Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
High TSH, normal T4 and normal antibodies?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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High TSH, normal T4 and normal antibodies?

My doctor has been saying for a few years that my thyroid is enlarged, however, no tests have been done on it so far.  She was just going on visual exam.  All TSH tests through 2007 were normal.  My last one, in 2007 was 2.something.

Last week, they ran another TSH and Free T4.  TSH was 11.6 (range 0.27-4.20) and Free T4 was 1.11 (unsure of the range, but it was "normal.").  Since I had been having symptoms, including low heart rate (58) with heart palpitations and a lot of fatigue, they decided to start me on 25 mcg Synthroid.

To make sure the TSH wasn't an error, they ran another one (before starting Synthroid).  TSH was 12.82.  No repeat Free T4 was done.  Thyroid antibodies were negative:  TPO was 3.8 (range <9.0) and Antithyroglobulin was 3.9 (range <4.0).

My questions is, since Hashimoto's is the most common cause of Hypothyroidism, I suspected my antibodies would be elevated.  All the other causes I've found associated with Hypo (thyroidectomy, radiation therapy, thyroid surgery and medications) don't apply to me at all.  What could be causing an elevated TSH with all other thyroid labs normal?

I have a thyroid ultrasound scheduled for next week, but that's it.  I'm waiting on a referral to an endo, but it's going to take 6 weeks or so to get in to the office.
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Good research on causes of hypo....10-15% of Hashi have negative TPO/Tg antibodies.  So Hashi is still the most likely culprit.  Thyroid ultrasound will help measure the thyroid and look for nodules.  If the thyroid is described as "heterogeneous" then this is likely evidence of Hashi.  Treatment is appropriate to get the TSH back to around 1.
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Sorry, forgot to add:  I'm a 33 year old female, I've had 2 children (one in 2003 and one in 2006).  
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Thank you so much for your response!  I was beginning to get very anxious, thinking it might be cancer.  Do you not think this is a likely scenario?  I know I will have to wait until the ultrasound to find out more information, but my current family medicine doctor does not seem very interested in doing more tests or giving me much information at all.  The right side of my neck is slightly more swollen than the left, but I don't feel anything that feels solid or like a cyst or anything like that.
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