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High TSH (18), Normal Free T4
My daughter is 17 years old. Recently in a regular check, we found out that she has high TSH (18) and normal Free T4. She feel tired and cold sometimes. My family doctor asked her to repeat the test as well as antibody test in two month. Is this a subclinic hyperhyroidism or hyperhyroidism? Does she need any treatment? Does two month too long to wait?
Thank you for the prompt response.
Our family doctor did not order FT3. So we only have TSH and FT4 results in hand.
Actually, I have discontinued her medication for three days up to today. I was not sure if I need to let her to continue with the previous dose (25 mcg) or wait up to see the endo.
I think it is a good idea to resume her previous dose after discontinue few days of medication.
Before seeing the endo, I am not able to reach her at all. I will bring all the copies of my daughter’s lab results to her.
Thank you so much for sharing your experience.
Our family doctor did not order FT3. So we only have TSH and FT4 results in hand.
Actually, I have discontinued her medication for three days up to today. I was not sure if I need to let her to continue with the previous dose (25 mcg) or wait up to see the endo.
I think it is a good idea to resume her previous dose after discontinue few days of medication.
Before seeing the endo, I am not able to reach her at all. I will bring all the copies of my daughter’s lab results to her.
Thank you so much for sharing your experience.
Your daughter is clearly overmedicated, and she has a couple of hyper symptoms, although her blood pressure and heart rate are still good. What is her current FT3 and its range?
The last time I was overmedicated, my endo advised me to discontinue all thyroid meds for three days and then resume at the previous dose. The three days helped a lot in alleviating the hyper symptoms. However, they did still linger to a lesser degree for a couple of weeks. Is it possible to call the endo you will be seeing next week and ask what to do for the next week considering current labs? Does the endo have her results in hand?
The last time I was overmedicated, my endo advised me to discontinue all thyroid meds for three days and then resume at the previous dose. The three days helped a lot in alleviating the hyper symptoms. However, they did still linger to a lesser degree for a couple of weeks. Is it possible to call the endo you will be seeing next week and ask what to do for the next week considering current labs? Does the endo have her results in hand?
Thank you for you all. My daughter is getting better.
However the recent lab results shown TSH is 0.02, and T4 is 26, much higher than the normal range (10-20).
She is not feeling cold anymore, instead she is sweaty a little bit; instead gain weight she lost some weight (a few pound) since July 15th her T4 increased to 37.5 mcg from 25 mcg.
Her blood pressure is 100/70, and heart beat is about 65-70/minutes as usual.
We are going to see the specialist in a week.
I am wondering if I need to completely stop her drug for a period of time or just reduce the dose to 25 mcg for one week before we meet the specialist.
I do not want to bring her to see the family doctor anymore; I think she is not knowledgeable at all about this kind of disease. She prescribed T4 50mcg at the very beginning of the treatment (even I asked for the 25 mcg she was not agree with me) and I have to remind her to take my daughter’s blood test for TSH and T3, T4 every six weeks.
However the recent lab results shown TSH is 0.02, and T4 is 26, much higher than the normal range (10-20).
She is not feeling cold anymore, instead she is sweaty a little bit; instead gain weight she lost some weight (a few pound) since July 15th her T4 increased to 37.5 mcg from 25 mcg.
Her blood pressure is 100/70, and heart beat is about 65-70/minutes as usual.
We are going to see the specialist in a week.
I am wondering if I need to completely stop her drug for a period of time or just reduce the dose to 25 mcg for one week before we meet the specialist.
I do not want to bring her to see the family doctor anymore; I think she is not knowledgeable at all about this kind of disease. She prescribed T4 50mcg at the very beginning of the treatment (even I asked for the 25 mcg she was not agree with me) and I have to remind her to take my daughter’s blood test for TSH and T3, T4 every six weeks.
I would talk to the doctor about a slight increase in her meds. to get the t4 level up a little and the TSH a tad lower in normal range as she is still having symptoms of hypothyroidism. Many people feel better when the freet3 is kept higher in normal range with t4 atleast mid range. TSH is often under 2 and can even be close to zero. This does not mean that you are necessarily over medicated if you are not having having hyper symptoms. In your daughters case , she may still be needing slightly more thyroid hormone replacement. Just because someone falls within normal range does not mean that it is the optimal range for them to begin feeling better. Also, remember that it takes time to get well with hypothyroidism even when all is right with the meds and ranges.
Finally our family doctor decided to start the treatment.
So now, after taking 6 week of T4 (25mcg), her TSH is 3.39, however the FT4 is still 12 (normal range is 10-20) and FT3 is 3.36 (it is still in the middle of the normal range).
In this case, do I need to increase T4 to 37.5? She is still feeling tired even she sleeps 9-10 hours/day. Why FT4 does not increase?
Thank you very much for your help.
So now, after taking 6 week of T4 (25mcg), her TSH is 3.39, however the FT4 is still 12 (normal range is 10-20) and FT3 is 3.36 (it is still in the middle of the normal range).
In this case, do I need to increase T4 to 37.5? She is still feeling tired even she sleeps 9-10 hours/day. Why FT4 does not increase?
Thank you very much for your help.
Thank you so much for the very helpful response; you make me feel much better. I will fight for getting the treatment as early as possible for my daughter.
Hi,
properly dosed the medicine will not have side effects (though the starting dose should be low - usually 25 mcg, and the adjustment slow - usually every 6 weeks). It will just make her feel better.
Properly dosed the medicine will also not suppress her thyroid, but rather support it to produce as much as it can.
Her body also produces T3 by converting T4 to T3. That is why most doctors only give T4 meds, and they work well for many people. Some people seem to have a problem with converting T4 to T3 (not so common), and in this case both a T3 and T4 med (either natural or manmade) may be given.
Once she is medicated she will need regular testing about every 6 weeks for a few months until levels are optimised and then stabilised. After that testing would be about every 6 - 12 months, unless she gets new symptoms.
Testing should always be TSH, FT3 and FT4.
properly dosed the medicine will not have side effects (though the starting dose should be low - usually 25 mcg, and the adjustment slow - usually every 6 weeks). It will just make her feel better.
Properly dosed the medicine will also not suppress her thyroid, but rather support it to produce as much as it can.
Her body also produces T3 by converting T4 to T3. That is why most doctors only give T4 meds, and they work well for many people. Some people seem to have a problem with converting T4 to T3 (not so common), and in this case both a T3 and T4 med (either natural or manmade) may be given.
Once she is medicated she will need regular testing about every 6 weeks for a few months until levels are optimised and then stabilised. After that testing would be about every 6 - 12 months, unless she gets new symptoms.
Testing should always be TSH, FT3 and FT4.
BUMP
Many thanks to all of you to provide me the valuable info. In Canada, we need to have a GP's referral to get an appointment with any specialist. I have just booked another appointment (next Tuesday) with our GP to explain to her to get an early appointment.
Another thing that I am worried about is that as soon as my daughter take the medicine, what would be the side effects? Does her body will rely on the medicine and do not produce any T3 and T4 by itself?
Another thing that I am worried about is that as soon as my daughter take the medicine, what would be the side effects? Does her body will rely on the medicine and do not produce any T3 and T4 by itself?
Definitely September is too long to wait. Your daughter is hypothyroid and needs to start treatment. Will the GP start her on thyroxine? Normal starting dose would be 25 mcg. Then the doctor should retest her TSH, FT3 and FT4 six weeks after starting the medication. Further adjustment would likely be needed.
You need to tell the doctor how long you have to wait and ask her what to do, and if she can treat in the meantime.
Of course, if you can get in to see another endo in the next couple of weeks that would be best.
Let us know what happens.
You need to tell the doctor how long you have to wait and ask her what to do, and if she can treat in the meantime.
Of course, if you can get in to see another endo in the next couple of weeks that would be best.
Let us know what happens.
September is too long too wait. Can you find another endocrinologist who can see her sooner?
Finally we got an appointment with an endo, which will be at the end of September. I am wondering it is too late? I have asked them also put our apointment on the cancellation list and hope we can see the specialist early. Is there any other way around?
I'm happy to hear you were referred to an endo. There are a number of young people on the forum with Hashi's. It's probably more common a little later in life, but it's not unheard of in young adults and children.
There's a lot of information on the web about Hashi's. Read all you can. If your research generates any more questions, please feel free to ask. Best of luck...
There's a lot of information on the web about Hashi's. Read all you can. If your research generates any more questions, please feel free to ask. Best of luck...
We get a referral to an endocrinologist. The doctor said she never see this happen to this age group patient. I am extremely sad.
It's not possible to figure out when it started unless you had a negative antibody test followed by a positive, in which case you'd know it started in between.
Yes, the diagnosis is based on positive antibodies.
The cause of autoimmune disease in general, and Hashi's in particular, is unknown...the rest is just someone's theory. I've never heard of anyone who could trace their Hashi's to toxic metals.
Read about Hashi's. There are differing opinions on when to start therapy. Some argue that it should be started before symptoms appear and labs are "out of range" while others feel that it's best to wait for labs to be off and symptoms to appear before starting. Your daughter's TSH is already very high. What are her actual FT3 and FT4 results and their ranges? Medication is the only option...when to start is the only variable.
Lifestyle and diet changes can all be positive for slowing the process of Hashi's, but it will not cure itself, it will just get worse as the antibodies "kill" more and more of the thyroid.
Best of luck with your appointment...let us know how it goes.
Yes, the diagnosis is based on positive antibodies.
The cause of autoimmune disease in general, and Hashi's in particular, is unknown...the rest is just someone's theory. I've never heard of anyone who could trace their Hashi's to toxic metals.
Read about Hashi's. There are differing opinions on when to start therapy. Some argue that it should be started before symptoms appear and labs are "out of range" while others feel that it's best to wait for labs to be off and symptoms to appear before starting. Your daughter's TSH is already very high. What are her actual FT3 and FT4 results and their ranges? Medication is the only option...when to start is the only variable.
Lifestyle and diet changes can all be positive for slowing the process of Hashi's, but it will not cure itself, it will just get worse as the antibodies "kill" more and more of the thyroid.
Best of luck with your appointment...let us know how it goes.
Thank you very much for the replies. We got all the test results now. TSH is even higher (23), free T3 and T4 are normal, antibodies are positive.
I did a research; it looks like "Hashimoto’s thyroiditis", a kind of autoimmune disease. It says that this kind of disease often happen to the women between 30-50 years old. 50% of them have family history of "Hashimoto’s thyroiditis”. However, my daughter is only 17. She does not have much symptom. She took the test was for the regular check. We do not have family history at all. Does the diagnosis can be made based on the above lab reports? I have just got an appointment for tomorrow afternoon.
I have following questions:
- How can we figure out when it started?
- The cause in my daughter’s case. Some article says that toxic metals like mercury could be the cause for autoimmune disease, where can we get the test done?
- What should be the next step? Take medicine is the only option?
- Since her Free T3 and Free T4 are still normal, can we delay the treatment? This kind of disease can be cured by itself? Let’s say if we change live style, diet, etc…
What other questions I should ask the doctor?
A lot of appreciations for any reply.
I did a research; it looks like "Hashimoto’s thyroiditis", a kind of autoimmune disease. It says that this kind of disease often happen to the women between 30-50 years old. 50% of them have family history of "Hashimoto’s thyroiditis”. However, my daughter is only 17. She does not have much symptom. She took the test was for the regular check. We do not have family history at all. Does the diagnosis can be made based on the above lab reports? I have just got an appointment for tomorrow afternoon.
I have following questions:
- How can we figure out when it started?
- The cause in my daughter’s case. Some article says that toxic metals like mercury could be the cause for autoimmune disease, where can we get the test done?
- What should be the next step? Take medicine is the only option?
- Since her Free T3 and Free T4 are still normal, can we delay the treatment? This kind of disease can be cured by itself? Let’s say if we change live style, diet, etc…
What other questions I should ask the doctor?
A lot of appreciations for any reply.
Hi Zoe,
I doubt that low iodine and not eating outside would cause the TSH that high and the FT4 is low.
However a supplement with iodine in it is probably ok.
Her TSH is high, her fT4 is low. Low end of the range is not ok, particularly with her TSH so high. THe doctor is wrong that she is not hypothyroid.
Make sure the retesting is for antibodies FreeT3 and FreeT4 not the total T3 and Total T4.
THe doctor also calls the feeling tired and cold "no symptoms"? They are very clear symptoms of hypothyroid and would not be normal in an 17 year old.
Please push to get the retesting done sooner than later. I would also recommend that you seek a second opinion or get referral to an endocrinologist. I believe your daughter should be treated already. Don't give up on this. A 17 year old needs to be well to cope with the demands of growing up.
I doubt that low iodine and not eating outside would cause the TSH that high and the FT4 is low.
However a supplement with iodine in it is probably ok.
Her TSH is high, her fT4 is low. Low end of the range is not ok, particularly with her TSH so high. THe doctor is wrong that she is not hypothyroid.
Make sure the retesting is for antibodies FreeT3 and FreeT4 not the total T3 and Total T4.
THe doctor also calls the feeling tired and cold "no symptoms"? They are very clear symptoms of hypothyroid and would not be normal in an 17 year old.
Please push to get the retesting done sooner than later. I would also recommend that you seek a second opinion or get referral to an endocrinologist. I believe your daughter should be treated already. Don't give up on this. A 17 year old needs to be well to cope with the demands of growing up.
Thank you very much for the reply.
The Free T4 is 12, the normal range is 10-20 from the lab report. (I forget the unit used in the report)
My family doctor said that even the Free T4 is normal, but it is barely at the bottom. That is why she wants to further test antibodies and repeat TSH and T3, T4.
But she doesn't consider the treatment at this stage since my daughter doesn't have symptom. I am very worried.
The Free T4 is 12, the normal range is 10-20 from the lab report. (I forget the unit used in the report)
My family doctor said that even the Free T4 is normal, but it is barely at the bottom. That is why she wants to further test antibodies and repeat TSH and T3, T4.
But she doesn't consider the treatment at this stage since my daughter doesn't have symptom. I am very worried.
Very appreciated for all the replies. I have one question for Supper_sally888.
In your replay, you mentioned about "temporary problem", this really give me a hope.
My question is what could be the temporary problem? I hope iodine deficient is one of these. I only put a little bit salt in our meal because my high blood pressure since last couple of years. I did not know if this can cause her iodine deficient. Also I do not allow her to take any junk food outside. Do you see this could be a problem? I cooked a lot of seaweed recently, I really hope this will help her.
BTW, my family doctor is going to further repeat TSH, T4 testing plus T3, antibodies test. I am thinking to take the test early rather than late.
In your replay, you mentioned about "temporary problem", this really give me a hope.
My question is what could be the temporary problem? I hope iodine deficient is one of these. I only put a little bit salt in our meal because my high blood pressure since last couple of years. I did not know if this can cause her iodine deficient. Also I do not allow her to take any junk food outside. Do you see this could be a problem? I cooked a lot of seaweed recently, I really hope this will help her.
BTW, my family doctor is going to further repeat TSH, T4 testing plus T3, antibodies test. I am thinking to take the test early rather than late.
I agree with the above postings.
A tsh this high would be considered hypothyroid, even in the face of the apparently normal FT4. What it means is that the thyroid is being pushed much harder than normal to try to put out enough thryoid hormone.
I think that she should be treated already to bring the TSH down to the reference range (normal target is 1 - 2 for most people).
I would also hope they do further testing for antibodies to try to determine the cause.
A second opinion is warranted.
I think the Dr. wants to make sure that this is not a temporary problem before treating.... but retesting in just a couple of weeks could achieve that rather than waiting for 2 months, particularly considering that your daughter does have symptoms that are consistent with hypothyroid.
I think that she should be treated already to bring the TSH down to the reference range (normal target is 1 - 2 for most people).
I would also hope they do further testing for antibodies to try to determine the cause.
A second opinion is warranted.
I think the Dr. wants to make sure that this is not a temporary problem before treating.... but retesting in just a couple of weeks could achieve that rather than waiting for 2 months, particularly considering that your daughter does have symptoms that are consistent with hypothyroid.
Do you have her actual FT4 result and it's reference range? Ranges are lab specific and have to come from your own lab report. We can coment better knowing that.
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