HomeAnswersEndocrinologytsh levelWhich of the two opinions for my TSH value is correct?

I have got different opinions for my TSH value. Which one is correct?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Bindiya Thakkar

Medically reviewed by

iCliniq medical review team

Published At November 14, 2016
Reviewed AtMay 31, 2023

Patient's Query

Hi doctor,

I am very concerned about my health. I made an appointment last year with an endocrinologist. I had a laboratory work and my TSH was 3.4. It was considered normal on laboratory ranges. But, my primary doctor said that 3.4 is high on what it should be consider the new normal. My LDL cholesterol was also high. After a year of very good nutrition, I asked my doctor to also check my free T3, T4 and reverse T3. Basically, I did this because of my research. Laboratory work came back as TSH 5.8 (out of the normal) and my doctor said it was fine, again. Free T3 low and he said it was fine. Reverse T3 a little on the high end. Based on the research, when free T3 is low it can affect cholesterol and then both thyroid and cholesterol affect my free testosterone, which is lower now. He just gave me medicine for cholesterol. I went to another doctor and he said that he only considers hypothyroidism when someone is with TSH higher than 10. He is completely different than all information on the internet and books. He said my cholesterol is high, but HDL ratio to triglycerides was good. He thinks that I may be the exception and have a problem with a 5.8 TSH and wants to give me Synthroid. I am planning to go to another doctor. My TSH is high and my free T3 is low. It can be a conversion of T3 to T4 problem. Therefore, in order to solve it, I need Armour or Armour plus Cytomel. But, the two doctors whom I consulted, think that my TSH is fine. They believe TSH is the important part, when everywhere doctors keep repeating to check FT3 and FT4 and reverse T3. I need your opinion. Thank you.

Hello,

Welcome to icliniq.com.

Work up of hypothyroidism involves just TSH (thyroid stimulating hormone) or TSH and free T4. TT3 (triiodothyronine) or reverse T3 has no role in the diagnosis of hypothyroidism and it is useful in hyperthyroidism. TSH more than 10 is hypothyroidism and definitely needs treatment. TSH between 3.5 to 10 is subclinical hypothyroidism and is treated in various scenarios as follows.

1. Symptoms of hypothyroidism, such as weight gain, constipation, etc.

2. High cholesterol, which is positive in your case.

3. Strong family history of Hashimoto's or hypothyroidism.

I would not recommend Cytomel or Armour (natural thyroid hormone from animal thyroid gland) as it is T3 and this is something your body converts from T4 on its own based on need. Besides, studies show no benefit, but the potential harm from taking T3.I would suggest you do a trial of Synthroid or Levothyroxine and see if it helps you with your doctor's consent.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Bindiya Thakkar

Dr. Bindiya Thakkar

Endocrinology

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