However, tsh levels may also be normal or even slightly elevated. This is why a complete thyroid panel is often needed. For a free t labs drawn say 5 to 12 hours out from taking thyroid meds you would want the free t3 to test well over 3. Jul 10, 2018 high tsh, normal t4, normal t3 this is the pattern weve been discussing in this post and will usually present with hypothyroid symptoms. It is important to first make sure that it is low t3 that is the culprit of your symptoms. Five thyroid patterns that wont show up on standard lab tests. My tsh and t4 levels are low, and my t3 levels are very high.
I dont feel like a tsh of 55, maybe 8 or 10 at most. Unfortunately mainstream doctors often do not test free t3. The treatment of such patients is controversial, particularly when they have few or no symptoms and no other clinical evidence of. In response to this low level of thyroid hormones, the pituitary releases tsh to try and stimulate thyroid hormone. Patients with decreased tbg levels will have normal tsh, normal t4, high t3 levels, low t3 uptake, and low thyroidbinding globulin show up on their blood test results. Another possibility is a tumor in the pituitary secreting too much tsh resulting in thyroid. The symptoms of hypothyroidism are very discrete and the tsh level is the only reliable indicator of the levothyroxine dose. That is why you are hyper from the ft4 and hypo from the fact your ft3 must be almost nothing. Especially t3, because of the direct effect it has on thyroid hormone as opposed to t4, which is more of a. Thyroid function tests american thyroid association. Would usually not treat this situation but recheck labs using different lab or different t3 assay test ie, free if. Aug 19, 20 therefore free t4 and free t3 levels are important please note that free t3 and free t4 are different than total t3 and total t4. Doctors give trusted answers on uses, effects, sideeffects, and cautions.
However, many organisations agree that a reading of 2. Thyroid function test interpretation tft interpretation. Another reason for low tsh levels and normal free t4 is if you are undergoing t4 treatment for hypothyroidism. There are many treatments and ways to raise your free t3 level. T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. When there is underconversion of t4 to t3 we cant have normal thyroid responses. Help with labs, low t3, low t4, suppressed tsh, high iron.
Amiodarone can or 6mthly tsh, t3, t4 estrogens can t4 by tbg androgens, corticosteroids can t4 tbg methadone can t3, t4 tsh pulsatile release, peaks during night takes 46wks for tsh to reflect circulating thyroid hormone levels abnormal tsh can persist for several months after achieving clinical euthryoid. T3 and t4 are important hormones produced by the thyroid gland and both t3 and t4 is made up of a protein and iodine in the form of iodide. High amounts of t4 and t3 mostly from peripheral conversion of t4 cause. Thus, reduced ft4ft3 ratio and increased shbg and ck levels represent. Honestly, exact normal levels of tsh, t3 and t4 depends on particular pathology lab. Lowtshnormal t3 and high t4 hashimotos thyroiditis. In the cases of free t4 ft4 and free t3 ft3, the optimal zone is roughly half way between the usual lab normal lowhigh values. These labs seem at odds, with tsh suggesting overactive thyroid and ft4 underactive thyroid. High free t4 46 but normal tsh and t3 endocrineweb. In response to this low level of thyroid hormones, the pituitary releases tsh to try and stimulate thyroid. These tests can help doctors diagnose if you suffer from hyperthyroidism overactive thyroid or hypothyroidism under active thyroid. Since t3 is the most active useable form of thyroid hormone that can be used in the cells of the body, free t3 is critically important.
Can anyone help me understand my latest lab results. P shares important new information about how hashimotos autoimmune thyroiditis can make you feel bad, even if your tsh, t4, t3 are normal. Dec 15, 2017 if your ft4 is that high and your tsh is that high, your ft3 must be zilch. I have had thyroid issues since i was seven years old. Hashimotos autoimmune thyroidpatients with normal tsh.
Also, is one week long enough for changes to show up in blood tests. My t4 and t3 are also normal, but my tsh was high and the doctor put me on medication and it. Therefore free t4 and free t3 levels are important please note that free t3 and free t4 are different than total t3 and total t4. I felt pretty good on that dose not great but decent. High tsh, normal t4, normal t3 this is the pattern weve been discussing in this post and will usually present with hypothyroid symptoms. Asked for female, 27 years hi, my t3 t4 are high but tsh is normal. Problems with the assessment of thyroid function in. Abnormal tft results guidance abnormal thyroid function tests. High tsh, high t3 and high t4 thyroid disorders medhelp. With a non functioning thyroid, you will expect to see the following. Tsh levels thyrotropin test, normal, high and low level. Abnormally raised tsh with normal free t4 and t3 is suggestive of mild often referred to as subclinical hypothyroidism, and low tsh with normal free t4 and t3 suggests mild subclinical hyperthyroidism.
Bone mineral density may be increased with treatment of sch sor. Dec 12, 2016 if functionally your body lacked thyroid hormones, it would through an absence of physiological feedback inhibition cause your tsh to rise. Alternatively you can repeat the test after a month or two. Problems with the assessment of thyroid function in pituitary. Index of thyroid function when the thyroxinebinding globulin tbg is normal. Most patients who have a mildly elevated tsh have a normal free thyroxine t4 level. But,as per sources normal tsh levels for the average adult range from 0. Normal ranges for adults generally fall between these values. In normal health the brain and the pituitary are able to sense the amount of free t4 and free t3 circulating in the blood and adjust the amount of tsh produced by the pituitary so that levels of free t4 remain in the normal range in much the same way as a central heating thermostat turns on the heat when the temperature is too low and turns it.
Im sticking to a ketolow carb diet to help control an allergy. Why can you have low tsh levels but normal t3 and t4. They prescribed me 25 mg levothyroxine for a start. Low tsh with normal t3 and t4 with no symptoms is likely to be due to inflammation of thyroid thyroiditis, or early hyperthyroidism. In some individuals with a low tsh, only the t3 is elevated and the ft4 or fti is normal. I was diagnosed with graves disease in 2011 after an auto accident. As thyroid hormone has a long half life, it takes 34 weeks for a new steady state level of thyroid hormone to equilibrate in. Changes in thyroid status are typically associated with concordant changes in th and tsh levels eg raised t4 and t3 with suppressed tsh in thyrotoxicosis. Note that the normal range for these hormones may change a bit from lab to lab. This algorithm provides a strategy for differentiating analytical interference, resistance to thyroid hormone, and tshsecreting pituitary adenoma in patients with a high total or free t4 and a normal or high tsh.
We have gotten the run around for weeks from doctors. If this is a total t3 that is high with normal free t4 and tsh, then it is likely high binding proteins usually due to estrogen, ie birth control pill, etc. My doctor said my free t4 was a little high so she suggested cutting my levothyroxine, which is a t4 only medication, 50 micrograms in half, which would be. I always thought the sweet spot was around the 4week mark. Abnormal tft results guidance abnormal thyroid function. I had half my thyroid removed 3 years ago due to a benign nodule. From june 2008 until jan 20, i was on 150mcg synthroid and 50 mcg cytomel. For this reason, tsh is often an unreliable measure of secondary hypothyroidism and should not be used to assess the. Download table differential diagnosis of disorders with a high t3, low t4, normal. What is needed in this scenario is a tsh, free t4, free t3, and, and rt3. When thyroid hormone is bound to tbg, it is inactive and unavailable to tissues. The thyroid gland, therefore, produces less t3 and t4. The other combinations of thyroid function tests are rare. T3 t4 high but tsh normal hi, my t3 t4 are high but tsh.
Normal range of tsh,t3 and t4 be beautiful and healthy. I would think about secondarycentral hypothyroidism. Aug 28, 2017 tsh fluctuates due to the change in the trh. The reasons for t3 and t4 being within the normal reference range but having tsh lower than 0. After adjusting thyroxine slightly, t4 back to normal but tsh up to 7. The range of free t4 seen in normal healthy people is very wide. The tsh level is the indicator of the dose of the last 2 months.
Nov 27, 2008 you would take medicine because your tsh is high, and it is not ok for it to stay high. T3 or t4 is high hyperthyroidism, and increase of tsh if t3 or t4 is low hypothyroidism. Abnormal tft results guidance tsh high t4 normal t3 normal. I saw 3 doctors and only the last one requested to check for antibodies. Thyroid function tests an overview sciencedirect topics. High tsh, normal t4, low t3 this pattern may be an indication that you are having issues with thyroid conversion and. It made be better but i was like 50 pounds heavier so it made me depressed and i hated myself. In these cases, rt3 might provide the answer to the apparent pardox.
Problems with the assessment of thyroid function in pituitary disease. I have been steady gaining weight and have no energy in the last year but my doctor says i am not hypothyroid. Im going to tell you why hashimotos negatively affects your quality of life even if your tsh and your hormone levels are normal. Nov 20, 2014 if t4 is elevated then tsh is suppressed. Even with normal diet my weight is increasing continuously. In the case of tsh, the optimal zone is skewed far toward the low end of the standard lab lowhigh range. The low t3 and t4 would normally stimulate the pituitary and hypothalamic glands to increase trhtsh production, however, they are unable to increase production. For this reason, it would seem intuitive that if a low tsh is commensurate with good health, that a high free t3 and free t4 would be, as well. You would take medicine because your tsh is high, and it is not ok for it to stay high.
Differential diagnosis of disorders with a high t3, low t4, normal tsh. Differential diagnosis of hyperthyroxinemia and nonsuppressed tsh. University of groningen lownormal thyroid function and. High total or free t4 analogue method normalhigh tsh. I cant see the correlation between the really high tsh and normal t3 and t4.
High levels of tbg reduce levels of free thyroid hormone, causing hypothyroid symptoms. Do you have thyroid symptoms with normal lab results. So if t4 and tsh look normal on the lab panels, the true problem may never be investigated and the person may go on suffering indefinitely. Introduction screening and treatment of subclinical. Jul 16, 2018 for this reason, it would seem intuitive that if a low tsh is commensurate with good health, that a high free t3 and free t4 would be, as well. Can you please suggest,can these be a reason for weight gain. With this version of hypo, the symptoms are the same as all forms, but the cause is not the thyroid conking out. I am to a point where my health is being serverly comprimised by migraines, pelvic pain any of the above for hypothyroidism. It feels like the easy answer for optimal t3 levels. Endo thinks i have hyperthyroidism because of toxic multinodular thryoid, but the blood work is throwing me off. High tsh, normal t4, low t3 this pattern may be an indication that you are having issues with thyroid conversion and most often presents with hypothyroid symptoms. Hypothyroidism california center for pituitary disorders.
If your tsh levels are abnormally high or low, doctors will usually arrange for free t4 or free t3 blood test. The thyroid scan is to be sure that there is nothing wrong that could cause a hyperactive thyroid, such as thyroiditis or a tumor. Generally, secondary hypothyroidism is associated with low tsh and low t3 and t4. Sep, 2017 i would think about secondarycentral hypothyroidism. High tsh, high t3 and high t4 divyasri my blood test values are t3187 normal 70149 t416. Especially t3, because of the direct effect it has on thyroid hormone as opposed to t4, which is more of a carrier for t3. My wife has normal t3, t4, and low tsh but very high thyroglobulin 1. The t3 or t4 being low represents a thyroid gland that is not working well to make enough thyroid hormones. Currently, i have two or three clinically hypothyroid patients, who have the aforementioned paradoxical normal tsh, low t4, and comfortably normal or high free t3. High tsh and high free t4 what doctors want you to know.
The decreased tsh level seen in sch results from the pituitarys response to minor elevations in serum or tissue t4 and t3 levels. The prevalence of sch depends on the level of tsh used as a threshold. To manage decreased tbg, insulin sensitivity and blood sugar tests like fasting blood glucose, fasting insulin levels, glucose tolerance test, and hba1c are also helpful. The t3 is just a tad high, and odds are you are just fine. This isnt so, so no, no hypothyroidism, please refrain from taking synthroid. May 19, 2010 low tsh normal t3 and high t4 posted in hashimotos thyroiditis hashis disease forum. If the tsh level is slightly raised but the ft4 level is still within the normal reference range this is called subclinical hypothyroidism or mild.
Amiodarone can or 6mthly tsh, t3, t4 estrogens can t4 by tbg androgens, corticosteroids can t4 tbg methadone can t3,t4 tsh pulsatile release, peaks during night takes 46wks for tsh to reflect circulating thyroid hormone levels abnormal tsh can persist for. Free t4 tests can be inaccurate in some people who have interfering substances present. Patients can be severely hypothyroid with a high tsh and low ft4 or fti, but have a normal t3. At your age is suggested to keep it at the upper normal ranges. The main causes of these test results are shown in table 5. Patients with this pattern have normal tsh and t4, low t3, high t3 uptake a measure of the quantity of thyroxinebinding proteins such as prealbumin and albumin and high tbg.
Obtain tsh levels normal low reconsider diagnosis obtain free t. The body produces more tsh to stimulate the thyroid when t3 and t4 levels are low. The goal is to get your t4 to better convert to t3. Subclinical hyperthyroidism sch is defined as a low thyroidstimulating hormone tsh level with normal free t4 and free t3 levels in. If functionally your body lacked thyroid hormones, it would through an absence of physiological feedback inhibition cause your tsh to rise. Its the glands further up the chain having issues hypothalamus or pituitary g. I assume you are taking no thyroid medications, supplements or herbs. You need a combo t4 t3 or dtendt for sure, plus a doc that tests ft3, ft4, rt3, and tsh as secondary to the others. This sounds like graves disease hyperthyroidism or the very earliest phases of hashimotos thyroiditisplease consult an endocrinologist asap. To determine if the levels of thyroid hormone have been corrected, a repeat set of blood tests, usually a tsh and perhaps a free t4 or free t3, should be obtained after about 4 weeks following initiation of treatment. What causes a low tsh level with a normal free t4 level. Her symptoms get worse daily and the last doctor said that lots of people have your symptoms. A mildly elevated thyroid stimulating hormone tsh also called thyrotropin concentration is the most common thyroid function test abnormality encountered in everyday practice. My t4 and t3 are also normal, but my tsh was high and the doctor put me on medication and it made me feel much better.