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. i’m 41, male and my TSH currently is 2.47 (10y ago it was 1.7). fT4 is 13.3pmol and fT3 is 4.9pmol. i have low body temp (36.3C) and low resting heart rate (43bpm), but am NOT particularly sensitive to cold. my problem since at least 20y is lack of drive, chronic fatigue (undiagnosed), limited muscular performance and slow recovery from exercise (compared to my younger age), and recurring phases of IBS and gluten + casein/whey intolerance. because of the IBS, i changed to paleo a few months ago, which improved digestion considerably. i’m also taking 10kIU D3 (which btw cured my dermatitis, yay!) and around 6mg Iosol (which doesn’t do anything besides giving me bromide acne..). i’m also usually taking about 10-20 different supplements like ALC, Q10, NADH, ALA, Creatine, etc (everything that boosts/supports mitochondria and ATP production seems to help) for restoring my energy and fitness levels into an acceptable range.
    Q: do you think it is possible to have low thyroid function despite being pretty lean (usually around 10%), rather muscular (BMI 24), and not having any problems losing weight, and NOT having temperature regulation problems? that’s what confuses me about all this. on one hand, i have elevated TSH, and rather low fT4/fT3 (i guess) and on the other hand, i’m lacking some of the typical symptoms. do you have any idea how to interpret this? thanks!

  2. Dear qualia,

    Yes, you can absolutely have low thyroid function with all of your characteristics.

    The simplest explanation for this pattern is:
    1) You have a chronic infection that is causing your chronic fatigue. (It might also have caused your dermatitis.)
    2) The immune system is consuming iodine as it fights the infection. It obtains iodine by stripping iodine from thyroid hormone, thus depleting thyroid hormone levels and causing the elevated TSH.
    3) Your thyroid remains functional, and the body is processing thyroid hormone properly. That is why you don’t have the more extreme symptoms of hypothyroidism. You have an iodine deficiency rather than thyroid dysfunction. The body is prioritizing scarce thyroid hormone for critical functions, but your health would improve if iodine/thyroid hormone were more readily available.

    If this is right, the solution is high-dose iodine supplementation. So let me ask you a few questions:
    1) Were those TSH/thyroid measurements taken before or after you started the Iosol? It would be nice to see if the Iosol made an improvement in thyroid numbers. I would get regular thyroid panels and see how they’re changing as you experiment.
    2) Have you tried higher dose iodine, and are there recognizable pathogen die-off symptoms from it? You can try gradually ramping up to 50 mg/day and see what happens. Possible pathogen die-off symptoms include increased fatigue, brown or foamy urine, swollen feet, histamine reactions (as in seasonal allergy). The nature of die-off symptoms depends on the pathogen in question.
    3) Have you been tested for thyroid auto-antibodies? I would do that immediately. If you had IBS and gluten intolerance, you very likely developed auto-antibodies to the thyroid. This would complicate matters, and it would also raise alternative possibilities for your high TSH.

    You are on the right track with recent dietary and nutritional changes. I would be sure to take plentiful vitamin C as well as NAC or glutathione for immune function; selenium along with the iodine; and magnesium and vitamin K along with the vitamin D. Vitamins B1/B2/B5/B6/biotin would not be out of place. Follow the diet recommendations on our diet page. Be sure to include at least 200 calories per day of starches (white rice, taro, or sweet potato are our recommended sources). This will help maintain glycogen for immune function.

    It’s well to keep in mind that chronic infections are generally cured slowly. You will probably notice steady improvement for years, once you get the diet and nutrition right. If you can identify a pathogen and get appropriate treatments, that would speed up recovery.

  3. Dear qualia,

    My wife asks if you have tried supplemental thyroid hormone and suggests you try that at a low dose to see if symptoms improve. That will help clarify your situation. Your doctor can prescribe some.

    Best, Paul

  4. excellent, thanks for your comprehensive answer!

    i agree with the possibility of a chronic infection. as far as i remember most of the problems started with a unusually long and severe cold when i was ~20y old that lasted for 6 weeks (!) after returning from a vacation in miami (i’m swiss), all while under heavy work stress and not taking the time out to cure it properly. since then, i also have more or less constant rhinitis and i believe my neurodermatitis also appeared the first time around then. a few month before, i got my first batch of antibiotics when i was in military for the treatment of another “cold”. so that all could make sense chronologically..

    i’m indeed planning to do a thyreoglobulin and TPO test next week, together with another TSH. the last TSH (2.47) was from before beginning the iodine. so that will be interesting to see if something changed.
    if i don’t have antibodies* i’m gonna ramp up the iosol up to 50mg as recommended. i wonder how my skin will be able to handle this lol. i suspect that i have tons of bromide in my system from years of working in the PC business, and having assembled thousands of computers and motherboards etc which likely all where soaked with bromide for the usual flame-retardant purposes.. as i read somewhere in a small study, one can excrete up to 8gms or so of bromide per month under iodine treatment! crazy stuff.

    re. pathogen die-off: that’s interesting. i remember noticing unusually dark/brown urine a few times recently (which i never had before). i’m not quite sure if it correlates with the beginning of the iosol treatment, but it’s certainly possible. i will monitor that, especially when ramping up the dose.
    how would you recommend to take the iodine when i’m up to 50mg? all in a single dose with water, or spread throughout the day witch each glass? i think spreading it would probably be better, right?

    i’m also taking NAC and C (plus brazil nuts for selenium) since a few months, because i recently have had my 11 amalgam fillings removed and therefore i’m trying to support the mercury detox process with this as well.

    as i currently don’t have a doctor i trust (enough), i’m doing all this testing and tinkering on my own (after researching it on the internet). luckily we have a pretty high-tech walk-in lab here in zurich, which is very practical.

    * maybe i’m gonna ramp up the iodine even in the presence of antibodies, as one of those iodine gurus which apparently treated thousands of patients and always did a before/after antibody scan insists that he didn’t have a single case of iodine induced or worsened hashimoto’s. what do you think?

  5. ps: thanks for the tip! i haven’t tried supplemental T4 (or T4/T3) yet. but i’m planning to do so as a next step if nothing helps.. 🙂

  6. Dear qualia,

    As far as ramping up iodine doses, I would go gradually. Double the dose and stay there for two weeks. If nothing bad happens, double it again. If you get side effects, reduce the dose until side effects are modest/tolerable, maintain that dose until side effects disappear, then double it again. Drink plenty of water to help flush the bromine.

    Monitor thyroid hormone levels through this process. You want T4/T3 to be in normal ranges and TSH to go near zero. If TSH rises when you increase iodine doses, back off. To save money you can monitor TSH only, listen to your body to detect hypothyroid or hyperthyroid symptoms from T4/T3 deficiency or excess.

    As far as when to take iodine, I take it with food. I don’t think you need to divide doses, but you could split 50 mg into two 25 mg doses if you like. But listen to your body rather than me. If bromide symptoms are better with divided doses, go with divided doses.

    As far as how auto-antibodies influence strategy, I’m still learning about that myself. I never had that problem personally, so I didn’t have to master the literature, nor did I get the benefit of personal experience. However, our commenter Mario agrees with your iodine guru. See the comment thread here:

  7. qualia,

    As Paul has said, I agree with all iodine guru’s and profundly desagree with Dr. Datis Kharrazian on this matter.

    While I do/did not have all your symptoms, I have some in common, like some misterious fever when I was young, was thin pratically all my life (I’m changing little by little with resistance trainning), have mitral valve prolapse, had low cholesterol (around 130/150), high myopia, low body temperature (around 35.5ºC), epstein-barr virus, hypotension, all symptoms of hypo. I, too, extracted 11 amalgams last year (this increased my TPO antibodies for 3 months, and then they started to lower again. Took 6 months after the extraction to anti-TPO lower to the previous value).

    I have been taking 50mg of Lugol’s for about a year and half (took 150mg for about a month and half), plus selenium (some brazil nuts), magnesium, vitamin d3 (4800 UI) and LDN (

    Initially, iodine will rise your TSH, sometimes up to 75! Mine rised to 10. This is normal. What is important is to watch your free T4, free T3, your antibodies and, most important, your symptoms. My free’s pratically haven’t changed. I didn’t had many symptoms with iodine. I had some symptoms with amalgam extraction, especially a little decrease in strengh, a decrease in testosterone and HDL and increase in lymphocytes and TPO antibodies.

    What I have read, it’s that sometimes, specially when someone is high in bromide, two strategies are attempted: salt loading and a higher intake of iodine (up to 200mg).

    You can read about detox strategies and symptoms here:

    By the way, I also have been working profissionally with computers for 21 years (I’m 46).

    Anyway, as Paul has pointed out, do it slowly (I didn’t, but I was fortunate…).

    • Let me just add a bit more on the logic for going slowly. First, there is Paracelsus’s rule – “the dose makes the poison” – when you are releasing a toxin like bromine and it’s producing visible toxic side effects, you don’t want to release more, because the negative effects are non-linear and you might do significant damage. You want to find a level of side effects that is noticeable, but comfortable/tolerable. Second, the thyroid gland needs 2-6 weeks to adapt to substantially higher iodine levels, and if you give it time to do so before stepping up the dose you’ll do better at keeping thyroid hormones (T4, T3) near optimal levels, which is good for health and immune function.

      When I started iodine I had to spend a month at 1.5 mg/day and then a month at 3 mg/day, after which I could increase the dose fairly rapidly. I had both die-off effects and hyperthyroid symptoms when taking high doses early on.

      For an idea of time scales, if we take qualia’s statement that one can excrete 8 grams or more of bromine in the course of detox, and if iodine atoms substitute for bromine atoms one-for-one, that requires 12 grams iodine. If side effects limit you to 6 mg/day, that amount of bromine would require 2,000 days to displace. I suspect over a 3 month period you could gradually ramp up to 50 mg/day which would cut the time down to 8 months.

      So, it’s reasonable to expect complete normalization of iodine status to require 6-12 months. And that’s apart from any infectious disease issues (which the iodine will be helping to address).

  8. Paul,

    Your logic is sound, and I think is a good advice. I just want to say that SOME people (and don’t ask! I don’t know why!) do better with a higher dose. There have been reports on iodine list from people that have bad reactions on a lower dose (say 50mg) and fell good at a much higher dose (sometimes 100mg, 150mg, even 200mg).

    But, regardless of dose, one has to be sure to eat enough selenium to protect the thyroid from bromide:

    And, eat enough sodium to enhance bromide excretation:

    This is generally done with sea salt, as described on salt loading protocol on brestcancerchoices site.

    • Thanks, Mario!

      It’s fascinating that excretion of bromine is proportional to salt intake. Yet another reason to ignore the conventional “salt is bad” wisdom. Salt is an essential nutrient, and healthy people have no difficulty excreting an excess. Yet sodium and chloride are both important for kidney function. Not only bromine, but also excretion of other toxins including excess amino acids depends on adequate sodium and chlorine intake.

      Remember to drink plenty of extra water with the salt. The goal is to maximize excretion through the urine.

      The other paper is fascinating too. For those who haven’t looked at the paper, selenium and iodine supplementation each individually lowered thyroid bromine level by almost 50%, and both taken together lowered it by about 60%.

      For me the paper raises issues about selenium toxicity. The selenium level that is beneficial in this study is at a level considered to be toxic in humans (equivalent to 1000-1500 mcg per day, 55 mcg is RDA and 400 mcg tolerable upper intake level according to US authorities I wonder if selenium is toxic primarily through its effects on thyroid hormone, i.e. if the tolerable upper intake would be higher in iodine-sufficient individuals. Selenium without iodine can induce hypothyroidism ( and some of the symptoms of selenosis are also those of hypothyroidism. Of course, this study only lasted 8 weeks and was in rats, and can’t be taken as evidence for non-toxicity of these levels of selenium.

  9. Re the issue of why some people may have more trouble at 50 mg than 200 mg, I would bet that these people have an infected thyroid.

    Infections of the thyroid are fairly common in chronic disease patients, and the infection itself can induce or aggravate hypothyroidism. Iodine enhances immune activity in the thyroid; higher doses mean greater immune activity. One could get a sort of equilibrium at 50 mg where the infection persists and there is chronic inflammation in the thyroid, but at 200 mg the infection is defeated and the thyroid heals.

    Just speculation of course, but seems to me the most likely explanation.

    I would expect 50 mg to lead to healing in those people too, just more slowly.

    A century ago daily doses of 770 mg/day iodine were given for occult infections. This was a standard treatment. The people who benefit from very high levels may be reproducing this old therapy.

  10. ah, found the article with the bromide excretion test: “After one month, the estimated total amount of halide excreted was 24 mg fluoride and 8700mg bromide.”
    after ONE MONTH!!! crazy isn’t it?

    and here is a very nice diagram of some of the known physiologic and therapeutic ranges of I on page 17:

    here are some other links i found in my bookmarks:

    i def. am taking it slowly with the iodine so far, exactly because of the skin symptoms. i’m also doing pauses in-between to let the rash heal, which is mainly on the forehead. but i def. plan to go up to maybe 50mg/day at some point in time. also need to up my salt intake, which probably even with this low dose I is a bit too low right now. what i also notice since beginning of the I supplementation is some heavy hair loss. not in a pathological amount, but very noticeable. however, as i around the same time stopped taking finasteride (1mg/day for hair loss), it could very well be just because of this. but still, you often hear the hair loss complaint of people taking iodine.. any thoughts or insights on what the cause could be for this? thanks!

  11. qualia – You have two known causes of hair loss.

    Hair loss is a known consequence of wheat intolerance, as is dermatitis, autoimmune hypothyroidism, and your gastrointestinal problems. So the simple explanation is that this is celiac disease or a subclinical variant of it. The autoantibodies that cause the hair loss usually disappear within 6 months after you cease eating grains. I would expect the hair loss to stop around 3-6 months after you eliminate grains and legumes.

    You can help slow the rate of loss with an inflammation-minimizing diet. Eat salmon or sardines regularly for omega-3 fats, and low omega-6.

    The other likely cause is hypothyroidism. This is where taking thyroid hormone along with the iodine and selenium, as my wife suggested, might help. See for how levothyroxine can improve autoimmune hypothyroiditis.

    • Wow, I didn’t know these causes of hair loss. Does this apply to men with early balding e.g. mid 20’s? I’m thinking my husband should be checked for wheat intolerance.

  12. alright, i just got some new lab data 🙂

    hashimoto and celiac markers are all completely zero, which is good! however, i’ve been off gluten for about 2 weeks before the blood-tests, but as i read somewhere this is not important for the antibody tests alone, just for the colon biopsy (gluten/celiac antibodies last up 6 months, right?). i tested gliadin IgG and IgA, plus Transglutaminase IgA (as recommended by the lab doc).

    furthermore, my TSH and fT4 are basically unchanged compared to the last test 3 months ago (TSH 2.5). this is while taking IOSOL in a dosage of mostly 1.8 – 5.4mg/day. i can’t go higher yet, because of the persistent bomide acne.

    other test results:
    CRP -> 0
    Ferritin -> 120ug/L (12ug lower than last time)
    Anti-CCP and RF -> minimal/unsuspicious
    Total IgE (food allergies) -> slightly elevated

    i actually have several food allergies, which are a significant contributor to my fatigue day to day – maybe even the main cause of all my energy and recovery problems (?). i’m still sorting out what foods exactly are the culprit. root cause is most likely my pollen and grass allergy, for which i show several cross-reactions like carrots, banana, cucumber, some nuts (almonds, cashews, walnut), and eggs. those are just the ones i registered in the last few months because of the oral or digestive symptoms they create. and i also get tired and lethargic from milk and wheat (or gluten). additionally, all dairy products immediately create RA symptoms in the left knee which fade away after a few days of stopping dairy (luckily). i would say leaky gut and leaky blood-brain barrier is pretty obvious according to my reactions.

    but now comes the kicker, and the mystery of the month:

    my D3 three month ago (while on 5kIU D3) = 81nmol
    my D3 today, after upping the dosage to 10kIU right after the first test AND sunbathing for an hour at least 3x a week = 62nmol!!!

    What The Eff? i’m doubling the D3 dosage to a rather high 10’000IU/d and sunbath as much as i can and the D3 level drops like 20nmol and becomes clearly deficient??

    as i can “feel” the 10kIU working from the slight neurotransmitter-boost the D3 generates within half an hour after taking it, i have to assume it’s not the D3 supplement that is not working. right now, i actually suspect the lab has messed up, because after complaining to the lab like “wtf, can’t be!”, they re-tested both samples under controlled conditions and had to correct the first level down from 81 to 61nmol! the second sample stayed the same. so, all in all, i doubled the D3 dosage, and sunbathed a lot (admittedly not over noon, but usually at around 3PM @ 47°N), and stayed exactly where i was, which is deficient.
    i’m gonna do a second test tomorrow in a different lab to get a second D3 measurement, to see if indeed the first lab has messed up. any thoughts on how this could be possible, assuming the lab didn’t mess up? i take a MV with K, plus Mg daily, so i believe my D3 co-factors should be ok. thanks!

  13. Hi qualia,

    Good news about the antibodies! Guess you can just ramp up the iodine as soon as the bromine toxicity permits.

    You’re right about the leaky gut and that would be the place to work on to fix the food allergies. Almost all plant proteins can create an immune response if the gut is leaky, and you’ll tolerate most of them fine once the gut is healed, so I don’t see that it makes that much sense to chase after allergens. Check out my bowel disease posts for some basic steps on leaky gut. Also, I would try whey protein isolate and see if you tolerate that fine – it helps heal the gut (infants have immature gut linings and milk proteins protect their guts).

    Re vitamin D, I would stay at 10k IU for a bit and see what happens.

    Sounds like you’re good with co-factors: Some but not too much vitamin A (food and multivitamin only should be perfect, eat egg yolks and liver), some vitamin K2, magnesium citrate, zinc (food and multivitamin only should be perfect), copper, boron. See my latest post on calcium, in the comments I list my recommended supplements.

    It would be good to get your blood 1,25OH2D3 level measured as well as the 25OHD the next time you get blood tests. In some chronic diseases, this “activated” form is extremely elevated and 25OHD is rapidly converted to the 1,25 form, depleting it. See for instance sarcoidosis:

    Even if 1,25D is normal, some people with chronic infections go through D very quickly. Your experience is not unique.

    A faulty lab test is a possibility too.

    I would bet that over time your 25OHD level will creep up. Keep trying to get sunshine and cholesterol.

    Good luck.

  14. Paul/Mario, I’ve recently started supplementing lugols iodine since finding a slightly elevated TSH of 2.4 and some hypo symptoms (cold feeling, anxiety, shakiness, fatigue). I’ve gotten T3/T4 tested too and my doctor had stated that they seemed in normal range levels. I’m also waiting on my antibody results.

    Getting to my concern, I have been having some horrible effects of hyperthyroid symptoms (increased anxiety, racing thoughts, increased heart rate) as you had mentioned above when taking in 1 drop of lugols iodine per day. Since having these side effects, I have backed away from the iodine and don’t dare touch it again.

    I’m wondering if these effects are normal and if I should just use a much lower dose? Or maybe I’ve actually got antibodies and the iodine is inducing the attack even more? Basically Paul, your statement about having hyperthyroid symptoms when starting your iodine dose intrigued me since I’m running into the same problem.

    Thanks for your help

  15. Hi Tyler,

    Yes, you have to increase iodine very slowly to let your thyroid adapt.

    Basically, start with less than 1 mg/day, wait a month, and then double the dose once per month. (It takes 3-4 weeks for the thyroid to fully adapt to a doubling of iodine.)

    If you go right away to, say, 3 mg/day, then you’re likely to have hyperthyroid symptoms. This can then induce a reactive hypothyroidism.

    So, yes, this is normal and you should use a much lower dose.

    Best, Paul

  16. qualia,

    There are so many reasons you should be taking probiotics! Sounds like your normal gut flora was wiped out by the antibiotics and has never recovered . . .

  17. Paul — I’m wondering if there is anything to increased iodine aiding or prompting fat loss.

    I was VLC for a year — weight static the whole time — and finally went “full-fledged” PHD in January (including safe starches and the recommended supplements).

    I noticed no real change for the first 2-2.5 months. In fact, I got sick a couple of times, and I gained 3-5 pounds the first month. (I do weight-train, but that type of gain in a month is well beyond my abilities.)

    I have upped my iodine however — two times — and after starting with Kelp tablets (one a day then two a day) I am now up to a drop of Iosol formula daily (1800mcg). In the past 2-3 weeks since starting the Iosol my fat loss has been dramatic — visibly noticeable — and my weight has dropped back to December levels.

    Do you think iodine could be abetting this? I feel great, I have no other side effects other than I am less able to sleep nine hours straight than I was before, which I don’t really count as a negative.


  18. Hi John,

    Yes, absolutely iodine could contribute to weight loss. Thyroid hormones are intimately involved in energy and weight regulation, and improving iodine and other thyroid mineral status should enable better regulation of weight.

    Was your initial weight gain in fat, muscle, or water do you think?

    7-8 hours sleep seems to be associated with optimal health, so the shortened sleep could reflect improved health.

    I’m glad you’re doing well!

    Best, Paul

  19. Hiya Paul —

    It had been 1Y, so I went in to the doc yesterday.

    Background: I was VLC for all of 2010. Starting Jan 2011 I went “perfect” PHD, inclusive of supplements. I am up to a daily Iodoral (12.5mg) as of 2w ago. I haven’t had wheat or other grains in more than a year, blah blah. I have 200-600 calories of safe starches (rice, rice flour, tapioca, etc.) a day.

    Needless to say, I was excited to have my TSH/D levels checked (along with regular panels).

    (Fasting) blood glucose: 100 mg/dL*
    TSH: 3.92 uIU/mL
    25-OHD: 61 ng/mL

    TSH and glucose surprise me. On TSH, I would assume to keep raising my iodine every month? I’ve had no noticeable side effects from my path to 12.5mg (no acne, no hyper symptoms, etc.) And on the D I would guess it’s time to drop from 4000-5000 IU a day to 2000-3000.

    On the fasting glucose level I have no idea. This is the highest I’ve ever been — last year (VLC, no supplements) I was 96. Four years ago (high carb, low fat) I was 90.

    Thx in advance if you have any thoughts!

  20. “Obsessive, heal thyself!”

    After some more reading I’ve decided to do the following:

    1) Maintain at the Iodoral/day dosage for a while and retest TSH in a bit. I’m not sure if I’m on my way up or down yet, so can’t really get concerned until I have a second test. Likewise not ready to toss out the iodine altogether. I have had selenium in the mix so I am not too concerned about going haywire…

    2) On the glucose side, will test my HbA1C and see what’s up there. That’s based on a lot of what you’ve written re: physiological insulin resistance, and Hyperlipid on same, Robb Wolf, etc.

    Despite my attempts I think most days I am still too low on carbs. Your comment to Remo (#2 below) in particular highlights this. I am a 180-lb man (compared to she, a 115-lb woman) and probably not getting to 400 carb cals every day. So I will up my carbs too. (This part is the best!)


  21. Hi John,

    High TSH is not uncommon after a recent increase in iodine intake. This is because TSH upregulates production of thyroglobulin which stores iodine – thus helps temporarily deal with a surge in iodine in the thyroid.

    Over time TSH should come down with stable iodine intake. As long as you feel good, I would keep iodine stable, since 12.5 mg/day is a good finishing dose. I’ve been taking 12.5 mg/day for the last year.

    I would agree with reducing the supplemental D. Sunshine is better, so you want the lowest supplement level that gives you an optimum level. Personally I take 0 in the summer and 2500 IU in the winter.

    The fasting glucose is above population norms but not alarming. Higher carb intake should lower fasting glucose, so your 90 on high-carb is consistent with your current 100 on low-carb. Most people on high-carb are in the 80s, so you were still high for your diet back then. VLC level should have been higher than today’s, considering carb intake alone, but the supplements may have increased glucose utilization, and the difference between 96 and 100 is within the noise.

    Adding carbs would lower the fasting glucose a bit. If you think you’re still too low in carbs, you probably are.

    Best, Paul

  22. Hiya Paul — thanks as always for the response. I’m curious if that higher iodine TSH ramp-up could have other hypo symptoms? After a pretty consistent half-year of PHD, the past three weeks I have noticed significant weight gain: at least 5lbs on the scale, and I out of nowhere grew out of all of my pants. (Though no other symptoms that I’ve noticed.)

    The only other change was a pretty mild increase in carbs — maybe an extra 50g a day.

    I just noticed that I’ve been low in protein too — well, possibly low for someone who lifts weights, and is a 180-lb man — 80g or so a day. Scratching my head and wondering if too much fat by % caught up with me; if it’s hypo-esque symptoms; and whether or not more protein+carbs is the right direction or not.

    What a complicated thing this is, eating! Or we’ve made it to be.

  23. Hej Paul

    I took yesterday 1 drop of Lugols solution orally and I put one drop on hand.

    2 hours later my lymph gland on neck enlarged, the salivary gland on the same side and I tomorrow got 37.5 temperature.

    I was previously taking from 500 – 1600 ug per day.

    Do you think its endotoxin related ?

    I wasn’t sick in last 2 years once.

  24. I forgot, I eat around 4 brazil nuts per day for a year or so.

  25. Hiya Paul. QQ — I had my TSH run again and was mollified a bit that it had dropped from 3.9 to 3.0 (over exactly three months). I’ve continued at 12.5mg/day of iodine.

    Does that slow drop seem legitimate? You’d mentioned up above a temporary TSH increase is normal (



  26. Can you tell me if potassium iodide is okay to take? Only one of your iodine supplement links is viable, and I was looking for a slightly cheaper alternative. Also, do you recommend kelp? I notice when I type in iodine that a lot of kelp supplements come up. Thank you.

  27. Hi John,

    Sorry I missed your comment from August! Thanks for the November update.

    I assume you’re tending to selenium intake. What was TSH before you started iodine? Has your weight come back down?

    I guess having been on the iodine a while, I would stick with it at the current dose. Thyroid typically does improve very slowly.

    Hi maj,

    Odd. I don’t know. You can have symptomless chronic infections, but I wouldn’t expect them to be that sensitive to a mild increase in iodine dose.

    Hi Mrs Smith,

    Yes, potassium iodide is good. I don’t recommend kelp generally, as it tends to have a lot of impurities and toxins. If you go with kelp for a low-dose iodine supplement, I would use it for low doses only – maybe 500 mcg per day, not more.

  28. @ majkinetor, I had swollen lymph nodes on and off as I was increasing my iodine dosage. It’s not on the list of “bromide detox” symptoms, but I did find mention of it on yahoo iodine discussion group. At any rate, whatever sort of adjustment it was, it appears to be completely resolved.

  29. Thanks Paul!

    Yes on selenium intake — I take the full PHD suite.

    Re: pre-iodine TSH, I did not measure prior to starting supplementation… so I have no clue if 3.0 is high, low, or what independent of my iodine experiment.

    My weight has come back down but that’s due largely to work on my part (LeanGains-style calorie restriction). Most of my days are now about 70-100g carb, 130-150g protein, rest fat… total of around 1600 calories.

    During my accidental “gaining” phase I was still only ~2200 calories/day, but low (~75g) protein and even lower (~30g) carb… the rest fat. Combined with weight training it was a swift ride up the scale.

    Will test TSH again in another 3-6m. Otherwise sticking with 12.5 of iodine a day.

    • Hi Paul, not sure if you see these replies, but will try. I had my annual labs after another year of pretty perfect PHD.

      TSH was 3.4. In July 2011 it was 3.9, and November 2011 it was 3.0, so I’m back up a bit despite 12.5mg of iodine and 200mg selenium for the past year.

      My LDL was up from 126 (last year) to 171.

      Glucose was down to 74 (after three years of 94, 99 and 100). I attribute that to more daily carbs and my once-a-week post-workout carb loads.

      I’m mostly concerned about my TSH.

      I’ve been on 12.5mg iodine for a year, and 2w ago dropped to 6.25mg every other day. I also temporarily paused selenium 6w ago, then resumed 200mg every other day 2w ago. So while I’ve futzed with iodine a bit lately, I’d think my levels would have been lower from the past year?

      I’ve also been in a long-term weekly caloric deficit, and have lost 25lbs since last year’s appointment. (The computer flagged a big warning when they entered the new weight.)

      Just curious if you have any suggestions/thoughts in re: TSH. As always thanks in advance!

  30. Dear Paul,

    I’ve been reading and recommending your blog and book for a while now, and I’d like to thank you for your many contributions to the ancestral health movement. Going paleo via Mark Sisson a few years ago was a big improvement for me, and when I changed my macronutrient ratios and micronutrient profile to that of the PHD about 9 months ago, things got even better.

    I have a question regarding an earlier comment you made to qualia on July 30, 2010, above. You mention a histamine reaction as a possible response to higher-dose iodine, and that this might be indicative of die-off symptoms from certain pathogens. I’ve been slowly ramping up my iodine intake over the past 6 or so months, doubling at about your suggested rate, but occasionally I’ve tried taking a higher dose, around 6.25 mg. On these occasions, I suffer from what I think is a histamine reaction: my throat feels like it’s closing up, and my tongue feels slightly too large for my mouth. (I hadn’t had an allergic reaction to anything before this, so I lack previous experience with this phenomenon.) Though I can’t see any tongue swelling in the mirror and my breathing has never actually been impaired, it’s pretty unpleasant to linger near what feels like the edge of suffocation. The reaction takes place higher on my neck than my thyroid. My question is: assuming this is a histamine reaction, does that tell us anything specific about what pathogens I’m likely dealing with? Said another way, do certain pathogens have histamine reactions as tell-tale die-off symptoms?

    I’m taking many of the PHD and Curezone recommended companion supplements: 3g Vitamin C, 200mg selenium, 400mg magnesium citrate, and a Vitamin B complex, as well as CoQ10, Vitamins D & K, a multi-vitamin, and turmeric daily. I do salt pushes with Celtic Sea Salt , and those seem to help a bit. I’ve eaten a very nutrient-rich diet for a couple years now: homemade bone broth, kombucha, and raw-milk kefir daily, half a pound of beef liver per week, grass-fed beef and butter, organic vegetables, various coconut products, and white rice and sweet potatoes for safe starches. I only observe the histamine effect after taking iodine, and it usually begins within about 10 minutes of ingestion.

    In case it’s relevant, I’m a 24yo male, and my attempts with iodine are part of recovering from almost a decade of feeling terrible that I learned in August could be attributed to hypogonadism (free testosterone in the first percentile) and hypothyroidism (TSH = 3, adequate T4, Free T3 in the first percentile). I’ll be tested for thyroid antibodies in a few days, though Hashi’s seems unlikely, given my age, sex, and lack of both family history of autoimmune problems and hyperthyroid symptoms. I don’t think I’ve been exposed to an overwhelming amount of environmental toxins, past what we all experience on a daily basis.

    Thanks in advance for your input!

  31. Yes, it looks like herx reaction.
    Try salt loading.

  32. I have Hashimoto’s, my starting TSH fluctuated between 3.5 and 5, I have been on 50mgs of 5% Lugols, 200mcg Selenomethionine, 2000mgs Vit. C absorbic acid, for 4 months watching my TSH increase to 8, then 11 and now 35 which my doctor says is life threatening. Of course I read tons of info on the internet that says iodine will make Hashi’s worse and since my TSH continued to increase over 4 months it has scared me to continue. Can someone please give me advice if I should continue, lower Lugol’s dosage, increase Lugol’s dosage or stop Lugol’s please.

  33. Hi Sandy,

    First of all, don’t take selenomethionine. It doesn’t release selenium easily and can be incorporated in proteins as selenomethionine. You need other forms of selenium. It’s possible lack of free selenium is behind the thyrotoxic effect of the iodine.

    Start a different form of selenium immediately, 200 mcg per day. I would also reduce the iodine immediately toward something in the 3-12 mg range. Test TSH again within a month.

    Also, vitamin C, magnesium, salt, water, tyrosine, other thyroid supports.

    Perhaps Bill or Mario will have additional ideas, but I think these are probably the most important.

  34. Sandy wrote:

    “I have Hashimoto’s, my starting TSH fluctuated between 3.5 and 5, I have been on 50mgs of 5% Lugols, 200mcg Selenomethionine, 2000mgs Vit. C absorbic acid, for 4 months watching my TSH increase to 8, then 11 and now 35 which my doctor says is life threatening.”

    How do you feel?

    Has your T4 or free T4 been measured along with TSH?

    Iodine supplementation can cause a benign rise in TSH, a physiological reaction to upregulate iodine absorption after it becomes available. It is not generally a sign of a problem.

    If you are really going hypothyroid, as your doc seems to think, your T4 values would be dropping and you’d feel awful.

    Are those things happening?

  35. Bill,
    just in case you missed (tho i’m sure you didn’t), be aware that Sandy mentions she has Hashimoto’s.

    (her thyroid antibodies test results may be useful as well?)

  36. I was feeling energetic on iodine, but I had unusual swelling of my hands and feet at night. My nails broke more on iodine but my hair seemed stronger (i know that is a odd)but you are asking. When my TSH started to approach 35 (looking back at it) I started to begin to feel fatigue, rough lump in my throat, joint pains again and somewhat dryer hair. My doctor rarely tests for anything other than TSH so I no readings for T3s T4s when my TSH was 8, 11 and 35 I do have my free T4s at the beginning when my TSH was 3.5 it was 105. During these same 4months I was on iodine I switched to Celtic sea salt at home. I am considering taking 1/4tsp in water for trace minerals?

  37. Sandy, if you’re not feeling well and your doc isn’t experienced with iodine, maybe the best idea would be to find an iodine literate practitioner, if you can. One list is here:

    Based on my own experience (I have been diagnosed with Hashimoto’s, too) and a lot of reading, I think iodine should be expected to help the thyroid, not cause more problems; I was able to reduce my thyroid meds by almost half, something none of my doctors had ever seen or heard of. But there are a few exceptions to this rule, and everyone is different. Hence, again, to me, maybe the need for an open-minded practitioner with iodine supplementation experience.

    With a TSH of 35 I can certainly understand why our doc is upset. Free T4 labwork would be informative, I think, because as I understand it the benign TSH rise with iodine supplementation is not normally accompanied by below normal T4. In your case maybe something else is going on. It might or might not have anything to do with iodine.

    You could also ask at the Yahoo iodine group. They have a lot of experience, but just be aware that they are very pro-iodine—and pro “natural” (pig) thyroid extract for hypothyroidism, which I’m personally much less convinced about. Everyone has perspectives that bias their thinking, including doctors. Good luck figuring this out!

  38. Hi Paul,

    I don’t seem to understand the benefit of reducing tsh levels through iodine and selenium. If I have difficulty concentrating,etc (the whole suite of hypo symptoms), could this decrease in tsh somehow help with that, and if yes then what is the mechanism? I just don’t seem to understand how this can improve anything if the thyroid will just adapt..

  39. Sandy, one more thought. The Yahoo iodine group’s Guide to Supplementing with Iodine says:

    “My TSH went up on Iodine.

    This is a common occurrence when a person starts to take iodine after being deficient. The body increases TSH to stimulate production of thyroglobulin which is used to bind to the iodine in thyroid hormone production. Individuals can have TSH levels as high as 75 for up to 6 months without clinical signs of hypothyroidism. The best values to check with labs if there is a concern are the Free T3 and Free T4. You will find in most cases that the “frees” are nicely within the ranges.”

    I believe this advice accords with that of Dr. David Brownstein (a personal friend of the owner of the Yahoo group) and the other experienced iodine doctors.

    So your TSH of 35 may be no sign of a thyroid problem at all. But, if it were me, I would certainly investigate further with a knowledgable doc to make sure. Since conventional docs rely almost exclusively on TSH to diagnose hypothyroidism, they will jump to a conclusion here which may not be justified.

  40. Hi Jason,

    Iodine aids with toxin removal and immune function. It supports the myeloperoxidase pathway to pathogen killing.

    Since toxins and infections are causes of hypothyroidism, iodine may have a long-term therapeutic effect.

    So even though the short-term effects on thyroid function are likely to be neutral at best once a deficiency has been relieved, there’s reason to think that a long-term benefit may be realized.

    Best, Paul

  41. Most people (varies by state) have the option to order blood tests on their own.

    See HealthCheckUSA or Direct Labs. Direct Labs has monthly specials worth keeping an eye on.

    These are good options for people who want to monitor their blood work more frequently than their MDs are willing, or for people who want to monitor certain parameters (thyroid antibodies, FT3..) their MDs are unwilling to order for them.

    I rarely see this discussed online, but my MD maintains that high dose iodine like Iodoral will affect progesterone levels (generally increasing P). It’s recommended to monitor sex hormone levels by saliva, and thyroid, when increasing iodine, as both systems will be affected.

    Perhaps this is more important for those who are supplementing with progesterone or thyroid hormone, as the iodine may necessitate a change in dose over time, the reduction or even elimination of the supplemental hormones.

  42. Bill/Paul:


    It’s hard to understand the author Mario Renato Iwakura completely, but I think I do. There are many many studies that suggest iodine for Hashi patients makes symptoms/numbers worse but what the author is saying is those studies didn’t take into account Selenium supplementation and selenium deficiency. Okay I get that. But then it gets further confusing by saying that is one has a Selenium deficiency and or Iodine and or BOTH then too much iodine can exacerbate Hashi’s and/or too much selenium can ALSO exacerbate Hashi’s. Then further goes on to say that a BALANCE is needed. Then further goes on to say the people with HEALTHY thyroids should be extra careful with finding a balance.

    This is extremely scary to me because Dr. Brownstein has National Best Seller’s out there bringing awareness to his opinion that most Americans are iodine deficient because of too much of the other halogens (bromine/fluoride/chlorine), then there are sites out there that support this finding. His books and those sites are extremely convincing and encourage many people to try iodine supplementation even if they are healthy. People who are desperately looking to fix their thyroid problem via natural means are even more encouraged that this is the answer and put faith into trying iodine.

    Okay, that all said. I tried it, and I didn’t leap into it, I read all Brownstein’s books I read all these sites supporting iodine supplementation. I started off slow with iodine increasing from 2drops to 4, then 6, then 8. I took selenium along with it. And now my TSH is 35. I’m ‘not’ in any way complaining, so bear with me here, I have used only alternative medicine for years and am not going to bale out, I just need help figuring this out.

    Here’s the scarey part, people like me get TSH tests to see what the results of taking iodine does. People who are encouraged by Brownstein’s books that do not have a thyroid problem but want to detox bromines don’t get TSH tests and don’t know what is happening to their TSH levels. Hence I put my full faith that this was a good thing and almost never causes any problems only benefits by driving bromines out so I started my entire family on iodine supplementation too and I currently don’t know what happened to their TSH. My friend who has Graves also started the same time as I with iodine/selenium supplementation and unfortunately her numbers are going in the wrong direction too.

    So what to do is now where I’m at. I will find someone to give me a selenium test also to check ALL thryoid numbers not just TSH, but then what? No doctor in my area that I have found yet (and I live in Norther CA) so it’s very progressive knows how to dose iodine and selenium to balance a thyroid. And lastly, the most important thing here is with my TSH that used to be between 3.5 and 5 is NOW 35, have I don’t something permanent to it that is now irreversible? and what are my family’s and now we all probably have to go through testing when maybe I should have left well enough alone? This is the situation I am in and a friend of mine with Graves is in (who also had her husband start iodine supplementation). We are ‘not’ complaining, we are both committed to figuring it out, but in order to figure it out we need guidance. Thank you for any and all guidance.

  43. Hi Sandy,

    I sympathize. This is a complex area of biology and it’s really tricky to get supplementation right.

    I would consider Dr. Brownstein as occupying one extreme and the majority of thyroid doctors occupying the other (anti-iodine) extreme. The trouble is that iodine supplementation done correctly is likely to deliver modest benefits, but done incorrectly might do significant harms. And it seems to be easy to do it incorrectly.

    I think a normal intake of iodine is maybe 3 mg/day and an optimal selenium intake maybe 200-300 mcg/day. As you raise iodine higher above this, it becomes more and more important to get selenium and other cofactors right, or the risk of something going wrong may rise. At least, the severity of harm that you do when you have something wrong with your selenium intake will be greater.

    An iodine intake of 3 mg/day will still lead to excretion of bromine and other toxins, it will just happen slower. That’s OK. These conditions generally take a long time to heal. A slow low-risk approach is better than a fast risky approach.

    I think TSH of 35 is worrisome especially since you have some hair and hand symptoms. So I would reduce iodine to a more normal level representative of food intakes from someone eating a lot of shore foods, provide optimal cofactors, and give the thyroid some time to heal.

    Best, Paul

  44. Hi Sandy,

    I’m in no position to give you advice, but if it were me I’d hold off worrying about this until you get a full thyroid panel. As I said before, elevated TSH by itself while repleting iodine is apparently common and probably healthy, even at levels much higher than yours. The thyroid labs should help you determine if you really have become more deficient in thyroid hormone or if you’re just experiencing a benign TSH elevation to help your thyroid absorb the iodine it needs. They symptoms you mentioned might be caused by various things, it seems to me, including bromine detox.

    I would think your family would develop symptoms if they were going hypothyroid, though I believe the iodine docs do recommend thyroid monitoring for everyone on iodine orthosupplementation just to be safe.

    What medications are you on for your Hashimoto’s? Have you changed those medications in any way during the iodine supplementation? As far as I know, it’s extremely uncommon for someone to need *more* thyroid hormone after repleting iodine. About a third of people, including me, can greatly reduce their thyroid meds, while the rest, apparently, tend to stabilize and at least stop the usual rise in dose requirements over time. Of course we are all different so I have been very careful myself and would urge everyone to take care as well.

    Here’s one more idea for the hopper if you want to pursue this. You could order an iodine loading test (with bromine if possible) from FFP labs, run by Dr. Flechas, one of the most experienced iodine doctors. He will talk to you, or your doc, to help interpret the results. (My doc has done this, and it was very helpful.) I think Dr. Flechas could offer you advice about your thyroid labs in light of the loading test results. I believe he has followed over a thousand people on iodine, many with Hashimoto’s.

  45. I have many symptoms of hypothyroidism but all of my lab values are “normal.” My TSH is only 1.1 and everything else is in range.

    However, my free T3 is at the very low end of the range and my reverse T3 is at the very high end of the range. The ratio of free T3:reverse T3 is only 8, I’ve been told optimal is 20 or higher. So, apparently my thyroid is fine but my liver is in famine mode and making far too much reverse T3 … or so I’ve been reading.

    Do you have any insight into reverse T3 hypothyroidism, also known as Wilson’s Syndrome? The common treatment is to take synthetic T3 hormone, which I would prefer not to do.

  46. Hi, Paul, thanks so much for your article! I have recently found that my TSH is non-existent, or nearly at .007. I am 30 years old, been a nutrition-conscious raw/vegan for years and one of the healthiest people I know – never sick, no symptoms of thyroid irregularity, and only got the tests done to check in… I had some more tests done and found the following:
    Triiodothyronine,Free,Serum 9.4
    T4,Free(Direct) 2.87
    Thyroxine (T4) 14.6
    T3 Uptake 37
    Free Thyroxine Index 5.4
    The last bit is that I live on a tiny island in the Bahamas with barely a nurse in sight, and no experts to speak of. I’m looking for some knowledge so that when I head back to the States I can speak to some doctors about alternate theories. Do you have any theories ideas or info for me? Thank you so much!!

    • Hi Amanda,

      Well, are those numbers within the reference ranges, or high? Have you googled symptoms of hyperthyroidism and looked to see if you have any?

      I would recommend supplementing iodine at a low dose if you aren’t already. Iodine deficiency is a major risk factor for hyperthyroidism.

  47. Those numbers are supposed to be a few points higher than the upper limits of normal, TSH much lower.
    I have looked into symptoms of hyper and hypo, and a few other disorders, and I have no symptoms of any of it. I can try adding more iodine, would be quite happy to. Let me know if you think of anything else!

  48. what would you make of tsh 1.5
    t4 17 and t3 results not back

  49. Amanda,

    TSH .007 together with the other results indicates mild hyperthyroidism and it is plausible that you still don’t have any symptoms. Try to test your antibodies: TSI – the most reliable measure for Graves’ disease – TPO and antithyroglobulin ab. I would not do anything drastic at this point. Try Bugleweed (liquid formulas) or a low dose of antithyroid hormons like metimazole or PTU prescribed by a doctor. If it is Graves, iodine can exacerbate symptoms – maybe in the long term it can help but I would be cautious. Certain geographical areas trigger Graves in susceptible patients. I wonder if proximity with the ocean and lots of iodine were the trigger for you. Stress (including from infections) is also considered number 1 cause of Graves.

    Keep us posted,


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