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Can You Have Normal Thyroid Levels And Still Have Hypothyroidism

Case 2: How Your Thyroid Medication Can Falsify Your Normal Tsh Test

Why Your TSH Is Normal Yet You Still Have Hypothyroid Symptoms

Your body is designed to self-regulate its own thyroid hormone production.

To ensure that you have an adequate supply of thyroid hormone available, your body monitors how much thyroid hormone is in your bloodstream.

It then self-adjusts your TSH to tell your thyroid gland how much more thyroid hormone you need.

This is referred to as the thyroid hormone feedback cycle.

When your thyroid hormone levels are low, your TSH increases to tell your thyroid gland to produce more thyroid hormone.

When thyroid hormone levels are normal, your TSH decreases to tell your thyroid gland to produce less thyroid hormone.

Now, heres the problem

Doctors are trained to believe that your liver will automatically convert the inactive T4 in your thyroid medication into the active T3 thyroid hormone you need.

If your thyroid hormone pathway werent blocked, then this feedback cycle would work flawlessly as doctors expect it to.

However, this is rarely, if ever, the case.

In fact, most hypothyroidism suffers cant properly convert their thyroid medication.

to your cells, youll always be hypothyroid, as I covered in this post on How We Overcome Hypothyroidism When All Else Fails.)

Heres what happens when you take your thyroid medication and your liver cant convert it:

  • Your inactive thyroid hormone builds up in your bloodstream.
  • This tricks your thyroid hormone feedback cycle into thinking your thyroid is happily producing plenty of thyroid hormone.
  • and youre still hypothyroid .


    Cholesterol Thyroid Hormone And Tsh Measurements

    Cholesterol, TSH, and thyroid hormones were measured using the Roche Cobas 6000 . FT3 and FT4 were measured by ultrafiltration isotope dilution LC-MS/MS using a SCIEX Triple-Quad-6500 System as previously described . TT3, and TT4 were measured by atmospheric pressure photoionization liquid chromatography-tandem mass spectrometry using the Agilent 6460 triple-quadrapole mass spectrometer coupled to the Agilent 1200 Infinity Series HPLC as previously described .

    What To Consider In Your Personal And Family Medical Histories

    Its important to give your physician as many details as possible about your personal medical history, as well as family history . Be sure to discuss:

    • Your general state of healthparticularly any changes you have noticed in your general overall health.
    • Your familys health historyespecially if a close relative has been diagnosed with hypothyroidism .
    • Whether youve ever had thyroid surgery, or radiation to your neck to treat cancer.
    • Any medicines you may be taking that could cause hypothyroidism .

    Physical ExaminationLooking for Signs of HypothyroidismYour physician will perform a thorough examination and look for physical signs of hypothyroidism, including:

    • Evidence of dry skin
    • Swelling around the eyes and legs
    • Slower reflexes
    • Slower heart rate

    Blood Tests:;Hypothyroidism can be detected by different blood tests.

    • TSH Test.;;A thyroid-stimulating hormone or TSH is a blood test that measures the amount of T4 that the thyroid is being signaled to make. If you have an abnormally high level of TSH, it could mean you have hypothyroidism.
    • T4 Test.;The thyroid gland produces T4 . The free T4 and the free T4 index are blood tests that, in combination with a TSH test, can let your physician know how your thyroid is functioning.;

    Normal and Abnormal TSH Ranges

    An easy way to remember how the thyroid works–think about supply and demand. As the T4 level falls, the TSH rises. As the T4 level rises, the TSH falls. However, not everyone with hypothyroidism has elevated levels of TSH.;

    Read Also: Is Thyroid A Problem In Pregnancy

    How To Test For The Five Thyroid Patterns

    The standard thyroid panel is insufficient for detecting these five patterns of thyroid dysfunction. Additional tests are needed to determine which thyroid pattern is affecting your patient.

    A comprehensive panel of thyroid markers: This panel should include TSH, T3, T4, free T3, and free T4.

    DUTCH test for assessing HPA axis function: This test can help you determine whether chronic stress and high cortisol are causing pituitary dysfunction, under-conversion of T4 to T3, or thyroid hormone resistance.

    Estrogen and testosterone: Measuring these hormones can help you determine whether elevated or decreased TBG, respectively, are the cause of your patients hypothyroidism.

    Fasting blood sugar and hemoglobin A1c, to assess blood sugar imbalances and insulin resistance, which contribute to hypothyroidism caused by pituitary dysfunction.

    Ferritin and serum selenium, to identify deficiencies of iron and selenium.

    Assess gut health: Stool testing, hydrogen breath testing for SIBO, and a urine organic acids profile can be used to identify potential gut infections and dysbiosis contributing to hypothyroidism.

    Follow Along With Me Here For Just A Minute

    Thyroid Disease

    Above you see some of the blood work I recently ran on a patient. She was still suffering with thyroid symptoms despite being told everything is Normal.

    Imagine how long this patient was suffering prior to coming to our office and getting the diagnosis that she has an autoimmune disease. You can clearly see that her TSH is normal, Her T4 levels are Normal, Her T3 Levels are Normal. She clearly has an autoimmune problem.

    If we just treat numbers we miss the person standing in front of us! The person whose world is crashing down.

    As you can see form this study published in Expert Review of Endocrinology and Metabolism- A patient suffering with a Thyroid disorder Should Have their Antibodies tested. Patients can have normal thyroid stimulating hormones but have Hashimotos.

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    Need To Check Your Thyroid Maybe Not

    • By , Contributor

    As medical science advances, we have more tests and biomarkers available to help identify illnesses. Yet overdiagnosis and overtreatment that may occur following abnormal results can cause dangerous adverse effects and costly consequences. Hypothyroidism a lower than normal range of thyroid hormones may be the poster child for this problem because it is such a common condition.

    What Causes Hypothyroidism

    Hypothyroidism can have a primary cause or a secondary cause. A primary cause is a condition that directly impacts the thyroid and causes it to create low levels of thyroid hormones. A secondary cause is something that causes the pituitary gland to fail, which means it cant send thyroid stimulating hormone to the thyroid to balance out the thyroid hormones.

    Primary causes of hypothyroidism are much more common. The most common of these primary causes is an autoimmune condition called Hashimotos disease. Also called Hashimotos thyroiditis or chronic lymphocytic thyroiditis, this condition is hereditary . In Hashimotos disease, the bodys immune system attacks and damages the thyroid. This prevents the thyroid from making and releasing enough thyroid hormone.

    The other primary causes of hypothyroidism can include:

    In some cases, thyroiditis can happen after a pregnancy or a viral illness.

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    What Is A Tsh Test

    Thyroid testsBlood tests to measure thyroid hormones are readily available and widely used. Not all thyroid tests are useful in all situations.

    TSH TestThe best way to initially test thyroid function is to measure the TSH level in a blood sample. Changes in TSH can serve as an “early warning system” often occurring before the actual level of thyroid hormones in the body becomes too high or too low.

    A high TSH level indicates that the thyroid gland is not making enough thyroid hormone . On the other hand, a low TSH level usually indicates that the thyroid is producing too much thyroid hormone . Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid . In most healthy individuals, a normal TSH value means that the thyroid is functioning properly.

    How Is Goitre Treated

    Why You Still Have Thyroid Symptoms With Normal TSH and T4

    Treatment depends on the underlying cause of the goitre.;Simple goitre, where there is no thyroid hormone imbalance and no problems arising from the size of the thyroid, is unlikely to cause problems. In case the goitre is large and symptomatic , it may be appropriate to consider surgery , though this will result in the patient requiring lifelong thyroxine replacement.

    Treatment of overactive and underactive thyroid is explained in articles on hyperthyroidism and hypothyroidism, respectively.

    Also Check: What Is The Isthmus Of The Thyroid

    Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism

    The Thyroid Federation International estimates there are up to 300 million people worldwide suffering from thyroid dysfunction yet over half are presumed to be unaware of their condition. Hypothyroidism, an underactive thyroid, is one of the most undiagnosed, misdiagnosed, and unrecognized health problems in the world. It is an epidemic that is sweeping the globe yet doctors are failing to recognize and diagnose hypothyroidism. Hypothyroid patients are falling through the cracks of mainstream medicine, left to suffer debilitating and even life-threatening symptoms. What is going on?

    The Myth Of Blood Tests As The Only Reliable Way Of Diagnosing Thyroid Conditions

    If your TSH test result is abnormal the lab will run an FT4 check as well.; Whilst this is an improvement on a TSH only check, it is still fallible and can produce false negatives.

    Doctors have been looking for a diagnostic test for thyroid problems ever since the importance of thyroid hormones was recognised late in the eighteenth century.; There have been numerous proposals for different tests for thyroid illness prior to the advent of the blood test used today but not one was found to be reliable. ;Unfortunately, the currently used thyroid function test, based on a blood sample, has its own limitations.

    What should really be measured are the thyroid hormone levels in every cell in the body. ;As it is not practical to do this, they are in effect inferred from those in the bloodstream. ;However, the transfer of thyroid hormones from the bloodstream and into the cells is quite a complicated matter and there are several points in the process where problems may arise.

    If your clinician dismisses your symptoms as being too general and non-specific Non-specific “have more than one possible cause” to allow a definitive diagnosis to be made from them, your hypothyroidism may well remain undiagnosed. ;Ideally non-thyroidal blood markers indicating thyroid hormone insufficiency should be identified and these would be more informative.

    Also Check: What Happens When Thyroid Nodules Grow

    Your Labs Aren’t Optimized

    You can really think of this as an extension of #2 which has to do with your dose of thyroid medication.;

    Your dose of thyroid medication directly influences your thyroid lab tests.;

    And when I am talking about thyroid lab tests I am referring to much more than just the TSH.;

    I am referring to the combination of TSH, free T3, free T4, and reverse T3 .;

    Any thyroid medication that you take by mouth will have a direct influence on these lab tests either for the positive or for the negative.;

    For instance:

    As you take thyroid medication you should notice that your TSH decreases.;

    This decrease is more prominent with medications which contain T3 thyroid hormone but any and all thyroid medications will cause a decrease in the TSH.;

    But in addition to influencing your TSH, your thyroid medication will also have an influence on the other thyroid lab metrics I’ve listed above.;

    If you are taking the thyroid medication levothyroxine then this medication should be causing all of the following changes to your labs:

    • A reduction in the TSH
    • An elevation in free T3
    • No effect on reverse T3
    • An elevation in total T3

    Taking this medication SHOULD impact your thyroid lab tests in the following way. But just because it can impact them does not tell you anything about the degree with which it impacts them.;

    And the degree to which levothyroxine impacts your lab tests has to do with the dose that you are taking.;

    This optimization is complex but it is nonetheless very important.;

    Why Hypothyroid Patients Get Frustrated With The Tsh

    TSH Test Results are often Normal even with Hypothyroid ...


    This article is dedicated to people who already have low thyroid conditions such as hypothyroidism or Hashimoto’s thyroiditis.;

    If you do NOT have a known diagnosis of hypothyroidism or Hashimoto’s then you would want to look at this article about the TSH instead.;

    Interpreting the TSH level in people who are taking thyroid medication is much different compared to people who are NOT on any thyroid medication.;

    Back on topic.;

    Thyroid patients often get incredibly frustrated with their doctor when it comes to the TSH.;


    Because their doctor is constantly trying to tell them that their TSH is normal even though they are experiencing low thyroid symptoms such as fatigue, weight gain, constipation, etc.;

    How can you experience low thyroid symptoms while simultaneously being told that your thyroid is “fine”.;

    Something doesn’t make sense here. Either you are lying or your doctor is wrong when they say that the TSH is a measure of thyroid function.;

    And, unfortunately, it’s not that you are lying but that your doctor is wrong.;

    The standard reference range that your doctor will use to determine if your TSH is “normal” typically ranges from around 0.5 to 5.5 .;

    And your doctor will consider you “normal” if you are anywhere on this range.;

    Many thyroid patients have realized that this range is far too broad and have found that narrowing the range may help improve how people feel.;

    This has lead to the “optimal” ranges that you see so frequently floating around .;

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    The Five Thyroid Patterns

    Thyroid physiology is complex and regulated by input from multiple endocrine glands, the immune system, the gut, and many cell-signaling molecules. Malfunctions in any one of these components can cause hypothyroid symptoms. However, these malfunctions are not revealed by a standard thyroid panel. Patients with hypothyroid symptoms but normal TSH and T4 according to the standard thyroid panel may be told that nothing is wrong with their thyroid glands and sent on their way. Some are handed prescriptions for thyroid hormone replacement. This one-size-fits-all approach to managing hypothyroidism ignores the multitude of factors that influence thyroid function and may even worsen symptoms in some patients. At best, it does our patients a disservice, and at worst it could be considered sheer negligence.

    Reasons You May Have Thyroid Symptoms Even Though Your Tsh Levels Are Normal:

    • The pituitary which produces TSH is dysfunctional and does not produce enough TSH even though there are low levels of thyroid hormone in circulation.This is considered secondary hypothyroidism.
    • The testing margins of normal TSH are too wide for optimal health, resulting in subclinical hypothyroidism.
    • Under-conversion of T4 to the active T3 form, which happens due to certain medications, high cortisol levels , high carbohydrate / low protein diets, selenium deficiency and kidney/liver dysfunction.
    • Elevated or decreased thyroid binding globulin that transports thyroid hormone while in circulation.
    • Elevated levels of reverse T3; which displaces active T3 thyroid hormones from cellular receptors, and is caused by stress, inflammation, low calorie diets, infections and kidney/liver dysfunction.
    • Autoimmunity in the form of Hashimotos thyroiditis where the body attacks thyroid peroxidase or thyroglobulin . Approximately 90% of primary hypothyroidism is autoimmune and caused by Hashimotos thyroiditis.

    As our doctors rely on a single test such as TSH to determine hypothyroidism, misdiagnosis is common. The TSH test is an indicator of pituitary production, and cannot be relied upon as way to measure the effectiveness of the thyroid gland which it regulates. If you are experiencing thyroid symptoms despite a normal TSH level, request your Free T4, Free T3, and thyroid antibodies be tested. You may need to visit a Naturopath to get these tests done.

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    What If They Never Identified Your Immune System Triggers You Would Get Sicker Wouldnt You

    Hashimotos is the most common cause of low thyroid.

    New research out this year proves that when women have TPO antibodieswhich, along with anti-thyroglobulin antibodies are what you test for when youre lookng for Hashimotos-have a decreased quality of life even if their TSH and their hormone levels are normal.

    Case in point just yesterday, I was talking to a new patient and she told me she just found out from her endocrinologist that she has a raging case of Hashimotos.

    But the doctor; cant do anything for her because her TSH is normal.


    I was floored.; Its like her doctor thinks shes handcuffed.

    I know youve got these antibodies, but I cant do anything for you because of some bogus artificial rule that the patients TSH must be higher than X number etc.

    The doctor could do something for her,; IF the doctor had training in non-drug management.

    But I guess in fairness the only thing that her doctor can do is prescribe Thyroid hormone replacement. ;Doctors guidelines state that if ;TSH ;levels are normal, , then the doctor cant do anything for the patient.

    Treatment Based On Severity

    Spartanburg SC Low Thyroid Clinic: Why You Have Normal TSH Levels But Still Have Symptoms

    If your TSH levels are low but still detectable and you dont have complications, you may not receive immediate treatment. Instead, your doctor may choose to retest your TSH levels every few months until they return to normal or your doctor is satisfied that your condition is stable.

    Treatment may be required if your TSH levels fall into Grade I or Grade II and youre in the following risk groups:

    • youre over 65 years of age
    • you have cardiovascular disease
    • you have symptoms suggestive of hyperthyroidism

    Your treatment will depend on what type of condition is causing your subclinical hyperthyroidism.

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    What Is The Thyroid Gland

    The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

    Five Thyroid Patterns That Wont Show Up On Standard Lab Tests

    In medicine, accurate diagnosis is essential for selecting the most effective course of treatment for a patient. Unfortunately, misdiagnosis is commonplace in the management of hypothyroidism. Countless patients with hypothyroid symptoms are dismissed because their lab values dont fit within the narrow diagnostic criteria established by standard thyroid panels; others are given prescriptions for thyroid hormone replacement, a blanket approach that fails to address the underlying causes of hypothyroidism. Many of these patients suffer from patterns of thyroid dysfunction that dont show up on standard lab tests and that are unfamiliar to conventional doctors. Read on to learn about the five patterns of thyroid dysfunction that are missed by standard lab tests and how you can successfully correct these patterns and restore thyroid health in your patients.

    Also Check: How To Reduce Thyroid Cysts Naturally


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