elevated TSH and Free T4

[dp09]

I had abnormal thyroid test results.  I don't have the numbers but both my TSH and Free T4 results were elevated.  My dr wants me to get an mri to evaluate the pituitary.
Could you tell me why this would occur? is this unusual?

[ghazala898]

A related discussion, raised tsh to 7.5 and raised free t4 22,86 was started.

[dp09]

Thanks for your help.  my dr did re take my blood.  my tsh dropped a little but he thinks that I have hasimotos.  I am not going for the mri.  
he prescribed a low dose of Levothyroxine to start off and see how it goes.

[jeneric46324]

I understand your confusion and concern of both you and your Dr., it can be a rather long and confuseing jorney to reconfirm and decipher odd labs like these, it was when my family was DX with Thyroid Hormone Resistance.  IMO i think your doc might be jumping the gun a little bit here, as Dr Lupo has said it is usually normal practice to repeat and reconfirm these abnormal blood levels first, but there may be labratory/clinical signs and or symptoms that may lead him to beleive it is a tumor.

Running off the assumption that if this is a tumor, it would be classified as a hyper functioning tumor (giveing the elevated TSH), now from my research I have found that a strictly TSH secreting pit. tumor would be extremely rare, so is there any other hormone levels that your DR had tested along with the above tests that were out of wack?  Also from my research I have also seen a rather high prevelance of the hormone levels of prolactin being effected in cases of hyper secreting tumors, so much so that some clincians use it as a diagnostic aid to help confirm wether or not a tumor is likely and a MRI is the next step to take.  That is the extent of my knoweldge on that area of these types of labs.

On the RTH side of this differential a MRI is not necessary, but also the first step taken is usually hormone levels to reconfirm abnormal values, with some tests added, usually a T4 antibody test would be run in these new labs along with a Total serum T4 and Total serum T3.  If they come back with the same or near same values the quickest and easiest way to aid a RTH DX is to test family members.  RTH is what is called a autosomal dominant syndrome so 1 of the parents and 50% of the siblings are also likely to carry the syndrome.  There are sporadic cases of it, meaning neither parent has it, but these cases are usually more severe in origin and coincide with other genetic abnormalities that these cases are almost always readily apperent from birth or early adolescents.  Since with your post I assume this was not a childhood problem, the likely hood of it being in another member or your family is pretty significant, and all that would be needed is your average thyroid panel.


I do not mean to scare you or to step on Dr. Lupo's toes but I have been a long time reader of this site and understand that there are some limtations that must be made in responses here.  I am just trying to give some information that I wish I had when I had to go through this process and let you know that while being a rareity is scarey there are others here that can help you out.

[Mark Lupo, M.D.]

The reason for the MRI is to test for the rare entity of a TSH secreting pituitary tumor.  I would first retest the TSH, free T4 and free T3 -- if still elevated, proceed with MRI.  there is also a perhaps more rare entity called thyroid hormone resistance which can cause TSH, T4 and T3 to all be elevated.

Try to re-post a follow-up if possible.