Being Hypothyroid with a Normal TSH

Have you been told that your TSH is ‘normal’, ‘fine’, ‘OK’,  or ‘in range’, and still have hypothyroid symptoms? You could be on thyroid medication or not, and have a TSH as described above, and still be hypothyroid.

You could be hypothyroid at a cellular level, due to conversion problems of T4 into T3.

T4 is said to be about 90% of what the thyroid gland produces, with around 9% being T3. Some of the T4 also converts in to T3, or at least it should, and adequate levels of both is what’s needed to help us feel well and carry out all our usual bodily functions and processes.

But an inability to properly convert T4 to T3 is common among thyroid patients and can result in a fluctuating TSH or TSH that is ‘in range’ and low T3 and T4. This could be for someone on or not on thyroid medication. Conversion problems can be caused by adrenal fatigue, or other vitamin deficiencies such as iron. By addressing  these, you may fix the conversion problem. Other people simply have a problem converting and don’t know why. But it’s a big reason as to why NDT tends to work better for a lot of patients, instead of Levo or Synthroid.

This is because a lot of people do better on medicine that gives them direct T3, so they don’t have to rely on their body to convert it. This can be NDT or T3 and T4 combination medication.

It still baffles me that doctors expect those of us with an already rubbish thyroid gland, that already can’t function properly, to also convert what it is producing, in to the right amount of hormones. It just doesn’t make sense!

The optimal TSH level is well reported to be between 0.5-2, with ‘the lower the better’ being the main consensus. But I’ve heard that many doctors use an out-dated reference range going anywhere up to 6 or even 10 (disgusting), and feel that anyone falling within this huge range is adequately managed. If your hypothyroidism is not properly managed, it puts you at risk of developing other health conditions, whether it is too high or too low. 0.5-2 is what you should be aiming for to avoid conditions such as dementia, heart problems and mental health problems, as explained here.

If your TSH is within the recommended 0.5-2 range and you still don’t feel well, or even if it isn’t 2 or below, you’ll need to make sure that your Free T3 and Free T4 also sit in the right place, with optimal readings being suggested as: Free T3 being in the top quarter of the range and a Free T4 mid-range or a bit higher, recommended. Other key tests, like adrenal function, are explained here.

You can click on the hyperlinks in the above post to learn more and see references to information given, but more reading and references can also be found at:

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