High TSH and T4 in upper range?

[thyroidmom84]

My most recent thyroid labs from yesterday:

TSH 6.100 (range .450-4.500)

T4 Free Direct 1.75 (0.82-1.77)

I am waiting on the T3 results which I know is what we really need to crack this puzzle but I couldn’t wait to ask- is it normal to have a high T4 and a high TSH? If the T3 is low, would this suggest a conversion problem? I don’t feel very well and I’m not sure why my TSH keeps going up even though I am taking a higher dosage now (was taking 120 mcg day then increased to 137 mcg about 3 weeks ago- we tested early because I have been feeling so bad- hot flashes, sweating, super anxious. Prior TSH was 5.06).

I think what I am also curious to know is could the high T4 be causing my hyper symptoms even though my TSH indicated hypothyroidism? I know that Hashi’s patients can have both types of symptoms but the sweating and feeling hot really freaks me out and my doctors don’t seem to want to link them.

[greygoose]

Is that an FT4 or a TT4?

[thyroidmom84 in reply to greygoose]

T4 Free Direct is what shows up on the lab report

[greygoose in reply to thyroidmom84]

OK, it's just such a narrow range. But, it's the word 'Free' that is important.

[thyroidmom84 in reply to greygoose]

Would you mind explaining what the free emphasizes? Also, what do you make of the results? When I first started treatment I remember my TSH climbed very high and my endo (different one than current) had to prescribe cytomel/T3 for a week to get it down.

[thyroidmom84 in reply to greygoose]

Ok I just googled the “free” aspect which appears to mean unattached to globulins and this free to be used by the body. Still very interested to get your insight on the other aspects.

[greygoose in reply to thyroidmom84]

Well, that just about sums it up, it's the T4 that is available for use by the body. Bound T4 (attached to globulins) can't be used until it's unbound. So, you need to know how much is available to be used.

I have no idea about your results. You really need the FT3 result to make any sense of them. But it is possibly that you're a poor converter.

How long did you leave between your last dose of levo and the blood draw?

[thyroidmom84 in reply to greygoose]

Not long- only about 5 hours

[greygoose in reply to thyroidmom84]

Well, there you are, then. That's why your FT4 is high, you were measuring the dose you just took. You should leave 24 hours to get the normal circulating level of T4.

[thyroidmom84 in reply to greygoose]

Wow- so I have never been told this by my endo. I know that probably isn’t surprising.

[greygoose in reply to thyroidmom84]

I doubt your endo has any idea. This is a patient-to-patient tip that we don't discuss with medical personnel. They really do not understand how it all works.

[thyroidmom84 in reply to greygoose]

Blowing my mind. I checked my last draw when it had been almost 24 hours and I was at 1.48 so that makes sense! Thank you

[greygoose in reply to thyroidmom84]

You're welcome.

[SlowDragon Administrator in reply to thyroidmom84]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

5 hours is about the worst gap.....as demonstrated by your results........your daily dose is clearly seen

Absolutely essential to also test vitamin D, folate, ferritin and B12 too

[thyroidmom84 in reply to SlowDragon]

Thank you- this is very helpful!

[Lalatoot]

The measures you want are for free T4 and free T3. I am not sure what the direct means after your t4 result.

[thyroidmom84 in reply to Lalatoot]

Tbh I’m not quite sure either