Your doctor should also be testing the actual thyroid hormones, FREE T3 and FREE T4 every time you have blood work. Now having said all of those things it doesnt mean that the TSH is entirely useless (in fact I will talk about how it can actually help somewhat helpful later). In this way, D2 helps regulate how much thyroid hormone each cell gets by activating or inactivating thyroid hormone as necessary. #supplements #lifestyle #medication #thyroid doctors #symptoms #hashimoto's #blood tests #diet & recipes Hyperthyroidism is usually caused by Graves' disease (an autoimmune disorder) in expecting moms, where the immune . And, in order to become active, it needs to be changed by certain enzymes in your body. 7 The circadian differences in secretion may cause a small variation in TSH levels in older literature a mean of 0.952 mIU/l although generally this does not result in TSH values outside the normal . Herpes sores blister, then burst, scab and heal. That means we need to change our definition of normal. Hypothyroidism FT3 and FT4 are much more important than TSH. If left untreated, this condition eventually may lead to serious health problems. Third trimester: 0.48 - 4.71 uIU/mL. For these, please consult a doctor (virtually or in person). All laboratory results need to be interpreted in the clinical context and the doctor who ordered the tests is usually in the best position to do that. More information is needed in order to answer the question. In fact, T3 thyroid hormone is 3x more potent at decreasing your TSH than T4 thyroid hormone(14), so put that into perspective when using medications like cytomel, liothyronine, or NDT. ANSWER: For mild cases of hypothyroidism, not all patients need treatment. If it does, how is it treated? I like to think of it as the gas pedal to the car. She is the author of "The Thyroid Diet Revolution. Some people developthyroiditis after pregnancy. Herpes spreads by oral, vaginal and anal sex. face, muscle weakness, hoarseness, and joint pain or stiffness. All rights reserved. In the case of standard hypothyroidism, your TSH increases. Nowadays due to the Standard American Diet (4), decreased activity levels, absurd rates of insulin resistance, and many other factors, it is truly rare to see a healthy person. Here are 4 ways you can get more help right now: #1. Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications. This often leads patients with autoimmune thyroiditis until their TSH finally increases to a point where providers feel thyroid hormone is indicated. So lab tests in this instance would look something like this: This pattern is seen very frequently in patients who are treated based on the TSH alone but have insulin/leptin resistance and/or a history of calorie-restricted dieting. Has your doctor taken a blood test for thyroid antibodies? With careful monitoring and treatment, when necessary, hypothyroidism can be effectively controlled, eliminating symptoms and decreasing your risk of complications from this condition. Instead, each of the cells in your body has a different demand for thyroid hormone depending on the situation, time of day, stress you are under, etc. That there is a circadian rhythm to thyroid hormones is not surprising as the hormonal milieu is associated with diurnal rhythms. Wang D, Cheng X, Yu S, et al. and I'm proud to say that over 80,000+ people have used them over the last 6 years. Are you having your thyroid tested at approx the same trime of day. The rate at which your TSH drops can be helpful in determining your total dose of thyroid hormone needed. I was diagnosed with Hashimoto's 14 years ago. He checked my thyroid levels and my TSH was 7.36. raise T4 production. Sometimes an initial level of 0.1 to 0.5 mU/L is acceptable, even though these numbers are mostly below the normal range. Truly "healthy" people have a TSH < 1.0 and yet the "normal" range extends all the way out beyond 5 in this case. why do i still feel sick? Obviously, there is a better approach and that is to look at and evaluate all thyroid laboratory tests (in addition to the TSH) and treat if there is a combination of symptoms + abnormal lab tests (even if those abnormal lab tests are just antibodies). I have been taking a thyroid adrenal . What would cause TSH at 8 go down to a normal level a week and a half later withouth meds. Fortunately, it is relatively easy to check for and just requires the complete thyroid panel which we will be going over below. for several years, monitoring usually can switch to once a year. why not all thyroid lab tests are created equal and why the TSH falls short if used by itself. But, as a result, its not well recognized by many providers or physicians who arent trained to identify or look for it despite the fact that it is highlighted in the medical literature. Can TSH levels fluctuate without medication? That means it is entirely possible to have a normal but less than optimal TSH. 29 year old male, 6'5" 230lbs, very active, very fit, don't drink, don't smoke, and no hypothyroidism symptoms but I was recently diagnosed with hypothyroidism in November of 2020. . This hormone is at the center of your digestive and . That means your Doctor won't flag your TSH as abnormal unless it falls outside of those reference ranges. #1. https://www.ncbi.nlm.nih.gov/books/NBK499850/, #2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578364/, #3. https://www.ncbi.nlm.nih.gov/pubmed/21415143, #4. https://www.ncbi.nlm.nih.gov/pubmed/21139124, #5. https://www.ncbi.nlm.nih.gov/pubmed/3051835, #6. https://www.ncbi.nlm.nih.gov/pubmed/16148345, #7. https://www.ncbi.nlm.nih.gov/pubmed/27051079, #8. https://www.ncbi.nlm.nih.gov/pubmed/2333963, #9. https://www.ncbi.nlm.nih.gov/pubmed/17991805, #10. https://www.ncbi.nlm.nih.gov/pubmed/21104580, #11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608008/, #12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC377492/, #13. https://www.ncbi.nlm.nih.gov/pubmed/19941233, #14. https://www.ncbi.nlm.nih.gov/pubmed/402379. Some mild cases For example, TSH naturally rises somewhat during colder months and drops back down in the warmest months. Yes, TSH can go back to normal. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Studies using both older [ 59, 60, 61] and newer [ 62] thyroid hormone assays have suggested a diurnal rhythm of free T3 and TSH in healthy subjects with no thyroid disease. During the exam, your health care provider may check for: Slight tremor in your fingers and hands. In some cases, after months or years of taking antithyroid medications, your condition cango into remission. Mammen also recommended repeating testing after finding an isolated elevation of TSH in older adults, because levels can fluctuate. DEFINITION: WHAT DO THE FOLLOWING PATIENTS OVER THE AGE OF 60 YEARS HAVE IN COMMON? Unfortunately, patients who fall into any of these categories tend to get misdiagnosed and/or mismanaged by providers who rely solely on TSH levels for diagnosis. She is the author of "The Thyroid Diet Revolution.". This highlights that each patient has a unique demand for thyroid hormone in their body and standard dosing should not apply to everyone. How old is the child? And stress, your diet, medications, and having your period can all make TSH fluctuate. decreases, and the level of TSH increases to encourage the thyroid gland to Learn The Facts. Above you can see a chart that depicts all thyroid lab tests over time and based on disease severity. In men, high prolactin levels can cause . Your current TSH actually isn't "perfect" although in the middle of your reference range - around 1-1.5 (or at least below 2) would be. Again, it highlights the importance of not focusing solely on the TSH but instead using other markers to help diagnose thyroid-related problems. Why is it that in all of these conditions (they account for the majority of you guys reading this post by the way) the TSH and other lab tests remain decidedly average despite obvious dysfunction in other lab tests? Think of your pituitary gland as a . Now compare that to other tissues in the body which have the ability to both inactivate and activate thyroid hormone (your body does this through increasing or decreasing reverse T3 levels). But while some studies suggest that adding T3 to T4 may help weight loss, "it is not a skinny pill," says Dr . For example, a 29-year-old woman may have normal TSH around 4.2 mU/L, while an 88-year-old man may reach 8.9 mU/L at their upper limits. As thyroid hormone levels change during pregnancy, the hormone replacement dose may change with them. Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone. The big problem is that this condition is relatively new and our understanding is limited. Fluctuating TSH and Thyroglobulin Levels. a couple months ago my test was TSH of 5.82 (0.35-5) T4 14 (10-20) every month it was getting higher until last month. Second trimester: 0.11 - 3.98 uIU/mL. You can see the example below which shows a free T3 level of 2.5 with a reference range from 2.3 to 4.2. And this process is controlled by these very important enzymes. Taking your medication at the same time every day is essential. Since it's a signaling hormone, high TSH indicates that your body detects low hormone, so it's turning up the volume on the signal to make more. Sometimes when you are taking thyroid medication, your thyroid hormone blood levels may change. I love to write and share what I've learned over the years. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. In simple words, it means that thyroid hormone gets inside the cell and directly turns on genetic transcription (it changes your DNA/RNA directly). But what if there was a better way? Once you start treatment with thyroid hormone the TSH generally has less utility than the other thyroid lab tests indicated above, but it still can be useful under certain circumstances. It is important to follow your doctor's advice and not make changes to your medication without discussing it with the doctor. Get my free thyroid downloads, resources, and PDFs here. Some medications that may affect thyroid levels include: Certain herbs are known to increase or decrease thyroid function, alter test results, and produce various thyroid-related symptoms. the last rsc 5month was 0.275. There was no history of thyroid disease or drug consumption. Then, "the patients returned 2 hours after breakfast for their samples to be rechecked between 10:30-11:00 am on the same day.". She is passionate about the intersection of healthcare and technology. Standard treatment for hypothyroidism involves taking a daily oral medication called levothyroxine, a synthetic form of thyroid hormone. If your TSH is suppressed it will come back as < 0.005 or < 0.001 or something similar. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. It would be prudent to consult a gastroenterologist as you may not be absorbing your. These studies suggest a peak of T3 at around 4 am with a nadir between 3 to 5 pm; this appears to lag behind TSH levels by about 90 mins [ 62 ]. In many instances, even when your treatment is at the correct dose, you may notice the following effects of disease progression: With Graves' disease, the opposite can happen, too. I've had rapid weight gain. As part of the endocrine system, the thyroid gland makes and stores hormones that help regulate the body's metabolism in the form of blood pressure, blood temperature and heart rate. often is recommended. Depending on your condition, these potency variations can cause mild increases or decreases in your T4, T3, or TSH. One particular enzyme, known as D2, plays a major role in converting T4 into the active T3 hormone (8), especially at the cellular level. In fact, it has been shown that calorie restriction can even cause low T3 syndrome(5). Make sure to wait for at least three to four hours between taking thyroid medication and any fiber, calcium, biotin, or iron supplements. Without TSH, the system would fail. Jonklaas J, Bianco AC, Bauer AJ, et al. And in case you are wondering here are other conditions that can cause Low T3 syndrome and put the brakes on your thyroid function: If so, then there is a good chance you may have low T3 syndrome which is causing hypothyroidism but NOT altering your TSH. In fact, you can see her before/after pictures and her entirecase study here. The Standard Treatment Protocol for Hypothyroidism. T3, or triiodothyronine, is a thyroid hormone produced in small amounts by the thyroid gland. Rapid or irregular pulse. Tsh tests are very sensitive but often not real reproducible. If you plan to change how you take your thyroid medication, make sure you clear it with your healthcare provider first. This content is strictly the opinion of Dr. Westin Childs and is for educational and information purposes only. Can You Get Everything Your Thyroid Needs From Food? At any rate, certain dietary choices and lifestyle practices can help you lower and stabilize your TSH levels. I'm Westin Childs D.O. Depending on the results of the blood tests, you may need other tests too. Wong M, Inder WJ. Overactive reflexes. That's why it's such a poor indicator of thyroid status. And this is good, but what is important here is that each tissue has a different demand for thyroid hormone depending on the situation. The situation where patients have hypothyroid symptoms, normal lab tests but elevated antibodies to either Thyroglobulin or thyroid peroxidase. The following table provides. In addition to the conditions listed above, there are a few other states that make the TSH less reliable. On the left is a mild disease state (inflammation, autoimmunity, chronic infection, dieting, etc.) These hormonal drops cause your thyroid-stimulating hormone (TSH) to rise in response. The amount of levothyroxine needed Some prescription meds that can influence thyroid hormones: We suggest regular monitoring of your thyroid function during the long-term use of any of the therapies listed above. I know this post is a little older but thought I might add I am sitting in the same boat. A TSH measurement at 09.00 has been shown to strongly correlate with the total 24-hour TSH secretion, sampled at 10-minute intervals. Thyroid disease can remain stable or worsen as the years go on. It certainly doesnt mean that anything < 1.0 is normal (we need your other thyroid and hormone lab tests to determine that), but it does give us some guidance in terms of understanding how someone can be inside the standard reference range and still have symptoms. Therefore, if you maintain the same treatment dose, your thyroxine (T4) and triiodothyronine (T3) thyroid hormone levels can drop. However, the changes in these levels are more extreme if you already have a thyroid condition before becoming pregnant. I am a 57 year old female who has had hypothyroidism for 20 years. Why Do I Have Thyroid Symptoms If My TSH Is Normal? When you understand the physiology and how different aspects like inflammation, insulin resistance, differences in genetics, and leptin resistance alter thyroid physiology it is easy to see how the TSH falls short. Call your doctor or 911 if you think you may have a medical emergency. 2018;60:59-63. doi:10.1016/j.clinbiochem.2018.08.008, Glynn N,Kenny H,Salim T,et al. medication because too little levothyroxine won't adequately control We offer this Site AS IS and without any warranties. Signs and symptoms will be expe Work with your doctor and follow advice. For people with thyroid disease, certain things can cause fluctuations in thyroid hormone levels. . This would indicate, at least subjectively, that the ideal TSH (provided the disease is not present in any form) is somewhere around 1.0. This TSH is elevated at > 3.0 which most physicians would agree is suboptimal (in fact some providers have recommended we change the range to include anything > 2.5 as abnormal(6)). Symptoms can include fatigue; weakness; dry, rough or pale skin; muscle cramps and aches; constipation; depression; irritability and decreased libido. diagnosed using a blood test that measures the level of thyroid hormones in the When the TSH level is above 10 mIU/L, there's uniform agreement that treatment with levothyroxine is appropriate. Low T3 syndrome is exactly as it sounds. When hyperthyroidism develops, free thyroxine (T4) and free triiodothyronine (T3) levels rise above normal. She is the founder of the Center for Hormonal Health and Well-Being in San Diego, California. Around 10 years ago I was diagnosed with Hashimotos Diease and my TSH level was 13. If you fall into that category you will need advanced thyroid testing and a provider who can interpret them for you. Tsh level is 0.023 dr lowered medication to 77mcg from81 mcg. If hypothyroidism persists for more than a few months, treatment We tapped the CDC for information on what you need to know about radiation exposure, Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them. The amount of thyroid hormones your body makes is regulated by another hormone called thyroid stimulating hormone, or TSH, that's produced by the pituitary gland. Below is an example of a hypothyroid patient who underwent a partial thyroidectomy some 20+ years ago. The condition occurs in about one to four of every 1,000 pregnancies, according to the National Institutes of Health. Follow me on Facebook, TikTok, and Instagram for up-to-date thyroid tips, tricks, videos, and more. Ive created a resource designed to help you find knowledgeable doctors which you can use here. TSH levels in children, babies, and pregnant women can fall outside of the normal range for adults. TSH can actually be very helpful in initially diagnosing hypothyroidism and (sometimes) in helping to determine the ideal dose of thyroid hormone medication. Check out my own personal health story. 2 This is probably one of the most common questions I get on a daily basis (or some variation of are my lab tests normal). Alpha Lipoic Acid (ALA) and Thyroid Health: Is it Safe to Use? And stress, your diet, medications, and having your period can all make TSH fluctuate. Occasionally this scenario will prompt a physician to simply recheck the thyroid lab tests within a month without proper treatment with thyroid hormone. If you feel that your TSH doesnt reflect your thyroid status then your best step is to look for a knowledgeable provider to order all of the tests necessary for diagnosis. Treatment. Both rT3 and T3 can be used as sensitive markers for assessing thyroid disease severity because they become abnormal earlier than other thyroid lab tests. Food and exercise change would not help with this. If the body is able to preserve thyroid function after a partial thyroidectomy (as evidenced above) then it is certainly able to preserve function if 10-50% of the thyroid gland is destroyed. Levels of TSH and Free T4 were evaluated during the course of treatment in a STUDY entitled "The Effects of Simvastatin on the Serum Concentrations of Thyroid Stimulating Hormone and Free Thyroxine in Hypothyroidism." Forty-one patients taking 20mg of simvastatin were evaluated and their levels of Free T4 (FT4) and TSH were studied. Normal TSH levels for the average adult range from 0.4 4.0 mIU/L (milli-international units per liter) ( 3 ). We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Can cause variable TSH results. Paloma Health helps to make that process easy and personalized. Ask him to test TPO ab and Tg ab. We are going to go over them below, but I need to say something first: Thyroid lab tests shouldnt be used as THE definitive test for diagnosing and managing hypothyroidism by themselves. Problems can be either short term and transient, or longer and chronic. The liver has the greatest regenerative capacity of any organ in the body, making it possible for surgeons to treat cancerous and noncancerous diseases with Mayo Clinic in Rochester is again ranked No. The following medications can cause your thyroid hormone levels to fluctuate: Oral contraceptives Iron, calcium or biotin supplements Anti-depressants Corticosteroids Cholesterol-lowering drugs It is important that you inform your doctor if you're taking any of these. Tsh is secreted in spurts an. Low TSH and normal FT4 is common in people who have Graves' disease or nodular thyroid disease. I am talking specifically about insulin and leptin resistance: Both of these conditions reduce T4 to T4 conversion (studies showing this link for insulin resistance here(10), studies showing this link for leptin resistance here(11)). In others, your T3 and T4 may not increase enough; this is common with hypothyroid women. The pituitary is a gland in your brain that attempts to tell your thyroid how much thyroid hormone to produce. This is where things can get a little more complicated. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. My TSH and Thyroglobulin numbers were way different from 4 months ago and I am wondering what they mean. Hereditary factors, gender, radiation exposure and pregnancy all influence a person's likelihood of getting Hashimoto's . In an attempt to oversimplify thyroid function and management, doctors have become reliant upon TSH testing. I am having TSH levels of 5.6 and taking medication .025 mg .I observed midcycle bleeding with lower right back pain after zumba .What can cause bleed? 1) TSH increased because of low T3 T3 is the active thyroid hormone. Some herbal supplements and medications can have an impact on thyroid hormone levels. If you indeed require medication, suggest you comply. I have a tsh level of .31 t3 t4 are good i had unintentional weight loss of 80 lbs in 6 months have diabetes 2 and my a1c is 5.3 no medication for it is this part of the cause for my extreme weight loss my doctor just srugged it off help? I also happen to formulate the best supplements on the market (well, at least in my opinion!) Work with your doctor to manage thyroid level fluctuations. Without making it too complex the pituitary gland has only the enzyme which activates thyroid hormone. Instead one of the most sensitive ways to determine if tissues are getting enough thyroid hormone is the reverse T3 to free T3 ratio (which we will discuss below). Something went wrong while submitting the form. The thyroid is the butterfly-shaped gland at the base of your neck. For these, please consult a doctor (virtually or in person). But in order to come to this conclusion you really have to look at the whole picture. Dr. Maritza Baez and another doctor agree. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. So lets say you are convinced that your thyroid is suboptimal and youd like to prove it. So if you are started on any medication containing T3 and your TSH does not drop very quickly then that is an indication you might need higher doses of thyroid hormone. That blood test is repeated at regular intervals to monitor thyroid She also has hashimotos syndrome. TSH levels fluctuate throughout pregnancy. So how are these newer T4 medications different, and how do you know which T4 medication might be the best for you? Generally, this means you will have to look outside of the insurance model (I know its not what you want to hear but its just the truth right now) because most Doctors practice what is known as the standard of care and that standard is to test only the TSH. Yes, hypothyroidism can cause a slow heart rate, or bradycardia, in some individuals. Hypothyroidism is These fluctuations happen because human chorionic gonadotropin (HCG), a hormone produced during pregnancy, stimulates the production of T3 and T4. And stress, your diet, medications, and having your period can all make TSH fluctuate. The target TSH level for a low-risk patient is the same as for a healthy person who has a thyroid gland, 0.5 to 2.0 milliunits per liter (mU/L). 2011 Aug;7(4):679-84. doi:10.5114/aoms.2011.24139, By Mary Shomon The ranking is a tribute Moreyounger adultsare being diagnosed with colon cancer also known as colorectal cancer and at more advanced stages of the disease, says the American Science Saturday: Researchers elucidate details about the role of inflammation in liver regeneration, Mayo Clinic again recognized as Worlds Best Hospital in Newsweek rankings, Mayo Clinic Minute: Why millennials should know colon cancer symptoms, Mayo Clinic Minute: How the thyroid affects the heart, Study finds similar cardiovascular outcomes for generic, brand-name drugs for hypothyroidism, Consumer Health: Understanding hypothyroidism, Womens Wellness: Hypothyroidism and pregnancy, Mayo Clinic Minute: Postpartum depression is different than baby blues, In the Loop: Fun with Mayo Mayo Clinic in pop culture, a retro retrospective. However, during the period of thyroiditis, your doctor may prescribe thyroid hormone replacement or antithyroid medications. For example, this might happen if you've gotten a refill of your thyroid hormone replacement medication or used a different pharmacy. Most doctors agree that any TSH above 10, especially when combined with an abnormal T3 or T4 reading, should be. Depending on the results, they may adjust your medication dosing. Hyperthyroidism is diagnosed with a medical history, physical exam and blood tests. These attacks make your thyroid less able to produce thyroid hormone on its own. Does a child with TSH level of 6.0 need medication? To better understand what is happening in your body its best to visualize the thyroid lab tests over time on a chart. Dr. Robert C. Smallridge, Endocrinology, Mayo Clinic, Jacksonville, Florida. Often, over time, the thyroid hormones and TSH eventually return to normal. T4 is inactive unless it is converted to T3. Hypothyroidism is most often treated through hormone replacement therapy a safe and effective treatment option that involves taking hormone medications to restore healthy hormone levels. Have you gone through a calorie-restricted diet in your life? Alternately, you could consider switching to a brand name to avoid this issue. High TSH High TSH indicates you're hypothyroid. If you're already being treated for a thyroid disorder, your doctor will probably consider. What tests do you need and how do you interpret the results? The addition of T3 can help patients who also have mood disorders like depression. Postpartum Thyroiditis and Related Issues After Pregnancy, Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement, Alternating hyperthyroidism and hypothyroidism in Graves' disease, Postpartum thyroiditis: management and treatment, Drugs that interact with thyroid medication, Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone, Alternations in thyroid hormone levels following growth hormone replacement exert complex biological effects. Learn which foods you should avoid if you have thyroid disease of any type. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. When you understand how inflammation (indicated by her high CRP) leads to T4 to reverse T3 conversion (7), her thyroid labs make perfect sense. Well, the pituitary gland is just another tissue in the body that has a demand for thyroid hormone and sensitivity to thyroid hormone. Potency tends to be reasonably stable within a particular brand name or generic manufacturer. Furthermore, elevated TSH levels have been observed with ageing. Potencies can vary from different brands and manufacturers. The doctor told me he didn't see a reason but it was my blood and money and so getting another test was fine. They can also contribute to related symptoms of hypothyroidism or hyperthyroidism. In addition, there are some other things to keep in mind when taking thyroid medication. However, this test can often time be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto's, the person affected may fluctuate between highs and lows. Some healthcare providers adjust for this. I would insist on antibody tests from your doc. But high thyroid hormone levels with low or high TSH can develop as well. TSH levels change inversely with how much thyroid hormone is in your body. My tsh level is 22.without medication how could i control this level through food and exercise? 18. hormone levels. Increasing doses of Synthroid or Levothyroxine will certainly drop the TSH (remember there is no competition for reverse T3 in the pituitary) but may actually make thyroid function in the peripheral tissues worse due to T4 to reverse T3 conversion. My antibody tests came back fine, my T3 and T4 levels were fine and my TSH was within a perfectly normal range.
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