High TSH Levels: What Should You Do?

When to get a second opinion.

If you have high TSH levels, what should you do? Many functional providers mistakenly misdiagnose patients as hypothyroid unnecessarily. In today’s video, learn the truth about elevated TSH levels, and how to tell if you need thyroid medication or not.

In This Episode

Episode Intro … 00:00:40
Too Quick to Medicate … 00:01:56
Get a Second Opinion … 00:05:05

Subscribe for future episodes

  • Apple Podcast
  • Google Podcasts
  • Spotify

Download this Episode (right click link and ‘Save As’)


Hey there, this is Dr. Ruscio. I just want to share a quick update regarding the thyroid TSH and why you should be really careful in terms of what you are told you should do about an elevation of your TSH. You’ve hopefully heard some of my criticisms of the field of functional, natural, and integrative medicine regarding how overzealously, we’re interpreting small perturbations and findings on thyroid labs. This certainly includes people I work with in the clinic. In fact, I just had a patient this morning and she had previously a TSH of 6.3. So the cutoff on most labs is 4.5. So she was according to the conventional lab ranges, slightly elevated. This is known as subclinical hypothyroid. When that minimum elevation of TSH is paired with normal T4, this is known as subclinical hypothyroid, meaning you’re not true hypothyroid. Why this is so crucially important is because the data here are fairly clear in showing that most of these cases will spontaneously remit or will spontaneously, all on their own with no treatment or therapeutics or support, go back to normal…


Sponsored Resources

Hi, everyone. Let’s talk about probiotics, which helped to make this podcast possible. Functional Medicine Formulations contains a line of probiotics that I personally developed, and I’m super excited to be able to offer you the same probiotics that I’ve been using in the clinic for years and are a byproduct of an extensive review of the literature plus my own clinical experience.

High TSH Levels: What Should You Do? -
High TSH Levels: What Should You Do? -
High TSH Levels: What Should You Do? -

In this line, you will find my favorite three probiotics in all three of the main categories that work synergistically to help you fight dysbiosis, like SIBO, candida yeast, and H. pylori, help to eradicate parasites, help to reduce leaky gut and repair the gut barrier, and can improve gas, bloating, diarrhea, constipation, and may even improve mood, skin, sleep, and thyroid function because of the far-reaching impact of the gut. You can learn more about these at drruscio.com/probiotics.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio Radio discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit drruscio.com and sign up to receive weekly updates. That’s DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey there, this is Dr. Ruscio. I just want to share a quick update regarding the thyroid TSH and why you should be really careful in terms of what you are told you should do about an elevation of your TSH. You’ve hopefully heard some of my criticisms of the field of functional, natural, and integrative medicine regarding how overzealously, we’re interpreting small perturbations and findings on thyroid labs. This certainly includes people I work with in the clinic. In fact, I just had a patient this morning and she had previously a TSH of 6.3. So the cutoff on most labs is 4.5. So she was according to the conventional lab ranges, slightly elevated. This is known as subclinical hypothyroid. When that minimum elevation of TSH is paired with normal T4, this is known as subclinical hypothyroid, meaning you’re not true hypothyroid. Why this is so crucially important is because the data here are fairly clear in showing that most of these cases will spontaneously remit or will spontaneously, all on their own with no treatment or therapeutics or support, go back to normal.

Too Quick to Medicate

DrMR:

Now, what was so interesting here is that while working with me, she was also doing some local testing with her NP, her nurse practitioner. I advised her not to be too quick to act on this 6.3, this elevated TSH paired with normal T4 and also normal T3. Let’s retest in a month or two, especially given the fact that she had been improving symptomatically. As the data suggests, you will likely see normality or normalization of your TSH. So what do you know, about two months later? Her TSH has now gone into the normal range of 3.6, from 6.3 and T4, and T3 are still normal. All the while she has continued to improve symptomatically. To contrast this with what I think really needs to be amended in the field, her NP wanted to put her on thyroid hormone at that initial visit with the elevated TSH. What a travesty that would have been, because once you put someone on thyroid hormone, the repeat testing doesn’t tell you if they no longer need the hormone, because all of the levels have been paved over by the hormone that the person is now taking orally.

DrMR:

So this is a crucially important situation where we don’t want to be too quick to act to put people on thyroid hormone without giving adequate time to see if, especially at these subclinical findings, again – high TSH, normal T4 according to the conventional ranges – normalizes all on its own at your next retest. The trajectory of these two different patient scenarios is so different. The one patient from the more, what I would argue, overzealous camp will be put on thyroid hormone in some cases for years, until a provider has enough common sense to go back and check this. Or, as in this case with a more reserved and kind of circumspect approach, no medicine was started and a retest a couple months later found she was back into the normal range. We stopped her from going on a medication ostensibly for years that she would not have needed.

SponsoredResources:

Hi, everyone. Let’s talk about probiotics, which helped to make this podcast possible. Functional Medicine Formulations contains a line of probiotics that I’ve personally developed. I’m super excited to be able to offer you the same probiotics that I’ve been using in the clinic for years and are a byproduct of an extensive review of the literature plus my own clinical experience. So in this line, you will find my favorite three probiotics in all three of the main categories that work synergistically to help you fight dysbiosis like SIBO, candida yeast, and H. pylori help to eradicate parasites, help to reduce leaky gut and repair the gut barrier and can improve gas, bloating, diarrhea, constipation, and may even improve mood, skin, sleep, and thyroid function because of the far reaching impact of the gut. You can learn more about these at drruscio.com/Probiotics.

Get a Second Opinion

DrMR:

If you’re concerned about this, double check and get a second opinion to make sure that you’re A) not on thyroid hormone that you don’t need to be, or B) that perhaps you are given thyroid hormone too quickly, based upon this lab work, that really didn’t justify that approach.

DrMR:

Now, according to the philosophy of some providers, subclinical hypothyroidism does justify use of medication. Although the data here are clear that there is almost no benefit shown when those who have that pattern of high TSH and normal T4 go on thyroid hormone. Almost no benefit has been documented unless you’re very young, you are pregnant or are struggling with infertility, or your TSH is well above 10. These are important nuances to understand in navigating the conversation around thyroid, which is all too often vilified or positioned as a cause of all symptoms. It may well be, but we don’t want to force upon someone thyroid hormone when the labs really don’t justify that because that can lead someone to be on medication they don’t need. This also distracts from actually determining what underlying cause is leading to the symptoms that you’re having. So again, I would encourage you to double check. Don’t stop taking the medication until you check with your provider, but if you’re suspicious that your provider is being a bit overzealous, have a double check. It may be well worth it. Okay. That is our show. Hopefully this helps.

Outro:

Thanks for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio.com to ask a question for an upcoming podcast, post comments for today’s show and sign up to receive weekly updates.

Need help or would like to learn more?
View Dr. Ruscio’s additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

Leave a Reply

Your email address will not be published. Required fields are marked *