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What happens when your TSH gets too low, or what happens when you are told to ignore it when it is that low? Some might say that you can, but others will tell you that there are real dangers present if you do. Today, I want to walk you through this complex topic and teach you a bit more about your TSH and what it means for your health.
What is your “TSH”?
Before we begin, we need to have a really solid understanding of what TSH is, what it does and what it can do. This is going to help give us a solid understanding of why a test like this exists, and why learning more is going to help us with our health down the road.
Key Insight: Thyroid stimulating hormone (TSH) is your pituitary gland telling your thyroid to work.
The cycle works something like this: when your thyroid makes too little hormone, your pituitary gland makes more TSH to stimulate it. The same works when you are on thyroid hormone. If you have too little hormone, you make more TSH, and if you have too much hormone, you make less.
I have heard people say that natural thyroid pushes down TSH more than synthetic thyroid – and that you can ignore a low TSH when you are taking natural thyroid. There have also been times when I hear others say that you can ignore a low TSH because your free T3 and free T4 levels have yet to rise. The logic of this is that folks often have hypothyroid symptoms.
This means that:
- They are struggling with fatigue
- They are dealing with weight issues
- Their hair is thinning
In this situation, when someone is taking too little thyroid, those symptoms get better when their thyroid levels are raised to a certain point. They feel more invigorated, and at a certain point, they get back to feeling how they felt before. Unfortunately, they also think that if it has helped them before that it will help them again.
This is where I have started to see plenty of online thyroid advocates suggest that your TSH is something worth ignoring. This is born from this previously mentioned idea that increased in thyroid dosage lead to lower TSH, and periods of feeling better. Patients may feel good at first, but I want to talk today about how there are long-term implications that we need to be aware of when we not only push our TSH too low but when we ignore it altogether.
Key Insight: It takes a while for your blood levels to change – it could even take several months to properly adjust. This means that while you might feel better with a temporary thyroid dose increase, your system will eventually regulate itself to the point where you are no longer reaping those benefits – in this regard, it is all just a matter of time.
The danger in raising dose after dose, trying to achieve that “normal” state where you are symptom-free, is that you continue suppressing the TSH to a point where it could be dangerous. There are risks present, and they could even become present before you have elevated free T3 or free T4 levels in your body.
In Conclusion: Once those free hormones go up, everyone can agree that it is a dangerous state to put your body in. What I want to talk about today, though, is how you might need to shine a spotlight on a low TSH before this even occurs.
The Dangers of a Low TSH
I want to pull back a little bit and bring a little history into our discussion today. In the past, we have had lots of people who have been on treatment for thyroid cancer. The logic behind treating them was that we needed to push their TSH way, way below the normal range. This was in order to protect them against a cancer recurrence.
Since that point, researchers have watched and tracked the results of these treatments. Those same treatments that sought to push TSH as low as it can go also resulted in:
- Higher rates of mortality (1)
- Higher rates of heart attack (2)
- Higher rates of hip fracture (3)
- Higher rates of dementia (4)
In Conclusion: These results are all incredibly unfortunate, and are unfortunate byproducts of pushing the TSH to a point where it is just too low. The risk of pushing your TSH this low is too high, risking cardiovascular disease, bone density, early brain aging, and even death.
We have also seen situations revolving around this term. This is where people who are not on thyroid treatment have a TSH that runs lower than average. They have no apparent hyperthyroid symptoms whatsoever, and they do not have high T3 and T4 levels. But, their TSH remains below 0.4.
What we have seen is that all of those people have those exact same complications as those who have been treated for thyroid cancer. They have hip fractures, greater rates of congestive heart failure, more brain aging, and more total death.
In Conclusion: These results of those with subclinical hyperthyroidism allow us to draw a more direct connection between the treatment methods seen in those with thyroid cancer. It really helps us ground our understanding of just how dangerous a low TSH score can be for our bodies and our health.
Should you ignore your TSH?
I have heard plenty of doctors suggest that you can ignore your TSH, as long as you are feeling okay. These same people have come to me, and I have screened them for their heart health and other issues and noticed the same thing time and time again: they have had these trademark low-TSH outcomes.
Someone might tell you “Oh, I have done this for years and I feel totally fine.” Well, this is where we need to emphasize the trickiness of risk factors. A risk factor does not mean that a potentially deadly outcome needs to happen in this moment, on this day. It can take time, and it often will take time to settle in.
Key Insight: Have you heard the statistic that most smokers do not actually get lung cancer? Examples of the risk not affecting some, does not mean that we can rule out the risk altogether. It typically means that someone simply got lucky!
Let’s take a moment and think about seatbelts. If I made a trip in my car to the grocery store, and put on my seatbelt, but did not get into an accident, I could reasonably conclude that seatbelts are unnecessary. After all, I did not get into an accident with it on, who is to say that I would get into an accident without it on? Obviously, you would probably tell me I was a bit crazy!
In Conclusion: Risk factors might not rear their ugly heads today, tomorrow or the next day, but they definitely do exist. It is not a guarantee that you will be afflicted by these problems, but it does put you “at risk” – and that can be, and should be, a scary thing that we want to minimize.
The interesting pitfall that people can fall into is based on the fact that the symptoms between low and high thyroid can sometimes be the same as one another. This means that you could be getting too much thyroid, and you could feel like you are getting too little thyroid.
There are many people who are hyperthyroid, and they do not have the classic symptoms that you might expect:
- They are actually tired
- They are actually gaining weight
- They are actually losing hair
Key Insight: What goes on in your body is that when you get too much thyroid, and your TSH goes low, your body begins to make itself thyroid-resistant. You start blocking thyroid hormone, and you push it out of your body more quickly.
After those first few weeks have passed, you may feel like you are getting too little thyroid into your system. You could totally start feeling like you are hypothyroid, instead of hyperthyroid.
Based on those symptoms, a doctor might look at your tests and suggest that you need more thyroid and that you can safely ignore your TSH. This might help in the short-term, but it is definitely not the right course of action to ensure your long-term health.
In Conclusion: I am in this for the long haul with you. Aging well and feeling better, they are long-term goals that we need to work towards each and every day. Ignoring your TSH often comes down to a short-term fix, with long-term implications that can harm our health.
What if I don’t feel good unless my TSH is low?
This all goes back to the idea that if you are increasing your thyroid dose, and feeling better, you are relying on ignoring those root cause factors that you need to understand to get to the real issues plaguing your health.
The goal is to find your too causes, because they will help those symptoms and will help you be healthier in the long run. The beautiful thing about your body is that when you identify and treat these root causes, those other issues going on inside your body have a way of working themselves out.
One thing I do want to mention before we sign off today is that the TSH is not a perfect test – this is based on the idea of “normal” versus “optimal.” When a test is presented to someone, they may be told that they cannot possibly have thyroid disease because their TSH falls in the “normal” range.
While I do agree that this is not the right way to use the TSH, I do agree with others who feel as though they want to scrap the TSH altogether. I do think that the data that we can learn from your TSH scores is helpful, and that it can inform the bigger picture of your health. Without it, we are missing out on some critical insights into your body, so we need it.
Your TSH, Your Thyroid, Your Health
You might be thinking to yourself, “today is the day I get to know more about my thyroid.” After reading this article, you have obviously seen that the role of your TSH can have grave implications on your long-term health – so why not resolve to learn as much about your thyroid as possible. Take the Thyroid Quiz (5) today, and start learning more about your thyroid and your overall health. One thing is for sure: it will help you gain better knowledge into how your body operates, and how you can start addressing your root causes, today.
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, and regain energy. Learn more about the surprising story that started his quest.