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3 month old with high TSH...

It seems that my 3 month old has always been a rather sleepy baby.  I took him to a pediatrician where it showed his CBC was normal, iron was fine, UA was fine.  His TSH came back 5.46, and Free T4 came back 0.76.  The pediatrician said that the cut off for a 3 month old is 4.8 on the TSH and wants to draw labs again in 1 month.  My baby seems to only be awake 2 hours a day on average.  He is 16 lbs 12 oz (98 percentile for weight and 73% for height)  When he is awake, he does not seem lethargic and is smiling, cooing, and seems to be meeting milestones.  Should I take a stronger course of action and get a 2nd opinion or wait the month for the results.  Also, his newborn screen was a bit off in the thyroid area.  Usually just a Free T4 is drawn, but if it comes back higher greater than 90% of normal then a TSH is drawn.  Looking at this newborn screen results, it looks like a TSH was triggered but then WNL, so I was never contacted about this ( but wouldn't you consider that he only passed half of the test).  Any help appreciated!  I am not sure what my next step should be...
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649848 tn?1534637300
Are you sure you understand how this works?  Typically, a TSH is drawn and if that's out of range, an FT4 will be drawn (and sometimes an FT3).

Thyroid is counter-intuitive in that when one is hypo, TSH is high and actual thyroid levels (Free T4 and Free T3) are low.  That's because the pituitary recognizes the low thyroid hormones, so it produces TSH to stimulate the thyroid into producing more hormones.  The lower the thyroid hormones go, the higher the TSH goes.

On the newborn screen, a TSH was done (as usual) and was WNL, so no further testing was done.  On the latest test, the TSH was too high and that triggered the Free T4.

What's the reference range for the FT4?  Ranges vary lab to lab and have to come from the individual's report.  Not having that reference range makes it hard to say much, but from what I've seen of reference ranges, if my son had an FT4 of 0.76, I'd be demanding a Free T3 test and probably hormone replacement medication.... or a second opinion at the least.  You might ask for referral to a pediatric endocrinologist.

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1756321 tn?1547098925
Queensland, Australia
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