How would you address normal TSH but low T4?

How would you address normal TSH but low T4?


Scott Habermehl says, “How would you address
normal TSH but low T4?” Well, the first thing I’d do is I’d look at
your T3. So, for those of you who aren’t familiar with
thyroid hormones, TSH tells your thyroid to make thyroid hormone. T4 is the precursor. T3 is the active hormone. So, your T4—so, if your TSH is normal, that
means that your pituitary is receiving the proper messages from your thyroid gland. But if your T4 is low, I would look, first
of all, is your T3 normal or high? So, if your T3 is high, then you’re probably
just converting it very rapidly. If your T3 is low, then even though your pituitary
appears to be receiving the right signals, you’re not making enough thyroid hormone. And in fact, it would become unclear whether
your pituitary is actually making the right signal because if your T4 and your T3 are
low, your TSH should be high because your pituitary should be saying, “wait a second,
T4 and T3 are low, so I need to make more of the message, TSH, to tell the thyroid gland
to kick into gear.” So, if the T4 and T3 are both on the lowish
side and the TSH is normal, I would reinterpret the TSH and say, actually your TSH is not
as high as it should be given your thyroid hormones. And so, I would then look to the pituitary. In terms of nutritional issues, I think the
big things that you’re looking at are calories, carbohydrate, and body fat, because the pituitary
is overwhelmingly asking the question, do I have enough energy in the short term and
the long term to engage in the health-promoting, long-term investments that thyroid hormone
governs? And those are many, like all the biological
peacocking, like making nice hair, and making nice skin, and making things look nice. But they’re also protecting your tissues from
damage. And then the big, big, big thing, if you’re
in the right age bracket, is fertility. So, if your pituitary is not making as much
TSH as it should, then that’s basically saying your brain perceives that you don’t have enough
energy on hand, and that means either your body fat’s too low, or your calories are too
low, or your carbs are too low because those are the big signals that your brain is going
to use. And then I would say, I mentioned in the Nutrition
in Neuroscience series, I mentioned that all of the releasing hormones, so all of the things
that the brain is making to govern the endocrine system, all of them require copper, vitamin
C, zinc, and glycine to make. So, I think the big thing to look at is body
fat, calories, and carbs. But the next layer to peel back would be those
four, vitamin C and copper especially, in the background zinc and glycine. And I would especially look at those if the
big picture incorporates all the other things you expect from those nutrients being missing
in the brain. And that’s not just low thyroid, it’s low
thyroid paralleled with low adrenal, low sex hormones. So, across the board, if that’s true, yes. And then also, if your appetite is dysregulated,
you’re eating too much, if your hair is graying, if you’re peeing too much, and I might be
missing a couple things in there, but if that general picture starts to look like that,
that’s when I start saying, maybe these nutrients are missing in the brain. But always first thing is carbs, calories,
and body fat.

2 thoughts on “How would you address normal TSH but low T4?

  1. I think the TSH ranges aren't correct either. They've lowered the top of the range to around 4, but I've read that people who don't have thyroid problems actually have a lower TSH. I've been to an endo who said that some people do better with a TSH below 2.

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