TSH – Why It’s Useless
(All of the below, plus even more detail, can be found in Chapter 4 in the revised STTM book, which can be helpful if you have the book right with you at your doctor’s appointment. Bookmark key areas.)
The TSH (Thyroid Stimulating Hormone) lab test:
It’s been around since the early 1970’s and has been touted as the gold standard to ascertain your thyroid state, or to know whether you are adequately treated according to a “normal” range. .
And talk to any Endocrinologist or most medical-school-trained doctors, and you will be told the following:
- The TSH lab is a reliable physiological marker of thyroid function (i.e. whether you are hypo or hyper)
- It’s an accurate guide for your medication supplementation amount.
- The lower your TSH while on desiccated thyroid, the greater your chance of osteoporosis or heart attack.
- There’s an optimal place to be on the TSH range when on meds, such as between 1 and 2, or ‘fill-in-the-blank’.
But, reported experiences of patients have found ALL THE ABOVE to be totally false!
Granted, you can have a high TSH and finally find out that you are hypothyroid. But…not only are patients with OBVIOUS hypothyroid symptoms being told they have no thyroid problem because of a “normal” TSH (i.e. a TSH number in range), they are being held hostage to the TSH range when on thyroid medications, even though the patient continues to have typical hypothyroid symptoms while in the range.
WHAT IS THE TSH?
In your body, the actual Thyroid Stimulating Hormone (TSH) is synthesized and secreted by your pituitary gland…i.e. it’s a “pituitary” hormone, NOT a thyroid hormone. You can view the TSH like a messenger sent to knock on the door of the thyroid. And its purpose is to regulate your thyroid gland–to tell it to produce more, or to tell it to produce less. In a healthy individual, its message is based on whether your blood levels have too little thyroid hormones to meet the demands of your body, or too much. When the thyroid gland becomes diseased or disabled and fails to do its job adequately (called hypothyroidism), the TSH knocks and knocks on the door, and theoretically, the TSH lab will show a high number. Or, if the thyroid gland gets on its exercise bicycle and overproduces thyroid hormones (called hyperthyroidism), the TSH lab will theoretically go low to show that the TSH in your body isn’t knocking. Occasionally, patients will have a very low TSH (such as 1 or less) along with a low in range free T3, plus with hypothyroid symptoms, and that can point to a problem in the Pituitary gland, called Hypopituitary. The latter is usually due to a diseased pituitary gland, or a problem with the Hypothalamus, which is the organ that sends it’s messenger to the Pituitary. (The Hypothalamus, Pituitary and Thyroid glands make up with is called a Feedback Loop.)
WHEN WAS THE TSH LAB DEVELOPED??
The TSH lab test was developed around 1973, using approximately 200 volunteers were used to establish the “normal” range. Over the years, additional population studies have been done to back up the range. The “normal” reference range is intended to represent the range of values for those in a healthy population without any thyroid problem. The lowest and highest readings to create the range are usually thrown out. But sad to consider, how do they really KNOW that those in the so-called healthy population weren’t already on a slide into hypothyroid? How many millions of hypothyroid patients have been told they were normal, even when symptoms persisted that doctors dismissed? Dr. David Derry of Canada was practicing medicine when the TSH lab was introduced, and he made the profound observation:
“The consensus of thyroidologists decided in 1973 that the TSH (lab) was the blood test they had been looking for all through the years. This was about two years after I started practice. Having been taught how to diagnose hypothyroid conditions clinically, I was in a position to watch to see what the relation of the TSH was to the onset of hypothyroidism. What I found was many people would develop classic signs and symptoms of hypothyroidism but the TSH was ever so slow to become abnormal, rise and confirm the clinical diagnosis. Sometimes it never did. Finally I began treating patients with hypothyroid in the normal manner I was taught. I could not see why I had to wait for the TSH to rise for me to be able to treat them.”
Dr. Derry discovered exactly what we, as patients, have experienced for more than three decades! Namely, not only has the TSH lab failed to reveal that we were ALREADY hypothyroid, it fails us when we are dosing our medication. In other words, the TSH is thoroughly unrelated to how we feel! This has been ESPECIALLY true when on inadequate T4-only meds, and it continues to be true when we start on an desiccated thyroid if we are forced to stay within the TSH range.
WHAT IS PATIENT EXPERIENCE WITH THE TSH LAB?
It’s lousy. Granted, there are many thyroid patients, like the creator of this site, whose high TSH can finally diagnose their hypothyroidism. But, there is also a huge body of hypothyroid patients who have a so-called “normal” TSH lab result and for years…along with classic or raging hypothyroid symptoms. And because doctors have become lab-obsessed rather than giving credence to clinical presentation, patients remain undiagnosed for years before the number rises high enough to reveal the condition. Then, even when the patient is on a T4-only medication, or on the better treatment with desiccated thyroid, some symptoms remain–from mild to disabling–when they are forced to stay in the TSH range.
Additionally, because doctors view the TSH man-made lab as infallible, they fail to understand that the continued symptom complaints by patients reveal that the lab and its range is unreliable and a huge failure! Patients who have switched to natural desiccated thyroid have discovered that when they are allowed to dose by the COMPLETE elimination of symptoms, which also puts the free T3 at the top of the range, they will end up with a TSH lab VERY BELOW range….and not one hint of hyperthyroid. It is not uncommon to see a TSH of .009 or .004 when optimal, for example, yet not one iota of hyper. (If you do have a suppressed TSH with hyper-like symptoms, it’s time to check your adrenal status or your Reverse T3/Free T3 ratio. The STTM book has more information about the latter.)
Additionally, patients see both their heart health and their bone strength completely improve, even with a TSH far below the so-called normal range, when on an optimal amount of desiccated thyroid and strong adrenals or adequate adrenal support.
NOTE: if you are still on Synthroid or Levothyroxine, pushing your TSH down by raising your T4 meds can backfire. The body can start converting that higher and higher T4 level into RT3–an inactive hormone.
DOES BEING A SMOKER AFFECT THE TSH LAB TEST?
Yes, in such a way that smoking will lower your TSH, which can hide the fact that you can be undiagnosed hypothyroid, or undertreated. See an interesting research study on smoking and your TSH here.
WHAT IS THE BOTTOM LINE ABOUT THE TSH LAB ACCORDING TO THE EXPERIENCE OF PATIENTS?
Two words: it sucks. It can leave hypothyroid patients undiagnosed for years. And even when on meds, its dubious normal range leaves patients with continuing hypothyroid symptoms, including bone density and heart problems. The best use for the TSH pertains to what is IS: a PITUITARY HORMONE! And for that, it’s a good guide to reveal if you have a malfunctioning pituitary gland, especially if you have a very low TSH and low free T3, accompanied by raging hypothyroid symptoms.
For thyroid diagnosis and dosing….the man-made TSH lab gets an “F” on the thyroid report card, as do doctors who use it. SEE CHAPTER 4 IN THE REVISED STTM BOOK for more pertinent information on the TSH.
Want to order your own labwork?? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/
Want to read more? Below are links to articles about the TSH and it’s fallacy:
And for further info, here’s the link to the webpage that states that “estimates of average normal secretion for euthyroid humans are 94-110 µg T4 and 10-22 µg T3 daily (259).” And that is approximately equivalent to 3-5 grains desiccated thyroid. And when you get close to or in that range of desiccated thyroid, you WILL have a suppressed TSH lab, which tells you how inaccurate the established man-made TSH range is.
A further note from Janie: I have observed that at least 50% of thyroid patients who come to thyroid groups or forums have a VERY “normal” TSH, even as low as the one’s…with raging hypothyroid symptoms. It seems to take years for the TSH lab result to rise and reflect their hypothyroid state. Not only has the man-made TSH lab been a total failure for diagnosis of hypothyroid for many, it fails the patient even on thyroid supplementation! We can only hope that doctors will start paying attention to “clinical presentation”!
Need help interpreting your lab results? Go here.