(re-)started keto ... feeling great but blood test shows 9 TSH - continue?

(Arie1985uk ) #1

A year ago I was 106 kg, started keto, went down to 91 kg.

2 months ago went back to 100kg, with carbs and lots of junk …

Now decided to be fully determined and go back to keto … I am now 93 kg…

I had a blood test today because in July 2022 my TSH level was 5.5

Today it was 9 …

Should I be alarmed because of this or this is “normal” when you lose weight because of Keto? (I feel like I am really into proper ketosis in the past 2 weeks)…

Would be happy to hear what you think or what’s your experience with something similar?

Must say I feel great, really don’t want to stop, just wondering if perhaps I can do something to reduce the TSH? Doctor prescribed for me today Levothyroxine but I don’t wanna take it, I am not taking any medicines at all, I don’t mind taking Vitamin D, Omega 3 or any supplements but I don’t like medicines in general.

Would be happy to hear what you think? Thanks.

(Bacon is a many-splendoured thing) #2

Usually people’s thyroid hormones go a bit lower on keto, but without symptoms of hypothyroid. Since you haven’t been back on keto for very long (if I’m reading your post correctly), give it six months or so, then re-test, especially if you are asymptomatic at the moment. At the six month point your numbers are likelier to be more settled, and you can see if there’s a problem or not. Or if you develop symptoms of hyperthyroid in the next few months, you can deal with it at that point.

Welcome to the forums!

(Arie1985uk ) #3

Thanks Paul, both for the welcome and for the response, I truly appreciate it, it sounds like a reasonable advice - can I just ask if levels of 9 TSH should be alarming at this point or is it okay to do nothing about it? (I mean from medical perspective is it dangerous not to treat it right away?)


(Bacon is a many-splendoured thing) #5

Well, I’m biased against unnecessary treatments. Thyroid problems usually come with noticeable symptoms, so if you don’t have symptoms, and the only reason you think there is a problem is because of a routine blood test, then leave well enough alone. If you start noticing symptoms, that’s a different situation, and of course you should get treated.

This is different from something like high blood pressure, which doesn’t come with noticeable symptoms.

And by the way, a number of clinicians are coming to the conclusion that low thyroid numbers on a ketogenic diet are not necessarily a problem, because the thyroid hormones appear to function more efficiently, without elevated insulin interfering with them. Again, it comes down to whether the patient is experiencing symptoms or not. People on a high-carb diet, I understand, can have the opposite problem, of feeling bad, even though their thyroid levels appear to be “normal.” So obviously, we don’t have a full understanding of what’s really going on.

So again, if you are symptom-free, get re-tested in six months, then re-evaluate. If you develop symptoms in the meantime, get treated.

(Arie1985uk ) #6

Thanks Matt !
Your link “testing is often not enoguh” - it says there

Others would prefer to see both TSH and T4, while still others would insist that a more comprehensive thyroid panel is worth performing in order to identify imbalances or deficiencies, particularly when TSH and T4 are normal but a patient presents with undeniable signs and symptoms of low thyroid.

Does it apply to high TSH as well?

I forgot to mention my T4 was normal in the test, 14.3 (normal range is 11.5 to 22.7)

(Arie1985uk ) #7

a number of clinicians are coming to the conclusion that low thyroid numbers on a ketogenic diet are not necessarily a problem

Paul, when you say “low thyroid” you also refer to high thyroid, right?

My levels are high … not low … and thanks so much again!

(Bacon is a many-splendoured thing) #8

I specifically mentioned low thyroid in my second post, because clinicians usually see lower numbers in their ketotic patients, but it doesn’t seem to be a problem.

Your case is unusual, with higher numbers (you will notice that I mentioned that in my first post), but the logic still applies: IF YOU ARE HAVING SYMPTOMS, GET TREATED. If you only think there MIGHT be a problem because of that blood test, wait for six months, get tested again, and then make a decision. No point in getting treated unless there is a problem.

(Arie1985uk ) #9

Gotcha, thanks a lot Paul !

(Joey) #10

This link below from the Mayo Clinic might be of interest. It cites the (many) potential symptoms of hyperthyroidism.

Of course many of these are perfectly normal (sweating, hunger, sleep issues,…) and unrelated, so to help separate serious symptoms from the rest, read down to the bottom section about when to contact a doctor.


And note that “weight loss” of concern would be unexplained, unintentional weight loss … whereas yours is explainable and presumably intentional.

(Arie1985uk ) #11

read down to the bottom section about when to contact a doctor.

Yes, it does mention there “If you lose weight without trying” - then go and see a doctor, but as you mentioned it’s intentional and very well explained.

I guess like Paul said, I need to give it some more time, test again in at least a few months and then see if there is any improvement or not.


What were your T3 and T4 levels? Your Thyroids gas pedal is too the floor right now trying to work. Most doc’s don’t like prescribing anything to help, I’d be downing bottles of T4 if I were you.

No, not normal, if anything your T4 may be around the same, but T3 should be up, and TSH would be down. Your Thyroid isn’t working efficiently, but you need the T4 and T3 levels to see the whole story. I’d absolutely be on the T4 with a TSH of 9, that’s literally nuts.

Keto screws with many peoples Thyroids, but that’s usually longer term, but not like that.

You want higher T3 and T4, low TSH.

(Bacon is a many-splendoured thing) #13

According to the OP, his or her TSH went from 5.5 to 9. According to the Cleveland Clinic the normal TSH level for an adult 21-99 is .27-4.2, so 9 is over twice that.

According to their Web site:

High TSH levels are usually a sign of hypothyroidism. Symptoms of hypothyroidism include:

  • Fatigue
  • Numbness and tingling in your hands.
  • Constipation
  • Unexplained weight gain
  • Depression
  • Being unable to tolerate cold temperatures
  • Decreased interest in sex
  • Frequent and heavy menstrual periods

It’s important to talk to your healthcare provider if you’re experiencing these symptoms. Hypothyroidism is treatable.

So, @arie1985uk, if you are experiencing any of these symptoms, then call your doctor’s surgery and arrange an appointment. Otherwise, it will probably not hurt to wait for a second test in a few months to see what happens. As stated, hypothyroidism is easily treatable.

(Arie1985uk ) #14

Thanks Paul,
I have no fatigue, at all, on the contrary, feeling really energized, not feeling numb hands, no constipation, no depression, and my wife had troubles dealing with the season change from winter to spring, I actually love it (before Keto I used to be sick a lot), no decreased interest in sex so none of these symptoms apply to me.

I did speak to my doctor, he said don’t rush it and you don’t have to take the pills, he said it could be 100% be linked to the fact the body works harder now to lose weight, all these changes, asked me to stick to one diet and said he does suggest the pills but I can wait a bit longer (so you were right).

He also told me in July 2022 my TSH was 5.26 but in August 2020 it was 8.1 so he said it was like this because of weight changes, and told me that if I stick to 1 diet, then stick to it all the way, otherwise this is not healthy and that’s why he thinks I had these fluctuations:

8.1 (08/2020)
5.26 (07/2022)
9 (Yesterday)

Does it make sense what he said?

Yes, I do take the blame for “playing” with nutrition and the diet until now in a very inappropriate way, moving forward I know what to do and I’m doing it.

(Bacon is a many-splendoured thing) #15

Absolutely. And he’s being more reasonable than it sounded at first. Let’s see how you do, going forward.

(Joey) #16

I’m so sorry! I misread the earlier posts and went off thinking the concern was about Hyper- not Hypothyroidism.

I have family members who take synthroid (for decades) to address hypothyroid conditions. Not hard to resolve. But getting the dosage right takes time and change in diet affects levels in many cases, so it’s wise to let your keto changes take root first. If you feel good, there’s little urgency… Watch and wait for things to settle down a bit.

Indeed, elevated TSH (thyroid stimulating hormone) is associated with a thyroid that is insufficiently active, not overly active. My apologies for confusing matters with my previous response(s)!

(Arie1985uk ) #17

No worries, it’s all okay - you said “elevated TSH is associated with a thyroid that is not active enough” - does it mean keto is affecting or it could be another reason? (if you had to guess) - yes, I guess I have to let time go by and see how it goes at least 2-3 months from now.

(Joey) #18

If I had to guess, I’d agree with what others have said above … keto is more likely to lower TSH, not raise it. Unless you’re experiencing significant symptoms of hypothyroidism, I wouldn’t freak about TSH while you’re in the midst of making such big changes in diet as it affects your entire metabolism (for the better in the long run).

Thyroid issues tend to be slow moving trains - so, absent an acute problem, you’ve got time (and healthy homeostasis) on your side. :vulcan_salute:

(Betsy) #19

You might be running on cortisol. I’m not sure why, but I have seen it happen before. Watch out for your hair falling out.

If you want to do something right now, just raise your carbs enough to get your TSH back to normal or at least normal.


I can’t cite anything specific right now, but maybe I can after a bit of research - and I will look! But based on what I know already, eating more carbs is not the solution to any problem.