Thyroid: More Evidence That “Normal” is Unhealthy

Two inexpensive blood tests should be done routinely, but often aren’t: Vitamin D levels (by serum 25-hydroxyvitamin D) and thyroid stimulating hormone levels (TSH). There are few easier ways to substantially improve health than to normalize levels of these hormones.

One difficulty, however, is disagreement over what “normal” levels are. The standard “normal” range for TSH on lab tests is about 0.5 to 4.6 mIU/L. This range originally encompassed two standard deviations about the US mean, meaning that 95% of the population fell in the “normal” range. Unfortunately, evidence that TSH values in this range were healthy has always been lacking.  In fact, many people with “normal” TSH live with symptoms of hypothyroidism.

As awareness has grown of the biological significance of thyroid hormone, researchers have looked more closely into the correlation of TSH levels with health.  This research is revealing is that many people are thyroid-deficient and that improving thyroid status can dramatically improve health.

The best research has been conducted in Europe:

  • The HUNT study of 25,000 healthy Norwegians found that their prospects were substantially affected by thyroid function. Those with a TSH level of 1.5 to 2.4 were 41% more likely to die over the next 8 years than those with TSH below 1.5; those with TSH 2.5-3.4 were 69% more likely to die. [1]
  • An Italian study showed that pregnant women with TSH between 2.5 and 5.0 had a miscarriage rate 70% higher than women with TSH below 2.5. [2]

Now, a Dutch study shows that the likelihood of breech birth rises monotonically with the mother’s TSH levels at gestational week 36. [3] Breech birth is a significant hazard:  it commonly requires a Caesarean section delivery, and both mother and infant are more likely to die or otherwise suffer damaged health if the baby presents in the breech position. The Dutch study found that:

  • Pregnant women with a TSH of 0.5 or less had NO breech births at all, and those between 0.51 and 0.71 had only a 1% chance of a breech birth.
  • Pregnant women with a TSH between 0.71 and 2.49 had about a 5% chance of breech birth.
  • Pregnant women with TSH of 2.50 to 2.89 had an 11% chance of breech birth, while those with TSH above 2.89 had a 14% chance of breech birth.

The authors didn’t provide a detailed breakdown of breech rates for TSH levels in the middle range, but it is a safe bet that TSH levels of 1.5 to 2.49 were much more dangerous than TSH levels of 0.72 to 1.0.

What these studies are telling us is that:

  1. People with the healthiest thyroid status have very low TSH. A TSH level below 0.5 can indicate either hyperthyroidism (too much thyroid hormone) or perfect health. Any TSH above 0.5 is suggestive of, at a minimum, a slight deficiency of either iodine or selenium.
  2. You can have impaired thyroid status with normal free T4 hormone levels. This study and others have found that TSH levels, not free thyroid hormone levels, are the best indicator of health.
  3. Health becomes significantly impaired above TSH levels of about 1.5. Any TSH above 1.5 should be addressed, if only through iodine and selenium supplementation (or abundant seaweed consumption with ~3 Brazil nuts per day.) Since a TSH of 1.5 is about the population mean, it’s a fair inference that most Americans are needlessly suffering impaired health due to impaired thyroid status.
  4. Especially during pregnancy, thyroid and iodine status are critical. Breech birth and miscarriage are far from the only negative consequences of impaired thyroid status. An elevated TSH usually indicates an iodine deficiency, and “even a mild iodine deficiency during pregnancy and during the first years of life adversely affects brain development.” [4] Iodine deficiency is the most common worldwide cause of mental retardation (cretinism), and elevated TSH during pregnancy can be expected to reduce the IQ of the child by up to 10 points and to produce other neurological deficits, including “visuomotor, memory, attention and posture” deficits. [5]

So, if your doctor doesn’t do it routinely, ask for TSH and vitamin D measurements at your next physical. There are few easier ways to improve your health than fixing thyroid and vitamin D status.

[1] Asvold BO et al. Thyrotropin levels and risk of fatal coronary heart disease: the HUNT study. Arch Intern Med. 2008 Apr 28;168(8):855-60.

[2] Negro R et al. Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH Levels between 2.5 and 5.0 in the First Trimester of Pregnancy. J Clin Endocrinol Metab. 2010 Jun 9. [Epub ahead of print]

[3] Kuppens SM et al. Maternal thyroid function during gestation is related to breech presentation at term. Clin Endocrinol (Oxf). 2010 Jun;72(6):820-4.

[4] Remer T et al. Iodine deficiency in infancy – a risk for cognitive development. Dtsch Med Wochenschr. 2010 Aug;135(31/32):1551-1556.

[5] Joseph R. Neuro-developmental deficits in early-treated congenital hypothyroidism. Ann Acad Med Singapore. 2008 Dec;37(12 Suppl):42-3.

Leave a comment ?


  1. “If it is Graves, iodine can exacerbate symptoms – maybe in the long term it can help but I would be cautious.”

    Always good to be cautious, but the opposite is more likely to be true. Dr. David Brownstein, perhaps more experienced with iodine supplementation than any other doctor in the world, says this:

    “1. Can those with Hashimoto’s or Graves’ disease take iodine?
    A: I explain this topic in much more detail in my book, but let me summarize the answer. My research has shown that both Hashimoto’s and Graves’ disease are caused, in part, from low iodine. In fact, nearly every new patient with either a diagnosis of Hashimoto’s or Graves’ disease has tested significantly low for iodine. My experience has shown that the vast majority of patients suffering with these illnesses improve their condition when iodine deficiency is rectified…”

  2. Bill,

    That’s interesting. All these years I have been told not to supplement with iodine with Graves! Fortunately I kept eating a lot of anchovies and sardines (head and everything) and my diet is rich in iodine, but still I wonder what is the best strategy with Graves and I do not think the answer is very simple. Will keep reading about it, thanks for the reference.


  3. “All these years I have been told not to supplement with iodine with Graves!”

    Yes, and I was told the same thing regarding my Hashimoto’s—even to avoid iodized salt, with its trace dose of iodine.

    In both cases, advice based on no evidence except irrelevant lab studies that were either bogus (e.g., Wolf-Chaikoff effect) or so abstracted from actual human disease as to be meaningless. The long clinical experience with milligram and even higher doses of iodine as a successful treatment for both hypothyroidism and hyperthyroidism went down the memory hole.

    50 mg of iodine daily (plus the rest of Dr. Guy Abraham’s iodine protocol) has allowed me to reduce my thyroid supplements by almost half. All my docs said they’d never seen nor even heard of anyone actually getting better from Hashimoto’s.

    LDN shows similar promise for these conditions, and I hope to try it soon.

    Some docs and sufferers believe that eliminating gluten, and maybe casein, can help. I don’t know if there’s as much evidence to support that as with the iodine protocol and LDN, but it’s easy and harmless.

  4. I have started LDN and believe it is a very safe option (never heard of anyone having major problems with it). The effect might be more long term and not immediate, but I have experienced improvements. Perhaps it can be see as an alternative for those who do not react well to high doses of iodine?


    • Hi. I have a question about LDN.. What is the protocol for beginning. I have Graves disease and Hashimotos antibodies. I’m currently hyper and being treated with beta blockers and antithyroid medications (Tapazole aka methimazole). I have heard that the dose is 4.5 mg LDN per day but do you start on that dose or work up to it?
      How has it helped you?

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  7. So, I’ve got a question. Five years ago I had slightly elevated T4, normal T3, and a TSH of 0.015—all indicating hyperthyroidism, I’d suppose. Anyway, I took a TSI test as well (fearing Graves, most notably the eye issues) and the letter I got from the endo simply stated: “Your TSI is 96 and in normal range. I do not believe you have Graves.”

    From some research I’ve done online, some people believe healthy individuals have ZERO TSI in their blood (or at least less than 2%). I’m assuming the 96 means I was at 96%, and anything less than 125% is “normal.”

    But, the question remains: Can you have TSI in your blood and never actually contract Grave’s Disease? Does everyone have TSI in their blood? Is it true you are suppose to have ZERO TSI if you are “healthy”? I have a small, practically unnoticeable swelling on the right side of my neck directly in front of the sternomastoid muscle, which I don’t believe has grown much or at all over the past five years. Again, no real symptoms either. Five years later, can I breathe easy and assume I’ll likely be free of Grave’s despite a single test that suggested hyperthyroid issues and “normal range” TSI?

  8. Hi Paul,

    I recently got some results back after being PHD from about October of last year. I am a female close to 30.

    My cholesterol: HDL of 58, LDL of 136, Trigs of 35, Total Cholesterol of 200. Blood pressure 121/80.

    From a TSH of 2.15 in 2008, and feeling about a 2 on a scale of 1 to 10, I am down to a TSH of 1.6, Free T4 of 1 and about a 3-5 now. Body temperature from 96-97F to 98.1F.

    My Licensed nurse practioner said she really couldn’t justify a Vitamin D test as those are mainly used for older women, so I am waiting on that test.

    Also – I am fairly certain I have leaky gut due to numerous allergies which I did not have pre-VLC paleo. To be honest, I sometimes wonder if am allergic to something in my supplements.

    I know you have said that it can take a while for the thyroid to heal and also that thyroid hormone is needed for healing of leaky gut.

    Obviously I know you are a health advisor only, but how, in general, do you know when you are a candidate for thyroid hormone?

    I’ve been doing supplementation of iodine and selenium pretty regularly as I was having symptoms of bromide/fluoride toxicity.

    I upped my iodine as your recommended – 250 mcg (Sept 2012), 500 mcg (oct 2012), 1 mg (dec 2012), then 2.5 mg and then 10 mg after no noticeably bad effects. I’ve tried staying on 50 mg for two weeks or so and again didn’t notice any additional benefit, so came back down to 12.5 mg and then, after re-reading the new PHD, realized you were back down to 1 mg. I had been staying at 2.5 mg of KI + Iodine for about a month before my test.

    So, I’m on about 2.5 mg of iodine a day and either try to supplement selenium that you recommend once per week or eat beef kidney, of course a dozen eggs and lots of fatty grassfed beef or soup- I don’t like chicken or pork as much, mussels or clams once per week and have to avoid salmon because I seem to have a skin reaction to it? – but perhaps I am not eating enough selenium?

    Perhaps I am a candidate for thyroid hormone?

    Thanks for any advice.

    • Hi LJ,

      Disappointing about the D test but if you get as much sun exposure as possible the status should be OK, now that we are entering the summer season.

      Your numbers are excellent — HDL could be a bit higher but yours is better than the population at large, and LDL, trigs, and total cholesterol are fine. Blood pressure is fine, maybe slightly high. TSH and body temperature have improved to basically normal numbers, there’s a bit of room for further improvement but these are pretty good.

      If you have symptoms of hypothyroidism then you are a candidate for thyroid hormone. The next step would be to do a test — take the lowest possible dose and see if it makes you feel better.

      It sounds like you are getting an excellent amount of selenium. Do you react to other sources of omega-3 like sardines or herring?

      Best, Paul

      • Thanks Paul.

        I’m trying to figure out whether I am hypothyroid or if I have something more complicated, like Chronic Fatigue. Some of the CPNhelp resonates. We’ll see.
        I’ll report back as I continue on this journey, if it helps anyone else.

        I do react to sardines and anchovies and herring no, and I’m also going to try fish eggs.

  9. Hi Paul,

    I had some labwork done several months ago and didn’t think much of it because everything was in the “normal ranges.” But now that I’m reading this I wonder if I’m slightly hypothyroid. I have fatigue, anxiety, sibo, food intolerances and can’t seem to lose weight.

    My TSH was 2.24 and T4 6.9. My HDL was 83 and LDL 101 (I’m not sure why it was so high). Vitamin D was 25.2 (I’ve been getting a lot of sun trying to get that up). . .

    Anyway, I was thinking about adding seaweed and brazil nuts first before attempting supplements. I do eat the recommended 3 egg yolks almost daily and seafood. Do you have any recommendations as to how much seaweed and brazil nuts I should add? Also, which kinds of seaweed would be best?

    Thank you in advance

  10. Hi i’m 42 suffer from celiac acid reflux and have a tsh level of 1.57 I have put on 3 stone in 3 years but my doctor still wont give me some thyroid tablets i eat healthy but don’t loose weight I tire easily and have brain fog but my gp won’t give me thyroid tablets what can i do

  11. Today i stumbled across the “iodine value” (

    “unsaturated are oils that have double bonds in their structure because there is not enough hydrogen atoms to bond with the carbon atoms. In such case, carbon atoms bond to each others to form double or triple bonds. adding iodine, saturates the oil as iodine atoms bond to carbon atoms as if they were hydrogen atoms. “(

    Also interesting:

    My Questions:
    – Is it correct to say that PUFAs can be converted to saturated fatty acids using iodine in the human body?
    – So i would conclude that PUFAs are a lot less stressful, if iodine is abundant?
    – If iodine is insufficient in the blood it could be drawn from T3 which would explain why high intake of PUFAs leads to hypothyroidism when iodine is inadequate. Does this sound plausible?

    I hope someone has looked into this one 😉

    – Michael A.

  12. When I took iodine for a period of time (2mg per day lugols) my TSH jumped to over 4 (I was also taking selenium). Now that I’m off iodine it’s back down to 2.3. I’m not so certain iodine is the solution.

    • It´s totally normal TSH level go above the normal range. It will back off soon (at least 3 months). Keep up taking iodine! I started with 12,5mg/day and my TSH is under 2 now (I used to have it over 4!).

  13. This article is worthless as you don’t clarify if you mean TSH FREE or TSH standard. This is fear mongering and one of the many reasons people do not take their health seriously.

  14. Okay so in September I started seeing a new psychiatrist & she had me fill out a 10 page packet of my family history which I didn’t know because my mother passed away when I was 8 so I happened to message an aunt of mine that lives in New Hampshire and she asked me if I had ever had my thyroid checked I said yes when I was in high school she said that I needed to get my thyroid antibody levels checked because she has it & her Dr told her that they could almost guarantee that every female in our family has it so I told my new psychiatrist & she told me to tell my family Dr that I want a referral to an endocrinologist because my thyroid antibody levels were 4206 & they are supposed to be 60 or below then I went to my family dr & she said she did not see any point in referring me to an endocrinologist because my tsh levels were normal so I must be fine then I went back to my psychiatrist & she referred me to an endocrinologist & there I was treated as if that is the only reason I wanted treatment was so that I could lose weight which I was not I was already losing weight do to starting meds for narcolepsy then I went back to my psychiatrist & told her that so she referred me to Iowa City which is a university hospital & I yet again got the same reaction from them then I went back to my psychiatrist & told her & she consulted with a colleague of hers who told her that she could treat my symptoms which included mania depression and anxiety with a low dose of levothyroxine & so long as I was still in the “normal” range for my tsh levels I would be fine well then my psychiatrist got fired & a new psychiatrist took my case over & told me that she was not an endocrinologist so she didn’t feel comfortable treating my hashimoto thyriodist & said that I need to find someone else to treat me for it she said that I had 3 months to find someone to treat me then I went back for my 2 month check up & she asked if I had found anyone who was willing to treat me but I had been too busy looking into my mother’s death that I totally had spaced it she told me that since I hadn’t found anyone else to treat me that I obviously didn’t need treatment for it then she stopped my levothyroxine meds & I immediately started feeling depressed stressed snappy & I couldn’t stop crying & snapping on my 5 year old daughter who didn’t deserve that my narcolepsy was worse I was tired & had no energy at all & my clumsiness had came back 10 fold lol I got off of an exercise machine didn’t step back as far as I should’ve smashed in to my ankle then the next day I was walking down a friend’s cement stairs and bam I fell off in to the mud & hurt my other ankle so I googled it to see if it is a symptom of hashimoto & it is so I called around trying to find someone who was willing to treat me with low dose naltrexone & I was told that there was an endocrinologist who didn’t know about it but was willing to sit down and talk to me about it well i went in today & I took a friend of mine with me because she saw what a difference the medicine made in me so the endocrinologist said she knew what low dose naltrexone is but she doesn’t believe in it for treatment of hashimoto because all it is is some guys theory but she did give me my levothyroxine back but I had to get my tsh levels checked again & to go ahead and check my tsh levels in a month after taking the meds & then again in 3 months & so long as nothing changes I won’t have to be checked again for another year but my thyroid was swollen today & she said she felt not nodules but granules on it does anyone else go back and forth between hypo & hyper? I asked the endocrinologist today & she said yes but that is called hashitoxicosis she made it seem like she knows that I don’t have it so why should she check to see if I have both antibodies present or not on May 4th I started having hyperthyroidism symptoms & my antibodieslevel was 4206 in September last year hasn’t been checked since but my tsh levels were 2.5 September last year also & the 7th of May they are only 1.62 & that was after only 25mcg of levothyroxine & being off it for 16 days I need input of what to do?

  15. I had Hashimotos and my good friend had Graves and we both followed a strict protocol of diet & life-style change and specific supplements targeting the cause and we both went into remission and have continued to stay in remission. I don’t take any thyroid hormones any longer and my TSH is 2, it hasn’t even seen 3.75 in over 15 years. Funnies part is that my eyebrow ends grew back too, haven’t seen those in over 15years also. Can you imagine my poor friend when her doctor wanted to rush her into surgery to radiate and then remove her thyroid? She’s still got hers and is glad she gave the holistic path a try first. Find a good holistic doctor and follow the protocol.

  16. Hi Paul. Could you please tell me how can i lower my TSH levels? I have hashimoto’s and I take 75mcg levothyroxine (“eutirox”) for about 6 years now. (was diagnosed when I was 14). Since switching to a gluten free diet I managed to always have my TSH 1 or lower and was doing fine all these years .. Until 2013. I started feeling very tired but ignored the symptoms because I thought it was because of college etc. Well last week I decided I should get my blood drawn. I am very disappointed to see the results. from my understanding they are not good.. I already eat a paleo diet with moderate carb now, and can’t increase my carbs more because i am very prone to reactive hypoglycemia for about a year now. I also gained 10kg since last year. Anyway these were my results:

    TOTAL T3 – 99.3 ng/dL 84.0 – 172.0

    TOTAL T4 – 8.0 ng/dL 4.5 – 12.5

    FREE T4 – 1.2 ng/dl 0.9 – 1.8

    TSH – 2.120 nUI/mL 0.400 – 4.000

    I don’t have the antibodies yet. Please give me your insight. I don’t know how to lose all the weight I gained and I am concerned that this change in my thyroid levels is whats causing all this crazy stuff with reactive hypoglycemia and gaining weight like crazy. 🙁

  17. Hi Paul,
    Thanks for writing an amazing book, and for this blog.
    I’m 41, male. I started PHD about 1 month ago. As part of the recommended diet, and supplements, I started taking some seaweed (about 1/4 nori sheet) each day to see if the iodine content might help. Within a few days of doing this, I noticed a sore throat sensation which I’ve had off and on for many years. I’ve also been taking 2-3 brazil nuts every day for selenium. When I stop seaweed, throat sensation goes away. This has me thinking if this is just a throat infection, or a thyroid/autoimmune condition.
    Background : I’ve had poor digestion, sensitivities to multiple foods, bloating, acid reflux, sinus congestion and headaches, low testosterone, stiff muscles (poor flexibility), generally low energy and fatigue, post-nasal drip for many years (Taking Mucinex would help).
    Here are some test results I’ve had in the past :
    TSH 1.21
    Free T4 1.34
    These are two years old TSH/T4 numbers based on which my GP ruled out thyroid issues. I intend to get tested again now. But am not sure if I should stop taking seaweed or continue in the mean time.
    Vitamin D 35 (I’ve been supplementing)
    ANA (Anti-Nuclear AB), Blood : Positive, speckled
    Anti-nuclear AB Titer 1:160
    Testosterone, total : 349

    The ANA test indicates some sort of autoimmune condition, but the titer proved inconclusive as per my doctor.
    I have had low energy, cold hands and feet, occasional shivering. I also noticed that I feel sleepy immediately after a meal after I started adding carbs back (I had been VLC for almost a year). After reading on your blog that this could be because of endotoxemia/leaky gut, I’ve been making sure to get bone broth soup each morning/as part of cooked dishes, along with intermittent fasting, circadian rhythm entrainment. I believe I have candida too (also planning to take a stool test now to confirm). I’ve been following this protocol for the past year :
    1. Raw candida cleanse (Garden of Life)
    2. bentonite clay/fiber.
    3. Primal defense ultra probiotics
    4. Wobenzym for inflammation
    5. Chicken broth
    6. 3 cups of Goat’s milk yogurt each day
    7. Omegazyme ultra enzymes
    Taking the candida cleanse tends to give me stools which cause a slight burning/stinging sensation. I had this same burning sensation, but much more severe when I took an Ayurvedic detox three years ago. The Ayurvedic cleanse was a 5 day program of taking ghee with herbs each morning in gradually increasing quantities, followed by massages/steam, and laxatives on the last day to eliminate toxins. After this detox, I had weakness/fever for a few days, and I found some restriction in my throat making it hard to breathe freely. It went away gradually. I believe that the anal burning is due to candida detox, and the throat issue seems to be something which keeps coming back. I’ve been feeling better, but still continue to have issues, and my condition is still undiagnosed.
    For the last 3-4 months, I’ve been doing hot yoga regularly especially as I sweat very little generally, and this might be a good way for me to detox. I now sweat more in the yoga room than I used to.
    Thanks again for all you are doing for the many folks like me out there who are desperately trying to understand their health issues!

  18. Just did a non-fasted blood test my TSH and TRIG came back as high as ever. Are they accurate? All other tests have always been fasted and my TG’s have never been above 70 and this time it was 202! 😳

  19. Thanks Paul. Really helps me not freak out ‘as’ much. I wonder if TSH has the same impact. Mine has been trending up going from 1.9 to 3.5 to 5.5 – all fasted to now 8.9 – non fasted. My doc made me eat a bagel with jelly to test my post-prandial and happy to see that come back at 100 BG but the Trig and TSH has me scratching my head. I have an appt with an endocrinologist next month because I take iodine, eat liverwurst, sardines etc so wondering what is going on. My morning body temp is usually 96.8 to 97.2.

  20. 😛 yes dad…I’m eating my liver. I am feeling some brain fog and I’m more tired. I know I’m not eating as many starches as you recommend. Mainly doing potato starch and cold and reheated properly prepared beans. I’ll let ya know what my doc says. I might need a bit of thyroid supplement.

  21. I’m taking 1000 mcg iodine a day….life extensions vitamin d and k2 and iodine.

  22. How much seaweed is “abundant seaweed consumption”?

  23. Excellent and informative One should take care of cholesterol and avoid fatty foods.

  24. Please advise the balanced diet for thyroid patients especially for vegetarians.

  25. Hi Paul, with a TSH of 0.52, I was told by my doctor that I should be feeling the symptoms of hyperthyroidism – but I don’t! glad to see from your post that this might be about just right. also trying to conceive so will be pleased to avoid a breach birth! 🙂

    • Hi Eleanor,

      Check whether you get symptoms of hyperthyroidism immediately after supplementing iodine. You might have a transient hyperthyroidism that goes away as the iodine supply is reduced. If so, you should avoid supplements and get iodine from iodized salt and food (nori/laver seaweed, seafood). But you can have that TSH and be quite healthy, and have a very healthy baby. Good luck!

      • Thank you very much for that! I have never tried Iodine supplements but do have a iodine rich diet, so figured I don’t need it, considering my thyroid is ticking over pretty well. Thanks again.

  26. My TSH came back as 2.6. My doc says it’s right in the middle of the range, so perfect. My free T3 was on the higher side of normal, free T4 on the lower side of normal. I don’t know if I should insist on more testing. I want antibody testing, but I almost don’t care any more! My joint pain of 5 years is thus far unexplained. I’m about to embark on the PHD supplement plan, so maybe that will help 🙂

  27. Hi,

    I’m glad this thread is relatively recent I just wondered if anyone can provide further insight into my test results below. My T4 and T3 levels are both at least double the highest value of the ‘normal’ range. Not sure whether this means it’s had longer to build up or what? After being diagnosed with overactive thyroid last week I think I may have had this creep up over a long period of time.

    TSH – 0.3
    T3 – more than 30.8 – that’s all I got
    T4 – 59.7

    I think it may be Graves due to stress that has really made me notice there’s something wrong but not sure. My heart was around 130bpm when I woke up each day which made me book my Drs appointment. I’m going to have to wait a while for an appointment with the endo but just thought my results seem higher than I’ve seen anyone else have?



  28. I’m wondering what my next steps should be. My thyroid has been wonky (with some hyper and a few hypo symptoms that come and go) since a CT scan in October. I had a pregnancy from Jan-Apr as well that ended at 14 weeks. My TSH has slowly been declining since before the pregnancy. It is now 0.3. Free T3 is 3.2 and Free T4 is 1.1. TPOab are 6. Should I be tested for Graves? Iodine uptake scan? We’d like to start trying again for another baby, but is it safe right now? None of my current doctors seem very competent with thyroid issues. I can’t eat iodine rich foods without having hyper symptoms now, either. I could before Oct.

  29. My tsh.0860U(ia)/mc,ft4.97p
    sedentation rt.8mm/mc.
    I’ve been synthroid for 50 yrs. Dr has lowered fom 150 mgs,I feel realy tired,sleepy and non-functional. are my resdigs,ok?

    ft4 .97pg/d

  30. Hi, Dr. Jaminet!

    My family and I continue to flourish on your diet and lifestyle recommendations. THANK YOU. I enjoy reading your answers to many other’s questions and noticed you mention one’s TSH would ideally not be lower than 1 (as also evidenced by your comment above to Trydy).

    I have been on a T3/T4 combo med for about six years and my TSH fluctuates between 0.20 – 0.40 ulU/mL (and my free T3 and free T4 barely make it onto the low end of the range, but I’m feeling well for the most part). As I have increased my carbs to your recommended levels, take the prescribed/updated supplements, and also incorporate IF, I’m now wondering if my TSH is just too low. (My 25-Hydroxy vitamin D level was 44ng/mL, last I checked, FYI.)

    My question is: do you believe it would be beneficial to increase my TSH by reducing my medication, even if I seem to be doing well otherwise?

    Thanks again for all you do; it is very appreciated.

  31. Hi doc. I have a TSH of 1.34 (which is within the normal range according to my doctor; however, I experience symptoms that are similar to hypothyroidism. Basal temp was 97.6 and 96.9. Also, nodules were noted on an ultrasound where my thyroid is slightly enlarged on one side. I was diagnosed with a nontoxic goiter. Judging from my TSH, does it sound like hyper or hypothyroidism?

    • Hi Tracey, we can’t really say from that information, it could be both — the nodules could overproduce thyroid hormone when you get iodine, creating a transient hyperthyroidism, with periodic hypothyroidism as the nodules heal. I would work on fixing the gut to reduce inflammation and improving wound healing.

      Best, Paul

  32. Hi Paul,

    What strategies can be used to reduce TSH further after optimizing iodine and selenium intake? I’ve been supplementing 225 mcg iodine for about two years and have consistently been near 1 lb/day meat intake (mostly from ruminants) during that time, but still have TSH around 2.2 and experience some symptoms that might be attributable to hypothyroid (difficulty waking in the morning, fatigue, brain fog).



  33. Please help Paul. I had my thyroid removed on 4 Oct and went on Eltroxin 100 and then onto 150. TSH below 0.5 but very low blood pressure and pains and swelling in veins, which comes in waves usually in late afternoon. Feel slightly better in mornings. What is causing the veins to swell and pains in chest – which doctors brush aside because BP is low — 90/60 dropping even further feeling very feint. I used to be 135/85 before the surgery. Regards Jeff

    • Hi Jeff,

      Are you eating PHD and following our lifestyle advice? Those are basic interventions which will help everything. Do supplement iodine per PHD recommendations. This will conserve thyroid hormone and may reduce the dose you need or make adverse symptoms less likely.

      It’s not possible for me to respond to medical issues but here are a few thoughts you may wish to discuss with your doctor:
      – After the thyroid is removed, it’s usually insufficient to treat with T4 only. Many patients do better combining levothyroxine with either a bit of T3 or with Naturthroid which has the full complement of hormones (T1/T2/T3/rT3/T4) although not in the right ratios for humans (thus, should be combined with some levothyroxine).
      – The TSH below 1 suggests you are overdosing the levothyroxine. Bulging veins are another symptom of hyperthyroidism / hormone overdose. (
      – The low blood pressure is a symptom of hypothyroidism and suggests you may be low in T3.

      Best, Paul

  34. I need some advise. I just had my TSH level tested and it came back 2.44 but somehow I still think something could be wrong because the ends on both of my eyebrows are gone and half the length of my hair has broken off and for me that is bad. I used to have hair to the middle of my back and now it is barely past my shoulders. I sleep a lot, my hair is coarse and brittle, I am constantly constipated and cant go unless I take a laxative and my weight is going up and down like a yoyo. Unless i take a multiple vitamin every day I have no energy. I am also losing height and used to be 5’6 now i am down to 5’2 1/2. wtf?? I am 55 yrs old. Please advise. My doctor thinks there is nothing wrong with me. I say there is. 😕

    • Hi Pam,

      Your medical situation is too complex for me to evaluate, but the first step in complex conditions is to eat a balanced natural whole foods diet, supplementing as necessary to obtain complete nutrition, and practice circadian rhythm entrainment and intermittent fasting. Have you adopted PHD? It sounds as though you are malnourished and not healing wounds or maintaining tissue well, as evidenced by your height loss.

      Re your doctor, it may be you are cycling between hypothyroidism and hyperthyroidism with hyperthyroidism apparent after iodine consumption. If you got tested more frequently that might become apparent to your doctor. Try getting a thyroid status test done (a) after eating a lot of seafood and seaweed the previous day, and (b) when your constipation is most severe. These will be the extreme states.

      A few nutritional keys: Make sure you are eating at least 3 egg yolks per day and supplementing the key bile nutrients, taurine, glycine, vitamin C. N-acetylcysteine would not be amiss either. Eat lots of extracellular matrix in the form of shellfish and soups and stews made with bones, joints, tendons, chicken feet and ox hooves and ox tail. Make sure your fat soluble vitamins A and D are in good shape per PHD advice.

      Best, Paul

    • Pam, you sound like a classic case of a frankly hypothyroid woman whose TSH is still in the “normal” range. But that doesn’t mean it’s normal for you. When my TSH is above 2 I feel horrible. If you can find a more open minded doctor, it’s dead simple to test this: try a low dose of thyroid replacement for a month or two and see how you feel. You’ll have your answer. I’m pretty sure you’ll start to get better. Good luck. My own endocrinologist’s latest book covers all this in great detail:

  35. Great article thank you very much. I homed in on the tsh levels and the Hunt study. Being active on forums I encounter a wealth of hypothyroid sufferers who know nothing about ideal levels and are kept in the normal to upper normal TSH range as a safety measure and never feel well. Heart issues from palpitations to irregular beats often come up.
    I have shared 🙂

  36. Hi, I’m 43 yrs old women, my TSH is 2.49 mIU/L (0.40-3.50), could you please explain if this result are normal. The reason I’m asking is because I can’t see my doctor at this time. Thank you.

    • It’s a little high but not so high that most doctors would normally treat you for hypothyroidism. Try following PHD diet, nutrition, and lifestyle recommendations.

      Best, Paul

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