Aaron Hartman, MDFunctional Medicine Specialist | Clinical Researcher

Why TSH Doesn’t Tell the Whole Thyroid Story #shorts

12 Jun 2026 · 1 min

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Aaron Hartman, MD explains why TSH alone misses thyroid problems: it accounts for only 1% of the variability in free T3, the active hormone your body actually uses. Doctors relying on TSH dismiss patients with real symptoms. A full panel including free T4, free T3, and reverse T3 gives a much clearer picture.

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Absolutely. So, you know, first and foremost, I mean, I, I know you're so aware of this too. There are so many barriers for people to get diagnosed and, and access good thyroid treatment. But number one, pervasively medicine has accepted, you know, TSH as the marker, the main piece of information that is used to diagnose and manage people's medication, thyroid dysfunction, whatever it is. And that accounts for in research about 1% of the fluctuation of our most important hormone, which is free T3. So, you know, to look at how someone's thyroid is functioning, we need to be checking a full thyroid panel, which is TSH, free T4, free T3, reverse T3. If our active thyroid hormone that we're assuming TSH reflects, we should probably be really certain that that's the case. And when research says it only reflects T3 1% of the time, I'd say, hey, we probably have a, an issue.
So 1% of the time, that's, that's missing a lot of people who are probably still having issues.
Oh yeah. I think, you know, and they're being written off as, hey, well, your TSH is normal, so it can't be your thyroid. But no one, you know, diagnosing and managing people's thyroid medication via TSH, in my opinion, is throwing dartboards at a dartboard blindfolded, just hoping to hit a bullseye.