When are Thyroid Meds Needed?

Hello brothers -

My latest TSH is 3.5 with Free T3/T4 mid range but I have elevated antibodies indicative of Hashimotos disease.

After going in TRT a few months ago I feel better than ever - no low Thyroid symptoms - but my doc thought I’d benefit from a small amount of synthetic Thyroid.

Any thoughts on this? My plan was to just cruise in TRT since I have no symptoms and get a full Thyroid panel in a few months.

Without digging through any other threads you have for background …

In general, if there is any reason to suspect that there has been iodine deficiency, one should attempt iodine replenishment and throw out sea salt, kosher salt, pink salts, “real salt”, Himalayan salts etc.

“elevated antibodies indicative of Hashimotos disease”: Also note that when the thyroid has been stressed with higher TSH levels and subjected to a lack of selenium, free radical damage can occur as selenium needing enzymes are not working and tissue damage can occur with possible immune system then detecting normal thyroid tissues as foreign. In this situation when numbers are not so bad, one can restore iodine intake and use a multi-vit that contains 150mcg iodine and 150-200mcg selenium. So one might be able to restore normal thyroid function.

Note that higher iodine dosing does and is expected to increase TSH and then TSH labs are sort of useless. Many doctors with limited knowledge will freak out - needlessly.

I have never seen a report that any doctors have ever asked guys here about their use of iodized salt. Too many have iodine deficiency addressed with thyroid meds. Otherwise, the insane thyroid lab ranges mean that people suffer with “normal” lab results and feel horrible, but docs have anti-depressants for that.

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I would be very careful with any iodine supplements. Depending on many other factors, iodine could possibly make things worse. I concur on the use of Selenium but also add D3 and Ashgwandha which has shown to be an adaptogen meaning brings balance. It helps stimulate thyroid hormone and maintain a balance. I deal with hashimoto’s and use these along with Synthroid. My TSH came down from 13+ to around 4 in one month. Of course some gluten free dietary changes also come into play there.

But don’t be quick to start using any thyroid meds without assurance of its need. TSH is on the high side of normal but should be monitored. I suggest a blood test every 6 weeks to stay on top of it. And relax, stress is the hardest on the thyroid.

Please see this. Body temps may be a better indicator of dosing needs than labs. TSH=~4 is still quite bad. See the reference sticky as well.

I suspect that your knowledge re iodine may be quite out-of-date.

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

The problem is that your immune system can mistake the thyroid for gluten, causing it to come under attack. When people think of gluten intolerance, they typically think of celiac disease (CD), but this is just one manifestation of gluten intolerance

I recommend checking into: Gluten, Leaky Gut, and Autoimmune Thyroid Disease

Hashimoto’s is caused by a selenium deficiency. If the thyroid has been under active with an iodine deficiency, supplemental iodine ramps up the pre-existing problem. At some point, the inflammation can trigger an unwanted immune response. So it is really not good to state that iodine is the cause. It is like saying that putting gasoline in your car caused car accidents. I strongly feel that years of low iodine with higher TSH levels is damaging and we do see that causing thyroid nodules and progress from hypo to hyperthyroidism with cancer end-points.

How else can this be stated? Iodine deficiency protects from selenium deficiency auto-immune progression? What the is the cost of that? - low energy, lethargy, low libido, mood/depression issues, lower immunity, general hair thinning and a connection to low-T is suspected

I think it depends on how long the underlying Hashimoto’s has existed and specifically how much damage or lost thyroid tissue has occurred.

In my case 4 years ago after a Fistula surgery I became extremely hypothyroid and a TSH blood test was run that came back at 20.85. I do not know how long I may have had Hashimoto’s and I have gone back looking through pictures looking for thinned eyebrows and tried to recall any symptoms I ignored.

Additional labwork was run, Prolactin, T4 Free, T3 Free, TPO antibodies which was discovered to be 485, MRI on the pituitary and also an ultrasound of the thyroid showing partial tissue damage.

I ran through Idiot after Idiot and was put on Levothyroxine 75 mcg which looking back now was a mistake I should have been put on a Natural Dessicated Thyroid instead of the synthetic T4. With all the problems of trying to find a good Doctor to work with TRT the exact same thing applies to Thyroid Docs. Endo’s are worthless.

So at the very least I would get a Ultra sound of the thyroid. I switched my diet to Paleo…no Wheat (Gluten) dairy, soy ect… My Thyroid antibodies are now down to 37 ( Range <9) after 4 years. Stay away from synthetic T4. I recently in the last 2 months switched to WP Thyroid it is the cleanest NDT available with only two fillers and also with the knowledge I gained here i’m now supplementing with Iodine and Selenium and on a solid TRT plan hoping that those three changes can get my TPO antibodies to less than 9 and return to the same man I was before 4 years ago.

Best source for Thyroid info: www.stopthethyroidmadness.com



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Very interesting information fellas - thanks for sharing.

I guess you could say I’m subclinical Hypo (TSH 3.5 (down from 4.1) as of my last labs a few months ago with antibodies slightly past normal.

An ultrasound of my thyroid revealed no nodules.

I was very symptomatic before starting TRT but now have really no issues. I have begun supplementing with 200 mcg selenium daily as well.

A TRT doc wanted to give me a low dose desicated thryroid but I wanted to try the selenium first and see how things progressed. I will get labs done in another month or so and post back. Btw- my free T3/T4 were all in the normal range the last time.

Hello Jim, I’m having the same dilemma as to should I start on Levothyroxine or not. My TSH is at 8.190 and fT3 and fT4 on the lower end of the range. Also have TPO and other antibodies of the thyroid slightly elevated. I just recently started supplementing with Selenium, magnesium, and Kelp. Will se how that makes a change. Just wondering how this have helped you? Any improvements?


Kaliman - I have not had blood work done to confirm if the supplements are helping. Those are scheduled for mid-August - but I definitely feel a lot better and am hopeful things are now in order.
Regarding your results - with a TSH that high, you may be well past the point where selenium could provide any real benefit. My understanding is that once the TSH hits 5 or higher, thyroid meds are usually required. My TSH was high normal - but yours is way over the top. Personally, I would probably start the Levo, or another med. A wellness doctor told me that even with my score of 3.5-4.0 with slightly higher antibodies, I would benefit from desicated thyroid. I didn’t bother researching this because I wanted to try the natural route to see. Anyway - I will post bloods later this month.

Just got my labs back and my TSH was 4.3 – higher than it’s ever been – despite having selenium supplementation over the last two months.