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On page 11, part 2 of week 38 it says in a box to watch out for falsely low TSH levels of thyroid medication replacement. But why is it falsely low? As in the explanation given on that page below the box, the pituitary actually does decrease the TSH production when the body has TSI production. To me this would be actual low TSH levels versus false, is what I’m saying. Is this the example talking about Graves’ disease or facetious hyperthyroidism? Would you treat until T4 and T3 are both normal even if TSH is low? But if T4 is high and TSH is low and T3 is within the normal limits, does it just depend on if they have symptoms?

On page 11, part 2 of week 38 it says in a box to watch out for falsely low TSH levels of thyroid medication replacement. But why is it falsely low? As in the explanation given on that page below the box, the pituitary actually does decrease the TSH production when the body has TSI production. To me this would be actual low TSH levels versus false, is what I’m saying. Is this the example talking about Graves’ disease or facetious hyperthyroidism? Would you treat until T4 and T3 are both normal even if TSH is low? But if T4 is high and TSH is low and T3 is within the normal limits, does it just depend on if they have symptoms?

Chris Kresser: No. So the most recent research I’ve seen suggests that facetious hyperthyroidism is only risky when T3 is high or perhaps high normal, or T4 for that matter. So if T4 or T3 are high and TSH is low, then that patient may be at additional risk. If TSH is low, even if it’s very low but T4 and T3 are normal, then the research I’ve seen most recently suggests that there’s not a lot of risk that comes with that. So generally treating until T4 and T3 are in the normal and optimal range seems to make the most sense when you consider that.

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