I always had "normal" thyroid labs. T4/T3/TSH were always in range. I always had cold hands and feet and hypothyroid symptoms. I have been reading articles and interviews from a doctor from Canada who is no longer in practice. He mentions that before committees on health got together in the 70s (I think) that CFS and Fibromyalgia were nonexistent terms. The epidemic simply did not exist, because it was recognized as a hypothyroid condition. TSH blood tests were not used. And according to him and to me they are completely useless. It wasn't until 4 months ago that my thyroid started showing Low T4 and T3, and TSH. I have suffered these fatigue symptoms for practically 7 years (not to the same extent the entire time). Due to the hypothyroidism I think my entire endocrine system started failing. Hypothyroidism caused low testosterone without a doubt. This doctor claims that the longer a patient has chronic fatigue, the longer it takes to restore the patient. He uses 5+ grains of armor thyroid a day in CFS/Fibros which is equivalent to like 200mcg+ of T4. Personally since taking 200mcg of T4 I have noticed huge improvement in energy. When you have comorbid cortisol deficiency like me it is tricky though because low cortisol will allow thyroid hormone to hang around in the blood longer. I had to increase my cortisol dose because I was getting hyperthyroid symptoms at 100mcg of T4. I now take 200mcg T4 a day without a problem. I have long suspected that TSH is completely useless, and it is. Hell, even thyroid labs are completely useless IMO. These are my opinions and if someone replies that I am insane for listing ten possible treatments of chronic fatigue over ten posts screw off because I am not going to reply. I do help this information helps some of you. I also think T4 plays more of a role in the body than doctors think. When I use T3 it lasts like 2 hours in me. That is the opinion of many doctors too. It is arguable whether timed release T3 even absorbs properly down the intestinal tract. I choose high dose T4. The problem is that the brain can need more thyroid and it has no way of demanding more direct thyroid hormone ... the thyroid will proceed at its normal level of production, which in some people is next to nothing. I will find this doctor's name. He apparently had a huge success rate - and he mentions pre 1950 doctors treating this condition with high dose dessicated thyroid hormones. I think the reason that it takes people who have been ill longer longer to respond is that the whole hormone system and possibly nervous system is impacted. I think beta agonists might benefit a CFS patient in addition to high dose thyroid hormone because lack of thyroid causes down regulation of beta adrenergic receptor production. I don't have a citation for this at the moment and I don't feel like looking for it. In summary, it is quite possible that the committees that decided TSH to be king effectively ruined thyroid replacement therapy for everyone by underdosing them by one third. If you respond extremely to hormones please give it some time. The receptors are upregulated so it takes time for them to normalize. I don't think this means less hormone should be taken in all cases. Thyroid hormone seems like more is better. Taking only high dose T3 I might not recommend. I write these posts because I genuinely empathize with other people who have spent tens of thousands of dollars (or years) fighting what should be completely curable by a physician who has read medical literature pre 1950. It is amazing how one idea like the TSH test can completely ruin medicine. My goal of this post was to inform you all that my thyroid symptoms showed up long before lab tests did, and that I only respond to high dose T4 (200mcg). Anything less does nothing for my CFS. You all are free to comment but I'm not about to argue if that is the intention of any of you. If you think you may be cortisol deficient, an ACTH stim test is needed to verify this. An AM cortisol test says absolutely nothing. I have seen people have very high PM readings of cortisol and low levels of AM cortisol. If you have low cortisol and go on thyroid hormone, you probably will feel worse.