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high TSH
My doctor is puzzled...for 12 years my TSH reading have been 11.7 to 18.9 with T3 and T4 always in the normal range. I'm 63, 5'6.75, 137 lb, BMI 21.4, very healthy, very energetic, great hair/nails, good BP,pulse 63, temp 97.2 strong heart, no lung problems, cholesterol 191, etc. She has said I have the body, test results and visually appear 10 years younger. I am on no medications, eat very healthy foods, exercise, walk, do stairs...everyone should have the energy I have. She has wanted me to go on Synthroid...I have always refused. A pharmacist once told me by starting Synthroid without any of the symtoms, it could create problems for me. I do not want to take any medicine unless I have to.
What could be causing this? My most recent reading was 18.7...it has been slightly higher before...it goes up and down. How can I feel so great and be told that I shouldn't be able to get out of bed due to lack of energy? I look forward to any help!
What could be causing this? My most recent reading was 18.7...it has been slightly higher before...it goes up and down. How can I feel so great and be told that I shouldn't be able to get out of bed due to lack of energy? I look forward to any help!
Your FT4 is definitely on the low side. It's only 9% of range, and the target for FT4 is around 50%. FT3 is at 33% of range, and the guideline for FT3 is upper half of range. Most people would be very hypo with those labs...not me! We all have our own comfort range, and with no symptoms, apparently you are in yours, i.e. this is "normal" for you.
I'd keep an eye on it, and make sure they always test FT3 and FT4 along with TSH. If your FT3 and FT4 stay where they are, and you still feel well, you will have confirmation that this is right for you.
Hashimoto's thyroiditis, which is an autoimmune disease, is by far the most prevalent cause of hypo in the developed world. A simple blood test for the antibody markers for Hashi's, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies), would indicate if you might be in the early stages. Unless you start not feeling well, you might ask your doctor to test those next time you have blood work.
In the meantime, I'm with you...don't fix it if it ain't broke.
I'd keep an eye on it, and make sure they always test FT3 and FT4 along with TSH. If your FT3 and FT4 stay where they are, and you still feel well, you will have confirmation that this is right for you.
Hashimoto's thyroiditis, which is an autoimmune disease, is by far the most prevalent cause of hypo in the developed world. A simple blood test for the antibody markers for Hashi's, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies), would indicate if you might be in the early stages. Unless you start not feeling well, you might ask your doctor to test those next time you have blood work.
In the meantime, I'm with you...don't fix it if it ain't broke.
My T3 is 2.8 (range 2.0-4.4)
My T4 is 0.8 (range 0.7-1.8)
Any guidance is appreciated!
My T4 is 0.8 (range 0.7-1.8)
Any guidance is appreciated!
As others have explained to you above, there are many causes of high TSH with "normal" FT3 and FT4. I have a pituitary issue (not a tumor), and my TSH hovers around 20.0 permanently. Sometimes my FT3 and FT4 will go up and so will my TSH or vice versa, but it's always one side or the other of 20.0. It's been that way for years.
TSH is nothing but a messenger from your pituitary (which evaluates thyroid levels) to your thyroid telling it to produce hormone. High TSH, per se, has NO symptoms. Low FT3 and FT4 are what cause symptoms.
When you get your actual numbers from your doctor, I will be happy to give you a rundown on how FT3 and FT4 look. However, I think you can let your symptoms (or lack thereof) be your guide in this.
TSH is nothing but a messenger from your pituitary (which evaluates thyroid levels) to your thyroid telling it to produce hormone. High TSH, per se, has NO symptoms. Low FT3 and FT4 are what cause symptoms.
When you get your actual numbers from your doctor, I will be happy to give you a rundown on how FT3 and FT4 look. However, I think you can let your symptoms (or lack thereof) be your guide in this.
Just to add extra info from the case study...
"Unexplained elevated TSH without a coexisting low fT4, in the absence of clinical features suggestive of hypothyroidism or thyroxine replacement, is often attributed to non-thyroid illness (NTI), some sort of interference in the analysis of thyroid hormones, or subclinical hypothyroidism.
By definition, subclinical hypothyroidism encompasses high TSH, normal fT4 and absence of clinical features of hypothyroidism. However, a past history of thyroid disease and thyroxine treatment and other causes of a raised TSH, such as a TSH producing pituitary adenoma, need to be excluded before a diagnosis of subclinical hypothyroidism may be made.4
The accepted upper limit of TSH is usually 10 mU/L, which is consistent with subclinical hypothyroidism.5 A higher value (as present in our patient) is almost always considered pathological and necessitates further investigations."
"Unexplained elevated TSH without a coexisting low fT4, in the absence of clinical features suggestive of hypothyroidism or thyroxine replacement, is often attributed to non-thyroid illness (NTI), some sort of interference in the analysis of thyroid hormones, or subclinical hypothyroidism.
By definition, subclinical hypothyroidism encompasses high TSH, normal fT4 and absence of clinical features of hypothyroidism. However, a past history of thyroid disease and thyroxine treatment and other causes of a raised TSH, such as a TSH producing pituitary adenoma, need to be excluded before a diagnosis of subclinical hypothyroidism may be made.4
The accepted upper limit of TSH is usually 10 mU/L, which is consistent with subclinical hypothyroidism.5 A higher value (as present in our patient) is almost always considered pathological and necessitates further investigations."
Causes of falsely high TSH include laboratory technical problems especially with the washing step; any interfering substance eg: heterophilic antibodies, human anti-mouse antibody (HAMA); macro TSH (TSH of high molecular weight).
An example of a case study from BMJ: Unexplained high thyroid stimulating hormone: a “BIG” problem....
"We present a case of a clinically euthyroid patient, who had persistently elevated thyroid stimulating hormone (TSH) but free thyroxine within the reference limits. She underwent repeated thyroid investigations and thyroid hormone interference studies, until macro-TSH was identified as the most likely cause of unexplained elevated TSH."
An example of a case study from BMJ: Unexplained high thyroid stimulating hormone: a “BIG” problem....
"We present a case of a clinically euthyroid patient, who had persistently elevated thyroid stimulating hormone (TSH) but free thyroxine within the reference limits. She underwent repeated thyroid investigations and thyroid hormone interference studies, until macro-TSH was identified as the most likely cause of unexplained elevated TSH."
It sounds like you found a good Dr. She's advising you according to routine guidelines for all the right reasons. That's prudent and a good CYA practice:). But she's also letting you and how you feel control the decision. You've got a gem there. Keep her and just continue to follow up.
Originally she was concerned when I was her new patient nine years ago that it could lead to heart issues. Since then, she says all my other tests are great, heart strong (myeloperoxidase reading 151)...every thing really good! It was a previous doctor that scared me to death by saying it was the highest reading his office had seen, that they were surprised I could even function. I told them if I had any more energy, I could probable fly. They informed me that if I didn't get on medication immediately, I could have a heart attack any minute...I was about 51 at that time. That day I went to have the RX filled...the pharmacist took one look at me and asked what my symptoms were...told him I had none other than the high TSH reading and that the other thyroid readings were normal. He asked if I was cold, tired etc and could see I was not even close to being overweight, I have twice as much healthy hair as most women, long nails and energy. He then said off the record that if I were his wife, he'd tell me not to take it...that it could cause the very symptoms the Dr. thought I should have. Since I felt so well, in spite of tremendous stress due to a ill husband at the time, I never filled or took any medication...still haven't.
My doctor for the past nine years is a concierge doctor, I like and trust her, she really listens, does additional tests routinely for her patients that most yearly exams don't cover. While she is puzzled by my issue, she feels that as long a I feel great and all my tests are so good, she will watch and allow me to listen to my own body. I believe she has tried to find other doctors that may have had a history with this type of thing...to no avail.
My doctor for the past nine years is a concierge doctor, I like and trust her, she really listens, does additional tests routinely for her patients that most yearly exams don't cover. While she is puzzled by my issue, she feels that as long a I feel great and all my tests are so good, she will watch and allow me to listen to my own body. I believe she has tried to find other doctors that may have had a history with this type of thing...to no avail.
I've asked my Dr. to email me the actual readings. She has said year after year that because all my other thyroid tests are all within the normal ranges, my heart and all other blood work is great and that I feel well, she is not that concerned...just confused as she has not seen this before. I have long, full bouncy hair, long strong nails, skin not overly dry for my age group, energy most 30 years olds would envy, sleep well, not depressed or moody, eat what I want and maintain a good weight, run a business...no symptoms at all in the 12 years this has been going on. Prior to that TSH was normal. Went through menopause at 38-40 years and I feel great!
Will post the reading when I receive them...thank you!
Will post the reading when I receive them...thank you!
We should all be in as great shape! :)
What you have is called subclinical hypothyroidism. Your pituitary is working hard to stimulate your thyroid which is still working effectively enough to produce sufficient thyroid hormones. To treat or not is a subject of medical debate but in general TSH >10 is usually treated routinely for supposed, but not yet proven cardiac benefits such as lowering of cholesterol levels and improved lipid panel. You're probably going to need thyroid replacement sooner or later but since your cholesterol is within range I think it's still your call as long as you continue followup. At least that's MHO. What reasons/benefits has your MD given you for starting therapy?
What you have is called subclinical hypothyroidism. Your pituitary is working hard to stimulate your thyroid which is still working effectively enough to produce sufficient thyroid hormones. To treat or not is a subject of medical debate but in general TSH >10 is usually treated routinely for supposed, but not yet proven cardiac benefits such as lowering of cholesterol levels and improved lipid panel. You're probably going to need thyroid replacement sooner or later but since your cholesterol is within range I think it's still your call as long as you continue followup. At least that's MHO. What reasons/benefits has your MD given you for starting therapy?
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