I Have Symptoms of Hypothyroidism but My TSH Is Normal

Hi, I’m Dr. Stephanie Smooke-Praw, an endocrinologist at UCLA Health. One of the most common questions I hear from patients is,

“Why do I have symptoms of hypothyroidism, but my thyroid tests are normal?”

And it’s a great question—because it can feel confusing and frustrating when you’re not feeling your best, but your labs are telling a different story.

Let’s start by talking about what the symptoms of hypothyroidism are. These can include feeling tired or sluggish, gaining weight more easily than usual, feeling cold when others are comfortable, having constipation, dry skin, or even feeling down or depressed. These are classic signs that the thyroid might not be functioning at full strength.

When someone has these symptoms, it makes a lot of sense for their doctor to check thyroid levels. That typically includes tests like TSH, and sometimes free T4 or T3. If those labs come back abnormal—especially if the TSH is elevated and the thyroid hormone levels are low—that usually means the thyroid isn't producing enough hormone, and that’s when we consider treatment with thyroid hormone replacement, like levothyroxine.

But sometimes—labs are normal. And yet, the symptoms are still there.

That’s when the conversation gets a little more complicated.

When the thyroid hormone levels are normal, but the symptoms look like hypothyroidism, we have to take a step back and ask: Is something else going on?

Because here’s the thing—these symptoms aren’t specific to hypothyroidism. Fatigue, weight gain, constipation, and mood changes can be caused by a wide variety of medical or lifestyle factors. So even though we always hope it’s the thyroid—because that’s something we can easily treat—when your thyroid is doing its job, we need to cast a wider net.

So what else could be causing these symptoms?

We start by checking for other medical causes. That might include:

• Anemia or other abnormal blood counts
• Vitamin deficiencies, like low B12 or low vitamin D
• Kidney or liver function issues
• Hormonal changes, such as perimenopause or adrenal problems
• Or even depression or anxiety, which can sometimes mimic low thyroid symptoms.

If all of those labs look normal, we also think about lifestyle factors. Things like:

• Nutrition – Are you getting enough nutrients and calories to support your energy?
• Physical activity – A lack of exercise can lead to fatigue and weight changes.
• Stress – Chronic stress can impact energy, mood, digestion, and sleep.
• And of course, sleep hygiene – poor sleep alone can cause fatigue, mood swings, and even changes in weight.

So while it’s natural to want a clear explanation—something like “your thyroid is low, here’s a pill to fix it”—the truth is, the body is complex. And sometimes, these symptoms are the result of a combination of subtle issues rather than one specific diagnosis.

If your thyroid labs are normal, it’s a good sign that your thyroid is working well. But it also means we have to dig deeper—and that can take some time, partnership, and often a bit of trial and error.

So, if you're experiencing these symptoms, and your thyroid levels are normal, don’t give up. Keep working with your doctor to explore other possible causes. A thorough evaluation and a holistic look at your health can often point us in the right direction.

Thanks for spending a few minutes with me today. I hope this helped clarify a confusing but common situation.

If you have questions about your thyroid health, visit us at the UCLA Endocrine Center website or call to schedule an appointment.

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