Thyroid questions

Subclinical Hypothyroidism is what my doctor called it. My TSH level has risen to 6.56 which puts it above the normal range of 0.45 to 4.5. My T4 level while still normal is near the lower limits of the normal range.

My GP says that the elevated TSH indicates a problem brewing with my thyroid and that I have a choice now to treat or not treat. My Endo believes it should be treated. The problem is that I do not know which one to listen to. I really don’t want to start thyroid meds if I don’t need to.

1 Like

Gary, it’s not a big deal. They will start you on synthroid (or generic equivalent) pill once a day and a couple times a year they will do the TSH test as part of your bloodwork, and adjust your dose until your TSH is normal or low end of normal. They will also occasionally check T4 and other thyroid numbers.

You already are seeing an endo so there won’t be any new doctors to see.

I was diagnosed with hypothyroidism almost 40 years ago. At that time they diagnosed it by poking and prodding my thyroid glands and then confirming it with follow up TSH blood test. And I have been on synthroid ever since. (Although no modern young doctor would ever think about poking and prodding my thyroids and other glands!)

It is NOT a big deal. A trillion times easier than diabetes. And you will probably feel better with it treated.


1 Like

Thanks Tim, I understand the relationship between TSH and thyroid production, my problem is I don’t know which number I should be concerned with, on which indicator should I make decisions TSH or T4.

First level is to look at TSH and set synthroid dose based on that.

If they are unable to get your TSH normalized with synthroid, or your other more detailed thyroid labs are out of whack in the “wrong direction”, they will start looking at the more detailed thyroid tests and maybe prescribe a more specialized thyroid supplement or even do other (surgical or radiological) procedures.

Having TSH mildly elevated with T4 on the low end is far and away the most common case of sub clinical hypothyroidism. Very much “vanilla”.

Gary, I’m currently doing some more reading on thyroid health. Unfortunately, the mainstream medical practitioners, especially endocrinologists, simply measure TSH and treat with T4. This regimen does not help everyone.

TSH, or thyroid stimulating hormone, is actually a pituitary hormone. It signals the thyroid to release T4, an inactive storage form of thyroid hormone. T4 gets converted to T3, the active hormone that does all the work.

TSH and T4 can be “normal” yet if the T4 to T3 conversion is impaired, then you don’t feel well. It’s complicated and the more I learn, the more I realize that I don’t know!

Like diabetes, the more you know about the thyroid system, the better you’ll be able to advocate for yourself.

I was diagnosed with hypothyroid all the way back in 1987 and I concluded that it was a very simple system, especially compared to diabetes. It’s more complicated than any simple analysis and thyroid disfunction play a large role in overall health. If I were you, I’d advise learning more about it.

I’m currently reading The Thyroid Patient’s Manual by Paul Robinson. The more you know about how the thyroid works, the better your results will be. At least you’ll be able to hold your own in discussions with your doctor. Good luck!


LOL… That’s what what I think about it, in my opinion my endo’s np is at times overly aggressive, but that’s what I like about her, while my regular nurse practitioner is more center of the road, a trait I like about her. I want to go with my regular nurse practitioner but I can’t dismiss that the thyroid is the domain of the endo.

Here’s a good article on T3 and T4.
I just had an increase in Synthoid, but if symptoms don’t improve, my endo said I can try T3.


I am curious, do you feel “over medicated” or overburdened with medical concerns already? As a T1 I have felt that way many times. That might be one reason to be reluctant to start thyroid medication when it’s not strictly necessary and you aren’t noticing any hypothyroid symptoms.

By the way, most doctors will compare your blood sample TSH and T4 levels against the lab published “normal” range. Where do labs get this range? They look at the average levels in thousands of tests and then set +/- 2 standard deviations to determine the upper and lower limits of normal.

Now that would work if they only used a population without any thyroid illness. But they use everyone to calculate “normal.” And doctors use lab normal to determine if your numbers are normal or not. What you want is optimal for your unique metabolism.

Doctors that only treat thyroid illness using blood tests will often miss the mark with their patients. They need to listen closely to reported symptoms and treat the symptoms.

In my opinion, naturopathic physicians and functional medicine doctors are way ahead of mainstream medical doctors when treating thyroid illness.


Totally agree.
My previous (-1) endo refused to up my rx when my levels were in the high “normal”. But endo prior to that had kept me in the lower end (and bummed when she retired!).
So current endo more on board with treating symptoms, not just numbers.


Your tsh too high. Most doctors and endos don’t know how to properly treat hypothyroidism. Tsh should be around 1.2 to feel good- get a full thyroid bloodwork with tsh, free t4, t3, reverse t4 etc. and antibodies for hashimotos and other autoimmune thyroid diseases such as graves. You may need more than t4, I needed t3 as well due to not converting t4.

Thyroid levels affect your entire organ system. Your thyroid is being damaged and will be destroyed in time which can cause heart and other damage. Start treating it before that happens. Bg levels are also affected. My bg is better after treating my hashimotos with t3and t4. I still take a little levo.

Get a scan of your thyroid as well.

For the first few months at least it needs to be monitored every few weeks or so to see how you respond to meds.


It’s even more complicated than that when you consider, freet4,freet3 and t3 uptake.
It gets kind of crazy. Hopefully you can get a good doctor to pinpoint the root cause and medicate appropriately.

When your Tsh is elevated but your t4 and t3 are normal, it just means your thyroid is overworked but still giving you enough.

When you have low t4 with a high tsh, your thyroid can’t keep up, and you likely need to take some thyroxine.

Of course if you have normal or high t4 and low t3, then you are not converting it properly.

It’s a very complicated system of checks and balances.

I always get my Free T4 and Free T3 tested and also the reverse T4. I have had these tested for a long, long time.
I take both T3 and T4. I haven’t had problems with my thyroid in quite some time.
It took me a long time to find a doctor who would treat my thyroid appropriately, but once I did, I started feeling much better. Now I rarely even think about it at all.

Gary, I have been on synthyroid for quite a few years now. I don’t remember my numbers, but certainly my symptoms. I was very cold sensitive. Walking by open top freezer cases in a supermarket were torture, and my nails were thin and weak. As I am bald don’t know about hair quality.

Being on thyroid meds caused me to really see Feet on the Floor syndrome on my CGM. It is best taken fasting and to not eat for 30 minutes. I’d see BG just ramp up every 5 minutes. That’s better now since I changed my Lantus schedule.

1 Like

Yes I do sometime feel over doctored. I guess I often see this wrong but each time I am diagnosed with another ailment I feel more trapped by the medical establishment. The medical establishment makes it no easier for a T2 than it does a T1

I do have a few symptoms which I would not have associated with thyroid. The most noticeable are fatigue, dry skin and feel cold at times.

1 Like

Do not be afraid to tell any of your docs that you are feeling over-medicated. They can talk you through the decision points. Synthroid is very low risk medication but maybe you are taking other medications that could be managed away instead.

I remember being told 40 years ago that I’d have to take insulin several times a day for the rest of my life and resenting it at least a little. Then they started me on home bg testing (va urine testing) and I felt that was an unmanageable burden. Etc. in retrospect those were obviously the right things to do BUT at the time they did seem outlandish and unfair burdens to take on.

1 Like

I have done just that before with some success. I believe I’m not that different than most, I don’t like the fact that I must depend on someone else for lifesaving medication such as insulin, I hate the hoops one must jump through just to survive. I have made my peace with it out of necessity.

Right now I just don’t want to set my sights on another set of hoops to jump through, especially those necessary in the adjustment phase. If starting treatment is not urgent I prefer to wait. I feel the necessity to treat will come soon enough, my TSH has risen considerably in the last year from 3.5 to 4.7 to 6.5 I expect it will only continue to rise.

Do you have symptoms? When my T4 got up to 3-4, I was extremely tired.

You could start with low dose and then see if it makes a difference. I feel best with levels under 2.5.

Listen to your Endo,he specializes in this area. I have had thyroid disease for years. No big deal. Nancy50

I started on thyroid meds about 2 months ago and I am amazed at how much better I feel. My energy has doubled and I feel like a brain fog has been lifted. I Highly recommend if you need to take it