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Thyroid Disorders Community
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Avatar universal

TSH over 6

Hi,
  My TSH is  6.30, Free t4 is1.22 and Total T3 is1.07, T4 is 6.77.  I am tired and achy all over.  Am I wrong to want my doctor to treat me?  I found out about my thyroid antibodies 20 years ago and have periods of time where I felt good and times where I have felt not so good. My PCP doc does not want to treat me.  Should I get a referral to an endocrinologist?  I am starting to gain weight and I personally think something needs to be done.  I don't have a lot of energy but still have a lot of living to do!
Thanks for you help,Pat
16 Responses
Avatar universal
Please post the reference ranges for those test results, as shown on the lab report.  
Avatar universal
Forgot to ask if you have been diagnosed with Hashi's?  Are you taking any thyroid med currently?  If so, what type and what dosage?
Avatar universal
tsh should be brought in between 1 and 2 so need to increase current levothyroxine dosage under doctors prescription. yes it would be best if you consult an endocrinologist if current doctor is not willing to prescribe.

also make sure your vitamin d, b12, ferritin all in optimal range and correct if deficient.
Avatar universal
As I have explained previously, treatment should not be based on TSH levels.  There are many scientific studies that have shown TSH does not correlate well with either of the biologically active thyroid hormones, and does not correlate at all with symptoms.  This is a quote from one of those studies.  "We found no correlations between the different parameters of target tissues and serum TSH........Therefore, the biological effects of thyroid hormones at the peripheral tissues-and not TSH concentrations-reflect the clinical severity of hypothyroidism."   So stating that the TSH should be brought in between 1 and 2 is very misleading.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.   Symptom relief should be all important, not just test results, and especially not TSH results.  

After we allow Indypat a chance to give us the needed reference ranges then perhaps we can better assess her status and provide her some suggestions based on scientific evidence.
Avatar universal
Reference Ranges are
TSH    0.465-4.68
Free T4    0.78-2.19
Total T4     5.53-11.0
Total T3     0.97-1.69
Ferritin    37.5        range  6.24-137
Vitamin B12     641     Range   239-931
Vitamin D is not on this report but was around 50 the last time it was checked and he has me taking that.
Avatar universal
I have thyroid antibodies since 1992.  No thyroid meds.
Avatar universal
From your symptoms and those test results it is clear that you are hypothyroid.  Your FT4 is only at 31% of its range.  Your Total T3 is only at 14% of its range.  I expect that your Free T3 is similar to your Total T3, but you should make sure they always test for both Free T4 and Free T3 every time you go for tests.  

I explained how a good thyroid doctor would treat you.  With Hashi's the output of natural thyroid hormone decreases as the gland is being destroyed by the antibodies from the autoimmune system.  So you obviously need to increase your thyroid med dosage.   In addition, you need to supplement your D, your B12 and ferritin.  D should be about 55 min, B12 in the very upper end of its range, and ferritin should be about 70 minimum.  So it would be good to supplement all three, especially with some iron for the ferritin.  

You don't necessarily need an Endo.  Many of them specialize in diabetes, and many of them have the "Immaculate TSH Belief"  That doesn't work for hypo patients.  If they test beyond TSH it is usually only Free T4 and then they use "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the range is adequate.  That is also wrong.  

If you are interested I have the name of a doctor in your general area that has been recommended by other thyroid patients.
Avatar universal
Yes. I need a thyroid doctor.  My internest is having me come back every 6 months am I am wearing gradually down.  I would appreciate any help I can get.
Avatar universal
I just sent a PM with info.  To access, just click on your name, and then from your personal page, click on messages.
Avatar universal
so suppose one's free t4 and free t3 in upper range but his tsh is high like 15 then based on free t4 and free t3 values approach as you said doesn't require on levothyroxine replacement therapy?

in subclinical hypothyroidism free t4 and free t3 all normal, only this out of range is tsh and it does require replacement therapy as increasing tsh no's indicate a struggling thyroid gland.
Avatar universal
exception is pituitary gland issue but one which tsh reduces when increasing thyroxine suggest thyroid gland is struggling to cope with demands and supplementing surely helps.
Avatar universal
That would be a very unusual situation to have Free T4 and free T3 high in the range, and also high TSH.  And you haven't even mentioned the most important thing, which is whether the patient had symptoms or not.  But assuming no symptoms, not the high TSH does not require thyroid med.  TSH does not cause symptoms.  The main value of TSH is to identify overt hypothyroidism (high TSH and low FT4 and FT3) and to distinguish Hashimoto's Thyroiditis from central hypothyroidism.  

Again the important consideration is symptoms.  If no symptoms because FT4 and FT3 are high enough in the range, then TSH is irrelevant.  If TSH is increasing due to Hashi's then eventually the FT4 and FT3 will drop enough to cause symptoms.  It isn't the TSH that is important to a hypo patient, only symptoms (associated with levels of  FT4 and FT3), along with a few other important variables such as Viamin D, B12 and ferritin.

I can give you tons of scientific evidence that TSH does not correlate with tissue thyroid effects , which affects symptoms.   So it is misleading to tell members to adjust TSH as a way to fix their hypothyroidism symptoms.  We need to keep telling them to get a doctor to adjust Free T4 and Free T3 as needed to relieve symptoms.  Most often this will actually result in suppressed TSH, which does not mean hyperthyroidism, unless there are hyper symptoms due to excessive FT4 and FT3.  
Avatar universal
so

suppose a person have some optimal free t3 and free t4 with tsh 6 then after some months he have exactly previous free t3 and free t4 with tsh 10. so based on your theory he require no treatment?

forget about vitamin d, b12 and ferritin as they all in optimal ranges.

Avatar universal
Yes, most likely no treatment required since optimal levels of FT4 and FT3 would not be causing any hypo symptoms.  So why would anyone want to treat a higher TSH, since it causes no symptoms, and is only an indicator (poor) of levels of the biologically active thyroid hormones?

I really don't want to spend time debating hypothetical situations that rarely occur.  Instead, why don't you spend some time reading some of the many  sites like the following.  And don't overlook the numerous subjects listed on each site.

https://www.nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/

http://www.hormonerestoration.com/Thyroid.html
Avatar universal
Here's a scientific study you should read.  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341585/pdf/bmjcred00253-0040.pdf

In the study a group of 148 thyroid patients that were taking thyroid med were clinically evaluated very thoroughly.  Of the 148, 108 were judged clinically to be euthyroid, 22 hyperthyroid and 18 still hypothyroid.  The 108 that were judged as clinically euthyroid had TSH levels that ranged from .1 to 19.7.  Even the hyperthyroid group had TSH levels that ranged from .1 to 14.4.  

This is the kind of info that clearly says TSH is a useless test when already taking thyroid med.  As I said the only real value for TSH is to identify overt hypothyroidism in untreated patients and also to distinguish primary from central hypothyroidism.  
649848 tn?1534633700
COMMUNITY LEADER
gimel has given you some good sites to look into, but I can give you some good examples right here on the forum...

We have one member whose TSH, routinely, measures between 15-20, and the FT levels are in the lower part of the ranges, but the person is comfortable at those levels.  When the doctor tried to increase medication to lower TSH, the patient went into thyroid storm and became very ill... In this case, the TSH is irrelevant. Symptoms are all important.  

Myself is another case... My TSH stays at < 0.01 - 0.01 and I feel best with FT levels about mid range... In order to get my TSH between 1-2, I'd have to be removed from all thyroid hormone medication, which would, then drive it much higher than that, and I would be very hypo... Again, TSH is irrelevant.

As gimel says, TSH causes no symptoms; it's a messenger only and useful to help with diagnosis.  Then, it, typically, becomes irrelevant.  Free T3 and Free T4, along with symptoms are what's important.
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