Let’s Kill The TSH Test

We have before us multiple scenarios, all of which start and end in the same place. (This is going to be a tad long, so grab a cup of coffee to see you through to the end.)

The adventure starts when you drag into the doctor’s office complaining about weight gain, extreme fatigue, thinning hair, mood swings, feeling a little down, and so forth–the standard hypothyroid story. Dr. Sherlock, if you’re lucky, will take these clues and decide to test for a thyroid problem.

And so you give a little blood for a few blood tests, and our scenario starts diverging.

The big kahuna of thyroid blood tests is the misbegotten TSH (thyroid stimulating hormone) test. That’s what we’ll talk about here.

Here’s the theory behind the test: The pituitary gland, which controls the thyroid and every other part of the endocrine system, tells the thyroid gland when to make thyroid hormone.


  • If the pituitary decides you have enough thyroid hormone in your system, it quits ordering more.

  • If you’re producing too much thyroid hormone, the pituitary backs off any TSH and puts out a factor that tells the thyroid to knock it off.

  • If you don’t have enough thyroid hormone racing through your cells, the pituitary pours out more and more TSH to get the thyroid gland to do its duty.

  • Based on that theory, the doctor, with one quick look, will decide your thyroid fate.


  • If the TSH is withing “normal range,” he’ll declare you fine. Problem is, there’s no agreement on what the “normal range” is. Chances are you’re not at one extreme or the other–although the TSH test isn’t reliable, so who knows–but that doesn’t mean you’re home free. You don’t have to be far off the mark to be in a world of hurt. For instance, even mild hypothyroidism explodes your chances of heart disease, but you may still be in the so-called normal range.

    Besides, you feel bad. So the good doctor solicitously offers you an antidepressant. And you probably feel wretched enough to take it. It won’t do a bit of good, but the deal is sealed. You’ll have to change doctors and try again to get proper treatment. It’s not unusual to go to six or seven doctors before somebody gets it right.

  • If your TSH is low, the doctor declares you hyperthyroid. Maybe not, Sherlock. If the pituitary is out of whack, it won’t produce TSH no matter the circumstances. Besides, hyper symptoms usually take a different path; then it’s about losing weight, heart palpitations, extreme nervousness, etc. I’m hypothyroid because my pituitary doesn’t work, not a situation for the weak of heart–patient or doctor.

    To handle your hypothyroid symptoms, the doctor takes out the prescription pad to scribble the name of an antidepressant. As if! It won’t do a darn bit of good. It’s like putting a cast on your leg because you have a cold.

    But what if the TSH test is legitimately low. Well, you could have an infection. And, as I mentioned, the test is unreliable. Or you may really be hyperthyroid. In any case, before you get involved in irreversible hyperthyroid treatments, research the tar out of alternative medicine’s options. Let the irreversible stuff be a last resort.

    Meanwhile–and I can’t believe these words are coming out of my fingers–drink V8 juice. It contains a little soy (natural flavoring on the label), which will depress your thyroid, which will help with the symptoms. Soy is a menace to health–but V8 has high nutritional value, and it’s only for a short time until you get things sorted out.

  • Finally, if your TSH is high, the doctor will declare you hypothyroid and, this time, write a prescription for a thyroid medication instead of an antidepressant. But don’t celebrate too soon.

    You’ll get a prescription for Synthroid, levothyroxine or some other T4 medication–none of which is worth spit. Doctors, however, see T4 medications as the medicine of choice, indeed the only medicine they’ll order. Some of them know it doesn’t work, but they still have to order it. Explaining why T4 meds don’t work is a long, long tale, so I’ll just talk results–or lack thereof–here.

    T4 medications help very, very, very few people. Like, maybe, none. Your symptoms persist unchanged. Oh, you try to will things to be better because you’re so tired of feeling like garbage, but nothing happens.

    So you drag yourself back to the doctor for another test. And here’s where a Catch-22 rears its ugly head. While the T4 medicine does nothing for your symptoms, it does normalize the blood test. The TSH test is always normal if you take T4 meds. The doctor may fine tune the dose a few times, but in the end, if you keep complaining about feeling terrible, you’ll get an order for an antidepressant. Which, of course, won’t help.


  • I can offer but a small ray of hope: Doctors are losing faith in the TSH test. Some medical schools no longer teach it. It’s about time.

    Before advent of the TSH forty-some years ago, doctors treated thyroid issues by addressing symptoms; the approach that works. Also back in the day, doctors prescribed the bio-identical Armour thyroid instead of the synthetic T4 meds for hypothyroid patients, and Armour worked well. Exceedingly well. (It still does, if you can get a doctor to order it.)

    So, here’s a suggestion: When your doctor hands you a prescription for an antidepressant, try to bargain for a trial of Armour thyroid before you try the antidepressant. What do you have to lose?



    Bette Dowdell is not a doctor. She speaks as a patient who has experienced and studied endocrine issues for more than 30 years. Her opinions, while researched, are her own. She’s successfully handled her own endocrine problems based on her research. She offers a free health e-zine, introductory teleseminars and an in-depth12-month subscription program, “Moving to Health,” about living well with endocrine issues. She explains how things work–or don’t, discusses what things to avoid as well as the things that help, and she provides a lot of well-researched nutritional information. Subscribe to her free e-zine at Information is power.