What would a high tsh indicate with a mid range... - Thyroid UK

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What would a high tsh indicate with a mid range t4 and very high (but in range) t3?

Dee8686 profile image
17 Replies

This has been the case in several sets of my results from different labs except nhs which show usual undermedicated pattern and results that make sense.

I have had an mri to rule out pituitary tumour. All clear- and I’m awaiting results of a lab to see if I have something interfering with blood assays.

However- with the above question and pituitary tumour rules out, has anyone come across that combination in labs and if so how is it treated?

Thank you.

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Dee8686 profile image
Dee8686
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17 Replies
jimh111 profile image
jimh111

What hormone doses are you taking, what time of day and when was the blood taken? Also please post the actual TSH, fT3, fT4 results. We need the numbers to comment.

Dee8686 profile image
Dee8686 in reply tojimh111

Usual protocol- fasting, no meds before bloods, no biotin etc.

On this particular occasion tsh 4.76,

Free t4 18.1 (11-22)

Free t3 5.8 (2.8-6.5)

I’m just interested to know what the answer would be should these results be correct

jimh111 profile image
jimh111 in reply toDee8686

It's not possible to comment on the results without knowing what you are taking and what time of day you take the hormone and what time the blood was taken. The time interval between your last dose and having the blood taken can have a big effect on the fT3 figure. Sorry, to be picky but the timing and dose really affects how you can interpret the results.

The TSH does look a little high for these fT3, fT4. This can happen if the blood is taken around the middle of your menstrual cycle or the TSH assay can sometimes report the wrong result due to antibodies interfering with the immunoassay. Can't really say for sure without knowing the timing of taking the blood.

Dee8686 profile image
Dee8686 in reply tojimh111

9am blood draw. On 20 t3 and 50 levo.

No meds 18 hours prior to test.

Just want to know what such treatment would be for those results if they are correct and no pituitary tumour.

Thanks

jimh111 profile image
jimh111 in reply toDee8686

18 hour gap is quite long so we would expect the fT3 figure to be reported just a bit low. Your TSH is a bit high for your fT3 and fT4 so it's a bit confusing. A pituitary tumor usually gives higher levels, at least when it is diagnosed. I believe it is very rare so I wouldn't consider it. Occasionally the assay can report higher TSH levels due to interference from antibodies but your TSH is not really high. It could be that you are normal with these numbers, this is where you are with your genetic make up.

Are you using finger prick tests? It's possible you are doing something wrong when taking the blood or perhaps they are sensitive to antibodies (assuming you have high antibodies). If the NHS tests are giving results consistent with your symptoms I would stick to the NHS tests.

Dee8686 profile image
Dee8686 in reply tojimh111

I’ve already had an mri and I don’t have a pituitary tumour.

My nhs results, show a high tsh, low free t3 and t4.

Genova, Medichecks and blue horizon labs all show similar with high tsh and high frees. Medichecks and blue horizon report high antibodies yet nhs and nhs report negative for antibodies. If all 3 private labs reported the same, it would make more sense.. it’s now that Genova have reported negative to antibodies, yet tsh etc all fit in line with the other private labs, it’s confused me more.

Medichecks are investigating my lab results. I know blue horizon and Medichecks use the same assays.

I’d be keen to know what Genova use.

All bloods have been blood draws by private nurse in hospital.

greygoose profile image
greygoose in reply toDee8686

Thing we should specify what antibodies we're talking about, here. Is it your TPO or Tg antibodies that some say are high and some say negative?

Even so, the antibodies that would affect a TSH test are TSH antibodies, not TPO or Tg. And you can't get a test for them. That is something for the lab to sort out - I'm afraid I don't understand the finer details. :)

Dee8686 profile image
Dee8686 in reply togreygoose

Tg and tpo antibodies x

Just so frustrating I can’t get a clear test

greygoose profile image
greygoose in reply toDee8686

Yes, it must be. But, I somehow doubt it's antibodies causing that slightly high TSH, because with antibodies it's usually a lot higher.

So, perhaps it is as jim suggested, something to do with your time of the month. Or have you had tests like that at all different times during the month?

humanbean profile image
humanbean

Are you taking any supplements that contain biotin? Biotin can interfere with lots of blood tests and can give spurious results, either higher or lower than they should be.

See these posts on the subject :

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

Dee8686 profile image
Dee8686 in reply tohumanbean

No biotin x

HughH profile image
HughH

First I would say that you should treat the thyroid condition - not the blood test results! This is a mistake doctors often make focusing on things like TSH and ignoring how the person feels.

Do you feel well with your current medication? If so I would not be concerned with the TSH result.

If you still do not feel well, the TSH result could indicate that your body would like an even higher Free T3.

Dee8686 profile image
Dee8686 in reply toHughH

I’m very ill to the point of being housebound 😢

HughH profile image
HughH in reply toDee8686

T3 is the active thyroid hormone and the Free T3 is the best measure of it. Your Free T3 of 5.8 (2.8-6.5) is near the top of the range and most people would feel well at this level.

One explanation of why you feel so ill with your good Free T3 is thyroid hormone resistance, also known as impaired sensitivity to thyroid hormone. If there are close relations with thyroid or autoimmune conditions it would support this possibility.

If not on meds, that would indicate that your thyroid is struggling and your thyroid is doing it's best to convert as much T4 to T3 as possible in order to keep you going, It's a very common pattern as people go hypo.

If on meds I would guess you are taking T3, so free T4 will be lower than if on levo. If you feel well, TSH doesn't matter, if not, you could probably do with an increase.

Dee8686 profile image
Dee8686 in reply toAngel_of_the_North

I am on meds, 50mcg t4 and 20mcg t3. Exhausted to the po By if bejng housebound.

LynnB79 profile image
LynnB79

Dee - I am just reading this as, like you, I am experiencing above range TSH and middle range (or so) T4 and T3. What are your symptoms? Like you, there are days I don't want to leave the house! But my symptoms are completely hyper - rapid pulse, loose bowels, head pressure, anxious, trouble sleeping, fatigue/weakness - just yucky! Crazy! I meet w endo next week and am expecting a scan of pituitary next.

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