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Avatar universal

High TSH and T4

Hi, so I have had a blood test and I have been told I have high TSH and t4. I'm not sure what this means and would like to know if this is a common problem. What could I do to bring my results into the normal range? I have a lot of symptoms and don't feel very well but my doctor hasn't given me a diagnosis yet and I feel it will take a while in till I get medication. Anyone who has the same lab results as me what did it turn out to be for you? and what do you do to manage your condition?
5 Responses
649848 tn?1534633700
COMMUNITY LEADER
It would be really helpful if you could post your actual lab results, along with their corresponding reference ranges as shown on the lab report.  This would help us better assess your situation.  Typically, high TSH is related to low thyroid hormone levels (T4 and T3).  Do you know if the T4 was Free T4 or Total T4?  If the report doesn't specify "Free" T4, then it's Total and not as helpful.  Were there any other tests performed at the same time?  

It would also be helpful if you could list the actual symptoms you have so we can get an idea as to whether you're displaying symptoms of having too much thyroid hormones or not enough.  

Are you currently taking any type of replacement thyroid hormone medication?  
29 Comments
My doctor said the tsh was 20 and t4 6 and t3 normal
What were the reference ranges for the T4 and do you know if that was Free T4 or Total T4?  If it's Free T4, the result looks pretty high, but if it's Total T4, it's low.  It should say on your lab report.  Do you have an actual number for the T3?  "Normal" range may not be normal for you.  

A TSH of 20 is pretty high, so depending on the other results, it does appear that you have hypothyroidism.  What symptoms do you  have?  Did you doctor mention what medication s/he might prescribe?
And I have problems thinking and remembering and staying awake, constipation, vision,  anxiety, and depression. Heat sensitivity and sweat a lot. Joint problems pale skin also dry. Dry mouth and white tongue cough up mucus.No motivation and social isolation. And overthink a lot. My brain doesn't work the way it should.
I don't have a paper result in my hand. but it's probably Total t4.
She told me all this over the phone. I've never seen my lab results myself. But she was talking about Total tsh and total t4
And if i had hypothyroidism my doctor would of prescribe me levothyroxine already. But she said i need to wait longer because i have abnormal results and need to see a endocrinologist. I don't have normal labs for hypo or hyper.
Your TSH result is definitely not normal, but I can't tell about your T4 without a reference range.  Ranges vary from lab to lab so I can't tell for sure about the T4.  One national lab has a range of 5.1-11.9 and another national lab's range is 4.5-12.0.  Using either of these ranges, your T4 of 6 is low in the range, indicating hypothyroidism.   Your lab could be using a totally different range though.

The way it works is that TSH goes high when thyroid hormone levels are low and TSH goes low when thyroid hormone levels are high.  

Sometimes other glands, such as the pituitary can malfunction too.  

Can you call your doctor's office and get a copy of the report?  Or does your doctor have a patient portal from which you can get more information?
I will ring them tomorrow and ask them to email me my latest blood test results
That would be good it they'll do it.  Many doctors won't e-mail lab reports because e-mail isn't considered "secure" - in other words, someone could read your e-mail, but it's definitely worth a try.
Thank you
They want me to have another blood test in this order  Free T3 (FT3) Thyroid function tests (TFT) (TFT)
I'm glad you're getting another set of tests.  TFT (Thyroid Function Tests) should consist of Free T4, Free T3 and TSH.  

Many doctors will also include antibody tests to determine whether or not you have an autoimmune condition - either Graves Disease, which is associated with hyperthyroidism or Hashimoto's Thyroiditis, which is, typically, associated with hypothyroidism but can present with hyperthyroidism in beginning stages.  Hashimoto's ultimately ends up with the antibodies destroying the thyroid gland.  

We'll look forward to seeing new results.  
I just went down today for a thyroid function test and ft3. Is this a useful blood test? I've had about 8 blood tests this year, and I'm if this doesn't give me a diagnosis. I'm probably just going to stop having them. My doctors are checking for everything, so it's a very slow process and i keep chasing them back and forth.
A complete Thyroid Function Test "should" include FT3 (Free T3), which is the actual thyroid hormone used by nearly every cell in your body.  They should have done it previously.  

What other tests did they order?  Do you know what all "everything" includes that your doctors are checking?   Checking for, and diagnosing a thyroid problem should not be a slow process, if the doctor knows what they're doing and it doesn't seem that yours really does, since she, most likely, originally tested Total T4 instead of Free T4 and neglected to test Free T3 at all.  

Did you ever get a copy of the other blood test results, so we can see what they tested, along with the results and reference ranges?  Without those, we can't be of very much help to you.  
No, but i will ask for them this week. I'm having another phone appointment with my doctor to discuss my last blood test.
Okay i have my results now I'll give you them
22.2pmol/L serum free t4
7.4mu/L  serum TSH level
Serum triiodothyronine pending
I have to go see a cardiologist for my heart and blood pressure.
Are these current results or are they the ones you didn't have previously?  What's the reference range for the Free T4?  Ranges vary from lab to lab so have to be posted with your results for the best comparison.

What type of heart symptoms are you having?   When will you see the cardiologist?
Current results, and i have chest tightness my blood pressure is 170 last time i had it checked was around 2 weeks ago.
L serum free t4 22.2 pmol [10.7-18.4] above high reference limit
Serum TSH level 7.4 mu/L [0.48.4.17 above high reference limit
Serum free triiodothyronine- Pending
As I noted previously, if TSH is high and TFT levels are low, that signifies hypothyroidism.  Low TSH and high TFT levels signify hyper.  

Since you aren't on a thyroid replacement medication, it's possible that the high TSH and FT4 indicates a pituitary issue.  The pituitary is the gland that produces TSH and your high FT4 should be telling the pituitary gland to stop producing TSH, which doesn't seem to be happening.

Has your doctor mentioned doing any other testing of pituitary hormones?

Your symptoms are indicative of either/both hyper and hypo, but could also apply to other conditions as well.  If you have a pituitary issue, this could cause your adrenals and other glands in your body to malfunction as well.  

When will you be seeing the endocrinologist?  Or that who ordered the latest set of tests?
They have and my pituitary gland is fine
Well they want to refer me to a cardiologist specialist For my blood pressure. And I'm supposed to receive a call this week about my thyroid, and the next steps.
I have all my blood test results on paper, Is there anything else you need to see?
What other tests did they do - for your pituitary?  Also did they test thyroid antibodies?   You could post those if you'd like so we can see what all has been done and/or what else might be helpful.  Be sure to post reference ranges, please.

Have there been imaging studies to rule out pituitary adenoma that could be releasing TSH? Or ultrasound to rule out thyroid nodule that could be producing thyroid hormones independently?
Not yet but they are doing stuff to rule out the problem.
I'm not sure I understand... the things I mentioned would all help rule out the problem.  

What pituitary tests were done?
Just the standard one to check if the pituitary gland was causing the high tsh
I'm not sure what a "standard" pituitary test would include.  Do you have test results so I can see what they actually tested for?  There are a variety of pituitary hormones, which could each indicate/rule out a pituitary malfunction.  The only way to definitively diagnose a pituitary adenoma is via proper imaging studies.  
Avatar universal
In trying to assess your status, a "high TSH and T4" is not nearly descriptive enough.  In addition, symptoms are much more important to making a tentative diagnosis than test results, unless TSH is extreme.   So please post your actual test results and reference ranges shown on the lab report.  Also, please list all symptoms yu have.  
Avatar universal
The last test was last week they tested my testosterone, pituitary gland, and cortisol along with TSH and t4. And the same result came back again. High TSH and t4 and my doctor think it's my pituitary gland. But she's taking a long time to call me back about it.
1 Comments
What were the exact results of your TSH and T4 and was that Free T4 or Total T4?  As explained previously, they aren't the same test.  We also need to know the reference ranges of the T4 tests since ranges vary from lab to lab and have to come from your own report(s).  

You also haven't let us know what symptoms you have.
Avatar universal
Barb's answer is on the money.  Until one doctor finally gave me the full thyroid panel which included antibodies, it wasn't diagnosed.  TSH alone won't tell the whole picture.  When it gets beyond the 'normal' values (which too many Dr's just focus on), that's usually when they may do more tests.  Even then, you'll probably have to push for a full thyroid panel (w/antibodies labs).  
3 Comments
I hope they diagnose me soon. I just went down today for a thyroid function test and ft3. But yeah i was thinking the same thing, it makes more sense to test for antibodies as well.
Absolutely.  They typically don't test for it, sadly.  I didn't even know until one primary care knew enough to order it.  The others would remark at my high TSH, even my goiter!, but nothing further.  It's a challenge.  You can also get the tests by paying yourself (I do that sometimes), but of course most primary care doctors should be able to order this without much issue - the test itself is routine bloodwork.  If you can, ask them for the FULL thyroid bloodwork panel.  Here's a good list:  https://thyroidpharmacist.com/articles/top-6-thyroid-tests/
I didn't realise but they tested for anti bodies with out me knowing. And i don't have Hashimoto thyroidist .
1756321 tn?1547095325
That's an unusual pattern. Listed cause: lab interference, certain drugs such as amiodarone or heparin, T4 medication, resistance to thyroid hormone, TSH secreting pituitary adenoma.
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649848 tn?1534633700
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1756321 tn?1547095325
Queensland, Australia
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