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Why Normal TSH Doesn't Mean Your Thyroid Is Fine

Have you ever had your thyroid levels tested because you've had symptoms, only to be told that your levels are within range? You're not alone. Many people have 'normal' TSH levels, but continue to suffer from thyroid-related symptoms.


Let's take a look at why you might have normal TSH levels and how to identify thyroid disease through testing.

Can TSH levels really tell us everything we need to know about your thyroid gland?

TSH is like the whip that the pituitary uses to tell the thyroid how much hormone to produce. So in theory, it should give us an idea of how the thyroid is functioning.


But in the early stages of thyroid disease, TSH may fluctuate from day to day, or even be within normal limits.


Many doctors will test TSH and report to the patient that their levels are ‘normal’. But what is normal is not optimal by any stretch of the imagination!


As a result, many spend months or even years suffering from thyroid issues based on a single test that only gives us one piece of the puzzle.


The tests you need for thyroid disease

So if getting TSH tested isn't enough, how can we get a good picture of your thyroid health?


There are 3 main tests I recommend to get a more holistic overview of your thyroid function:

  1. Thyroxine (T4) - this is one of the thyroid hormones. However, T4 is inactive - it needs to be converted before it can exert effects on the body. So some people may have normal T4 levels and still have thyroid issues. That's why we want to look at the overall level of thyroxine and the ratio between T4 and T3.

  2. Triiodothyronine (T3) - This is the active form of thyroid hormone. Free T3 is the form that our cells need to function properly. However, there is another form of T3 called reverse T3. If the body is under stress or if you have elevated T3, it converts the T3 to reverse T3 - another inactive form. This can reduce your active T3 levels below where we want them to be.

  3. Thyroid antibodies (anti-TPO, anti-TG, TRAbs) - if there is autoimmunity occurring in your body, the immune system will produce antibodies. Autoimmune thyroid disease can be detected by the presence of one or more of these antibody types.


Further testing may be warranted depending on your specific symptoms and history. We don't just want to identify thyroid disease - we also want to uncover any underlying causes.


Some tests I recommend to specific clients include:

  • Cortisol and DHEA – to assess stress hormone levels

  • Salivary sex hormones – if there are hormonal symptoms

  • HbA1c – to identify if blood sugar dysregulation is occurring

  • A viral panel - to identify potential viral triggers such as EBV

  • H pylori – if there are any digestive issues that suggest overgrowth

  • Stool testing – if parasites and other gut-related issues are implicated

However, testing is only one part of your health picture.


Some of my clients have had minimal symptoms despite having high antibodies and out of range thyroid hormones. Other clients have had every thyroid symptom that you can think of, but their levels have only been slightly abnormal or just within range.


Sometimes the tests may not be accurately reflecting what is going on. So how you feel is just as important - if not more so!


What if my tests still come back normal?

You may benefit from working with a practitioner who has experience with elusive thyroid concerns such as antibody-negative thyroid disease and cellular hypothyroidism.


Want to get to the bottom of your thyroid symptoms? Book an appointment here.


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