TSH Question

[Damavi]

I just got routine bloodwork done (for the first time) and noticed my TSH level was 0.020 (0.450-4.500). T4 was 11.5 (4.5-12.0).

Should I be concerned or have additional tests done? The doctor didn't mention anything, but I'm not sure he even noticed...it was at busy clinic.

[goolarra]

Does your insurance require a referral from your PCP to see a specialist?  Some insurance companies don't let you self-refer.  A PCP could order the tests...this might be faster since endos are often pretty backlogged.

How do you feel?  Do you have symptoms that are really bothering you, or do you feel you might have the luxury of waiting a bit to get an endo appointment?

[Damavi]

Thanks again for the help!

One more question. I am horrible about going to the doctor and don't really know how referrals and specialists and all that works. I also just moved and don't have a regular doctor here (thus the bloodwork at a clinic as part of a work physical). Should I see another general doc first or go directly to an endocrinologist?  

[goolarra]

Since that's a total T4, it really doesn't give us a lot of information.  It's considered an obsolete test and has been replaced by FT4.  TT4 measures total T4 in the blood, but much of that is chemically bound by protein and unavailable to cells.  FT4 is what's actually available.

So, with only TSH to go on (which is a very poor diagnostic), you appear hyper, but any number of other things might be going on.  Until you have further testing, it's really hard to say.

Good luck...

[Damavi]

Thanks, I will look into getting those tests. The T4 result I have is total, not free.

I definitely don't feel hyper symptoms, much more hypo instead.

[goolarra]

I think you should.  Specifically, have FT3 and FT4 tested.  I believe that was a total T4 at 11.5???  If the lab report doesn't say "free" T4 or FT4, then it's total.  I'd also have thyroid antibodies tested (TPOab and TGab) to determine if you might have an autoimmune thyroid disease.  A TSI test would confirm or rule out Grave's.