Thyroid Disorders Community
26.1k Members
1182559 tn?1305787988

High TSH with normal FREE T4

I recently went to my see my doctor because I was having massive Hypo symptoms. Fatigue, constipation, insomnia, hair loss, brain fog, weight gain and most of all a ton of joint pain- everywhere.Because my last test was 3 months ago and I am currently on Levothroid 0.50mcg (That test came back TSH 2.22)  I basically had to demand my thyroid be tested again because I was sure the levels were off. He did the test and my TSH came back 5.90 with a Free T4 of 1.19. Also, I'm not sure if this is related but my WBC was low as well. After getting my lab results I asked if I could be referred to an Endocrinologist to discuss posibly a new medication and thyroid management. My doctor said he didn't think a referral was necessary and because my T4 came back normal he didn't believe I had a thyroid problem at all. Am I crazy for thinking he's crazy??? I changed to an Internal Medicine doctor and I have an appointment with him next week. There is one thing I'm concerned about though. I have been having a constant sore throat..not so much sore as horse. And I feel like there is a lump in it when I swallow. My voice goes in and out. I have had this for the past 3 weeks or so off and on. My Doctor said this has nothing to do with my Thyroid. Is this true? And I just being paranoid?
17 Responses
231441 tn?1333892766
Please post the reference range for the FT4.  

Normal FT4 with High TSH is called subclinical hypothyroid.  It needs to be treated, particularly if you are symptomatic.  Target TSH is about 1.0, but more importantly Target FT4 and FT3 should be in the upper half of the reference range AND you should feel good without hypo symptoms.
1182559 tn?1305787988
The normal FREE T4 range according to my doctors office is 0.81 - 1.48. My T4 has always been in the middle range.
Avatar universal
You have all the symptoms off being hypo thyroid,
Ive got an high TSH, at the moment , with a normal T4.
I have demanded to see an endo as i feel like s**t, Just like you.
Even though ive had thyroid disease for 12 years.
I had a feeling in my throat what the doctors used to always prescribe antibiotics for, which never worked.
My voice was hoarse, i always had to clear my throat, and the feeling like a lump in my throat.
Well take it off someone you has suffered many years with that feeling in the throat, it is all very much thyroid related, and your doctor doesnt know what hes talking about.
Maybe your doctor needs a thyroid disease, to know the feeling. then he would know what youre talking about.

Because its all thyroid, i even get the low white blood cell counts also.
Keep me posted,
Hope you find a doctor who does the FT3, FT4, alongside the TSH. levels.
Take care
1097839 tn?1344579942
hi Diana

If your doctor doesn't know that hypothyroidism, including subclinical hypothyroidism can cause a sore throat it sounds like you really want to get another doctor.

I was diagnosed sub clinical hypothyroid in August last year and have also had a lot of hoarseness.  Unfortunately despite two increases in my dose of thyroxine (now on 100mg) I'm still struggling with symptoms. It's scary stuff, you definately need a doctor who is switched on and will listen to you.

I wish you every good luck with getting the treatment you need and would be really happy to swap notes with you anytime you like.

best wishes
1182559 tn?1305787988
I have developed about 3 quarter size nodules on the lower left side of my throat, so much for this hoarsness and sore throat NOT being my thyroid... I switched Doctors and ended up going with an Internal medicine Dr. I am going to try to get an appointment with him tomorrow. These lumps are pretty scary and starting to get pretty painful. My voice is constantly going in and out and I have heard that they could cause permanent damage to your vocal cords.  Thank you guys for all your information. Godd luck to you too! I will keep you updated on what my New Dr. says tomorrow.
1027416 tn?1252355428
Demand an ultrasound of your thyroid, my levels were always within "normal" range but I had a tumor and several nodules on an enlarged thyroid gland.  After I had a TT in Aug 09 I'm feeling much better.  Good Luck!!
Avatar universal
I have just had my second thyroid surgery due to a nodule, which was over my central trachea, it caused sore throat, hoarseness, and swallowing problems, also i couldnt lie flat without feeling constriction pressure,
I had my to go private, as my endo at the time said it was anxiety, and to go and exercise, i then went to one of the best endo surgeons in england ,who scanned it and said get it out asap. so that tells you something.
If you are having swallowing and breathing problems, get these symptoms cghecked straight away.
Keep me posted
Take great care
Avatar universal
Diana, you sound like you have Hashimoto's. I get the sore throat, caused by the goiter. Selenium once a day helps. I take a 200 mcg pill when I get the swelling.

Get your TGab and TPOab antibodies checked to determine if Hashi is the cause. With Hashimoto's, our TSH, FT4, FT3 levels will swing from hyper to hypo, especially if we have nodules. Your FT4 could be below range the next test. If you do have Hashi, I would strongly advise thyroid hormone treatment. The goal is to get both FT3 and FT4 at the top 1/3 of the range. Therefore, an FT4 of 1.1 would not be sufficient.

Make sure the internist tests and treats both FT3 and FT4 levels, not just TSH. If so, then switch again. I went through four endos. I found my newest and most awesome endo off this site.

:) Tamra
1182559 tn?1305787988
I saw my new Internal Medicine doctor today and he felt the nodules in my neck and ordered an Ultrasound. He upped my dosage from 50-75mcg and wants me to recheck my labs in one month. He ordered TSH, T4 and T3. I forgot to mention the TGab and TPOab antibodies though. But this will be the first time my T3 is being ran. I am going to try and get my Ultrasound tomorrow. I am not having any trouble breathing so far, just a constant feeling of something in my throat and I will sometimes choke on food or water :/ and then my voice goes hoarse. I will keep you guys updated once I see what my US results show.  
1168110 tn?1272682317
I was just reading your posts, and my gosh, it was like you were writing my story!!  How neat. in a weird way.
I have been having the same symptoms, and the worst being the lump in the throat.  I have seen many doctors, 2 ENT's, CT scan, ultrasound, x-ray....  on and on.. and not one of them think it is a thyroid problem.  
I have Hashimoto's, and have been in a battle with it for 12 years.  My highest TSH level was 127, and then we fought, and brought it down slowly, and now it seems like its stuck between 13 - 16.  I go for my blood test results tomorrow, so I will see what it is at.
My biggest problem is that I have pulled allergic reactions to 3 or 4 different thyroid medications, making the battle more of a war. So I am stuck with synthroid, and I have to take Benadryl for the allergic reactions, but then its worse, because it raises the TSH levels.  WOO HOO lucky me huh?  hahahaha
Anyhow, I do get to finally see an endocrinologist.  FIRST TIME.  You think the doctors here could even think of sending me to see one.  I have fought for about 6 years to see one, and now because I am pre-diabetic, and my throat is tight, the doc will send me.  Why I had to suffer all these years is beyond me.
I am so happy that I read your post, and the others who replied to your post.  I no longer feel like an idiot, thinking the awful pressure, and tightness, and choking sensation could very well be due to my thyroid.  4 months of this feeling is too much.  12 years of having so many  health problems because of the thyroid, and I finally get to see an endocrinologist.  
Got to love Alberta Health care.   Ya right !  it *****!!!

Anyhow, would love to add you as a friend, I will send out a request!  I would love to be able to 'compare notes', maybe pick up some valuable advice, or what to do next....

Hope to chat with you,
Good luck with your ultrasound...
1182559 tn?1305787988
Oh my, that is so aweful for you to suffer THAT long and never see an endocrinologist. Especially with your TSH level at 127!!! That's rediculous to me. I'm glad you are finally getting help even if it is 12 years too late. Keep us updated on what the Endocrinologist says.
1182559 tn?1305787988
Ultrasound results are in:

Thyroid Ultrasound:                                                  
RIGHT THYROID LOBE:  The right lobe measures L: 3.2 x  W: 1.2 x  H:  
1.5 cm.  The right lobe appears heterogeneous.                        
LEFT THYROID LOBE:  The left lobe measures L: 3.8 x  W: 1.3 x  H:  
1.8 cm.  The left lobe appears heterogeneous.                        
ISTHMUS:  The isthmus measures 8 mm.  A single hypoechoic nodule is
visualized in the isthmus, measuring 1.1 x .7 x .8 cm.                
8 mm solid nodule in the isthmus.                                    
Heterogenous thyroid gland.

I'm not 100% sure what that all means. I'm assuming Hasimoto's disease? But my doctor said he wanted to send me to Endo because they would know what the next step would be. Should I be concerned about the solid nodule it's located right in the mid-lower part of the thyroid which is why I feel like I'm choking some and like there is something stuck in my throat. My doctor did say though if ANYTHING changes in the appearance or feel of my thyroid to see him immediately.
1097839 tn?1344579942
hi Diana

I don't know what any of that means I'm afraid, I have my own ultrasound appointment on 8th Feb and the whole issue of nodules is one I have yet to get my head round.

I hope you get to see an Endo soon and get some answers and appropriate treatment. It's a shame your doctor couldn't give you any more info.

In the meantime hopefully someone else on here may be able to give some advice on what it all means.  

sending positive vibes - I hope it will all be okay for you.

1182559 tn?1305787988
I went in to see the Endocrinologist today for a consultation. She did another Ultrasound scan and said that my nodule is just over 1cm. She she did the biopsy right there in her office. Man did that hurt! I didn't expect to be this sore afterwards. I should have the results in 7-10 days. The waiting period is the worst.
1097839 tn?1344579942
hey, just saw your last post. biopsy on the spot sounds horrid, poor you. have you had your results yet?

I had my ultrasound last week. I haven't seen a report yet, seeing my doc tommorrow. the guy doing the scan just said it's bigger than normal and lumpy/rough and dark instead of being small, smooth and light in colour. but he said that's just what he would have expected given that it is under active, he said he wasn't sure if there were any nodules in there or not, so I guess there was nothing too huge or concerning to be seen.

I'm still feeling thoroughy unwell and off work for at least another two weeks. Tomorrow I'm going for a Theta Healing treatment to see if taking an alternative approach, combined with traditional medicine, might help things along at all. I met a woman who said it had worked for her and she seemed radiant with health so I'm kind of excited about the possiblitilies.  

bored, bored, bored of it all now! just want to get well.

sending a hug
1182559 tn?1305787988

yes I did get the results of my biopsy. Positive for Cancer- Papillary Carcinoma. :/ I was referred to a surgeon to have a full Thyroidectomy. The particular surgeon that my Endocrinologist wants me to see is on Vacation until Monday, so I will have to wait until next week to set up a consultation. I must admit, I don't think it has quite hit me yet. except on the days I do not feel well...like today. I don't know all the information just let. But I will for sure keep you updated. Let me know how the Theta Healing treatment goes!


1097839 tn?1344579942
oh diana! I'm so sorry, what a shock that must be for you. Am sending you the warmest thoughts. Thyroid cancer is so treatable though, I'm sure with the thyroidectomy you will be fine.

I have a colleague at work who had a full thyroidectomy years ago and you would never know there had been anything wrong with him - once he'd undergone all treatment in his words "it never held me back", he's a real high flier who totally got over the illness and has gone on to have a very successful career. I  only know he had been ill because he told me when I mentioned I'd been diagnosed under active.

As it happens I work for a cancer research charity (as a fundraiser, I'm not a scientist or anything) so I've seen the stats for your type of cancer and they certainly indicate, particularly given your age that treatment is most likely to be successful and you will be fine.

How scary for you though. I hope you are being very gentle with yourself and getting lots of support and love at the moment.

I did my theta healing session yesterday and enjoyed it. Will see how I feel over the next few days/weeks. I felt really good this morning but a bit tired again this afternoon.

keep me posted on how things develop and how you're feeling.  You will be in my thoughts.

L xxx

Have an Answer?
Top Thyroid Answerers
649848 tn?1534633700
Avatar universal
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
For people with Obsessive-Compulsive Disorder (OCD), the COVID-19 pandemic can be particularly challenging.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child