My TSH is 4.08, should I be treated for Hypothyroid?

[LisaR83]

I recently went to the doctor because I've been extremely tired as of late.  Absolutely no energy.  Plus...I've gained weight and can't seem to lose it.  My TSH came back at 4.08 and according to the Lab it is within normal range.  My cholesterol was also high at 268.  My LDL was 182.  The reason I'm having to ask is because I didn't even get a phone call from the doctor's office.  They mailed the results to me along with a low fat diet plan.  Can anyone give me some feedback on this.  It seems that since I went to the doctor with symptoms the doctor might want to treat me.  Thanks!

[AR-10]

"according to the lab it is within normal range."

If you were mailed the results and the doctor's assistant/nurse didn't call you, your doctor isn't going to treat you until there is a capital H next to the test score marking it high and outside normal range.

Whether that is right or wrong, I change my mind every day.

Your Free T3 and Free T4 should be the determining factor. If they show low, even "low within lab limits", and you are having symptoms, then you should be treated. If you need hormones, you need hormones.

But...

If it's a transient thing, and it may be, then letting it go away by itself would be smart. If you're stuck at 4.07 for the next year, then you may as well take meds now.

You should ask to be retested in 6-8 weeks.
Have a TSH
Free T4
Free T3
TPOab
TGab

If your TSH is the same, your T's look below the middle of the range, and you have antibodies, then you should be diagnosed and treated. If no antibodies and the T's are above the middle, then it is a tough call.

Just my opinion.

[LisaR83]

I don't see Free T3 and Free T4 results.  Is that something they normally check?  I think I'm going to have to ask that they be completed because I can't imagine trying to function like this.  It wasn't like I went to the doctor for a physical.  I went there because I feel so fatigued all the time.  I'm also extremely depressed because even though I am on a diet I am gaining weight.  Yuk!  Thanks.  

[cmclien]

I'm a good example for you.  My TSH was 3.9, my Free T4 was .9 and my new GP was very pro-active and ordered me antibody tests (I didn't even have to ask) which turned out to be positive and so I was put on meds.  
You should request the antibody tests like stated above because if it is positive combined with the subclinical 4.08 you have then they should treat or send you to an endo for a more indepth look at whats going on.
Cindi

[AR-10]

What are the lab limits on your TSH test?

They didn't even run a Free T4 test?
Normally a doctor will run a TSH and a Free T4. Sort of a check and balance. If one is off, the other should be off in the other direction.

Lab limits can be about anything. 3.0, 4.0, 4.6, 5.0, 5.07, 5.5  I have seen all those posted as the upper limit in the last week.

My lab is using 0.34 as the lower limit. Last year it was 0.5
My lab is using 5.0 as the upper limit.
Your's probably is, too.

You should have all those tests run. If you show positive for antibodies, the doctor should take that into account.

TSH is just one little part of the picture. But it indicates that your symptoms are being caused by hormone deficiency, and the exact cause of that should be determined.

[LisaR83]

The Lab limits are .35-5.5.  I'm definitely asking for the Antibody Test.  I sincerely thank each of you for your assistance.

[peggy64]

Hi Lisa,

THe new lab limits for the thyroid is 0.2-2.0. Many of the older labs do not have updated references.

I would recommend that you go to another dr if you are not happy with his care. I have been doing research and it is recommended that drs also assess your symptoms as much or more than the blood levels.

hope this helps

[kitty9309]

My endo says that the upper limit should be 2.5.

There are many references that state anything over a 2 is suspicious for a failing thyroid.

But as AR said, you do want more than one result showing a mild elevation before treating. Most doctors would want this as well.

Do you have any old records with a TSH result?

[LisaR83]

I called my doctor's office this morning and they weren't planning on doing any further testing.  I told them that I felt 4.08 TSH was a little high and considering the fact that I went to them with symptoms and a family history of thyroid problems I should at least get the T4 checked.  When I went to the doctor last year complaining of the same problems, but to a much lesser extent, my TSH was 3.8 (again no T4).

They are going to check the T4 and let me know the results.  They suggested that if that test comes back normal they are going to send me to a cardiologist for a stress test.  No mention of an Endo visit.

[kitty9309]

A TSH consistently in the high end of the normal range is cause for suspicion.

I had results just like you before finally going just above the range. My PCP wouldn't treat me, but the endo did so willingly.

Tell them you would like a referral to an endo. Do you have an HMO or can you just go to who you want?

[LisaR83]

So...you think I should see an Endo.  Shouldn't I wait to get the T4 back?  Thanx

[cmclien]

Make sure you request the thyroid antibody tests as well as the Free T4 because the picture won't be complete without it and I agree you need to see an Endo
Cindi

[kitty9309]

I don't think you should wait, The t4 or free t4 will probably be in range on the low end.

As Cindi said, a free t4 is best. T4 total is an outdated test.

[LisaR83]

I tried to make an appointment with an endo but they require a referral and blood tests from my pcp.  They are closed today.  Hopefully I will have my antibody and free t4 results early next week.

In the meantime I do have one question.  I don't really feel any swelling in my throat but I keep feeling I have a lump in my throat.  Like something is stuck in it and if I touch my throat area I will keep this feeling for hours.  Is this thyroid or something else?

[kitty9309]

I have tightness in my neck when shirts and scarves touch it. They did an US and found 2 small nodules, but go on to say that this isn't causing my symptoms.

You should ask Stella about this. She has had some of the same symptoms you describe. Try a new post about it.

UGH! Red tape on the paperwork you have to get! You would think that you could make the appt and then have the paperwork sent over!

[LisaR83]

My doctor's office called this morning with a referral to cardio.  I've never had any cardio problems and I'm 42 years old.  She said that the test results were all good.

TSH - 4.08
T4 = 1.01
Free T3 = 2.5

Would these number indicate hypothryoidism or could it be that this isn't my problem?  These doctor's are beginning to think I'm crazy.  They didn't say it but I can tell.  The nurse is supposed to talk to the doctor and tell her that I want a referral to an endo.  It seems like since I have every one of the symptoms I should be able to get it.  I'll see.

[kitty9309]

The TSH is too high. Have you had antibodies tested? TPO, Tg?

What is the free t4 and t3 range? Free t4 looks like it is on the low end of normal.

A cardio consult won't hurt, but you really need to see an endo.

Here is a great resource:

http://jcem.endojournals.org/cgi/content/full/90/9/5483

I'm telling you, I had results just like yours for years and no doctor would agree with me that I thought it was my thyroid causing my symptoms.

[LisaR83]

Thank you so much Kitty.  They must have not tested the antibody because they didn't give me those results.  They also didn't give me the range on the T4 and T3, only the numbers.  They are going to give me a referral. Maybe the endo will give me the time of day.  thanks again!

[kitty9309]

You got the referral to the endo? Yeah.

Ask for paper copies of your labs.

Good luck and let us know how it goes.

[tabbyb]

With a TSH at 4.08...what are the units the lab uses???this is important as we can't compare amoebas to rhinoceros'. The American Association of Clinical Endocrinologist recommend using a range of 2.0 to 3.0 uIU/dL or equivalent. http://www.aace.com/public/awareness/tam/2004/tsh.php Also you should demand your doctor checks your Free T3 which is the most telling. My TSH was at 2.010 uIU/dL with my Free T3 at 181 pg/dL, which was below the lower limit of 210 pg/dL and a Free T4 at 90 ng/dL, which was just below the 91 ng/dL lower limit. Also, THERE AIN'T NO SUCH THING AS NORMAL IN SCIENCE. NASA uses nominal...but when an indication starts getting to the outside ends of the limits they start looking for a problem. With your TSH and symptoms....oh, what is your average body temperature???this is another major symptom. When the body temperature goes below 97F then myxedema coma is a possibility, which can be deadly. My body temp had been at 97.4F for a long time. It's been back up to 98.4F now.

[PPhelps]

My doctor was the same way. My TSH was 3.77 back in 2007 when I had him check it, because thryroid problems runs in my family also. Everything was fine he said, I finally said the hell with it, and scheduled an appointment with an endo specialist. I also have the lump thing in the throat. Sometimes its tender. I was DX with Hashimoto's. I think the lump felling is the swelling of the thyroid. Sometimes we have to be our own advicate when it comes to our health care. Doctors just want to get us in and out. I was lucky and found a great endo spec the first try. When I told her my symptoms, I think she knew. Please get those antibodie blood tests done.

[tabbyb]

I meant a range of 0.2 to 3.0 uIU/dL or equivalent for the recommended range.

[tabbyb]

Hashimoto's causes inflammation in the thyroid, which is what is probably causing the lump. I've been doing a lot of study out of self-preservation...my PCP would have allowed me to slip into a myxedema coma http://www.emedicinehealth.com/myxedema_coma/article_em.htm
before he would have done anything. But even if you don't test positive for the antibodies you can still have Hashis. The only way to know for sure is a biopsy. Also Hashi's can cause periods of hyperthyroidism just as Graves can cause periods of hypothyroidism.

Mary Shomon has a great check list of hypothyroidism risk factors and symptoms.. http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm?p=1
I filled this out and gave it, along with my latest labs to my new doctor and he took one look at the list and told me he could diagnose me based solely on the list, and with my recent labs..it was a cinch. I'm now in the habit of keeping copies of all my lab reports.
Tabatha