struggling with everything like I am and it is getting worse. What is the best way to talk to my doctor about checking things out further as well as trying the iodine and selenium. Oh I also should say that I am a strick Vegetarian (I do not eat fish or eggs but I do eat dairy such as milk or cheeses w/no rennet). Any suggestions you could give would be greatly appreciated. I am only 55 and I feel like I am 75! Thanks Ann

  35. Judy says

    Great post Chris. However I believe your response to Angus #5 was somewhat weak. The only studies I’ve seen suggest that thyroid hormone resistance does not affect the pituitary. This is why synthetic T4 replacement can “normalize” blood tests without relieve symptoms.
    Also while low BBT is not definitive, it is a good indicator because it is a symptom that can be measured non-invasively at home.
    For those considering Armour, you now have to chew them for full effect.

  36. twiggynot says

    At 28yrs I was dx as having an underactive thyroid.
    rx: .75mcg? Synthroid.
    went up to .150mcg Synthroid within 2yrs.
    I go up and down but can’t figure what the pattern is.
    Dr: tests tsh only most of the time. I am 40 now with same dr. She has only tested antibodies once and it came back with a speckled reading. I don’t understand these tests very well. She sent me to get tested for lupus and it came back negative.
    For almost a yr now I have been on taking two 60mg of Armour plus half of another pill. On top of that was put on Adderall since I was having trouble focusing and keeping things organized at home and work. Adderall has worked well but Armour is not. I am still losing hair and extremely fatigued. I have to drink coffee or frapps at work to help me continue to have energy but by the time I am home I am ready to drop and I can’t because I have a family to care for. What tests should I ask my dr to request?

    I am 40 and weigh 185lbs (5’7″) this is what depresses me.

  37. Thera says

    How does ReverseT3 come into play and how do you feel about the Wilson’s temp therapy with the sustained release T3?

  38. Becky says

    I am currently experiencing hyperthyroidism, and they are trying to rule out Grave’s disease. I don’t have the antibodies, the eye or skin problems, and no family history of thyroid issues. I’m 35, 6 month post partum, have TSH that is almost non existent. And high T4 (70)
    You seem to be very knowledgeable with regards to hypothyroidism….do you know of any other reasons besides Graves that I would be hyper? I also forgot to mention, my thyroid ultrasound showed one small colloid nodule that they figured was in the process of degeneration…..they don’t want to biopsy, just look at it in another 6 months. It was hypervascular though, and inflamed.
    Thanks so much for any info!

  39. Alice says

    I am on Armour thyroid, 125 mg per day, because I had an incorrect dosage of thyroid (Synthroid I think) many years ago (when i was just trying to see if thryoid drugs would help even if my tests didn’t show problem except for weight gain), – too high of dose seems to have destroyed or seriously damaged my thyroid function. It took a long time to catch – long story so won’t explain here.

    So… Hashi’s is not the cause of my thyroid problem. My doctor recently bumped up my Armour from 90 mg to 125mg so I think I may be one of those that Armour doesn’t work on after it changed.

    I seem to have a serious lack of “get up and go” much worse than ever. I am 66 so maybe some of this is expected but I want to “try” something else. I don’t mind leading my doctor in some direction (which I hope she will go in) but I’m not sure which direction. Your 5 reasons didn’t seem to address someone who has thyroid problems because of damage due to incorrect treatment, do them? (maybe except for the comment from someone whose husband you thought should be tested for Grave’s disease?)

    What “direction” should I go in since my doctor may not want to try a lot of things? If you were to pick 2 or 3 directions (or maybe only 1 if there is one main obvious one) – which would it be? or which article of yours applies mostly to my situation?

    • sally says

      You could simply try a different thyroid med i.e. ERFA Thyroid instead of Armour? You can simply swop tablet for tablet; but they each have different fillers and sometimes this can cause problems for some people. ERFA is the same as the original Armour Thyroid.
      There is not a problem increasing your dose until you feel ‘well’ and your symptoms resolve; for example I take T3 (liothyronin) 100mcgs PLUS 3-4 grains ERFA Thyroid i.e. 180 – 240mgs; this dose makes me feel good but any less and I get a return of symptoms and don’t feel so good. This is a high dose of thyroid supplement but it works for me. Someone else might feel well on 1/2grain or 30mgs of Armour or ERFA Thyroid; it really is a personal thing but its not dangerous so long as you feel well on the dose.
      So changing the type of desiccated thyroid might help or indeed increasing the dose; your lack of get up and go is likely due to low thyroid hormone.

  40. Tasha says

    Hi Chris,

    Great article!

    Can I please get your thoughts on what’s happening with me as my results are a bit odd? Symptoms are fatigue, anxiety, quicker heart rate, insomnia, clammy hands and feet, weight loss and symptoms are usually worse in the morning than in the evening. My naturopath did a thyroid reflex test and said I was hypothyroid, yet my symptoms seem to be hyperthyroid. I did try 30mg of dessicated thyroid for 2 days and I didn’t like how my appetite ramped up, so I discontinued it. About a week after, my endocrinologist finally ordered the T4 and T3 bloodwork (my TSH has historically been in the normal range) and my TSH is 0.5 (normal range is 0.38-5.5mU/L), T4 free is 21.3 (normal range is 10.5-20 pmol/L) and the T3 free is 4 (normal range is 3.5-6.5 pmol/L). Do you think I’m hyperthyroid as opposed to hypothyroid? Could my T4 free be elevated from taking the 30mg of dessicated thyroid for 2 days?

    If you are able to reply to this, thank you very much!

  41. Jules says

    What concerns me about the two schools of thought on tsh is that unless medical community can reach consensus. We as patients cost ourselves and medicine a lot of money and continue to suffer poor quality of life. I know that I have low cortisol tested by 24 hr urine and its probably why my original tsh antibody was over a thousand when diagnosed with hashimotos 6 years ago. However because I can’t get a physiologic dose with dhea I continue to suffer even though labs say I’m optimised. The future will be tablets for low bp. Maybe tabs for depression a ppi for gastritis it will go on until someone can totally identify why inflammation starts and how it can be treated rather than the resulting disease and that’s going to take a huge study. In all other forms of medicine disease prevention seems to get a hearing. Talk about cortisol and doctors will hear hydrocortisone and rebound. Putting back the small 10mg dose with a catabolic match would surely help some of us with has hasimotos whose autoimmunity started with poor adrenal function or am I hooked on a theory which I’ve heard but can’t prove!!!!

  42. mary says

    HI.BEEN ON thyroid mere for 32yrs. Recently went in for a tic bite and asked for thyroid test. Had results mailed to me. They do TSH test only. Was 6.83 and docs comments said to stay on current dose 100mcg & retest in 6 mo. Icalled a month or so later and told nurse I thought this was off and could she ask doc to change. Was changed to 112mcg. I’ve had breathing problems: weakness; right neck pain; extreme aches. Am 54. Menopause at 46-47. High cholesterol mere were added at recent visit but have not taken Cuz I believe thyroid is off. I was prescribed a antiboitic for the tic bite as had a ring around it. This was in July 2012. This is the worst I’ve felt. Any help or suggestions would be appreciated.

    • Debbie says

      Hello Mary,

      My suggestions would be to get your adrenals tested, not by your GP – as that will confirm nothing, that test is as unreliable as the blood tests. It does sound like the your thyroid medication is not being taken up properly and breathing problems along with your extreme aches and weakness could be down to that adrenal Issues.

      Best wishes
      Debbie

  43. Stacy says

    For last 3.5 yrs since my daughter I’ve been breaking out with hives on my legs. They come and go and are worse in the winter. My family doctor has sent me to a Allergist (that I would NEVER recommend) and he ran some blood tests and put me on allergy shots. The hives never went away. Also since my daughter was born I’ve not been able to lose the 40lbs I gained during pregrancy even with diet and excercise. Now I found out that I borderline diabetic and suffering from Hypertension. I did have my thyroid checked a few yrs back but it came back normal. My OB/GYN also said my thyroid felt very off the other day. I’m waiting for the test results and it comes back normal again what should be my next step? I should mention that I’m only 32 yrs old with no family health history and I’m by far the healthiest in weight, diet, and exercise then my parents and siblings. Any help would be apperciated.

  44. Susan says

    I have classic hypothryroid symptoms but test results of TSH 1.44, FT4 1.34 and FT3 3.1. I am so sick of feeling fatigued, of my thinning hair, my growing intolerence for cold, my overall sluggish feeling both physically and mentally, low body temperature and so forth. How do I need to approach a doctor about these symptoms? Any help is appreciated

    • Pam says

      I feel the same way as you, Susan. Almost identical test results. I have every single symptom of thyroid issues but no doctor will help me. I am at a complete loss as to how to find help. I’ve lost my teaching career over this.

      HOW do we get doctors to help us? I even paid very large sums of money out of pocket to see two Integrative doctors here in Florida, but neither of them think it’s thyroid since my labs are normal. I know they are wrong. I even had a thyroid scan and it showed that I have an inhomogeneous thyroid, but nothing was explained as to what that is. I also have TPO antibodies, but was told they were low enough( below range ) and not an issue.

      Symptoms: Extreme fatigue/lethargy, hair loss/brittle/dry, super dry skin, dandruff, cold intolerance, menstrual problems, low ferritin that is difficult to raise, high cholesterol, weight gain and near impossible to lose even 1 pound unless I just stop eating, scalloped tongue, abdominal pain ( lost my gallbladder last summer ), brain fog, depression ( who wouldn’t be?), gritty eyes, spine pain, sore knees, sore heels, ridged nails, puffy/frumpy face.

      But I always just get antidepressants thrown at me and told I’m just aging. I’m 45 and my health fell apart when I was 37. I have very little quality of life because of this.

      Chris….please…help :(

      • Lynn says

        I’d suggest checking out the Recovering with T3 book and FB groups. Also stopthethyroidmadness.com. You can get good doctor referrals from these places. It sounds like you may be a person that does well on T3 only rather than combination therapy.

      • mary says

        OMG pam i have the same problems the doctors wont listen..the thyroid doctor i went to asked me if i was depressed..I was at my wits end to begin with and after i get done explaining to him how i feel he asked me that..OMG i am at a loss to i dont know where to turn..all my test come back normal and i still feel like crap…I stopped going to the doctor in 2010 begining 2011 because they werent listening ..so i figured it was me but 2 years have past and i still feel like crap so i thought i would give it another try..and low and behold they are doing the same thing they did two before..so now i am at that same wall i was back then…so if you have any answers please reply back to me…oh yea another doctor told me to read a Jillian Millian book OMG i wanted to scream..i am a LIFE TIME weight watchers i know what to eat how much blah blah blah…

      • Debbie says

        I also feel exactly the same as you and everything you have discribed happened to me.
        Things got so bad that I had to seek private medical advice. What I will suggest to you is to go onto the thyroid uk website and on their they recommend a particular Dr – he has written a wonderfal book which will lift your spirits, you can go and see him or just work through his book.
        I really know what it’s like, I was 29 when things fell apart for me and now at 32 I am still very poorly – but I seem to be an exceptional case sadly, but I won’t give in – their is hope out their, people do get better, it just takes along time and getting the right medication, as we all respond in a different way.
        Good Luck
        Debbie

      • RenegadeRN says

        Not to sound like a broken record, as I had the same recommendations to another poster-

        Please check out parathyroid.com. I had these symptoms, had been pretty stable on thyroid meds for over 20 years when they started…dr. Norman removed a small benign parathyroid adenoma and now I feel great!

        It was a gradual decline that I wanted to attribute other things , such as oncoming menopause, thyroid meds, Etc etc… The insomnia, brain fog, apathy, and stomach pains were new onset and told me it was something new. Oh! I also had bone pains in my hip at night. No identifiable reason , until the parathyroid tumor diagnosis.

  45. shaz says

    Hi Chris, I wonder if you could shed any light on this, I had my levels checked for my annual test while on levothyroxine and my TSH is 0.02 so the doctor dropped my meds. I agree it’s very low but so is my FT4 and FT3 – both bottom end of range. Do you know what could cause the TSH to become so low without FT4 going high? I have to go back for follow up bloods and if the FT4 and FT3 go lower still as I suspect I’d like to know what tests to ask for next as I got the impression the doctor didn’t really know why the result was like this but just wanted the TSH to come back up. She actually asked me if I had been taking my medication.

  46. says

    Hello Chris,
    I’m sure your super busy. My question if it’s possible at all to answer. I was tested for thyroid and my results were TSH.49 . freet4 .73 and freeT3 2.19. My symptoms are super cold,10lb weight loss that I’m happy about, rapid heart rate although in the normal range even though it is faster then it has ever been. Sleep issues, waking up, up for hours tired in the morning. I scared to go on medication because I model,normal size not skinny, if I gain weight I can miss out on lots of jobs. My freet3 was considered low. I am on birth control ortho novum 777 and my diet is not very good although I’m improving. I eat alot of suger but am thin because I run 5 miles a day. Any thoughts? I’m more then happy to switch drs if i need to as i am in the sf/sj area:)

  47. marie anton says

    bottom line what to do if my daughters that is 15 has been tested for Thyroid , TSH and according to her pediatrician all thyroid test have been done and keeps coming out normal. However my daughter is overweight has tried every diet , excercise nothing works. She also has trouble sleeping, has anxiety, depression and has loss of hair. Desperite please help! What do u recommend when everything comes out normal but these symptoms dont go away. no family history either.

  48. marie anton says

    May I add endrocronologist 2 of them say she is fine all she has to do is eat well to lose the weight . She has been eating very well now for 2 yrs vegetables , fruits all organic even almond milk and nothing. No weight loss no changes in symptoms.

  49. Brendan says

    Hi Chris,

    I realize you may not be able to respond directly to me, but I’ll try nevertheless because I’m frustrated with my current health situation. I am a 30-year-old male who was diagnosed with hypothyroidism at age 17. Ever since, I have had a steady dose of Synthroid which has helped stabilize my thyroid hormone levels. However, I still have many autoimmune symptoms with no diagnosed cause. My skin is the worst part – I get lesions and deep sores all over my body which don’t go away and which cause me immense pain (not to mention loads of shame). I have joint issues, general body pain and stiffness, abdominal pain/cramping/constipation/diarrhea, dry eyes/mouth/skin, constant fatigue, trouble concentrating, irritability/depression/anxiety, and trouble getting a good night’s sleep.

    I have no family history of autoimmune or thyroid diseases. I exercise regularly and eat a balanced, low-fat, low-salt diet. There are no structural problems with my organs which would suggest a problem with them. I am neither coeliac nor lactose intolerant. My blood work is always impeccable, so doctors never go further in investigating the causes of my problems.

    If there is any suggestion you can offer in terms of how I can go about getting properly diagnosed/treated, it would be very much appreciated. I’m at the end of my rope!

    Thank you.

  50. steaders says

    Hi im desperate for help!I I started experiencing unexplained weight gain over a year ago,Ive always been healthy and active.I visited the gym regularly and would run 4 miles about 3 to 4 times a week.I eat healthy and for some reason have gained a stone,which is impossible to lose.having to eat low calorie diet to try to maintain weight but if I was too eat 3 normal square meals a day i put on 4/6 pounds overnight,I weigh myself daily!I started getting dizzy spells last year with pins and needles in my hands and wrists,also around this time my memory started getting worse and worse.I visited docs and she tested tsh level which was 0.7 and tpo was 9.8 she said these were perfect and sent me on my way.Pins and needles disapeared but memory remains awful,i feel foggy all the time and cant remember putting things down a second after ive done it!Four weeks ago i developed an irregular hearbeat,went to doctors and they said my cholestrol was high it was 5,referring me to cardiology at hospital.I am convinced it is to do with my thyroid and worry about heart damage.Feel tired,shaky most days and totally no sex drive for last year(poor husband!)Any ideas I would be most grateful for.thankyou!

    • Angela says

      I know how you are feeling. My symptoms started back in November. I don’t know your age but I am 45 and am entering menopause . My thyroid is a bit under active and I gained weight. I am having all my hormone levels tested and it shows my adrenal gland is low and my testosterone an progesterone is also low. I have all the same symptoms as you. I have went on a 2 hr a day workout and very clean diet. No sugar or caffeine and off bad carbs. I lost 20 lbs and feel better but not 100%. I have a dr. Who does bio- identical drugs. I can’t use the progesterone because I am one of the rare people who react to the cream but I am hopeful I will find my treatment for the hormones. As for thyroid, I have Graves’ disease and through my life it has caused trouble and now I am a bit under active . I think going into menopause throws the thyroid out so you might want to check into that . Hope this helps

  51. Nicole Dougherty says

    I was told by my doctor that I have Hashimotos and that from my test results my T4 isnt converting enough T3. Im on a combination of both T3 AND T4 but since had to get off medication due to the Low Dose Naltraxone Im on for my Urticaria. The LDN is also suppose to help Hashimotos and is suggested that you go off your thyroid meds to avoid hyperthyroid symptoms. Now that Im into my second week of the using this new medicine im more tired than normal. Do you he any info on LDN?

  52. T says

    I am 43, normal weight, reasonably healthy eater, work full time. I have a problem with my spine that restricts me from a very high level of physical activity, but I am not ‘dormant’ and I move about as much as I can every day, moderately active. I have had serious depression in the past dealing with a particular problem, and overcome this with CBT and I am now good at managing any mood difficulties. For the last four years I have noticed a deterioration in my energy levels and general feeling of fitness and well-being. My mood also deteriorated, and for the last 12 months depression crept up on me and I am on antidepressants again for the last three months, although this feels very different to previous depression – there is nothing I am depressed about, I just feel all the symptoms. My mood has improved, however. But I am exhausted so much of the time and I cannot trace it to anything in my lifestyle – I seem far more tired than I should be for my age and health and activity. I have never needed more than 5-6 hours sleep, but in the last 12 months seem to need more and more, and after significant activity fall asleep within minutes and can sleep for 15 hours at a time, so deeply that I miss alarm clocks and people trying to wake me – this is absolutely out of character for me. Even after little or moderate activity I am physically exhausted, not necessarily sleepy, and have to sit or lie down. My concentration is appalling, although a bit better since taking the antidepressants. I am always freezing cold, with cold extremities and cold skin all over most of the time – I wear layers and layers of clothes whilst those around me are in shorts and t-shirts. In the last 3 months I have started having headaches, and I have never suffered from headaches.
    I have had blood tests and I have low iron and now take an iron supplement and have that monitored frequently. I also have had thyroid blood tests, and they are in normal range. Every female on the maternal side of my family has under-active thyroid, my mother, her sister, my grandmother, and 4 female cousins. My GP said I have raised TSH but normal thyroxine.
    I feel like a fraud when I talk to the GP about how I feel, because I am told ‘everything is normal’, and especially because I had depression previously and I think GPs automatically think it can account for everything, whereas on this occasion I feel like the depression is a symptom of something else, rather than is the central problem.
    I don’t know what to do, but I am becoming unreliable and I think my job might be at risk.
    I would actually like to think this is not a thyroid problem and work out what else it might be, but I am running out of explanations. I don’t know how to proceed. Thanks for any advice

  53. Jules says

    My husband is 66 years old and was diagnosed with a tumor on his pituatary gland about 22 years ago. He seems to have all of the symptoms that you describe in the 1st dysfunction. They just recently tested his thyroid and of course the test showed nothing. He is on a lot of medications including testostorone injections, anti depressants, acid reflux medicine and sleep medicine just to name a few. He has been tested for everything under the sun and no one has been able to really help him. Physically he is in great shape. Although it is a struggle he works out just about everyday. He recently has had a lot of trouble urinating and his bowels are irregular and have been for a while. He will be seeing his doctor next week. Do you think we should bring you article to the Doctor?

  54. says

    OK, Let’s cut through this mess.
    1. What tests should be taken to determine the type and severity of hypothyroidism?
    2. Is there a list of doctors that could act as advisors?
    Every Endocrine doc I have seen just looks at former tests. I paid out of pocket for the 4 X a day saliva test. Then they started to take me seriously.

    I have been seen by 3 of the best docs in the world when I lived in the Washington DC area.
    The Synthetic stuff makes me higher than a kite after one dose. I am now living out of my truck and on food stamps because this illness has caused me to lose DoD contractor jobs. I need help! I am tired of being mollified and patronized by young and older male doctors and older women doctors, as well as LPN and interns.

    So again what tests should I take and how do I find a doc that will correct my situation quickly.

    thanks for being there

  55. mcgww says

    I have number 1 elevated cortisol levels from being pregnant. I have all the symptoms of hypothyroidism but all my test come back great except for my cortisol and B12 levels. I felt as if my doctor blew me off, she stated we would watch it. I definately feel different sometimes I have no energy and other times I feel extremly energtic, but not good energy. I never feel normal. What to do?

  56. Monica says

    We really need to be very cautious when dealing with the thyroid. I went off off of my levothyroxine cause I felt I was feeling betterwith special focus on diet. My TSH ahot through

  57. Monic& says

    My TSH shot up through the roof and I was heading into thyroid storm. Be very careful when playing with the thyroid.
    I am sure my thyroid issue is an autoimmune and felt I could heal through diet and natural supplementation, did not work. Just my own personal experience.

  58. Teena Tucker says

    My daughter has had problems since she was in high school with her periods, very severe cramps. She seems to me to have symptoms of mild hypothyroidism, very sluggish and fatigue. At times, we thought maybe she was hypoglycemic. Nothing has ever tested out. She is 30 now and experiences infertility and yeast infections and bladder infections. She did get pregnant after 4 rounds of AI. Her tests show no signs of hypothyroidism but I am not convinced. I have hypo and hyperthyroidism in our family on both my mother and fathers side. My daughters doctor says her tests are fine. She is not fine and cannot get pregnant. Where do we go to find a doctor that will treat her old school? Should she go to a nutritionist? I am thinking this could be the reason she isn’t getting pregnant. In 8 years and 10 AI’s she has had one pregnancy. Any advice?

  59. Lisa says

    After years of working with the :best” in the world (D.C.), I still was mis prescribed. pay for the tests from your pocket. do your own research. and ask for second, third, and fourth opinions. Try to find a doctor who listens to ALL of your ailments. After looking at my blotchy calves. I was told that I was allergic to the synthetic thyroid medicine. and I needed to go to Armour thyroid. Drs get kick back from Abbott labs thats why they prescribed the synthetic. I also found out it was my adrenal gland as well affected. Consider looking for a doctor that is an MD as well as a homeopathic.

    you know you……. trust yourself.

    • Allison says

      Good luck with finding these docs. The one’s that seem to know this stuff, interrupt test properly, etc seem to be a precious few, (and or) charge outrageous fee’s. And that doesn’t mention the cost for the testing, supplements, trial and error, and so on.

      Perhaps it would be useful if people start making recommendations in their area’s of these “rare” docs. List their experiences. As Chris said the immune system is very complex. It’s very difficult for a layman to sort through all this clutter by theirself.

  60. Erin says

    Thank you so much! After reading this article, I printed a copy for my Doctor. We discovered I have Thyroid resistance due to chronic stress. We are working on adjusting my dosage and lowering my stress and supporting my adrenals. I feel so hopeful!

  61. Jimmy says

    Great post. Can you point us in a good direction for more information on #5: Thyroid Resistance? Would like more information on how this one would be diagnosed and/or treated.

  62. Mel says

    Great article. I’m glad someone has their head on straight! Thyroid resistance sounds like the worst of all these conditions–is their any treatment? Can these conditions ever be fully corrected?!

  63. Darek says

    Great articles. My name i Darek i’m from Germany i am specially interested in the 5. point. What may I do if in case of thyroid resistance ? How may i renew my receptors to be able to absorb more ft3 and ft4 ? Besides of reducing stress in my life. I am suffering for a long time actually and i am giving armour a chance know. I would be really glad for an answer.

    • Tina says

      Darek,

      I am in Germany, too. I posted to ask for confirmation of what my levels were in German, lol.

      Just wondering if you were able to find a doctor that listened to you. I cannot find anyone in Frankfurt. I have “normal” levels but I have a high level of TPO Antibodies. But I have an assortment of hypo symptoms. Worst is zero energy and weight gain of 9kg in the last year. I have gained tons of weight in my stomach. I cannot lose a single pound. Nothing. A year ago, I could do this with one small change if I needed to. I am irritable and have no patience. My hair is breaking all the time, I am cold, I am short of breath, I have allergies and asthma I didn’t used to have. And I am just exhausted all.the.time now which is a big change and gotten progressively worse for me in the last 3-6 months.

      I have the same trouble as I always do here. They want to do every test and it takes me about 8-12 weeks between appointments and then they want to schedule a separate appointment to discuss the results and meanwhile, my life is falling apart because I can barely function and deal with work, my son, get any exercise. Anything. And in the last couple months, I have gotten depressed. My doctor was trying to tell me I was always depressed and I was like, “No, I was not always depressed.” How can I have been a person that had fun, participated in and appreciated my life, enjoyed every minute with my son, laughed all the time be depressed?! NOW I feel depressed. I cannot get anyone to listen to how my entire quality of life has disappeared.

      I am starting to really dread the coming years which is really bad. If I can’t get this resolved and I just continue to gain weight and be tired all the time? And don’t have energy to do anything with my son? But I don’t know who to talk to. No one is listening.

      Tina

  64. Caitlin says

    Hi there, I found your article very interesting. I am a 29 year old female, and I synthroid until 18 when the endocrognologist took me off to see if my thyroid would kick back in, and it did, supposedly, but I have been suffering with fatigue since. I have had my thyroid checked yearly, but it always comes back as normal. My bloodwork has shown that I am deficient in Vitamin D and B12. I also have enlarged red blood cells, which the hematologist never found an explanation for. I also had problems with hypogyclemia as a teenager. I also have had migraines since I was a child. I have GERD, IBS and lactose intolerance, and a history of endometriosis. I also have red blood cells in my urine, which the urologist can not pin point a cause for. For over a year now I have had a severe case of plantar fasciitis which is not responding to treatment. I read about how people with hypothyroidism can develop connective tissue disorders like plantar fasciitis. I feel like I have been passed around from specialist to specialist but no one can seem to fix me. I have been to the neurologist, gastroentrologist, gynocologist, podiatrist, hematologist, urologist, chiropractor, ENT.
    Between the foot problems, frequent migraines, fatigue and some weight gain I was concerned something was wrong with my thyroid, so I scheduled an appointment with and endocrinologist. I referenced your post, but she “doesn’t believe that you can be hypothyroid if you have normal lab results”, and she told me there is nothing she can do for me.
    Free T3 was 3.1
    TSH was 0.67
    Free T4 was 1.1
    Thyroglobulin Antibodies <20
    Thyroid Peroxidase Antibodies <10

    I know you aren't taking new patients right now, but any advice you can give would be most appreciated!

  65. Matt Owens says

    I’m a 37 year old male who has been type 1 diabetic for 21 years. I’ve also been recently diagnosed with Hashimoto’s. I was told that I wouldn’t be a candidate for synthetic thyroid treatment until it progressed to hypothyroidism despite having fatigue, muscle pain, joint swelling, weight gain, & depression. The mention of hypothyroidism related to pituitary dysfunction struck a chord with me due to the fact that I have endured several severe hypoglycemic episodes over the years. I was wondering if you could give any guidance with how to proceed, and possibly refer me to someone in or near Las Vegas?

  66. Lisa Rothwell says

    1. YOU NEED TO SEE A GENERALIST FIRST. You need to have all of your symptoms evaluated. I went to three endocrinologists all gave the same response after seeing the same test results. Unfortunately, the medication prescribed I was allergic to. They all prescribed a higher dosage, which made the reaction even worse. I finally returned to see a generalist doctor at a free clinic. The first response was… you are allergic to the meds. I was put on the natural alternative and am now “normal”. (After one month.)

    2. HAVE YOUR OWN TESTS performed. I used the internet to find a lab and had ALL the tests done. (applied costs on taxes). When I showed to a general doctor who also was a holistic doc. I learned that it was more than hypothyroidism.
    The tests cost about $200. Including the saliva, and hair test. Blood and urine tests were done locally.

    3. Trust yourself, research, and ask questions. If not, write them all down, and give the list to a medical advisor.

    4. By the way, between the medicine and silkense volume shampoo, my hair is growing back.

  67. Di says

    Thanks for this very interesting discussion. I’m 61 and have been on 300mcg of a synthetic thyroid supplement since a demi thyroidectomy in 1998. Despite this massive dose I am frequently exhausted, have extremely dry, ridged nails, joint pain, and tinnitus. My concern at taking such a large dose has always been quashed by the medical profession however my cholesterol has now reached unacceptably high levels and I am losing bone density, despite an excellent diet, moderate excercise and the fact that I’m not at all overweight (5ft 2 & 8st 4lbs).
    My recent test results showed TSH right up at the top end of normal, & T4 & T3 both at the lower end of normal. Ferritin, & Vit D were low &, white blood cells and neutrophils were below the normal acceptable range. Everything else was fine.
    I’ve never participated in something like this before but I would be grateful to hear your comments on my situation. Thanks.

    • Debbie says

      Hello Di,

      Have you had your Adrenal glands & DHEA levels tested, not by your GP as they only offer the Synacthen test for the adrenals ( this only shows up anything if you have addisons disease).
      The reason I say that is your on a high level on synthetic thyroid but it doesn’t sound like it is being taken up properly. Have you ever tried other forms of thyroid medication like the natural product – some people feel a lot better on that.
      Best wishes
      Debbie

  68. Lisa says

    Chris,
    I am an active 55 year old female who has always enjoyed good health. Over the past year or so, I have developed a lot a joint pain in shoulders, neck, hips, knees. So much pain it has affected my tennis and exercise classes. ( heck just getting my sports bra on and off takes my breath from the pain). Even if I get through the classes, the recovery of the next two days makes me feel like an old lady. I can hardly get up and down. I went to a rheumatologist, he ordered a thyroid ultrasound. I learned that I have several thyroid nodules, and in fact only have half of a thyroid. Referred to an endocrinologist, my blood work (TSH and T4 ) are normal. They did not do a T3. Anyway, they just told me to monitor it and come back in a year. I didn’t really complain about the arthritis to the Endo because I never related it to thyroid. IS IT related to thyroid??? What is the best most comprehensive next step?

  69. Yolanda says

    I’m 41 years old and im sufre ring from high TSH and high testosterone and have suffered in the past from ovarían cists, Im not currently on any medication yet. Everything that I’ve read that says that hypothyroidism caused by high testosterone caused by PCOS or even just hypothyroidism caused by high testosterone will show a normal TSH and T4 but that is not my case; all my thyroid test came back normal only my TSH is high and my testosterone. Have you come across this scenario? What would be the cause?

  70. Kir says

    Hi Chris. Thanks for the great info. I have had nearly every symptom on the extensive hypo symptom list for 20 years. Labs, which includeTSH, T3 and 4 as well as Free T3 and 4 are almost always normal, with an occasional low normal over the years. My mom was hypo with nodules, as well as possibly her mom. I have been treated with the smallest doses of Armour in the past but reacted horribly to it. I also have AF, low cortisol in morning and high at night. I also have MTHFR, Lyme and Epstein-Barr and I think the unresolved AF is what made my reaction so severe. I meet the criteria on many of the 5 you have listed above. My question is, can any of my health issues be contributing to the false negative thyroid results at all? Are there any further tests you could recommend to get a more accurate answer? I am absolutely miserable. So tired of being sick and tired, bloated, anxious, overweight and watching my hair fall out. Thanks.

  71. Marcia says

    I have had hypothyroid for over 20 years always very low I was tested 5/3 and my tsh leave was 260.500 my t4 leave was .7 I had been very sick for three weeks before they took these leaves and wasn’t able to keep my meds in me…. So they didn’t change my dose of synthroid this test 7/17 came back with a Tsh leave of .036 and a t4 leave of 1.5…all my life it has gone back and forth with to high to to low… My doctor told me I just had to live with it… Any help would be great!

  72. Brenda Guadagnoli says

    I am having a battle with weight. My Dr does basic test on thyroid. Are there more exclusive test I can have on my thyroid that will help me with this problem

  73. jen says

    thanks so much for the very informative articles! my integrative doctor said my labs came back showing TPO Antibodies of 280. i had a full thyroid panel done (not TPO) at the beginning of the year and, while the numbers weren’t awesome, they were all within normal range. my question is: is the TPO Antibody test enough to diagnose Hashimoto’s and, if so, how do i know if any of the above scenarios apply? for the record, i do have symptoms….horrible symptoms…and all of my regular docs say what i need is a good antidepressant :/

  74. Jennifer says

    Hi Chris, I am at my wits end. I am 27 and since I can remember every summer my throat gets really tight and uncomfortable. Most of the time my ears are swollen and painful, I have memory and focus issues, 6 family members have been hypo thyroid, I have daily head aches, extreme fatigue, and my nails are very brittle and break way far back. I had allergy and asthma testing both negative. I had labs done for hormones, vitamins, and thyroid all came back normal but a little low on Vit D. I feel like my symptoms scream thyroid but the test said its normal, what do you feel especially about the tight throat feeling. It is like that all summer long and it makes me miserable.

  75. Lisa says

    I posted on June 30, no answer. I don’t see very many people getting answers on this forum. Is there a better place to post for Chris?

  76. says

    My last TSH leve was .81 and my T4 Free was 1.1 and my T3 Free was 2.6 all of which show in normal range. Do you think there could still be a problem? I am always tired and have gained a lot of weight although I did find that I was also in menopause but my TSH leve prior to menopause the year before was .88.

    • says

      Also, not sure what kind of doctor to go to since everything is in normal range. I have bee reading so much about this and seems even endocronologist don’t think anything is wrong if they are all in normal range.

  77. Mike says

    Hey Chris my lab results are free T3 at 2.9
    Free T4 at .9. And TSH at 1.19
    My doc is a believer in treating patient and not relying totally on labs. He has me on 1/4 grain of Nature Throid once daily. Since my t3 and t4 are on very low end of scale. Sound reasonable? I’ve had low-thyroid symptoms for years. My family doc wasn’t interested in my opinions, even after I begged for him to check my thyroid and ultrasound showed slight enlargement. He said that means nothing. My normal temp has been low for years. Barely reached 98. He also thought that meant nothing too. Frustrating

  78. Debbie says

    Good morning,

    Please could you offer some advise? I have an underactive Thyroid, but I can not seem to tolerate any form of Thyroid Medication. My TSH levels go from minus 0.5 to as high as 13.5, my Doc kept increasing the T4 – which made me much worse, I ended up seeking private professional help from a Thyroid Specialist. A test was done and it showed that my adrenal gland weren’t working very well, but my DHEA levels were fine. thirteen months later even though their has been a reasonable improvement in my adrenal glands i still can not tolerate the thyroid medication. I was under the impression that once the adrenal glands were working better I would be able to take a little T3 (Cynomel) for three days on just a quarter of a tablet things went from improvement to sheer hell as it has always done – I am now frightened to take any off these things as the effects are extreme. Even with the Hydrocortisone I can tolerate only very little of that. I am really very Ill now and their doesn’t seem to be any help for me, I have tried three different forms of thyroid medication and every one has gone the same way. I am taking various Vitamins, DHEA, Co-enzyme Q10, slight amounts of Hydrocortisone and only quarter of a tablet of T4 only when I really have to. Thank you

    • Debbie says

      Hello Lynn

      Thank you very much for your advice, I will certainly have a ATCH test done.
      Since being on all this differen’t medications I do seem to get a mixture of underactive and overactive symptons, for example my pulse is always high & erratic, I have heart palpitations, I struggle for breath at times, I can have lots of energy and my back, chest and face will burn with heat and those parts of me will sweat, on the other hand the rest of my body is freezing cold, all my muscles hurt very badly, I am confused, I am very pale, I have lost my sense of smell & taste almost completely, my blood pressure is Iow, I can not sleep etc and only if I go without any form of Thyroid medication for about a week do I become weak and lifeless.
      I can’t seem to take anymore Cortisone because of the symptons I get from that. My body seemed to be getting on ok until I started on my first lot of Thyroxine – then all hell let lose – I wish I could go back before I ever took anything, I may have been Ill but I would never have felt as terrible as I do now.
      Kind regards
      Debbie

  79. Lynn says

    Hi Debbie

    What symptoms do you get when you increase cortisol? Sometimes increasing it to a low amount can cause issues due to the HPA axis feedback loop. It’s complicated but happens a lot. How much HC do you take when you increase your HC?

    • Debbie says

      Hello Lynn,

      When I increase the HC i get a really nasty burning sensation in my chest, My Breasts become very sore and even have like a stinging sensation, my pulse will go up and my breathing gets very laboured and it feels like my heart is thudding. Thats why I started taking the DHEA but at present all I can take is half a gram of HC a day. I really thought I would need high doses of the HC after going by how bad things were before having any HC.
      Kind regards
      Debbie

  80. Lynn says

    I figured that’s what you were doing. Hence your issues. Those tiny increase are likely to be your problem due to the HPA axis feedback loop: http://forums.realthyroidhelp.com/viewtopic.php?t=239. In a nutshell, dosing with small amounts shuts down the loop but does not replace enough to make up the deficit. Hence a person ends up with less cortisol, not more.

    What type of adrenal test did you get done? What were your results? What is the maximum amount of HC you have ever taken?

    I am not a doctor, nor do I play one on TV. :)

    • Debbie says

      Hello Lynn,

      I am very greatful for your information. The Adrenal test i had was the ASI which showed the Adrenals as under performing They were not terrible and I was told to take some adrenal support (not HC) but that had a reaction, so I had to stop taking it, sadly after that my private Dr thought all I would need was various Vitamins, this was not the case and in Feb things were terrible and in all honesty I thought I was going to die, I laid on my bed for three days barely able to move, struggling for breath & full of pain, luckly my HC arrived and after about 9 hours after taking just 5mg this massive relief came over me.
      I kept trying to increase the dose, as 20mg seemed to be the normal amount but my body wasn’t having any of it.I did at one point get up to 30mg but the symptons were terrible (I thought it was the T3 causing the nasty symptons). – it was both.
      As things are I have been taking less that one mg a day for many weeks now, anymore I get these problems.
      The problem being if I need more HC, then why is my body reacting against it and if it isn’t the Adrenals at fault anymore then why can’t I tolerate the Thyroid Medication? .I am now 32 and would hope that things are going to get better than this.

      Kind regards

      • Lynn says

        Ah, sounds like you did indeed try the correct dosing then. I wonder could you be allergic to the fillers used? Some people actually need to switch brands because of this. Again, I suggest checking out addisonssupport.com for great info.

        • Debbie says

          Hello Lynn,

          Thank you for your advice, It is really aprreciated, I have tried a different form of HC and that does the same thing. I had a look back over my results and they said that I did not have addisions disease, just adrenal fatigue.
          I was wondering if the Oestrogen & Progesterone levels were low, as that effects the receptor uptake. I believe that they are are available in creams but I am unsure of what dose to take or if their is a reliable test available? Do you know about these Lynn?

          Kind regards
          Debbie

  81. lynn says

    The ASI does not test for Addisons. That is why experts would recommend you come off all adrenal supplements and sex hormones for at least 6 weeks and then do an ACTH stimulation test and an a.m. cortisol. Have you read Recovering with T3 or heard of the CT3M method. Many people with issues like yours seem to do well with the CT3M. You can find out more by googling it. There are also FB groups on it.

    I’d do the proper adrenal testing first, and then move onto other issues after that.

    • Debbie says

      Hello Lynn,

      Thank you very much for your advice, I will get the test done. I am not keen on taking the T3, that is far to strong for me, even just quarter of a tablet is to much.
      I have gone back on the T4 (one day a week) and hope I don’t have the conversion problem.
      Thank you Lynn – you have been a great help
      Kind regards
      Debbie

  82. Lynn says

    Also, when you get the STIM test and the a.m. cortisol test, come post at addisonssupport.com. Many doctors do not know how to interpret these tests, so you need to do your own research. Also, CT3M can be done with a very small amount of T3. I’d at least research it if I were in your shoes anyway.

  83. Debbie says

    Hello Lynn,

    Thank you for your information – I will look into it and hopefully find out what needs to be done to make me well, I have spent a small fortune on differen’t medicines. I really don’t want to take T3 ever again – it is far to strong for me but I will find out where to get those tests done you mentioned and see what shows up. I did have the Synacthen test done by my GP last June but that said everything was fine, just like the blood tests.
    Kind regards
    Debbie

  84. lynn says

    Get a copy of the ATCH stim test results and the bloods. “Normal” is a setting on a dishwasher, not a blood test result. :) Very few doctors know how to interpret the results completely. As for T3, I had an extremely bad experience my first time on T3 too. So much so that I was terrified to go on it again for years. However, thankfully I girded my loins and started it up Again in 2012. This time however I used the Recovering with T3 method and my life is completely different now. I’d suggest checking out the Recovering with T3 website and the CT3M method before discounting them. They are worth researching in terms of the potential to heal the adrenals.

    • Debbie says

      Lynn – does that mean that you are completely well on T3 and that their is hope for a full recovery?
      I to am terrified of taking the T3 as everytime I take it I get a nasty response, no matter who small the dose or what i am taking.. I have gone back to T4 but have been concerned that I may have the conversion problem.
      I have purchased a copy of the recovering with T3 book – it is on it’s way.
      I do have copies of my blood tests and it was quite clear that the amount of antibodies attacking the Thyroid is much higher now than before I started treatment over two years ago.

      Kind regards
      Debbie

  85. Lynn says

    Hi Debbie

    Yes, T3 only has given me my life back. I specifically used the RWT3 method, as most other T3 methods out there include raising too fast and by too much at a time.

    Re: blood tests, I was specifically referring to the ACTH stim test and a.m. cortisol blood test results. :) You need to find out if the adrenals are the root cause of your problems, IMO.

  86. Debbie says

    Hello Lynn,

    Thats great to hear you got you life back. I must admit I am not keen on trying the T3 anymore but I will read up about the RWT3 method.
    My test results from the ASI were as follows
    On waking 11.6 nmoI/L – range should have been between 12 -22
    Mid day was 4.8 nmoI/L – range should have been between 5.0 – 9.0
    Evening was 1.5 nmoI/l – range should have been 3.0 – 7.0
    Just before Bedtime was 0.5 – range from 1.0 – 3.0
    So total score was 18.4 when the ranges should have been 21 – 41 – so not really dreadful
    DHEA: Cortisol Ratio was 3.72 which was in the OK range.
    Kind regards
    Debbie

  87. Debbie says

    I haven’t had that test yet, I am searching where I can have it done. The Iron & Vitimin D levels were very low but everything else was ok.
    I am taking lots of various vitamins

    Kind regards
    Debbie

  88. Lynn says

    Hi Debbie

    That test would have to be done by an endo, generally. Your very low iron is likley to be a significant factor in your intolerance to thyroid hormone.

  89. Debbie says

    Hello Lynn

    I have got an appointment with the endo in Oct. I certainly do have an intolerance to the Thyroid Hormone but I am sure the results will come back as normal.

    Kind regards
    Debbie

  90. Lynn says

    Yes, but you need to get a copy of the actual figures. Most endos don’t actually even know how to interpret a STIM correctly.

    • Debbie says

      Hello Lynn,

      Yes, I did have concerns about the endo’s – that why I have been putting off going.
      I will certainly get the test results if they do tests.

    • debbie.paxman says

      Hello Lynn,

      I am reading the book you recommended – recovering with T3, It seems to be a fantastic book, thank you for recommending it. I was shocked to see the large list of suppliements & Vitamins he takes every day, Did you take such large amounts of vitamins & minerals and did you continue taking them when you were well?

      Kind regards
      Debbie

      • Lynn says

        Hi Debbie

        Yes, it’s a fantastic book. I feel it has a tremendous amount to offer, even to those who don’t do T3 only. I used to take iron, but don’t need to now. I take: Vitamin D, B Complex, B12 a few times a week and a lot of supplements for interstitial cystitis.

        • Debbie says

          Hello Lynn,

          I spoke with my GP today & asked if I could have certain vitamin & mineral levels checked, he said that they didn’t check vitamin/mineral levels & that Vitamins were dangerous as they can react with each other.
          I am now concerned what to take – I did think by the book that I was lacking in Magnesium & B1 but how will I know?

          • Lynn says

            I find it hilarious when doctors think vitamins are dangerous, as they pass out prescriptions for statins/antacids/addictive painkillers/diet drugs. Yes, vitamins are dangerous if taken in extreme excess and without keeping an eye on levels, but taken in a moderate way they are not. Sheesh! I forgot the magnesium. I use the oil as well. In the modern world, most ppl are deficient. Plus, unlike say Vitamin D, you can’t overdo the magnesium as the excess washes out.

            And you don’t *ask* a doctor for tests. You assertively demand them. If he won’t budge, just go to a different doctor! I have had to learn to be demanding in order to get my needs met. Sad but true…

            • Debbie says

              I must admit I was shocked when he said that about the Vitamins & Minerals.
              He is saying that They won’t check anything other than Vitamin D & Magnesium, He has said that in July my Magnesium level was fine but going by the book I really thought I would benefit by having more. The problem is hard enough as it is without them being so unhelpful.
              He also said they will only every presribe T4 and are not allowed to presribe anything else – he is either clueless or being arkward

              • Lynn says

                Hi Debbie

                Well, even the Vitamin D and magnesium tests are useful, so find out the results of those. I’d *demand* B12 testing though, as it’s important to know if you are deficient before starting it. B complex vitamins are water soluble and very safe to take, but you need to know if you will need to take B12 for life before starting. Unfortunately, it sounds like you need to go doctor shopping. Sadly, most of us had to do this to find someone good. :( :(

                • Debbie says

                  Hello Lynn,
                  I have my appointment with the Endro next month, so I will see what the results are from that – although I am not optimistic.
                  I have been taking vitamin B complex for about 6 months now, along with various other supplements, but still the outcome is the same whatever t3 or t4 I have I get a nasty reaction to, that even happens with the HC. I don’t understand why this is and I am still feeling really terrible, nothing seems to help with the pain either. It’s going to be really terrible if this endro goes along with my GP, Im just so fed up and would give anything to be well

                • Debbie Paxman says

                  Hello lynn,

                  I have seen Dr Peatsfield 3 times – I think very highly of him and he has helped me and all credit to him he is still trying to help

            • Debbie says

              Hello Lynn,

              Where do you buy your T3 from?
              I can get the Cynomel in 25mg but that is far to strong, The book said that Tertroxin can be puchased in 5, 10,15 & 20mg but I can not find a supplier.
              Kind regards
              Debbie

              • Lynn says

                Unfortunately I don’t live in a country where I can just buy my meds online. So I had to hunt *hard* for a doctor to treat me. Anyway, so I get an rx of Thybon, which is the German version of T3.

                • Debbie says

                  Hello Lynn,

                  I think I may also have to hunt hard for a doctor to prescribe it, the prices seem to have gone through the roof, now their is only one site that I can get it from, but people are saying pressure is being put on them, to force them to stop supplying it.
                  I have started crumbling the T3 up and taking just a tiny amount to see if it goes in better.
                  I am glad you are well Lynn & you can get it prescribed, It gives me hope – thank you

                • Lynn says

                  Hi Debbie

                  What country do you live in?
                  It was a hard slog to get it prescribed, so don’t give up if it takes a while.

                • Debbie says

                  Hello Lynn,
                  I live in the UK in a little village in Suffolk, I left my local doctor & got accepted in one in 20 miles away, now I am being told you have to have a Doc in the catchment area.
                  I am getting rather concerned to be honest my breathing problems are getting worse and my pulse is normally around 94 (even the waking one) I get chest pains sweating and all sorts of nasty symtpons. I am half way throught the book but his symptoms were normal for that of an under active Thyroid, Mine are mixed. The only time my pulse drops below 80 is if I haven’t had any thyroid/adrenal meds for about a week, as soon as I take a tiny amount it shoots back up. Their must be something else going on and I really need the help of a Doc – but know one will listen – my blood tests always come back now with a High TSH but they say I am getting by. I am taking vitamins/Supplements, walking and doing yoga but its still the same. The T3 eases the underactive symptons but gives me all the hyper ones.

  91. betty says

    Hi, I’m 29 and have had my thyroid tested several times and everything comes back normal. I moved toanother state and they have found I jave a small nodual. I have several symptoms of an under active thyroid and am very concerned that the nodual will get bigger and need surgery. My question is does anyone know what causes a nodual to form?

    • Debbie says

      Hello Betty,

      Do you mean a mulitinodular goitre? – I have one of these and I am of the understanding that these are caused by the thyroid not having the correct treatment.
      Unless it causes any problems for you then their doesn’t need to be an surgery.
      Just because your blood tests come back as normal doesn’t really mean anything, it is very important it is monitored by how you feel, your Pulse & Temperature.
      Best wishes
      Debbie

  92. Hoosier says

    This essay is interesting, but it doesn’t say what it means if the TSH is high but the T4 is normal. What is the most likely cause of that scenario? What most likely needs to happen to correct this?

    Thank you.

  93. Debbie says

    Hello Hoosier,

    In my case the TSH was high because the T4 was not getting processed very well and it was just building up in my body causing toxicosis – which is terrible, you still have your underactive symptoms but you also get what appear to be overactive as well.
    What needs to happen depends on how you are feeling.
    How are you feeling?
    Best wishes
    Debbie

  94. Debbie says

    Hello Rhoda,

    As with this condition & all the symptons/problems that it causes – all are classed as OK with the Dr.
    I have a multinodular Goitre – which as far as they are concerned is ok, they do not seem to think it is caused by mis treatment of the Thyroid.
    Are you concerned by the Nodules? If so I would recommend a book by Dr Barry Durrant – Peatfield
    called Your Thyroid and How to Keep it Healthy: The Great Thyroid Scandal and How to Survive it – It is a fantastic book and may well help with your worries/concerns, it certainly did for me.

    Kind regards
    Debbie

  95. Adam says

    Hey all! My wife is pregnant with our second child and has been experiencing hypothyroid symptoms for severl months now. She just got her lab results in and her TSH is at 0.67 and her Free T4 is at 0.9. . . this would lead me to believe that she would fall under the category of Chris’ first classification “Hypothyroidism due to Pituitary Dysfunction.” Can anyone shed some light on what types of treatment can be done given this classification?

    I was reading that B12, Selenium, and Zinc may play a role in this. . .

  96. Anja says

    Can anyone tell me short and precisely EXACTLY what lab tests I need to get done in order to be diagnosed correctly and be given the right treatment ASAP?
    I know for a fact I have hypothyroid disease – I was diagnosed over a year ago during a hospital stay under other circumstances but never did anything about it. I am now really sick, only 23 years old and experience every symptom of hypothyroidism on a daily basis. I am 6′ tall, I model and I was under 130 lbs just a couple of months ago – I sweat at the gym for 3 hours (loosing nearly 3,000 cal/day) and eating under 1,000 cal – however I have GAINED a tremendous amount of weight in a short time under this regime, and still gaining. I have my period or period like symptoms every week (+5 months now), my hair is falling out (half my hair is gone), my skin went from being oily for as long as I can remember to being extremely dry and I have been passing out several times for no apparent reason (blood sugar and head is fine!). I am not a US citizen and medical expenses are costly without insurance so I am not looking to go to a bunch of different doctors to seek help. I would very much appreciate it if someone with a friendly soul could list me exactly what tests I would need done so I can put an end to my miseries. Thank you so much for reading.

  97. Lisa says

    Anya, There are free clinics you are eligible for. But, make sure they check for allergic reactions. After many frustrating years, I found out through a free clinic, I was allergic to the synthetic medication. Your symptoms are the same as I had.

    Go the the local Salvation Army or the Social Security Office, and find out what you can have access. Most free clinic have a sliding scale. And , See a general practice doctor… endocrinologist do not necessarily look at all the symptoms combined. Before you go, prepare a list of issues/ changes with a timeline.. Once in writing, the doctors can not ignore what you have described.

    good luck.

    Get a second or a third opinion as well.

  98. Tim Hamill says

    Chris, your last paragraph in the introduction is WAY off. Labs (at least good ones) do not derive or normal ranges by testing patient samples. As you point out, testing a bunch of samples from sick people would give you a very skewed look at what ‘normal’ is. Lab go to great efforts to secure samples from healthy adults who are ostensibly clinically ‘normal’….typically volunteers or samples collected at the time of blood donation from healthy donors.

  99. Em says

    I would really, really be grateful to anyone who can give me some suggestions about my case. I had an appointment with my doctor who said that my thyroid is normal and my fatigue is not due to that. But I’ve read enough about the thyroid online to feel skeptical.
    2 years ago, my TSH was 4.1
    As of last week:
    My TSH was 3.1
    My T4 levels are normal.
    My T3 uptake is low.
    Other things that may or may not be relevant:
    Last week, my iron came out low.
    2 years ago, my “good cholesterol” came out as quite low (really weird b/c I exercise plenty).

    I would love to hear anyone’s thoughts. thanks so much!!
    My iron is now low.

  100. Christi says

    I’m going crazy. All my lab work comes back fine. However, I’m still tired and now for the last 2 months my legs swell and have anxiety attacks. Went to a Cardiologist and all is good there. My Endo just increase my Synthroid to 175, trying to get me regulated and still hasn’t done anything. Still tired, still swelling, still grumpy and still having the anxiety attacks. Does this sound like my parathyroid?

  101. Lindsay says

    I had my first child 3 years ago. After his birth I breast fed for a year. I never felt “normal” after I had him. At one year and 1 month postpartum lab results revealed I was hyperthyroid. Prior to that I had several labs….which indicated extremely elevated calcium which eventulally came down on its own. I had an ultra sound which indicated nodules followed by an uptake scan and was seen by an endocriniologist. I was never medicated. I was diagnosed postpartum thryoiditis and told I would likely end up hypothroid. Although my thyroid level stabilized within 6 months the symptoms never went away. I am 31, I have night sweats, hot flashes, occasionaly feeling of a “lump” in my throat, chronic dry eye, hair loss, feeling of lethargy/sluggishness, difficulty concentrating, memory loss, irregular menstrual cycle, joint pain, muscle weakness etc. My “female” hormones were also tested due to the irregular cycle which I have never had an issue with. I was recently placed on the lowest dose of Levothyroxine with the only improved symptom being sluggishness. My thyroid functioning prior to medication over the last 6 months has indicated a normal TSH, followed by slightly elevated TSH, followed by a normal TSH but slighty low T4. They have also checked the parathyroid with lab as well which was normal. What should my next step be? I’m extremely frustrated. My primary dr. referred me to an OB/GYN about 3 months ago when my menstrual cycle stopped for over 90 days. The OB/GYN is the one who started the thryoid meds. Should I see an endorinologist?

  102. Ruthie says

    Hi,
    I have had symptoms of hypo for a couple of years now. I’ve been tested twice and told I was in the normal range. Not sure of first results but did see the second TSH. It was 1.0 last month. Also back in the spring I had an ultrasound that determined I have an enlarged thyroid with nodules. Go back in November to see if its grown. I have trouble swallowing at times.
    Anyways just wanted your medical OPINION on this and if I should be seeking out help.

  103. Chi says

    I know how licensing and finals are! I wouldn’t want to have to go thru that again! It makes perfect sense that anyone could produce some typos and mis-stated info under those conditions!

    THANK YOU! Chris, your article is so helpful to understand better!
    AND, it provides data I can show my Doc, to better hope the dose and med can be kept properly adjusted.
    I’ve been on Armour on a tiny dose–30mg–for some years, with little relief–but at least it was preventing feeling worse.
    Apparently, for somewhere over a year, my Provider Group has evidently been replacing [?] Armour Thyroid with “C29″. They had given Armour thyroid to begin with, then at some juncture, it changed to being labeled C29.
    Shame on me for not paying better attention–however, when a person is ill, not functioning right, it’s really hard to be one’s own advocate!
    Just couldn’t figure why I was feeling worse, until I paid closer attention, and discovered the new label.
    I called the Group’s pharmacy, and was told first, “It’s just like Armour thyroid”…then in same conversation, he said “It is Armour thyroid”.
    Hmmmm…!?
    Asked to clarify, he reiterated, “It is Armour Thyroid”.
    But he couldn’t answer why it was labeled C29.
    I’ve called a few other mainstream pharmacies; none can tell any salient information on it.
    Has ANYONE heard of this?
    Had anyone heard of a shortage of Armour Thyroid?
    Or that the company was not going to make it anymore?

    ALSO, I missed any mention of Anti-Thyroid Antibodies testing–especially if other thyroid tests show that so-called “normal” range? Where should this test come into the picture?

    Thanks!

  104. Pegster says

    Chris,

    Could you explain what you mean by physiological ranges for thyroid, as opposed to standard lab ranges? And could you give us the figures for the various physiological ranges?

    great topic and clearly a lot of hurtin’ people!

    thanks,

    Peg

  105. chimonger says

    Beverly,
    I failed to locate your post on here, but trying to answer:
    In the 1950′s Docs most likely would have been dosing a dessicated thyroid product, like Armour.

    It is fairly common for pregnant women to have some thyroid deficiency–pregnancy can magnify sub-clinical hypothyroid, and can cause larger weight gains, edema, high BP, etc. signs that someone might miss, many Docs mistakenly labeling it “just normal pregnancy for some women”.
    More savvy Docs know what it is, dose dessicated thyroid, and relive symptoms, keeping Mom safer, healthier. Some women, like my Mom, get “crazier and fatter” with each successive pregnancy.

    My Mom should have had it; Docs failed to recognize or dose her for symptoms she has had her whole life–her behaviors suffered direly, making her life and us kids far too “interesting”.

    An old Doc, back in the 1920′s, observed Gma’s symptoms in pregnancy and perinatal issues, & in my dad, too, when he was a kid, so dosed both of them.
    They both took it for some years, then moved, got new Docs who never paid attention to that, so doses got stopped. IMHO, in retrospect, factoring in their other health issues over their lives, both would have been healthier, if they’d kept taking it.

    Mom’s life, and us kids lives, would have been massively improved, had Mom gotten dosed regularly with thyroid. Now, she’s too far gone mentally to understand how badly she’s always needed it, and refuses to see Docs at all unless it’s an emergency. My siblings also do not understand [and likewise demonstrate hypothyroid issues] & block any progress towards helping her get it.

    It’s a real problem–how many in general populations have mental issues, which might simply be regulated by dosing dessicated thyroid?! IMHO, it’s not only sex hormones that can be blocked by hormone-interrupting chemicals in the environment. Just about all hormones can be blocked from use in the body, by the many thousands of chemicals in the environment…it’s a bunch of complicated studies begging for being done!

    • Chimonger says

      Beverly,
      DES would be a different discussion…but I will say this, since I have no other way to reach you to answer:
      It was VERY common for those receiving bad drugs, to get swept under the rug, back then.
      Unfortunately, those affected by it are suffering consequences more now, than before.
      The habit of closing class action lawsuits in a limited number of years, or ignoring doing studies on them, result in repeated mistakes, and perpetration of more bad medicine.

      As for a nurse failing to take note on their own meds? OMG! that happens ALL the time.
      Also, since Dessicated Thyroid was about the only treatment for hypothyroid then, who’d pay much attention? It was the only thing used..so, one only had to say, I took meds for this condition, and anyone in the Biz would know it was that—so it was kinda a non-issue—until BigPharma cooked up artificial hormones in the lab. It simply easily feel from memory.

      Hey…I’ve been the queen of “I will always look it up before I take it”
      …yet, when one is ill, there’s usually some degree or more, of mental fog or dysfunction
      –it might be all we can manage to simply follow orders.
      I made that mistake twice–and it resulted in a heart attack from adverse effects of a blood pressure med and a diuretic that both has similar adverse effects– additive effects that really crashed me….I was ill, not thinking straight, and -just took them- without questioning or looking it up.
      AFTER that, I got hold of myself, looked it up and determined to make rational choices, to take control of my health again.

      In the1950′s, as knowledgeable as nurses were then, it’s -almost- minor, compared with what nurses must know now. It’s to easy to make mistakes, omissions, or miss things related to daily overwhelm…trying to function in that milieu, AND be ill, such as from Hypothyroid, makes it far too “interesting” a challenge.

      A Mom in my family also took DES during each of her 3 pregnancies, to block nausea.
      It worked. Kids popped out seemingly healthy. She felt decent. But when information got published about it, she was also proactive, and kept her kids informed as much as she could.
      With that knowledge, the 2 girls chose to not have babies themselves; the boy eventually did have a son, late in his life, BUT, that man now has to make healthy choices, monitor his health for potential cancer or other residual consequences of that Mom taking DES, which could mangle genetic expression for generations, and make sure his –now teen–son ALSO does that. We have no completely clear idea how many generations it might affect, nor any surety of how, or if epigenomics science might show how to reverse damages. One of those daughters actually has had breast cancer–though her Docs swear it has nothing to do with that DES her Mom took, I suspect more sweeping-it-under-rugs might be happening there. She’s been successfully treated, though. The other daughter has taken great measures to keep healthier, make better choices, than the others, which can likely result in her overall better health..

      As prevalent as DES was in the 1950′s, it’s a miracle or few that my Mom didn’t take any–her poverty may have saved us all from it!
      Poverty meant she never got some treatments that were available–she nearly died from hemorrhage post-partum…also likely related to hypothyroid—but she survived.

      IF we could just get science to over-ride industry, to pay more attention to correcting how the thousand of chemicals in our environ can block use of all hormones, and correct the poor testing we do! Affected people might then get needed treatment; I believe we’d soon see a drastic drop in mental health issues, behavioral problems, and probably see better functional capabilities.
      Our world could rapidly become a better place, just on that alone!

      So don’t blame Mom for not pursuing it, or not paying attention—-her nursing profession meant she achieved greatly, in the face of adversity related to hypothyroid issues as well as bad drugs taken in medical ignorance & industrial/science/legal cover-ups—-that is remarkable!
      Those who manage to get thru life despite hypothyroid issues, have struggled mightily to do so, in the face of great adversity all too often.
      We’ve likely endured other foibles related to being in that condition, which otherwise might have been more deftly avoided.

      Oh yes–and miscarriages CAN be related to hypothyroid issues–multiple generations of that in my family–some couldn’t carry to term without being treated for it. .
      It might be debatable that Medical professionals are getting more incompetent—it’s more that they are completely overwhelmed by so much information, pressured greatly and too distraction from having insurance companies over-lord them at every turn, dictating what they can and not do, AND being forced to churn through unrealistically large numbers of patients per day just to “break even” on their operating costs. That whole setup is a guarantee to fail.

  106. Stephani says

    Thank you so much for this article. I seriously would have been undiagnosed and still feeling like CRAP. I finally switched doctors, recommended to be retested and test T4 and T3 as they were not done the first time and found out that my T4 and T3 levels were high. THANK YOU THANK YOU THANK YOU!!!

  107. Pat says

    I have a lot of the symptoms of hypothyroidism and would like to know what type of doctor I can go to? I live in Connecticut. Bloodwork done in 12/2012 showed:
    TSH, Highly Sensitive: 1.91
    T4, Free: 1.49
    Thank you for any help you can give me.

  108. Amanda says

    So I am one of those people that has had conventional thyroid tests that are “normal”, but suspect that I am actually hypo. I think my best route would be to do the lab tests independently, and out of pocket at this point. Are these tests normally HSA-elligible? How do I find a good lab? I live in Los Angeles. Thanks!

  109. Bethany says

    I’m starting to suspect that I have a thyroid condition of some form. I’m displaying some of the symptoms, not to mention that my diet is clean (90-95% paleo), I’m doing appropriate workouts, and I’m not overeating calories, yet my weight remained unchanged in a three-week period and my body fat % went up by 0.9% in that same time frame. Since many of these patterns won’t appear on standard thyroid panels (I have a dr appt this Monday), how should I go about further investigating this? Should I see a practitioner of another specialty? I’m going to request that all thyroid-related tests be done when I’m at the doctor, as well as my cortisol levels and any other hormone levels.

    Thanks so much!

  110. Veronica says

    Is this a joke? “Now, follow me on this. Who goes to labs to get tested? Sick people. If a lab creates its “normal” range based on test results from sick people, is that really a normal range? Does that tell us anything about what the range should be for health?”
    That is one of the most absurd supposed-medical line we’ve ever heard. Don’t blindly follow absurdity, no matter how simple it sounds.

    • Lee says

      Veronica,

      Who is “we” and what is absurd about it? This is a pretty well-known fact. Labs test the community of people, which includes various genetic populations on an American diet, and some with non-diagnosed diseases. How can a true “normal” range be established from that. Merck Manual seems to be a better source of what is normal.

  111. chimonger says

    It gets to be a lot of work, when searching for suppliers of NDT’s [Natural Desiccated Thyroid].
    My Doc told me she wanted me using “Westthroid–the kind that has no “inactive ingredients” except inulin and MCT’s”. OK, great!
    Several days & hoards of phone calls to lists of pharmacies showed:
    1. Doc wrote the script using old name [WestThroid], and failed to included “WP” in order to get the kind she discussed. She didn’t know that it came in bottles of #100, or she’d have weritten it for round numbers, instead of “a 90 day supply”.
    2. American pharmacies apparently tend to be labeled “NatureThroid”, not “WestThroid”, and few understand the difference between “Regular” and “WP” or “Pier”.
    3. ANY pharmacy can order things not on their formularies: but they usually refuse to order anything not on their lists from their main suppliers.
    Some will order it, but will charge you dearly for it.
    It is most always “out-of-pocket”.
    4. It comes in bottles of #30, #60, #100, for instance. If your Doc orders a quantity of pills that is less than a full bottle, you still pay for those wasted pills the pharmacy cannot give you.
    5. Smaller pharmacies/stores are more likely to either carry it, or, order it for you.
    6. IF you are a Medicare recipient, and your coverage is rolled into an Advantage Plan, you MIGHT be able to have your Plan’s pharmacy fill an order from an outside-the-system Doctor for this med.
    BUT you might need to spend time, phone calls, and numerous days to achieve them filling that script, and may or may not get some coverage for the cost of it.
    7. NDT’s are cheap.
    Pharmacies that charge large prices, are usually paying for high overhead like a remodel or move of their store, etc. [like one Compounding pharmacy in our area, which quoted almost $80 for #180 NatureThroid, [more than 4 x the practitioner cost].
    Wholesale cost for NatureThroid Regular, is less than $11 / #100.
    Wholesale for NatureThroid WP #100, is less than $17 or so…just to give you a clue.
    MOST Pharmacies will try to have people believe that all meds are expensive, that NDT’s are more costly than man-made, etc.
    But NDT’s are still way cheap! Don’t let yourself be buffalo’d into paying too much for them.
    8. Any MD, ARNP, or PA, [and others?] usually can order NDT’s directly from the companies that make them, at wholesale, or close to it—IF they are willing to do that [not all are willing].
    Practitioners authorized to prescribe meds, can then fill the orders they write for these—AND save their patients money, too.
    Many practitioners who prescribe and sell/provide other supplements, have included NDT’s in their stock, too. We used to do it at our office, keeping a bottle of Armour on hand to at least get patients started while they found a regular supplier; a practitioner needs to know: they need to sell whole bottles, not partials [sensible]; selling/providing a whole bottle of #100 tabs, makes it easier for everyone….most practitioners have no idea how hard it has become to find NDT’s in stock anywhere, much less the rarely stocked “WP” form.

  112. Jolien says

    I read your article because I have been taking Thyrax, levothyroxine. for 4 years now and somehow I feel rotten sometimes and good at other times. Anyway I try to get more info on the thyroid.
    What strikes me is that in yuour five types of thyroid disorders I find none of the ‘normal’ types (which I had). High TSH and low fT4….how is that possible???

  113. Sophia says

    Thanks for taking the time to write all these informative articles, Chris.
    I was wondering if you could write an article about the converse – over medication with synthyroid and if there are any patterns that won’t show up on TSH.
    For example, my levels have been fluctuating for over a year now after many years treatment for hypo, with my need for synthyroid mostly steadily decreasing. I am again having symptoms of hyperthyroidism, and the nurse taking the blood thought I was hyper as the veins on my arms and hands are very prominent, but the TSH came back firmly in mid normal range.
    Does one feel it long before it shows in tests or are there other causes? Hopefully others might find that subject helpful too.

  114. Lee says

    I am a male who has been taking straight T3 (Cytomel) for a number of years for my autoimmune thyroid disease. At 40 mcg per day (spread out over 4 doses), my TSH, FT4, and RT3 have always been very low with my FT3 running between 4.0 and 5.0 pg/mL. In addition, I have to supplement calcium and magnesium at 133% RDA or more due to my high calcitonin (thyroid tissue flooding my bloodstream due to autoimmune attack), low PTH, and low potassium. Recently, acute hypothyroid symptoms started coming back (dry skin, painful finger and toe joints in the morning, and shoulder and neck muscle pain). Lab test indicated no RA and my typical results, with the exception that my TSH is now 11.5. What would cause hypothyroid symptoms with a high TSH, even though my FT3 is at the high end of normal? T3 resistance? My doctor does not have any ideas besides pituitary adenoma for the high TSH, but thinks my hypothyroid symptoms are due to the relatively high amount of refined sugar I have recently had in my diet.

    Further info: My testosterone levels are normally quite low, though they were not tested with this lab. My corrected serum calcium was at 8.5 mg/dL, which is very strange for the amount of calcium I take, and my VitD25-OH was 37.1 ng/mL, though I have been taking 5000 IU per day of VitD3 for years. My serum iron was at 153 ug/dL, which is unusually high for me. I have also been taking low dose naltrexone for few years in order to keep my thyroglobulin antibodies down near 1000 IU/mL from their previous high of 16,000.

  115. Debbie says

    I am so Ill, can anyone offer any advice please?
    I have now completely stopped my Thyroid Medication (a total of 17 days so far) – I can not tolerate the terrible symptoms it causes, so would rather go without it – along with my underactive thyroid I also have Adrenal Issues & a Multinodular Goitre. I have tried building the Thyroid Medication up very slowly and it is not working – after nearly three years of trying I feel that it isn’t the only problem. I did wonder if Stomach Acid was a problem but don’t know where to go to find that out, or maybe Aldosterone is the missing link. I have used T3, Levothyroxine & Nutri Thyroid and all have had the same effect, out of all of them T3 was the one that done some good as well as causing terrible Symptons to. Does anyone know what is going on? I feel so bad and full of pain all the time.
    Thank you

    • Mike says

      Debbie. I’d be curious to know what your cortisol levels are. I’m finding that it is very important in relation to not only your adrenals but thyroid function as well. I believe something is making your thyroid work way too hard. Have you had your iodine level checked?

    • Mike says

      Debbie. I’d be curious to know what your cortisol levels are. I’m finding that it is very important in relation to not only your adrenals but thyroid function as well. I believe something is making your thyroid work way too hard. Have you had your iodine level checked?
      Do you track your temps? This too can provide valuable info.

      • Debbie says

        Hello Mike,

        I had the ASI test done (privately) July last year and the Adrenal Function was low throughout the day & evening, I was told to take Nutri Adrenal but that disagreed with me and I couldn’t take it, My private DR thought that Vitamin C with Liquorice & Gingseng Tincture would be enough to get them working again. this was wrong and as the months past I was getting extremely Ill, my Temp would be around 34.2 and my pulse would be about 98bpm and had lots of terrible symptoms including struggling to breath & Chest Pains. In Feb this year he told me to get Hydrocortisone – It was nearly to late – I didn’t even have the energy to lift my hand, I just laid on my bed praying that I wasn’t going to die. After approx seven hours after taking just 5mg of Hydrocortisone – It was wonderfal and I though I was then on the road to recovery. I was wrong and soon realised that taking more than 5mg would cause terrible symptoms including the feeling my chest was burning, sweating, struggling to breath and terrible pain. My GP was not interested in checking Iodine – and advised me to not take vitamins because they were danagerous. He said my Adrenals were fine and all that was wrong was that my TSH was aliitle high. I just don’t know what to do, I can’t take anymore (than what I am doing Hydrocortsone) & can’t take the Thyroid Medication. I have had stomach problems for years and wonder if thats part of the problem

    • Amy says

      Debbie, have you considered you may be intolerant to inactive ingredients in the pills? You may want to try a compounded thyroid supplement. My understanding is that Westhroid Pure and Tirosint are gluten-free.

  116. Kathy says

    I am curious about your number 1.:
    Hypothyroidism caused by pituitary dysfunction

    It is about the only place I”ve seen hypothyroid considered when TSH is low.

    About me: turned 40 yrs Jan 2013. From 2004 when I stopped breastfeeding until approximately Jan 2013 I weighed between 128-132. I am 5’1″.
    Since Jan 2013 to now Nov 2013 I have gained weight and now up to 143. Gain of 11 lbs. It might not seem like I lot, but remember I didn’t gain for 9 years. My exercise has always been on the lower side.

    I also have been perimenopausal for the last 9 years or so and on bcps since the diagnosis. I did stop them in 2012 for some time, tried hormone replacement, then went back to bcps (Sprintec) in Sept 2012. This was the first time I discontinued bcps since 2004. I’m adding this b/c of course the perimen and/or the bcps might be the real issue, who knows.

    I do have some autoimmune history – psoriasis, mono, some evidence of immune issues when trying to conceive.

    Here are my last thyroid test results from august 2013:
    T3 Uptake 26.3 22.5 – 37.0 %
    Thyroxine 9.5 4.5 – 12.0 ug/dL
    Free Thyroxine Index 2.5 1.01 – 4.44 Ratio
    TSH 0.911 0.55 – 4.78 uIU/mL

    Symptoms besides weight gain: constant fatigue, sleep a lot, stressed, extra facial hair (testosterone levels were normal), intermittent hair loss on head, dry hair, tire easily, low energy, anxiety and depression (on effexor 150 mg which helps but not completely).

    As you can see, my TSH is on the lower side, as is the T3 Uptake. TSH has gone down about 50% in last 2 years. The test previous to that was in Dec 2011 and it was 1.4 at that time.

    I’m not sure how I can be hypothyroid with a TSH of .9, but according to your number 1, it can.

    So my question is, if you agree that this is worth pursuing, where do I go from here? An endocrinologist? What do I ask for? How do I figure out if this is the issue? What other symptoms would I have?

    I really don’t feel like my life or eating habits have changed all that much to cause this weight gain. Yes I have been eating late at night more, but not a LOT more. I have cut back on what I eat during the day. My regular diet is pretty reasonable, I don’t pig out, don’t drink much soda, I eat a lot of fiber, etc. I have not started any new meds this year except for the Sprintec bcps last September (restarting them after 9 mos off of them but I was on hormone replacement some of that time). My day 3 fsh was 24 last September (perimenopausal). That’s all I can think of…

    • Kathy says

      Two things that just occured to me: 1. My tsh says it is in uIU/mL but most of what I”m reading online says uIU/L…what’s the deal there?

      ANd 2. other symptoms are really bad memory, especially recall memory, word finding, short term memory, difficulty concentrating, and also, well, saying the wrong word (like I call a doorknob a car). Of course these are all stress related as well.

      Would I go to an endocrinologist to get cortisol levels tested? I really like my nurse practitioner, but I hate to ask her to order tests that she isn’t personally recommending. This is not exactly her speciality. Would getting cortisol levels tested help clear up the picture?

      • christine says

        ”bad memory, especially recall memory, word finding, short term memory, difficulty concentrating” that’s me most days.

  117. Umair Ahmed Khan says

    Hello there…It’s a really good place to ask about my thyroid condition…I am form Pakistan…3 months ago in August i started to feel a bit tired but i didnt notice it and carried on my life but gradually gradually it started to get worse and after few weeks i was very tired and had sleepy brain all the time..whatever i eat whatever i do i will always drowsy and tired…I got my sugar,Thyroid and Cbc checked and as a result…i had TSH 6.9 and in cbc i had low platets 64000 and my sugar was ok with 86mg….the ENT Doctor gave thyroxine 50mcg and i have been using it for 1 and a half months now but i still feel tired and my brain is unfresh even i sleep all the night with peace…plz help me to get out of this condition…i want my brain freshness and agility back again :( My parents think that i mostly stay at home all the time due to no job so i m taking stress on my mind and i am depressed…i try to keep my mind calm and do not think of it but my tiredness don’t leave me…I really want help from you people…i had vitamin d3 test also in which my vit d level was 28…i recently had a cb and thyroid test again and all came normal…Tsh T3 T4 were all normal and platelets now increased up to 115000….last year i had kidney stones issue which i dont have now…Now i am waiting for you people to help me out…Plz

    Regards

    Umair Ahmed Khan

  118. christine says

    Hi Chris,
    I had some major concerns about my current health.
    I am a 27 year old female, smoker (unfortunately), am 5’9” and weigh maybe 120lbs at best.
    6 years ago, I know my weight was at 140lbs and that to be was perfect. So, I know I am underweight.

    My symptoms tend to fluctuate between hyper and hypo. I did an intense research tonight, and I learned a couple of things. Firstly, I know that hyper/hypothyroidism cannot be caught using the basic simple tests that are used, also, that fasting and time of day can possibly affect the results. Also, I didn’t know that there was a possibility that I could have Hashimoto’s and Graves’? From the article I read, I don’t feel quite right, and sometimes it feels like a tug-of-war with energy, my weight loss, cold intolerance, heart palpitations and the pounding that is felt through the whole body, trouble concentrating and foggy memory. This has been going on most probably on and off for the past couple of years.

    I was tested once, but I have the distinct impression that I have a thyroid problem and the tests came up negative despite the symptoms of both hypo and hyperthyroidism. Just read this just now, ”hyperthyroidism (Graves’ disease is a common type), in which the thyroid unleashes a flood of excess hormone. This can shock your body into sudden weight loss, rapid heartbeat, insomnia, or bouts of diarrhea. Sufferers can feel constantly wired, warm, and shaky, as if they’re hooked up to an IV filled with espresso.”

    And a few hypothyroid symptoms are ”forgetfulness, fatigue, frequent chills, constipation”. It’s just a whole big combo of both hypo and hyper symptoms.

    But is it possible it’s also a mal-absorption deal?

    I would appreciate any advice.
    It’s definitely a trip to the clinic on Monday.

    Thank you

    • christine says

      Also wanted to mention that currently I am not suffering from swollen lymph nodes, but I had a swollen lymph node on the right side of my neck, at the back of my neck, two inches from my ear. It stayed there for months, and disappeared.

  119. Amy says

    Hi Chris. Great article. Are you familiar with the work of Dr. Alex Vasquez? He reports that thyroid receptor resistance can be inferred by testing for the total T3 to reverse T3 ratio. Optimal is 10-14, with lower values indicating thyroid receptor resistance. He suggests treating initially with T3 alone (no T4) and possibly pulsing every few months, with T3/T4 supplementation in between as appropriate. What are your thoughts on that?

  120. Michelle says

    About 10 years ago I was on a low dose thyroid medication and than my doctor went out of the country so I had to find a new doctor. My new doctor did thyroid test and they said I’m in normal range and they did not refill my thyroid medication. I have it checked every year and it still comes back normal. I have all the symptoms of hypothyroidism: I’m cold all the time, my BP is really low, I’m very healthy but yet I had an increase in my LDL cholesterol, and I’m tired and have no energy. I have another autoimmune disease called Interstitial Cystitis. Anyways, after my last lab results from my primary doctor I made an appointment to see an endocrinologist; hopefully I will get my answer. In the meantime I’m doing my own research. My primary physician only tested TSH and Free T4. They said my results came back in normal range but yet I have all the symptoms. My TSH read 2.495 and my Free T4 read 1.36.

  121. Romidla Morrison says

    Eight years ago I was diagnosed with Restless Leg syndrome. I had insomnia for 3 months and had a hypothyroid diagnosis. Dr stated it wasn’t low enough to treat. I was given Mirapex for the Restless leg and had taken it for the past 8 years. Until last November. I had gained weight from 156 to 206 over those eight years. Under much stress ect. I crashed November 30th 2013. I can’t seem to find a Dr. who cares enough to even run blood work. I have to tell them what to do and I am no Dr. I no longer take any kind of medication and have experienced withdrawal from the Mirapex. I feel surges in my head in the location of the pituitary upon waking in the morning. My body twitches, arms and rt leg, Neck ect. I have changed my diet and lost 15 lbs. I have an enlarged node on the left side of my neck. Which Dr. says check it again next year and will not refer my to the endocrinologist. The twitching has decreased greatly but is still experienced each night and morning. I must return to work soon and I am concerned I will not be able to handle the stress without proper treatment. TSH 1.060 uIU/ml thyroxine t4 10.00 ug/dL t3 uptake 26 free Thyroxine index 2.6 I am 60 years old Female. Is this twitching still part of the Mirapex withdrawal or do I need to find a new DR? Still very tired. Thanks

    • Chimonger says

      Romilda,
      It is a concern your Doc failed to listen to you enough, AND that he blew you off until next year to recheck that swollen gland? [maybe I misunderstood?]

      People can order and get their own lab tests these days–insurance probably won’t cover it, but, SOMEtimes, that’s Worth it!
      Places like:
      http://www.directlabs.com
      http://www.healthonelabs.com
      http://www.accesalabs.com
      And many more, on google search.
      People order, the kit is sent to you, OR, can go to a lab-draw-point near you. Results are sent direct to you; I believe you pay directly for their services.
      FIRST: one needs to learn what tests to order, before ordering willy-nilly.

      Surge-feelings in head: me too–they don’t seem to happen as much when using a good Natural Desiccated Thyroid [NDT] at high enough dose.
      Docs shined me on for years, only dosing the low 30 mg Armour–they err on the side of caution?
      I kept feeling like I was losing ground.
      So I tried doubling that dose for 2 weeks, and felt significantly better–EVERYTHING felt better [that's saying a lot!].
      Rather than have to argue my case as if it was a legal brief with HMO Docs, I found an outside clinic Doc who also does some alternative medicine.
      She listened; paid attention. I did bring in a sheet of paper to add to my file, listing:
      1. probable causes of my low thyroid; [family, exposures...]
      2. symptoms I had without taking NDT; [litany!]
      3. how I felt when taking double that does [60 mg. Armour]; 4. concerns Armour Company changed formulation–many people stopped getting relief of symptoms.
      5. why I came there for this: because I was too tired of struggling to get help from HMO’s, etc., something was needed…I’d seen too many people on tiny doses, getting no relief, who’s Docs actually said “Don’t expect to get relief from your symptoms when you start taking thyroid”.
      [[really!?]]
      She immediately RX’d 60mg dose in WestThroid Pure [WP], enough to cover using that new kind until the next HMO Doc appointment for lab tests [annual labs for thyroid testing are mandatory, or the RX will not be refilled].
      Getting that RX filled, was a whole ‘nuther circus–had to call a dozen+ pharmacies, 3 said they stock it, but really don’t–they stock the regular WestThroid, called “NatureThroid”, which they try to foist.
      My HMO Pharmacy finally DID order it for me: I paid out-of-pocket close to same as it cost them to order it–though they billed it on the records as having about double that practitioner price .

      Romilda, LOTS of things can cause muscle twitches, including low thyroid. Magnesium and/or potassium deficiency can also cause it, as could other things less likely. Some even get twitches and bad charlie horses from being Dehydrated.
      One Solution: Drink more water–at least 6cups or more, depending on your weight… daily, with some fresh lemon or lime juice squeezed into it–that gives hydration, a little electrolytes, and it helps alkalinize the whole system as it needs–and it’s very cheap!

      Detoxing from medications usually doesn’t take too terribly long–a couple weeks?? Average? “Hard drugs” can take longer.

      PLEASE look for a different Doc.
      IF your insurance only covers Docs/services they authorize, then to get coverage, you will need to try working within their “chain of command” rules, to get what you need.
      That means asking questions of that insurance system, learning the rules, and finding other potential providers that are in the network. You can interview staff, and ask questions like “How does this Doc evaluate patients for low thyroid? Does this Doc listen to symptoms the patients report, as well as lab tests? Does this Doc have good knowledge of “sub-clinical low thyroid”? Etc. to help screen for one that might do better for you.

      OR, pay for an alternative medicine Doc, out of pocket.
      I did, and never regretted it—but you still have to quiz the Doc or their staff, about whether they have any experience in this–OR, if they would be willing to help be a “Medical Sleuth” for your needs. [[my outside Doc cost $150 for a new patient work-up; follow-up office visits cost $45--I think that is for at least 30 minutes+; labs are extra, or, she can order them, and I can get them done at the HMO labs]]

      If I’d kept letting the HMO Docs keep me buffalo’d into accepting their “erring on the side of caution” any longer, I’d still be feeling bad, losing ground, related to low thyroid.
      Now there’s at least one Doc on my side, and I’ll have several months of the higher dose evidence to present to the HMO Docs doing the labs—the proof is in the pudding!
      THAT brings peace of mind!

  122. Rebecca says

    Hi there,

    I was just wondering if you might be able to shed some light on my symptoms. I am 24 and have suffered with quite bad tiredness, aches, pains, and sore glands plus a ‘slow’ kind of feeling, on and off for a few years now. I am always intolerant to cold and always have cold hands and feet. Anyway all of this was always fairly tolerable. I managed to get through uni ok for example. After having my son last January, symptoms have got far worse. My legs feel super heavy and I seem to be always tired, weak all over and slow in myself no matter how much sleep I get. My ankles hurt and have tiny fluid cyst like things on both. Along with this I now also get short of breath just by climbing the stairs, have indigestion and acid reflux type symptoms too, have chronic tonsil stones and I sometimes feel dizzy upon standing. I’m not overweight and was always active before pregnancy. In the past year i’ve been to the emergency department over this and also seen my gps several times. All tests showed normal including the thyroid function tests they did. My blood pressure has always been on the lower side of normal.
    The point is is that there is history of hypothyroidism in the maternal side of my family. (My mum developed it after having my sister and my grandparents on her side also have it).
    I’m tired of hearing there is no physiological cause for this since I do not feel that simple bloodwork is exhaustive enough to conclude this. I’m not depressed and I also don’t believe it is the usual ‘new mum’ type of tiredness. Are there any better tests I can get to check for thyroid problems? Any advice or suggestions would be grateful.

  123. Mike I says

    I love this article on thyroid disorders and have a question. Would the following lab results fit into one of these categories.

    TSH: 1.8
    T4: 2.4
    T3 Uptake: >50
    Free Thyroxine Index: >1.2
    T4, Free(direct) 1.63
    Reverse T3, Serum 12.8
    T3: 75
    Triiodothyronine, Free, Serum: 2.8

  124. andi says

    i have had test done on T3 and T4. i know in my gut something is out of whack with my thyroid. i have tingling, pins and needles all over my body, i am 51 and female, i am tired when i wake up, i have gained 20 pounds in two years with no life style changes to account for it, yet my tests are “normal”. i am not floating in dough and am hoping to figure this out on my own because i am a substitute teacher and don’t make enough to go to endocrinologist. my mother had a goiter removed. i just want to feel better. Not everything is aging. if there is one thing i have learned from this, do not except all the changes as aging and dismiss your body trying to get your attention! that is my hope for all of you who read this.

  125. Holly says

    So – you’ve described my plot. And yes my MD just continues to increase my dose despite no change in symptoms or lab work. But my question is – who can I go to to correctly diagnose and treat me???
    I’m currently being seen by a very well reproduction endocrinologist at UT Medical School.
    FRUSTRATED and confused in Houston -
    H

  126. Nada says

    I do a regular blood test once a year and i realized that my TSH level has gone lower this time but my T3 & T4 are the same and according to the lab test they are within the normal range. should i be concerned that my TSH level has gone down?

  127. Celine says

    Hello,

    Thank you for this great article; However I wasn’t able to find the answer to my question, maybe you would have advice?

    I have Hashimoto’s and my TSH is normal, T4 as well and T3 is low. I tested my cortisol levels, they are normal, and my oestrogen/testosterone levels as well. Selenium is within normal range but more on the high side, vitamin A and D are under-range. Iodine is under-range too.

    I still have thyroid symptoms, more than before.

    Could my symptoms be due only to the vitamins and iodine deficiencies? Or could it be something else?

    Many thanks for your help :)
    Celine

  128. Tamara says

    So, any idea how to or what doctor to go to that will listen? I have had thyroid disease as a child, and was on Synthroid for 6 years. Now my thyroid levels have been from 5.3 to 3.5 to last week 4.7. I have gained over 100 lbs without eating much. I am so tired all the time. I sleep 90% of the day, not wanting to I Have to. I am fatigued. I am freezing all the time to the point I Have 2 heaters in my apartment in addition to my regular heat being turned up to 90. I also need heating pads and blankets…because I am always cold. My hair and eyebrows are thinning. My skin is dry, I am light headed. My voice recently has started to get hoarse. But because my damn levels are withing the 5.0 normal range save for once no one will help me. I am seriously about to buy synthroid online or find another way to obtain it to get some relief. I KNOW what is wrong with me, no doctors listen and this is upsetting me. Do I have to die before they listen?

  129. Katy says

    Thank you so much for this. Now I can check what was tested and go back to the doctor if TS3 levels weren’t checked. This totally makes sense why blood results are normal when I am so sleepy. A sleepiness which does seem to get worse with stress, though not ruling out Chronic Fatigue Syndrome yet either.

  130. Mellisa says

    I’ve been battling hypothyroid for 3 years and before that hyperthyroid for 4 years. My problem is weight management. I live a very active lifestyle and have a very healthy diet and I am afflicted with no other illnesses. I take my medicine and am in the normal hormonal range for hypo management, but I keep gaining weight. I have put on a total of 25 pounds in the last 18 months and cant get it off. I am within my weight class for my height but not for the amount of physical activity and diet that I carry. I am also not comfortable with the additional weight. Has anyone else done everything right and still have trouble with weight gain not associated to overeating? What helped you overcome?

  131. Grace Hurtado says

    Dear colleague. I am a cardiologist, so these issues about rare causes of hypothyroidism are pretty unusual for me. But the fact is, that I have a daughter turning 34 who has been going to several doctors, experts in Endocrinologist, but none of them have given her a solution. Lets go to the point. She has all the symptoms of hypothyroidism, as gaining weight, fragil and lis of hair , weaknesses from time to time. She refers this symptom like an on and off. The blood test she was run were absolutely normal. In case the cause is a matter of high resistance of tissues, wich is the best treatment? To take T4 or T3 orally? And which will be the accurate dossis of T3 for her. Tnanks a lot. Best regards

  132. Rita Hodges says

    for all of those with these problems you should also have vitamin levels checked low D3 causes depression, low B12 will cause you to be tired. There are more effects than I have mentioned but these are I feel are the worst because if you have these you do not want to go outside and by not going outside and not taking D3 supplement will make your mood lower because we get natural D3 from the Sun. If you Fybromyalgia by it’s self or in combination with low vitamin levels and a Thyroid problem makes finding exactly what meds you need very hard also it is still hard sometimes to find out you ha Fybromyalgia because many in the medical world still do not accept it as a real condition. there is also another problem mentioned on here was “leaky Gut” which is a condition not recognized by the medical community as yet but my Gastroenterologist says sounds right is from a woman named J.J. Virgin who is a nutritionist and dietitian she explains about food sensitivities which are very mild allergic reactions which you are often told its your age or your not getting enough sleep etc. this can cause leaky gut I can only remember one of the symptoms right now and that is when you eat a regular meal with in 2 hours you feel hungry again (it might be 2-3 hrs.) not sure that is how mine goes. The best thing about the Virgin diet is you take out 7 categories of food for 3 weeks and then add them back one at a time to see if first the problems all or partly go away and when you add the items back what problems come back. Then you choose to limit intake or cut out the category. these sensitivities can also cause many of the other symptoms so like with vitamins check out every option available to make sure of every issue you have so you can get to feeling better. And please don’t just take my word for it with these issues search for yourself because as much as I am trying to help it is always possible I am not remembering everything correctly. I always tell people knowledge is power and I would add especially when it comes to your or your families health.

  133. Mellisa says

    Sensitivity to Synthroid! When my Hyper converted to Hypo, I was placed on Synthroid. I had an incredibly bad reaction to it, I had vomiting, nausea, my hair fell out in clumps and I had steady weight gain. I was changed to Tirosint and had positive results. Most recently I had my dosage increased, my TSH numbers are super high and my T4 is low. However, I was not given Cytomel for the weight gain which is my biggest problem.

    Has anyone had any success with Tirosint/Cytomel combo?

  134. Lisette Bornman says

    Hi, I was diagnosed with a underactive thyroid when I was 13 (after experiencing excessive hair loss, fatigue/lethargic- don’t know whats the correct term for very very tired all the time, and rapid weight gain) my mother also has hypothyroidism- and I was on medication for a while, I had to go for test every 6 months to check the levels, I cannot remember everything they tested. However after 3 years on Eltroxin 0.1mg, the doctor stopped my medication because she said that my tests show as normal. Since I have stopped it I had a sudden increase of weight gain to the point where I did not even lose weight when on a diet and I have been on a number of diets. I did not really notice that being overly tired as a result of stopping the medication but thought of it as just being due to stress from exams and later stress from work. Last year I once again tried to lose weight and have successfully lost 25kgs, the first 13kgs I lost in a period of 9 months and the other 12kgs in the past 3 months after a drastic diet and hectic exercise program and using “Duromine” 30mg (Since last year December). Where my question comes in is; I still have 10kgs to lose to be what I need to be according to my BMI, however it is becoming very difficult to lose that last bit, I have not deviated from my diet or exercise program and still on Duromine. Now Duromine helps to give you more energy, the first month on it was great I didn’t feel tired anymore like I used to, but then around the second month I was once again forced to rely on energy boosters to get me through the day, I use a multivitamin (Spectrum Hi-performance), which also helped but also only for a while. I have lately noticed that I am also experiencing excessive hair loss, constantly. Has my under-active thyroid really stabilized, is my weight problem, fatigue and hair loss enough symptoms to get retested and if I do test and they show normal how will I know for sure that they really are, because as I understand your article, the doctors and labs don’t really then know what they are talking about??

    In conclusion; I don’t want to waste my time and money going through all of this just so that at the end the doctor can tell me I’m fine, when she actually has no idea of what she’s talking about. What can I do to make sure I’m correctly diagnosed because I can’t tell her shes wrong, if my symptoms are due to my thyroid, I will need a prescription from my doctor.

  135. JoAnn says

    i have been diagnosed with everything but hypothroid even though I have been to numerous doctors with numerous tests and nothing in the blood. I was tested as a new born because as a newborn I was born with constipation issues which I guess is not right and have had all the symptoms of a thyroid issue my enitre life. Finally, my regular doctor put me on a very low dose of levothroxine which did absolutely nothing. Now I am on numerous anti depressandt drugs and more of the like as I have all the mood indicators, aniexiety, lifelong depression, panic attacks etc….. Both my children and I have suffered from severe migraine headaches since age 3-4. Mine have gotten somewhat better after a hystorecotomy at age 36. I am now 45. So the end result is the diagnosis of fibromyalgia which to me looks exactly like a thyroid issue. I feel that this diagnosis has been given to me as they can’t “find” anything else with test results but i don’t remeber fibro making your hair fall out among other symptoms of thyroid that I have. I don’t have the money to keep running from my regular doc and endochronologist and back to my regular doc. back and forth all the time and I am now on disability due to my “Fibro” and some issues with my back and neck. i never feel good even with all the meds from the phych doc. I take adderal so that I have a little energy and dont sleep my life away. It helps a little. I take 2 anti depressants and 1 anexiety medication. So, in other words it is all in my head ans therefore stick me on all these phych drugs that dont really help much at all…. Oh what to do what to do… my whole life i have been told by family and friends how they think I have thyroid issues. One even bought me a book about it and it was me completely. Now my daughter just recently did get the diagnosis of hypo with her blood test. She gained a huge amount of weight and was so tired she was missing more work that working along with her migraines. We both have very low basil temps. In fact she says that if she ever hits a normal 98.6 she knows she is getting sick. She is 26 now but has had high cholestorol since she was 20 or so. I have worked out 5 days a week which is hard to do when you feel so crappy. I can loose a bit of weight that way as long as I dont eat anything but i have battled my weight my whole life. I have only lost weight even with diet and exerciise with the help of phentermine or adderall. When the body gets used to those they stop working and the weight comes back even if I continue to follow a workout regimin and a diet. I am at a loss. My daughter is now on a dose of levothyroxine but she is still super tired and still getting headaches of which of course she takes a pill for. Seems like we complain and end up with another drug to take. My maternal grandmother had thyroid issues as well as paternal family members. Some no longer have a thyroid and are on complete replacement drugs. I have had gout and both my daughter and i have vitimin d deficiencies. I am in the sun alot as it feels good on my sore body but she is very fair skinned and almost looks aniemic. She also has an iron deficiency and my mother has hematchromotosis as do all of her siblings. My mother has all the signs of thyroid as well but she was a nurse and is old school so the test didnt show anything therefore she she doesnt believe anthing that a test cant prove. Her hair is also extremely thin, weight issues, mood issues, gout in big toe, loss of most of her eyebrows. Mine too. I guess is what I am trying to get at here is that there is a definate history of thyroid issues in our family. I have almost every symptom there is from my nails to my hair to my skin to my weight and my moods. EVERYTHING matches…. I dont know what to do….

  136. Sharon says

    I have a lot of Hypothyroid symptoms, but the blood tests have come back normal and after another trip to the Doctor I was nearly escorted off the premises for wasting their time.
    I’m almost at breaking point with not being able to cope with the symptoms, and want to go back to the doctors to insist on further tests or to see a Expert on Thyroid problems.
    what tests or expert do i ask the doctor to refer me to?
    sorry if that question has already been answered above, i notice there are a lot of comments, and is a relief to actually know there are other people suffering out there.
    i’m now being avoided as being the complete nutter in my work place.
    thanks for your help.

  137. says

    Good Morning Chris ~

    I’ve been diagnosed with hypothyroidism for a little over three years now. I have no symptoms nor have I ever.

    When first diagnosed, I inquired about managing with diet and was told it wasn’t possible. The doctor allowed me three months to try on my own, but offered no suggestions where to go for information. Obviously, I was unsuccessful.

    He also gave no indication or information about the effects of chronic stress. I was diagnosed at a time when my marriage was falling apart, my mother had been diagnosed with a terminal illness, and there were signifiant issues at work. All of these had been long term, on-going issues of which the doctor was aware (and for which had tried to prescribe me anti-depressents). After reading a considerable amount in the past few weeks, I’ve begun to suspect I am actually experiencing your point #1 in this article.

    I’ve recently been introduced to Paleo/Primal and was sent some of your writings on Thyroid. I want to thank you for giving me an avenue to begin research of my own self and personal reactions to food and stimuli.

    I’ve printed your foods to avoid and (shocker) a good majority of them were favorites of mine. Artichokes, asparagus, coffee just to name a few were in my diet multiple times weekly. Asparagus fills my freezer in the summer.

    I now have a new doctor due to insurance change. I see her for the first time later this month. I’ll be walking in armed with many of your articles as well as articles from some of the others associated with the Paleo movement who research this area. I will have been on the Whole30 elimination diet, including avoiding FODMAP foods, for slightly more than three weeks at that point, four weeks off of the foods you recommend avoiding for hypothyroidism.

    With any luck, I will not be renewing my Synthroid prescription. It’s out of stock half the time anyway, which is an indicator to me that this condition is not well managed by the medical community.

    I wanted to thank you for your research and for sharing it with the world at large. Please keep it up so that we can continue to educate our medical practitioners or at the very least be more self-aware.

    Thank you.

    • Laurie says

      Joyce, can you please direct me to the foods to eat and avoid lists that you refer to….. I searched the site and was not able to find them.

      Thank you SO much.

  138. Dan says

    Chris – I have symptoms of thyroid problems. Low heart rate, cool body temperature, fine brittle hair. Plus both my mother and brother take synthroid. Yet my blood tests don’t show any problem. Who can I see in the Miami, Florida area that can perform more comprehensive testing? Thanks.

  139. Marcia says

    Thank you for everyone’s comments, its wonderful to see I am not alone in this 10 year struggle to find answers.

    Heavy Periods, Fatigue, loss of energy, depressed, full body rashes lasting months, weight gain no matter low calorie count, natural whole foods with natural herbs and regular exercise.

    I am strongly opposed to medications, coffee, alcohol, soda, or beverage with color dyes, sugar or sugar substitutes. Only minimal amount of sea salt in the kitchen and dinner table…

    The human body is obviously very complex….most times trying to find balance feels impossible…

    I found bentonite clay simply mixed with water clears away rashes, lots of water (without chlorine or flouride), fresh lemon assists in ongoing cleansing- removal of toxins…

    But as of January 2014 have discovered essential oils- therapeutic grade, that addresses every symptom typed into the internet :) included thyroid issues, liver, kidney function and more.

    Join me in this journey of learning how naturally to heal our bodies, without the medications offered to us in every office and over each counter.

  140. Kelly says

    I’m SO glad to find this article, yet still wonder where I fall. I’ve been miserable with hypo symptoms for months. The first test was only TSH which was “normal”. 5 months later and I still feel lousy, so I asked for more testing. T3 is normal but T4 is low. How does that happen? He’s putting me on synthroid, but I wonder if that’s the solution or just a band-aid. Should I ask for additional tests to find a root cause? Thanks so much.

  141. Pam says

    So if normal lab results do not show these, where do suggest get test done? My allergist says there are NO (yes she said No)tests for food sensitivities. Is that correct if not who do you suggest I turn to?

  142. Ginny says

    Oh my goodness!!! This makes me angry. Just now read this. No FREAKING wonder I haven’t improved on levothyroxine. I told my doc felt a bit better at first for about a week then felt just the same almost as bad as before! Of course she upped my dose which did nothing but increase palpitations. So I made no more complaints because I knew it would do no good.

    I’m going to copy this, if I may, and send it to her. I wonder if she will be offended? If so, I will find another doctor! I want a correct diagnosis!

    • Lisa R says

      Ginny,

      I found out that levoxyl did not work for me as well. Try Armour thyroid instead. As a natural thyroid base it converts T3- T4. Levoxyl is a synthetic that does not,. Also, Armour 30 mg costs about 5.50 for 30 day supply at CVS.

      w.r

  143. Ginny says

    Chris,

    One thing you said does not sound right.

    You say that lab reference values are based on the values of sick people. Yet the medical director of Quest Diagnostics says the opposite. That “normal” values are based on the results of healthy people who do not have illness.

    Which one of you is right?

  144. Laurie says

    Can someone please direct me to the foods to eat and avoid lists that are referred to (above in post of “Joyce
    March 13, 2014 at 5:55 am”) ….. I searched the site and was not able to find them.

    Thank you SO much.

  145. shoshana says

    hi i am from israel/
    i have lat oncet 21 oh hyd. def.
    what can i do abut it
    what other disorders can i have?
    thank you shoshana

  146. Lisa R says

    Mark,

    Have your son been tested for food allergies, had a bio scan, and also does your son play videogames or watch a lot of cartoons?

    w/r

    Lisa

  147. k l says

    I’ve been having almost all of the symptoms of hypothyroidism for years. Specifically weight loss problems. I eat very healthy and watch calories very carefully. My two thyroid tests came back negative. I was so frustrated.
    I also suffer from extreme fatigue and chronic stress. The stress was so bad I got alopecia areata.
    Could this be a misdiagnosis? If so how do I treat this?

  148. Saska says

    I have a question reg.
    Hypothyroidism caused by pituitary dysfunction
    This pattern is caused by elevated cortisol, which is in turn caused by active infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance.
    I did saliva test last year when I felt ‘outside’ myself. My health has been declining for a couple of years, since 2005 as a matter of fact. It started off by anxiety, panic attacks (no reason really). I have been struggling with added on symptoms throughout the years. I am today 46. Thyroid disorders run in my family (my mothers side) and this is what I suspect to be the culprit. Here are some of the symptoms I have been struggling with the past years:

    - panic attacks/anxiety
    - dizziness
    - shivering/tremors/shaking/sweating
    - rapid heart beat (85 and up, in 2010 heart monitor showed 100 beats/min during rest/sleep)
    - low blood pressure
    - hungry fast after eating a meal
    - migraines optho only
    - sweating
    - blurry vision/floaters
    - nearsighted
    - pressure behind eyes/eyes easy watery (have no allergies)
    - seizure (first/recent)
    - immunity lowered since 2005
    - between 2003 and 2007 I had lactating breast, no pregnancies. Gone now.

    The saliva test showed increased cortisol in morning and very much so at night, right before bed. I also am feeling hungry soon after I have eaten, even though I eat big meals, and do not gain weight. Thyroid tests within normal range at all times. 3 years ago, one time it was at 2.30 Tsh. Glycemic testing all ok, 99.

    I know all this may sound confusing, but its tough to start at one end and make sense for you all. What I am thinking is, reactive hypoglycemia or thyroid issues? My FREE t4 tests have always been fine….Any advice? I want to get back to my normal self.

    • Saska says

      Forgot to add, the question was, if my cortisol is higher than normal, should then the pituitary function be tested? What do you recommend?

      • Saska says

        Here is what the report from my saliva cortisol lab wrote (I don’t eat any medication beside magnesium at night): DHEAS is within mid-normal expected age range. DHEAS is highest during the late teens to early twenties (10-20 ng/ml) and drops steadily with age to the lower end of range by age 70-80. Cortisol is high in the morning, normal throughout the day, but rises to a very high level at night. The very high night cortisol unlikely indicates stress-induced adrenal cortisol production (levels are much higher than high physiological range) and more likely reflects evening use of some form of medication that either contains a glucocorticoid or stimulates the adrenal glands to produce high levels of cortisol. Glucocorticoids could include cortisol (hydrocortisone) itself or synthetic analogues (Prednisone, Betamethasone) commonly used for asthma, autoimmune diseases (e.g. Lupus, rheumatoid arthritis), or other inflammatory conditions. While physiological levels of cortisol are essential for normal immune function and the normal cellular actions of other hormones, particularly insulin and thyroid, long term endogenous production of cortisol by the adrenal glands, or use of excessive amounts of glucocorticoids (natural or synthetic) can lead to immune suppression, inability of normal tissues to utilize glucose for energy (insulin resistance), functional thyroid deficiency (normal thyroid levels but thyroid deficiency symptoms), and excessive breakdown of normal tissues (catabolism) which include muscle wasting, thinning of skin, and bone loss. Exposure to high levels of glucocorticoids, whether produced endogenously (within the body) or taken as medication, increases risk for serious long term health issues (rapid aging, osteoporosis, cardiovascular disease, obesity, diabetes, immune suppression). Some of the most common symptoms/conditions associated with high cortisol include sleep disturbances, fatigue, depression, weight gain in the waist, anxiety, bone loss, functional thyroid deficiency (normal thyroid levels but thyroid deficiency symptoms, and insulin resistance/metabolic syndrome.

  149. cindy says

    Hey, this article is exactly what I’ve been looking for…. just one quick question…. what test should I ask my doctor to preform? I want to go to the office completely informed and armed with the proper information to help with my diagnosis..

  150. Pamela Plumley says

    Interesting convo! A little health history: I’m 53, have had bad headaches since 13 (which evolved into migraines at 24 after an auto wreck) and bad neck/shoulder pain since my teens. I have been told since my twenties that I have arthritis and subsequently fibromyalgia and one doctor told me I have spondylitis. I am proven by MRI to have degenerative disc disease and some reversing of the cervical lordosis, etc. I just hurt a lot.

    I also had a sigmoidectomy for colon prolapse in 2007 and uterine ablation for polyps and severe menstrual problems. I have had one miscarriage, but surprisingly to doctors, two children, including one at the age of 39! When my son was born in 1987, I was very toxemic.

    I have even had “unknown seizure” episodes, not epileptic, just uncontrollable jerking of the arms, legs and tongue until I could not talk, walk or hold anything in the early to mid 2000s.

    I began having hypo thyroid troubles at around 19, which flipped into hyper or normal until it went severely hyper with a goiter and Grave’s disease at the age of 23. I was given I- 131 uptake (nuclear capsule) (in 1984) after a round of heart medication, etc. in order to “kill off” the overactive thyroid. After that, of course, it became hypo. However, it has flipped between hypo and hyper since that time. The first endo told me I had abnormal thyroid binding globulins (sorry if that is not spelled correctly) and that it may have thrown off the test. Of course, free tests have become the standard now.

    I have ranged in doses from 1.5mcg to 1.00, .112, .125, .50, .75 and currently .88. I have diagnosed with bipolar, although the first psychiatrist told me he felt it was a very hyper thyroid causing the problem at the time.

    I have definitely been through a ton of stress in my life. Still am to a degree,as my husband just came through prostate cancer last year, and just things of life. And yes, I have tried supplements off and on, perhaps not long enough though.
    I rely on Ambien to sleep, but hate it and am stopping soon; hopefully something better will help me sleep.

    I have been to the stopthethyroidmadness.com and I know it’s said that hypothryoid can mimick a lof of other diseases or be the cause of them. I seriously wonder at times if I truly have bipolar, and if some of what I have gone through is just stress related. I would love to think I could reduce this pain by normalizing the thyroid! That would be a miracle.

    In January, my new doctor, who knows I have had a whacky thyroid history and believes in frequent testing, included some things on the thyroid panel I have never seen before, when I looked them up, at least one or two was in relation to Hashimoto’s dx. This month, he tested for TPO, third generation TSH and a TSI. These are all new to me also.

    I am kind of wondering why my doctor is ordering these different types of panels lately, knowing that this hypothyroid is secondary to the nuclear radiation I had years ago. This is a very confusing issue I think, but glad some people are talking about it.

  151. Jan Marie says

    I am asking for help from anyone on this site who has knowledge of thyroid issues involving sporadically very high and very low testosterone lab results. I see that SALLY posts a low and has a lot of knowledge.

    I discovered thyroid cysts in 2006 and was deemed to be euthyroid, which I was not and am not. I am hypothyroid but have a low TSH ranging from .4 to .7. I had a high rT3 two years ago and supplement T-3 solved that. I also take 5 mcg of T-3 (bio-identical compounded) in the morning now and at night I take Young Living’s THYROMIN one capsule supplying 550 mcg of Iodine and T-3 and T-4 and some essential oils to support the thyroid. I have good energy most of the time, in fact almost great. I still do have some occasional fatigue but nothing really bad. I still work all day long with the fatigue. Before taking thyroid supplementation I worked on the adrenals and supported them. I do not see any signs of having high cortisol even though I have central weight gain and an untypical big waist (historically I have had a very small waist). I had a very stressful event (in fact horrific) in August of 2011 and a few months later began losing hair. I had very thick hair prior. The issue that triggered this loss is still not resolved, but I do not have exposure to it, but rather it is in my psyche. I work hard at not thinking about it. I am happy and my health is remarkable for being a senior. With the hair loss I worked on anything that needed to be remedied in supplements and did all the appropriating testing to maintain. I looked at vit D3, iron, zinc, magnesium, copper, all vitamin levels. I have supplemented everything humanely possible using science not guesswork. I still have not regrown my former very thick hair. I still do have a bit of fatigue but not much. TO NOTE: I have very high and very low testosterone readings and I cannot make any sense of it. I also have low normal DHEA. I am currently supplementing 5 mg of DHEA daily. I am taking progesterone to correct estrogen dominance. Maybe I am not taking enough progesterone at 1/5 of a ML two times a day. I use to supplement bi-est but quit that long ago. I do like sweets and have worked hard at controlling the intake. I have an fasting insulin of 6 which is perfect. I just had an MRI and so far it does not look like I have a tumour on my pituitary.

    Could I have something malfunctioning in my pituitary that causes my Testosterone to go wildly up and down, test results a month to two months apart? I also have VERY hard time to lose weight. I am overweight by about 30 lbs. I am not grossly obese but have central weight gain and a large waist. I sleep very well and so I do not suspect cortisol involvement. When I did have cortisol issues I would awake in the middle of the night and sleep was bad.

    I just cannot find any practitioner, not even my functional medicine doctor, who can tell me WHY my Testosterone goes up and down and how this can be tied in with lack of hair regrowth and inability to lose weight even when on a nutritarian awesome diet. I am so at loss to get some help.

    Anything anyone can contribute would be so appreciated. I plan to call Chris and see if he will consult in regard to this. In the meantime I read a lot and am trying to get help.

    Thanks so much for any consideration………..Jan Marie

  152. says

    “…. we don’t have a way to test the function of cellular receptors directly.”

    Have you heard of Wilson’s Temperature Syndrome? Dr. Wilson asserts that body temperature is the best indicator for poor T4-T3 conversion when all other tests are in the normal range. He treats this condition in a novel way – time-released T3, once every 24 hours. This is designed to “reset” a person’s thyroid system and they often go off medication completely.

    • Maria says

      Who makes time released T3? and where do you get it? Is it by prescription only? If so, then many of us will not be able to get it because many Drs only prescribe synthroid or its generic equivalent and that’s assuming your Dr is running the proper Thyroid tests. Not everyone has time or money to keep switching Drs in hope of finding one who knows what they’re doing or seeking medical care outside of the US.

    • Jan Marie says

      Thank you for the comments. I have heard of Wilson’s yes. I do take time released T-3 every 24 hours, and it works great for me. When I first took it, it was as though I had experienced energy for the first time. I need to take only 5 mcg for it to work well for me. I started with 2.5 mcg.

      I do get it by RX only and it cost me $44.00 per month, or about $110 for three months’ supply. I get it at a pharmacy locally and it is prescribed by a CNP whom the pharmacist knew and directed me to her. I do know that it is very hard to find appropriate practitioners, ones who will listen well. I just kept asking until I found help. There are organizations of holistic practitioners you can google search. There is also ‘ Institute of Functional Medicine’ to find someone in your area. Often times now there is a division of a mainstream practice that has gone ‘eastern medicine’ and they will help you. I live outside Mpls-St. Paul and I found help in a few places but not many who were willing to formulate the dose, but rather to take over from another practitioner’s RX. It is very hard. If you want specific names of my pharmacist and my practitioner, you may email me at freespirits3244@att.net and I will give you the names. Maybe you could do something via phone/Skype. I do not know if they would demand you see them in person. But anyway I would share with you if interested. Jan Marie

  153. Molly Franken says

    Chris

    Thanks for your thyroid series, first and foremost.

    Secondly, do you have any insight for people that are low across the board ie TSH .006 T3 low T4 low? This seems a perplexing situation as the normal ‘see-saw’ effect isn’t occurring. My current physician is stumped and I’m suffering a bit without the answers I need (waiting to get into a new endocrinologist).

    Many thanks!

  154. Meri says

    Thank you, thank you. I have been so frustrated with my doctor. For three years she has been checking my TSH at my annual exam. It has been trending lower and lower but is still in the “normal” range. This last test was 0.58. She keeps saying, “It’s normal,” but I have just about every hypothyroid symptom. I can’t even get her to do other tests. Pattern #1 sounds just like me. I was beginning to think I was crazy. Do you think an endocrinologist would be willing to look into this? The last time I went to an endocrinologist she wouldn’t look past my pre-diabetes diagnosis. With a simple google search I find that the two can be related. Do you have any recommendations for what I can ask to get the ball rolling in the right direction?

  155. Debsta says

    What’s the difference in between T3 uptake and reverse T3? Please clarify.

    I’m having a bad reaction (last 5 days) to a new batch of a natural thyroid medication (with a tighter +/- than Armour). With my usual dosage, felt like ADHD going nowhere and not able to communicate, hyper symptoms and then depressed in afternoon, like spent. Great small company, called them up. Don’t even know of or the specifics of how to find a good “compounding pharmacy”, if needed or how to advocate for that if necessary???

    I’m due for my annual panel and I want everything tested and not sure what would be helpful; please advise. I probably need to be specific and relentless. I was originally diagnosed with Hashimoto’s and was allergic to Levethroid. I went off of everything and was put on a natural thyroid I had researched because they said I had to be on thyroid medication and my numbers were that of a coma (this was years ago). I had to start with baby dosages of the natural thyroid.

    Anyway, what do I prioritize? So, TSH (given), free T3 & T4, do i want reverse T3? How’s that different from T3 uptake? Is there a reverse T4? Do I want TBG?

    They don’t like it when I tweek my medication down or up, but I need to function in my body. I couldn’t drink a cup of coffee until this afternoon and stayed home from work today. Basically my feelings are the tests so far, don’t seem to give an accurate picture of what is available, resisted, and used by my system, and I would like a more complete picture to better understand how to compensate.

  156. Jose Blose says

    This article is riddled with misleading information. I realize there are an army of people suffering symptoms, but this site is not accurate.

    1. Reference ranges are not determined from ill individuals.
    2. TSH and FT4 values do vary between labs; the reference ranges also vary along with the values (it is not once size fits all with the wrong ranges applied blindly)
    3. Bell curves are not used to establish reference ranges (except where values are clearly normally distributed, an rarely even then).
    4. FT3 is helpful for detecting hyperthyroidism, but is not a panacea for detecting occult thyroid disease.
    5. T3 uptake testing is fraught with confounding, some of which you list and pathological conditions (estradiol, binding protein concentrations, contraceptives).
    6. There seems to be a complete misunderstanding of free hormone and bio-availability. Binding proteins high, low, or in between do not affect free thyroid hormone concentrations, which are the only factor that really matters.

    Readers, seek medical information from reputable sources (Pubmed, well-known tertiary care center websites, UptoDate, Quackwatch), not an acupuncturist with an opinion!

    • says

      Hmmm… let’s see. Quackwatch – a website run by a retired psychiatrist with LOTS of opinions, but apparently a guy who hasn’t even treated a patient in over 20 years!
      20 years is an eternity in the development of thyroid disease treatment. The information on Quackwatch on hypothyroidism is pathetically outdated and misguided. Dr. Barrett seems more interested in attacking those with opposing viewpoints than he is in actually helping anyone.

  157. says

    I would really like to know what one may do if reason #5 is the issue. It doesn’t seem like there is a way to fix that, or is there?? I am pretty sure that is my exact issue. Not 100% though. I do have lower T3 and elevated reverse T3 too. My TSH and T4 is basically in the normal range, all for functional med. parameters.. I have a few hashi’s antibodies, but they are not high.

  158. Diane says

    Dear Chris,

    Such helpful work you are doing– Thank You.

    I have a puzzle for you! I work with an “integrative” MD– my initial comprehensive thyroid labs (two consecutive) revealed normal levels on all: TSH, Free T4, Total T4, Reverse T3, T3 Uptake, Free T3, but LOW Total T3. I have many low thyroid symptoms and have for many years. I do not have elevated Testosterone (actually, low), or elevated Cortisol (although my cortisol 4 pt. test indicated some adrenal fatigue.) I have been taking cytomel for a year- felt a little better for a while, but no longer. My last labs indicated LOW TSH, Lower T4, ELEVATED Free T3, and normal levels of Total T3. I don’t believe the medication is my solution. Any ideas on what it could be? Not even Dr. Kharrazian’s book can help me with this one.

  159. AMANDA says

    MY DAUGHTER HAS GAINED 27LBS IN 5 MONTHS ALL IN THE BELLY, THE DOCTOR DID A FEW BLOOD TESTS AND HER T3 UPTAKE IS 29, HER HEMOGLOBIN A1C IS 5.5 AND HERGLUCOSE PLASMA IS 77 I WAS TOLD SHE IS FINE,,,,,BUT IS SHE, AGAIN SHE IS ONLY 8.

  160. Jessica says

    Hi there – I have had lymes disease (bullseye rash, tested positive twice etcetera) and now seem to be in an epic endless post lymes syndrome with all the joy that this entails. My thyroid tested fine last December but a lot of what I’m experiencing also seems to correlate with low thyroid. Could lymes trigger low thyroid and it not show up? I never used to get ill and now I feel ill all the time, I can’t exercise because I get lymes crashes and I’ve out on so much weight. I’m a bit desperate.
    Thanks in advance for any comments or help that might be offered. Jess

  161. Debi says

    I have fibromyalgia but believe I may also have hypothyroidism. I have severely swollen glands under my chin. I am cold all the time. I the last six months I have developed a chronic vomiting problem. Whatever I eat it seems to come back up. I cough incessantly and choke while drink eating or jist swallowing saliva. My cough is continual. Of course I am always tired but can’t sleep at night without sleeping pills. The nausea seems constant. My GP seems to think I am a hypochondriac and my rheumatologist was annoyed when I brought in a list of 19 symptoms to be addressed. I know my body better than they do and I KNOW something is wrong other than the fibromyalgia. Can anyone help me? Give me suggestions? Thank you

  162. ChrisK says

    Thank you for this very helpful article–I just found out that half my thyroid is atrophied. Just starting my info gathering, so I really appreciate this.

  163. JW says

    Chris,

    I was diagnosed with Grave’s Disease in December of 2010. I had Radioactive Iodine (RAI) treatment in December of 2011, which ablated my thyroid gland. I was immediately put on Synthroid afterwards to normalize my thyroid hormones. I conceived in October of 2012. During my pregnancy, my thyroid levels were completely normal (within mid-range) so I stopped taking Synthroid for the duration of my pregnancy. I felt BETTER THAN I EVER HAVE while I was pregnant. I lost 20 lbs within the first two months of being pregnant. My headaches were gone, I had NO brain fog, or ANY other hypo symptoms. I’ve done research and concluded that it was because of my elevated HCG levels. I was 175 when I was 6 months pregnant, 185 when I gave birth. After the birth of my child in August of 2013, I was not put back on Synthroid because my levels were still normal. I decided to go on a diet to lose about 15 lbs of baby weight. I was only able to lose 4 lbs in 4 months eating 1200-1500 calories a day. Still – I was just happy to NOT BE GAINING WEIGHT :)

    I went back to the Dr. for a checkup on my thyroid levels in April of this year, and my T4 was low at .7 (.6-1.75 NG/DL) I’ve also gained 17 lbs since January 3 of this year while dieting – that’s almost a pound per week!!! I’m sure it’s related to my low Thyroid levels, especially since I’ve had ALL my previous symptoms come back.

    My doctor will NOT prescribe Synthroid to me because she say’s my levels are in “normal” range. She is aware of my RAI treatment, and my previous doctor’s recommendation to be on Synthroid for a LIFETIME due to me having Grave’s Disease.

    What are your suggestions? I feel like my doctor is not doing the right thing by keeping me off Synthroid.

  164. Maria says

    Go to different Dr. or several different Drs if you have to. I was recently disappointed with endocrinologist for not running full thyroid panel, only to get full lab script from family MD during recent physical.

  165. Staci says

    I recently found this page and I’m so thrilled. I’m 43 and have been dealing with what I think are thyroid issues for years despite my doctor saying “everything is normal.” I’m NOT normal. I’m textbook thyroid and it doesn’t matter to even try to treat the symptoms instead of my bloodwork! How do I get someone to listen to me. I have a 1 inch nodule on my thyroid, cells are fine from biopsy. I’ve read about deiodinases and am trying to find out more research on that subject. Again, how do I get them to take me seriously instead of just thinking I want a weight loss pill (that would be nice, lol) but it is SO much more than me spending 4 months at the gym and only losing 4 pounds. My endo told me years ago that I had PCOS, however, I truly felt she was just giving me a diagnosis to give me a diagnosis. My ob/gyn checked my ovaries due to diagnosis but they were not cystic and I had no problem conceiving. I’m at a loss and so frustrated. Just had bloodwork done with PCP and of course “everything is within normal range.” Then WHY do I feel like this?

  166. Coinneach says

    I have kind of a weird thing going on – after a total thyroidectomy in August 2012 (multinodular goiter, and the pathologist found an encapsulated papilloma), my endo started me on 150mcg levothyroxine. I felt OK on this dose, but my TSH was still 0.0 (don’t recall my T3/T4 numbers). He proceeded to decrease the dose to, eventually 112. That dose brought my thyroid numbers into range, but everything else collapsed into a perfect hypothyroid presentation – weight gain, depression, brain fog, chills, etc. Against his orders, I started taking 1.5 112 pills daily. My weight started going back down, the fatigue and depression lifted, the shivers went away, and I felt genuinely good for the first time in years. The problem is that, yep, my thyroid numbers now indicated *hyper*, which made doc very angry. I stopped the 168, and sure enough, hypo. Now he’s threatening to reduce the levo to 100mcg, just for the sake of good thyroid numbers at the expense of everything else. How do I make him understand what he’s doing to me?

  167. mudd says

    Hello, I have all the classic symptoms of hypothyroid, I have seen 3 doctors, this last doctor is a surgeon, I have had the right part of my thyroid removed in 2004 due to a nodule. I have never been on any medicine for it. Now all of the sudden I have all these symptoms and the doctors do not know what to do. All my labs came out fine, I had a sonogram that showed my left thyroid is alittle bit swollen. I have now lost my voice. Now the surgeon wants to put a camera in my throat to see what is going on and why I am so hoarse in my voice. My gut is saying he wont find anything. I am very lost now. I dont no what to do. And yet I still have all the symptoms.

  168. Leanne Mcc says

    Hi my tsh was 27 last Wednesday then checked it again on Friday to be sure and it was 2.58 & they also tested T4 this time which was also what they called normal at 9,9!

  169. Tracie Arnold says

    I am 44 and been dealing with this same problem for over 10 years now. I have been through the gammit of testing as you spoke of by a few Endocrinologists and was told that ALL my levels were “normal” yet I still struggle to lose weight/keep it off, my hair is thin and falls out constantly, my skin is dry and seems tough and nothing helps. I developed KP on my upper arms which I never had before and have no family history of. I have stripped my diet down to 1200-1400 calories a day and only eat natural protien from lean meat/fish, fresh vegatables, fresh fruit, brown rice, moderate dairy in the form of greek yogurt or small amounts of milk in coffe or cereal and not every day. I only drink water and the occasional ice tea and coffee. THis seems to only help in mantaining my weight where it is at but that is all. I admit that I do not get the proper amount of exercise that I should as I am a night shift nurse so going to the gym or even taking walks etc is a challenge since I sleep during the day but my job does offord me to be physical 75% of the time as I work with ALS patients and am doing 100% care from meds to the physical so by the time I have finished a 12 hour shift I am pretty well worked out just from that. I wear a pedometer and walk the equivalent of 6 miles or more a day just at my job alone. Yes, I know I need more variety and I am working on this aspect. Also I will point out that this problem started long before I became a nurse or worked night shift. My delima is how do I get an MD to listen to me when I tell him that this is more than an activity/diet problem regardless of my tests coming back “normal”. This started when my children were very young and I was extremely active. I have gone through 2 Dr.’s now and 1 specialist. Both of which get back normal test results. The specialist and 1 MD put me on phentermine or phendimetrizine to solve the weight issue rather than trying to get to the bottom of the issue. This DRUG FIX only ever helped me loose 10 to 15 because it made me not want to eat anything since both drugs are and anorexic/stimulants. Well Duh! Starvation of course will make you loose weight. This was a temporary fix and never helps solve any of my other issues including the weight problem since I need to loose 50 pounds not 15. My problem is not my eating habits or how much I consume it is something else. Clearly that is and was not the answer and I feel like they were treating me like a diet drug seeker (which by the way I didn’t ask, suggest or hint that I wanted diet drugs). I wanted answers as to why my hair was falling out and I keep gaining more and more weight year after year without increasing my dietary intake and my activity level staying the same. This problem actually started back when I was in my late 20′s just after having my gallbladder removed but got increasingly worse after I hit my 30′s and now 40′s. Another lovely side effect of whatever is going on is I now have been growing very coarse man like facial hair on and under my chin which is multiplying bit rapidly. I read this suggests increased testosterone but when I have brought this symptom up they just ignore me. I’m no expert but I just wish I could find an MD who actually cares and wants to get to the bottom of the problem rather than prescribe “diet pills” as an answer since all my blood work is normal? Being a nurse this makes it more frustrating because I know something is wrong and if you try and rationalize the symptoms verses the tests and that there must be something underlying that the tests are not showing they tell me its not possible? Um not possible? Hello that is a nice way of saying “I don’t want to try and get to the bottom of it, now run along and deal with your weight problem since you obviously just eat too much”. Ok but ALL my test results are normal so if I eat too much and all the wrong things why is my BG levels, A1C etc.. normal? Liids, cholesterol, trigycerides etc…. NORMAL….. When I say all my test were normal it was like reading a chart of a very healthy early 20′s something year old with no diet issues who gets ample exercise etc… One of the endo’s said if even one of these were on the low side he at least could start there but there not? How do you move forward from there? This is also the MD that prescribed me phendimetrizine by the way? I am so frustrated. I am also so tired of feeling tired, gaining weight for even stepping out of my diet box for 5 minutes and sometimes even when I do not step out of my diet box I still gain. Any advice, help, direction etc.. would be SO appreciated. A guide/list if you will that I can take to an MD or Specialist that tells them what I want tested and done and followed up on etc…. HELP PLEASE…… Here is a list of my symptoms: Thin hair that falls out constantly and never grows beyond my shoulder area before it breaks off and or falls out, dry and pale skin that seems like it has thickened with patches of KP like rashes on upper arms, flank pain on my right side under my rib cage where my kidney is that comes and goes (had sonogram, checked and tested for stones, infections etc… with negative results) , fatigue, constipation, thin brittle nails, depression, joint pain, muscle pain, unexplained weight gain, thin eybrows and eye lashes. Puffy face at times, painful reaction to consumption of alcohol ( if I drink 1 oz of liquor I get a burning red flush on my face and chest. It feel like I have acid under my skin and then I start to itch on my face and chest)I almost never drink because of this. Any guidance or help would be greatly appreciated. I have always been very in tune with my body and I know something is wrong. I’m tired of feeling tired, depressed and having horribly thin hair on my head and dry skin that looks like a red bumpy dry war zone. I struggle everyday with remaining positive and persisting through all these problems but I’m starting to lose this battle as it has been a 15 year struggle and I am so tired of being told to watch what I eat and exercise as a solution. There has to be more to it than that if those recommendations are not working. Ok I will stop ranting now and hope for some advice and help. Thank you in advance to whomever responds. P

  170. Gina says

    Where do you go to get definitive answers? What other test are needed or what type of Doctor to get help? I want to sleep around the clock, have lost my eye brows on the corners on both sides. In desperation I went to a weight clinic for diet pills. Not losing weight but I can at least get out of bed a few hours like a normal person. I am at wits end.

  171. Laura says

    I have a T3 deficiency as a result of non-conversion of T4 into T3. My TSH and T4 levels are normal. My question is, how do I reduce my cortisol levels? I have alopecia areata as well which is an auto-immune disorder and probably as a result of elevated cortisol levels too. I have been taking synthetic thyroid hormone for the past 4 years which makes me feel alot better, however, my hair loss has not improved and I’m guessing this is because the underlying cause has not been addressed.

    • Lisa says

      If a T3 to T4 conversion is your issue, then you need to be on Armor (which is cheaper) because it is a natural thyroid and helps you with this conversion. None of the synthetic thyroid give you the T3 to T4 conversion. There is a great doctor in Fredericksburg, VA called Dr. Hill. His office is by the hospital. He is fairly good. It was a free clinic doctor who without seeing my test results, told me I was on a synthetic. and prescribed Armor. It made a hugh difference and it worked. Also, Silkence Shampoo volumnizer that helps my hair grow back. Rogaine for women did not work for me. Also, Witch Hazel is a great medicine for skin cleanser(acne), blemish and itch reduction. Great stuff.

  172. Kate says

    Just had thyroid testing done and was told I was not in the optimal range, but was in the “normal” range. Endocrinologist tested my TSH, Free T3, Free T4, cortisol, glucose serum, and several other things. He’s prescribed Armour Thyroid (60mg) daily, but if my levels are fine why am I being told to take this drug? I’m confused. Here are my results: cortisol 6.5 ug/dL, Free T3 2.5, Free T4 1.14, and TSH 2.18, glucose serum 112. My blood work was done in the late afternoon w/o fasting.

    Any help would be great!!

  173. Tamara Summers says

    Hi Dr. Kresser,

    I’m a 40 yr old woman, who lives in India, and currently weigh 260 lbs. I have battled the bulge for the past 20 years… and do have PCOD and Diabetes… I was diagnosed with Hypothyroid when I was 12, and was cured of it by the time I turned 16…however, at 17 I was diagnosed with a growth / tumor in my pituitary gland, however when I reached London for the surgery, which disappeared in 2 months on it’s own. after which, I did get tested every 6 months for 3 yrs, however, I was told it was all good since.
    I also am convinced that I do have Hypothyroid for the past 10 yrs, since I do have all the symptoms that define it…however, since all the usual tests, T3, T4 & TSH, always come back within the normal range, the Doctors here keep telling me that I’m normal and that my weight is only a result of my diet & lethargy! That all I have to do is eat less & exercise. Like I haven’t done that!!!
    What they don’t seem to grasp is that I actually do eat pretty healthy (NO sodas, fried foods, sweets, carbs and processed foods) and I do try and work out at least 3 times a week… and in spite of all that, my weight just doesn’t come off!!!
    My current medication is: I take glycomet (metformin) 1gm twice a day, glucobay-50mg thrice a day & glynase 5mg twice a day For my Diabetes. Since my periods come on time, I have not been given anything for my PCOD.

    Dr. Kresser, I really need your help and advice.
    Please write in to me at: tamarra28@gmail.com

  174. Mellissa says

    All of my thyroid hormones came back normal but I was very symptomatic. Sleepy, swollen face hands feet, etc., weight gain even with calorie counting. Ends up on a routine physical i had nodules on my thyroid (large ones) that I didn’t even know about. They all came back as Papillary Carcinoma. In surgery it was found that the Papillary Carcinoma had metastasized to the lymph nodes on both sides of my neck. I just went through radiation treatment two days ago. Strange is that I have been feeling better than I have for a LONG TIME just being on 25 mcg of Cytomel. Also I have lost 21 pounds! I have yet to start permanent thyroid hormone replacement because of my recent radiation treatment. Hopefully my body will be able to convert t4 to t3, since Cytomel is t3 and appears my body has responded well to it.

    • Mellissa says

      Also! I lost all 4 of my parathryoids due to lose of blood supply from the cancer around my thyroid..i hade deficiency in Vit. D and my nails started falling off.

  175. Hélène says

    Dr. Bryan Walsh is Da Bomb! He will educate you above most endos in just a few hrs!! Thyroid physiology is very understandable for the average layman. Even an endo could get it ~wickedgrin~
    The problem is finding doctors covered by health insurance and then paying for the pricey bloodwork and supplements needed. Especially as you try different treatments—needed even with the bloodwork (out of pocket again as not covered by insurance). Getting it exactly right off the first labs is unusual. Then more labs and more supplements.
    It’s out of the pocketbook of the average American and that is very frustrating. Dr. Walsh has the best model I’ve seen though…I noticed Chris is using it in his article :) Very familiar info!

  176. Mia Harris says

    Please help!!! So what is the solution? I have been to so many doctors and had so much blood work done, only (as you have stated) for them to come back completely normal. Yet, i have still have MANY symptoms of thyroid diseases. What type of doctor do I need to go to or is there a specific type of blood work that i should request? PLEASE HELP!!

  177. synthroid guy says

    Trying to get the insurance company to cover the screening for resistance to thyroid hormone is near impossible. Has anyone been able to get this passed through? Its $1000 test!

  178. says

    Hi I’m sitting in an exotic country where I cannot get T3 and my pharmacist miscalculated how many tablets I’d need and I’ve now had to take 1/4 of the dose to make it last til I get back to reorder back home. My husband has noticed my brain has “turned to mush” (his words) and of course I’ve noticed. My conservative doctor (I see two) didn’t believe in it, nor it seems do some other countries. All I can say is: I regained back a life with them, and without them I cannot function properly. Can someone explain in a quasi scientific manner at least, why it effects one’s brain functioning, so we both know?! Why this reluctance to acknowledge its benefits? Why does the mainstream research not back up people’s experiences?! I very much doubt it’s psychological…

  179. says

    Hi, Chris,

    I admit I did not read every comment … but I have Hashimoto’s and am working to find a cure for IT instead of simply treating my thyroid. I have been on Armour for about 4 years now (Synthroid did nothing to alleviate my symptoms) and would LOVE to get off of all the medication if I could. I have other complications as well: insulin resistance – pre diabetes. Bummage. I am using a (mostly) gluten-free diet, selenium, and iodine supplements. Any other advice you have for me regarding Hashimoto’s would be welcome.

    Meanwhile, I love proofing – I would happily proofread your articles before you post them for free. Let me know if you’re interested in that. :)

    God bless!
    -C

  180. Deanna says

    So I can see myself in two of these scenarios, but I don’t see where it says what the treatment that works so well would be if my doctor won’t prescribe Armour because my blood tests have me within a “normal” range even though I have been suffering symptoms for a long time and they are getting worse.

  181. says

    Following brain aneurysym have metal clip next to my pituitary gland. Since then have gone from being extremely hypo to
    being extremely hyper with thyroid readings according to
    my GP as being “like a galloping horse” . Also had extreme
    weight loss and barely able to function followed by adrenal
    failure.

    Since then my thyroid functioning has been extremely labile
    with both hypo/hyper symptoms for the past 20 years.
    Constantly have had my thyroid meds adjusted – major
    weight loss almost 20 lbs. despite truckdrivers appetite -
    Intense fatigue forcing my eyelids to close and again
    being forced to sleep. I also have IBS and with my now
    current very low TSH have gone to the other extreme
    of my IBS – constipation.

    Having coped with this misery for more than 20 years
    wonder why surgical removal of diseased multinodular
    goitre not being recommended – resolving the thyroid
    having any further influence on the pituitary gland
    obviously being effected by the brain aneurysm metal
    clip positioned beside it.

    Would like quality of life which my erratic thyroid
    functioning persists in denying to me – thankfully
    I am positive thinking and sure hope that a
    competent thyroid expert will be able to figure
    out the complexity of my symptoms.

    Thanks for listening.

    Marnie

  182. Trudi says

    Wanting to investigate some health issues before they become too great, I went to see an environmental dr to get to the bottom of what is actually happening in my body. Results show that I have elevated homocysteine levels. Other tests showed my TSH to be 0.8 (of which the dr was happy that all is well there, but which you interestingly list as being sub optimal). I have sometimes wondered about my thyroid hormones but a lot of the symptoms for hypothyroidism are the same as I those of Pyrrole Disorder for which my levels were found to be very high, explaining a lot of my symptoms. I was happy therefore with the outcome and that my thyroid hormones must be fine. I commenced nutritional supplements for the homocysteineand pyrrole issues and have been on for about three months. A couple of weeks ago I woke up with a huge lump on my thyroid, which was ultrasounded and found to be a burst cyst. The other thyroid lobe was found to have a 20-30mm nodule on it. My questions are: What causes nodules? Is it an indication that something IS going on with my thyroid? Can nodules be reduced in size or healed altogether? And you mention possible Thyroid resistance along with high homocycteine. How is this diagnosed? I am now lined up to get TSH, free t3, free t4 and thyroid ab’s. Is this enough? I certainly don’t want anything to be wrong with my thyroid. Am wanting to be over-tested? Or why is it so difficult to just get the whole picture on this?

    • Maria says

      Have you been tested for MTHFR gene mutation? If positive can cause high homocysteine levels. Its basically remedied by taking methylated folate, the natural form of folic acid, not synthetic folic acid. See MTHFR.net. My nodules went down when I started taking the right thyroid medicine and iodine which were prescribed through naturopathic Dr not allopathic Dr. Even my family physician knows how better test my thyroid than my endocrinologist so its important to go to the right Dr. one that has experience with actually healing the thyroid vs just treating the lab results, assuming the proper labs were done in the first place.

  183. Catherine says

    Thanks Chris. I looked over my daughters recent lab tests and her situation is best described by the first scenario I think. TSH 1.64. Free T3 2.7 Free T4 1.0. If supplementation isn’t the answer what steps can she take to feel better and function normally. She has the usual low thyroid symptoms
    Thanks
    Catherine

  184. vicky says

    I am definitely pattern no. 1. I have been for testing and told ‘im fine’ but I know something isn’t right, I was offered antidepressants! So with pattern 1 do I need something for my pituitary gland? I’d like to go armed with the right info to my dr so I can finally get this sorted.

    thank you so much for this information

  185. Hélène says

    Janelle re: convergence issue–I can’t find ur new comment, but I just got it in my email.
    My 9yo daughter has severe issues with reading. She also is now being labelled as having tracking problems, last yr it wasn’t bad enough to worry about. I thought tracking was a convergence thing. Her vision therapy trained optometrist hasn’t mentioned multifocals or any glasses for this. He just wants to do therapy. I homeschool and already do physical therapy exercises with her for this, among other things to help her brain learn the things we all do naturally in order to read. Last yr he had given her glasses for slight farsightedness, this year he said ditch them, not needed. I am very interested in your experience with this. Please email me my_bba at yahoo. Thank you so much :) Hélène

  186. Alicia says

    Hi Chris,
    My thyroid antibodies are rising since I changed to desiccated thyroid. What’s the deal with having a lot of antibodies- is it dangerous? It sounds bad!

  187. Virginia says

    You never mention anything about treatment. Do you have a link about suggested treatments? My doctor said all my test are normal but I have all the symptoms. I would love to explore some holistic alternatives rather than a prescription anyway. Any advice?

  188. jean says

    I have all the symptoms of hypo, tired, weight gain, can’t lose weight, const cold, dry skin, hair falling out, Mother has hypo etc… but labs are T4 free 1.0, total T3 112, TSH 2.03 and doc says normal! I’m thinking of self medicating by getting Amour or Synthroid from the internet. What else am I to do?

  189. Jessica says

    Hi Kris,
    Please tell me, how is hypothyroidism caused by pituitary dysfunction treated by endocrinologists? What do you recommend? Thanks!

  190. Emily says

    I think I’m having this issue, but with hyperthyroidism instead. I’ve had my levels tested and the first showed up slightly high and the others have been normal, but I’ve done so much research that I’m pretty positive it’s the issue. Are there reasons like those for hypothyroidism having “normal” tests with hyperthyroidism?

  191. Grace Green says

    I have an underactive thyroid…TSH, T3 & T4 tests seem to support this diagnosis.
    How important is it to know the cause of this?
    e.g. Do I need to know if it is Hashimoto’s?

  192. Laura says

    I just had my thyroid tested. I have so many of the issues that would be associated with hypothyroidism and my sister was recently diagnosed so I wanted a picture of what was going on. I purchased “they thyroid sessions” and have watched, listened and read until my brain hurt but I am still confused. My labs came back normal but I know normal isn’t always that clear. Can someone please help me understand them and offer guidance if I missed asking for something to be run? Thanks so much.

    Results: T4 1.0
    T3 80
    TSH third generation 1.430
    Thyroglobulin <0.9
    Peroxidase 1.6

    I am so thankful for any help and advice on understanding all of this!

  193. Eliana says

    I just had extensive blood work done and have high TSH (9.94). I do not see that listed among the five thyroid conditions you mention.
    Most of the other thyroid-related levels are within normal range, though toward the low end. Hemoglobin A1c is high, as is LDL and total cholesterol.
    I would appreciate your commenting on this configuration, at least the high TSH.

  194. Lindsey says

    I have all the symptoms of hypothyroidism but my blood tests came back normal. So what do I do now? Do I need to find a specialist? My doctor told me there is nothing else he can do. You said standard tests will not show the 5 patterns you listed so how do you know if you have one of them? Is there a specific test I can ask for?

    • Lindsey says

      My test results were as follows:
      TSH: 0.910 microIU/mL
      T4 0.91 ng/dl

      It looks like my TSH levels are bellow the functional range and my T4 is towards the lower end of the spectrum. Could it possible be a pituitary gland problem? How do I test for this?

  195. Cori B Lerner says

    I was just told I should get an MRI bc my TSH is low (.010) and T4 is also low. Dr suspects pituitary. I feel like my situation could be pattern 1 because I have been so stressed for so long… If the MRI reveals normal pituitary, what are my options for treatment for pattern 1? Thanks, Cori

  196. Melinda says

    I need help but don’t know were to turn I was recently told I have a 2mm cyst on my thyroid but my labs came back within normal limits but I have all the symptoms of hyperthyroidism what can I do

  197. says

    Wow. What an excellent article! I myself have studied thyroid time and time again, and have to revisit it with every thyroid case I see, because I haven’t been able to put the information into basic terms so that I can remember it (or describe it simply to my clients). Thank you so much for this clear explanation.

  198. Bonny L. says

    am I crazy

    TSH levels in May were 1.6
    September they were 2.4
    & cholesterol levels were slightly elevated
    And so was glucose level
    I asked for a Free T3 & Free T4 run. Results fro free T3: 2.7 & Free T4: .79
    I have itchy skin. Put on 12 pounds after dropping 10. So gain the 10 back plus 12 in a months time. Lightheaded at times, eczema issues. And just feel lousy and tired all the time. Should I seek a specialist I am tired of hearing your levels are in normal range.

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