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TSH 4.02 worried about levels

I recently had routine blood work and am concerned about my thyroid  levels my tsh is 4.02. T4 and t3 we're
tested I can't get in to my patient portal but they were right in the middle for the reference ranges. I will post later when I can get in.
In the past tsh level are as follow
Aug 11 2017 4.02
January 2017 .64 (this was from re visit I felt like the level must be a mistake bc. It like my normal range)
June 20 2016 3.340
June 16 2016 3.51
Aug 2015 3.5
I have random amount of time where I get dizziness ( have been to neourlogist/cardiologist etc) nothing found.  My blood pressure is routinely low 90/60, 88/60 but will spike when at the doctor. I suffer from anxiety as well. I am thin woman that is in her late twenties. Any advice about what to do about these level increasing to 4.02? Should I be concerned?
10 Responses
Avatar universal
TSH is a pituitary hormone that is affected by so many things, including the time of day, that the increase itself is not something to  be concerned about.  Even though within range, your prior levels are higher than most people with no thyroid pathology.  So that is something that needs to be evaluated.  With those symptoms we really need to evaluate your T4 and T3 test results compared to their reference ranges.  Also you need to get some further tests done.  We can discuss those later.  For now can you please try to get those T4/T3 results and ranges posted for us to review?
Avatar universal
August 2017 tsh 4.02
                   T3-  I will post these tomorrow when I get back in I got locked out from the wrong password
                    T4-
Thyroglobulin antibody <1.0

January  tsh .64 taken in ER did not get t3, t4,
        
June 20 2016 tsh 3.340
                   T3- 3.4
                    Free thyroxine T4- 1.15
Thyroglobulin <1.0
Thyroid peroxidase 11

June 1 2016 tsh 3.51 also ER visit not tested for T3, t4

January 2016 tsh 2.410
                         T4 1.24 blood work from gyn did not do a t3 test

August 2015 tsh 3.5
                       T4 1.26
                       T3 3.5
Anti thyroglobulin antibody <1.0
Thyroid peroxidase 8
1 Comments
June 2015 tsh 3.5
        
June 2014 tsh 2.45
                   T3- 3.2
                    T4- 1.2
Avatar universal
Hi here are the august levels. Any insight would be appreciated!! Thank you for your help!
August 2017 tsh 4.02
                   T3-  3.2
                    T4- 1.07
Thyroglobulin antibody <1.0
Thyroid peroxidase 12
Avatar universal
I have included the references ranges as well as vitamin d and folate etc August 2017 tsh 4.02
                   Triiodothyronine free 3.2 range 2-4.4
                    T4- free 1.07 range .82-1.77
Thyroglobulin antibody 3.0
Lipid panel
Cholesterol 185 range 100-199
HDL 51 range >39
LDL 118 range 0-99
Triglycerides 81 range 0-149
VLDL cholesterol cal 16 range 5-40
Avatar universal
What were the reference ranges shown on the lab report for the Thyroglobulin antibodies and the Thyroid Peroxidase antibodies tests?

Your Free T4 of 1.07 is only at 26 % of its range.  Most doctors would tell you that is adequate; however, the ranges are far too broad, due to the erroneous assumptions used to establish ranges for both FT4 and FT3.  Your Free T3 is at 50%, higher in range than your Free T4, which is not usually the case.  The reason, and some good information for help in diagnosing your status, is in the following quote from an excellent thyroid doctor.

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

When evaluating for potential hypothyroidism, the most important consideration is symptoms.  You have mentioned a few that can be related to hypothyroidism.  Do you have any others in this list of 26 typical symptoms of hypothyroidism?

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

In addition it is important of note that thyroid status is a function of what is called tissue thyroid hormone levels and effects.  Serum thyroid hormone levels do not always reflect tissue thyroid levels since it is affected by several processes and variables.  For that reason I highly recommend reading at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence for all that is recommended.  Note on page 2, Suggestion 4, the additional tests that should be done for you.  Those include Reverse T3 (and a Free T3 from the same blood draw), cortisol, Vitamin D, B12 and ferritin.  All are important for a potential hypothyroid patient.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf


So when you have a chance to read through all this you will realize that you need some additional tests and also need to be given a therapeutic trial of thyroid med adequate to raise your Free T4 and Free T3 levels and determine the effect on your symptoms.  Typically if cortisol is adequate, then Free T4 should be at least  mid-range, and Free T3 in the upper third of its range, and adjusted as needed to relieve symptoms.  Do you think your doctor would be agreeable to the additional testing and clinical treatment, rather than just based on test results?
Avatar universal
Thanks for the info! Would you say I need to be treated with meds? I seem to be somewhat sensitive to medicine and try to avoid taking them if possible but would throw be necessary in this case?
Thyroglobulin antibody 3.0
Avatar universal
Thyroglobulin antibody 3.0
Avatar universal
It won't let me post my other ranges for some reason it keeps cutting them off. I will try again thyroglobulin antibody 3
2 Comments
I am unable to get my full post to show up
Thyroglobulin antibody 3.0
Avatar universal
In looking at those symptoms I have tiredness and fatigue, I have low pressure which seems to be the opposite of mild high on the list and would say my heart rate tends to be faster, I notice an increase in my cholesterol, but I have also been eating not well. I am thin 104 5'2 and have maintained my weight without working out. I haven't been working out because my dizziness has been so extreme it will last for months and randomly go away
1 Comments
Also not sure why I can't post my other test results
Avatar universal
With those symptoms you surely need to get the additional tests done.  Once those results are available, I think it will be evident that you need thyroid med adequate to raise your FT4 and FT3 levels and confirm the benefit toward  relieving your symptoms.  Do you think your doctor would be agreeable to the additional testing and clinical treatment, rather than just based on test results?
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