McCall McPherson explains why elevated TSH causes symptoms even when T3 and T4 appear normal. He considers TSH above 2 high and uses an ROI analogy to show how your body works harder to maintain hormone output, draining energy and triggering symptoms.
Thyroid labs. If your TSH is elevated, it doesn't matter what your other hormones are, you are likely still going to feel terrible. And I'm going to give you an analogy as to why this goes without saying. Obviously, I am an enormous advocate for a full thyroid panel. You need that every time. But I also want you to understand the role that TSH plays and how I see it manifest in my patients at modern Thyroid clinic. So let's say your output hormones, your T4, your T3, even your reverse T3, look great, but your TSH is 3.6, which I consider to be too high. Anything above 2 for me, definitely. I expect people to be symptomatic much less when their TSH is 6 or 8 or 10 or 12. So normal output hormones, TSH. I want you guys to think about this. ROI or return on investment. Okay? Your TSH reflects how much energy goes in to produce your energy output, which is your output hormones. So we are comparing energy in versus energy out. Okay? If your TSH is high, you are using too much energy to produce energy and it's putting you in a deficit. A poor roi. You have to reduce the amount of energy going in and then obviously optimize the amount of energy going out or your output hormones to feel well. But this is how people feel bad even with a great T3. Great T4 if their TSH is 3. And I want to give you one more analogy, so hang with me. Train. Let's talk about a train. Let's say your T3 or your active thyroid hormone is 4.4.0. I want you to think about a train going 40 miles an hour, and that's a great speed. 4.0 T3 is fantastic. So a train can go 40 miles an hour on flat land or uphill. Either way, measurably, the speed of that train is the same. It's 40 or 4.0. The amount of energy required of that train to maintain that 40 miles an hour uphill is a heck of a lot more than is required to maintain that train speed. Same speed on flat land. Your TSH reflects the incline. So even if we don't necessarily increase the speed or the output of the train, your T3, if we lower the resistance or the energy having to be put in, you're going to feel better and energy will increase. I hope that makes sense. Tell me what other thyroid kind of scenario you want me to talk about and break down.
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