Tidal pumping, baroclinic circulation and vertical mixing are known to be the main mechanisms responsible for the estuarine turbidity maximum (ETM) formation. However, the influence of hydro-meteorological conditions on ETM dynamics is still not properly grasped and requires further investigation to be quantified. Based on a realistic 3-dimensional numerical model of the macrotidal Seine Estuary (France) that accounts for mud and sand transport processes, the objective of this study is to quantify the influence of the main forcing (river flow, tides, waves) on the ETM location and mass changes. As expected, the ETM location is strongly modulated by semidiurnal tidal cycles and fortnightly timescales with a high sensitivity to river flow variations. The ETM mass is clearly driven by the tidal range, characteristic of the tidal pumping mechanism. However, it is not significantly affected by the river flow. Energetic wave conditions substantially influence the ETM mass by contributing up to 44% of the maximum mass observed during spring tides and by increasing the mass by a factor of three during mean tides compared to calm wave conditions. This means that neglecting wave forcing can result in significantly underestimating the ETM mass in estuarine environments. In addition, neap-to-spring phasing has a strong influence on ETM location and mass through a hysteresis response associated with the delay for tidal pumping and stratification to fully develop. Finally, simulations show that the uppermost limit of the Seine ETM location did not change notably during the last 35 years; however, the seaward limit migrated few kilometers upstream.