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Thyroid Testing, Only Need TSH?

It was suggested by a urologist that I get my thyroid checked based on symptoms I’ve been having. And also, it was suggested to me on here as well.

So I made an appointment with my gp to get some testing ran. I wanted tsh, reverse t3, t3 and t4 ran. He told me that tsh was all that is needed and said that based on my past 4 or 5 tsh readings that he suspects that my tsh would be in normal range.

Is this true? My tsh came back at 1.8.

That is what is taught at GP school. On the surface, a TSH of 1.8 is not bad, however, especially if you are having hypothyroid symptoms, I think further evaluation is warranted.

I have an appointment with an endo for further evaluation. I think my gp is out of recommendations. He wants me to go on anxiety meds (ssri), but I refuse bc I’ve been on them before and they don’t seem to help. I’ve been dealing with symptoms for a while now.

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In the case of secondary hypothyroidism TSH can be normal. TSH is often unreliable for diagnosing secondary hypothyroidism.

For future reference, what levels of t4, t3, and rt3 are considered normal? I would assume the endo is going to do a more thorough evaluation and I want to know what I’m looking at.


So based on that chart, 1.8 isn’t a good number. Does this mean hypothyroid symptoms can occur if the tsh is over 1.0?

I have seen men at 3.8 and have no symptoms, good thyroid hormone levels and then I have seen a guy go on TRT and 6 weeks later is full blown hypothyroid at a TSH level of 2.7 and his Free T3 was below range.

As you can see TSH doesn’t always scale well with symptoms of hypothyroidism from the examples I’ve given you.

Your doctor left a lot up in the air by not checking thyroid hormones, he took a low resolution picture of his patient’s health and received limited information.

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So if his tsh was 2.7 and t3 was below range are saying full blown hypothyroid based on symptoms? I guess what I’m trying to ask is how do they make a diagnosis of hypothyroidism if numbers are in range?

Symptoms and a trial of thyroid meds. Thyroid bounces back to baseline pretty quick, so worst case you stop the meds and go back to baseline


So I assume that drs generally wont treat unless levels are outside the normal lab ranges? Basically like diagnosing hypogonadism.

Correct. TSH of 4.4 and textbook thyroid symptoms? Can’t be thyroid! Where’s the eye rolling emoji when you need it.

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Your garden variety sick care doctor (under insurance) will only treat the numbers when out of range. Now private doctors (paying out of pocket) tend to treat the symptoms and tend to have better treatment protocols.

Yes, but again privately you can get TRT and even thyroid treatment with in range numbers because you are paying for treatment. Whenever the insurance company is involved, barriers stand in your way of getting treatment.

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As mentioned above, they do not. By definition, you are not hypothyroid if your TSH is not above 4.5. You are subclinical hypothyroidism. Rendering a diagnosis of hypothyroidism without the clinical evidence to support it and submitting to insurance for rx coverage is fraud. Insurance carriers like to collect premiums, they do not like to pay claims.