T Nation

Thyroid - Please Help Me Understand


I have an under-active thyroid as a result of radiation to that area many years ago. I’ve been taking levothyroxine for many years. Current dosage 88mcg/daily.

Even though this medication has been in the “normal” range, I have been having symptoms like cold hands/feet, lack of energy, some foggy thinking and reading things on this forum are making me think maybe I should be treating this differently.

Here are my questions.

  1. I’ve posted labs from earlier this week to see if anybody here who is super knowledgeable about thyroid as any comments.

  2. I’ve read on various comments that you want to get your TSH at or under 1. If this number is lower, wouldn’t that mean less thyroid and therefore possibly worse symptoms? Or is there some sort of inverse relationship?

  3. Any thoughts on synthetic thyroid vs. Armour (for example) or something compounded?

Thanks for any informed input!

Very recent labs:
Free T 4 index: 2.5, range 1.4-3.8
T3 Uptake: 34, range 22-35
T3 Free: 3.1, range 2.3-4.2
T4: 7.4, range 4.9-10.5
T4 Free: 1.3, range 0.8-1.8
TSH: 2.09, range 0.40-4.50


I am interested in the replies you get on this, because this thyroid stuff is confusing, and I would like to understand it myself.


Briefly, your pituitary produces TSH to stimulate the thyroid gland to make thyroxine (T4). The TSH level indicates how much thyroid your brain thinks you need, so when it is higher, it’s trying to get your thyroid to make more T4. Your 2.09 is not terrible, but optimal is thought to be closer to 1.0.

To complicate things further T4 does not work and is converted to T3 by deiodinase enzymes and the free T3 is really the number to look at, as T3 does the thyroid work in the body. There is an enzyme that converts T4 to something called reverse T3, sort of an upside down version of the molecule. It does not work in the cells, but blocks the receptor site so free T3 cannot work. If that is elevated, your decent level of free T3 is misleading. Optimal free T3 is closer to 4.2. It would be nice to know your rT3 and with a fT3 of 3.1, it should not be over 15.

Some do fine with synthetic T4 preparations, if there is no conversion issue. Armour is desiccated pig thyroid and it contains T4 and T3. The advantage of compounded T3/T4 is that the exact T3 level is there, and you do not need to rely as much on the conversion of T4 to T3.

Your symptoms indicate your thyroid is not optimal.

Hope this helps.


The lower the TSH, the more the pituitary gland is satisfied with the amount of thyroid hormone being produced. People on thyroid treatment tend to do better with TSH almost suppressed, somewhere between a TSH of 0 - .5.

When the pituitary gland isn’t satisfied with the amount of thyroid hormone being produced, it will increase TSH to encourage more thyroid hormones production.

Curious what does your doctor think of your levels and symptoms?

I hope this doctor isn’t happy with these suboptimal results.


You can become hyperthyroid too if you do this. Which is not good.

Never heard of this target of TSH.
Under 2.0 should be fine.
It’s like chasing e2=22. Not good.


There are some people who don’t feel well unless TSH is almost suppressed, there are those that do well near the top of the ranges for Free T3 just like there are those who do well with Total T at top of the ranges.

I don’t believe in one size fits all.


When a TSH is greater than 1.0, it may indicate some degree of hypothyroidism for someone already taking thyroid hormone who is still symptomatic. A higher dose may be beneficial if other factors like iron, cortisol, blood sugar, etc. have already been addressed. The current TSH reference range probably goes too high because it includes undiagnosed hypothyroid patients. Data has shown that African-Americans, who have a very low incidence of Hashimoto’s thyroiditis, have an average TSH of 1.18. This may be more representative of the true normal mean TSH of a normal population. [2] Another study found increased arterial stiffness (which correlates with heart disease) in subjects whose TSH was 2.01-4.0, which is within the normal range.

Surprisingly, patients can have suppressed TSH levels while taking any form of T3, but do not exhibit any hyperthyroid symptoms. Dosing by TSH will usually leave the patient undermedicated with hypothyroid symptoms.

This is the case. ^^^^


I don’t want to highjack, but I have a question.
Will a basic thyroid panel TSH, T4, T3
help determine hyperthyroidism? Or does need to include rT3 as well?


A thyroid panel should cover everything, skipping RT3 could prevent a proper diagnosis. Ferritin and cortisol is also important for thyroid hormone production.


Free t3
Free t4
Reverse t3
And thyroid antibodies


Thank you!


Thank you! I just want to get this right the first time.


Your posts are super helpful. Thanks !

FYI: my cortisol was 12.2, range 4-22


TPO or TSi?


These two

Thyroid peroxidase antibody (TPO)—the most common test for autoimmune thyroid disease; it can be detected in Graves disease or Hashimoto thyroiditis. Thyroglobulin antibody (TGAb)— this antibody targets thyroglobulin, the storage form of thyroid hormones.


Thank you! I was looking at panels and wasn’t sure which one.


I have another question. I have an unreasonable fear of doctors, but am tired of starting over. Broke down and went to the doc. Tried to talk him into the thyroid panel, it ws a no go. He did however test TSH. Came back at .233 So he said that my levels were elevated.

Now then, he said that the TSH levels change slowly, and that this will show what was doing like three months ago.
Has anybody ever heard of this?