TSH - THIREOTROPINE - TSH REFLEX

TSH - thyrotropin

The TSH, also called thyrotropin, thyrotropic hormone or thyroid stimulating hormone, is a substance produced by the pituitary gland. Come on TSH values you can guess how the thyroid works: in fact, TSH is the main regulatory substance of the two thyroid hormones: T4 (thyroxine) and T3 (triiodothyronine).

Normal values of TSH

The reference values of TSH they are usually between 0.5 and 4 mIU / L. Depending on the institution or laboratory to which reference is made, these values may present small variations. This site uses as a reference only the most reliable sources in the world. We therefore report the ranges of normality according toauthoritative Medscape portal:

TSH normal values in pediatrics

  • Infants born premature (at 28-36 weeks) first week of life: 0.7-27.0 mIU / L
  • Children born from 4 days: 1-39 mIU / L
  • Babies born from 2-20 weeks: 1.7-9.1 mIU / L
  • Children born from 21 weeks to 20 years of age: 0.7-6.4 mIU / L

TSH normal values in adults

  • 21-54 years: 0.4-4.2 mIU / L
  • 55-87 years: 0.5-8.9 mIU / L

TSH in pregnancy

The range of TSH values during pregnancy varies slightly depending on the time of gestation. Here's what TSH looks like depending on the quarter:

  • First quarter: 0.3-4.5 mIU / L
  • Second quarter: 0.5-4.6 mIU / L
  • Third quarter: 0.8-5.2 mIU / L

The Mayo Clinic, one of the most important research institutes in the world, defines normal TSH values as between 0.3 and 4.2 mIU / L. Here are the normal TSH values stratified by age according to i Mayo Medical Laboratories:

TSH normal values in infants

  • 0-5 days: 0.7-15.2 mIU / L
  • 6 days-2 months: 0.7-11.0 mIU / L

TSH normal values in children and adolescents

  • 3-11 months: 0.7-8.4 mIU / L
  • 1-5 years: 0.7-6.0 mIU / L
  • 6-10 years: 0.6-4.8 mIU / L
  • 11-19 years: 0.5-4.3 mIU / L

TSH normal values in adults

  • 20 or more years: 0.3-4.2 mIU / L

TSH is a glycopeptide of approximately 28 KDa in molecular weight.

There TSH concentration in circulation is expressed in thousandths of international units of biological activity per liter of blood (mIU / L). This unit of measurement derives from the way the TSH concentration is assessed.

Thyrotropin levels are initially measured on colloidal tissue isolated from the thyroid gland of a guinea pig (guinea pig); an international unit was defined as the minimum amount of thyrotropin that causes an active biological response (i.e. production of cAMP by stimulation of thyroid adenylate cyclase).

Analyzes for measuring thyrotropin use standardized calibrators according to the guidelines of the World Health Organization (WHO), according to the International Reference Preparation (IRP) 80/558, which contain 7-5µg of purified human pituitary extract, which is the equivalent of 37mIU of thyrotropin. 

The measurement of the TSH ultra-sensitive, routinely in many laboratories, involves the use of immunoenzymatic method with microplates including mouse monoclonal anti-TSH antibody used for the solid phase and rabbit anti-TSH antibody for the liquid phase, which react simultaneously with the sample to be examined. The measurement of the TSH ultra-sensitive  it then continues with the washing of the kit and the conjugation with tetramethylbenzidine (TMB) for the determination of the concentration through the proportional gradations of color.

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What is TSH: mechanism of action and influence on thyroid hormones

The thyrotropic hormone it is produced by the pituitary gland, a small gland found in the skull. If thyroid hormone levels decrease, or if our body is subjected to physical or psychological stress, a part of our brain, the hypothalamus, produces thyrotropy-releasing hormone, also called TRH (thyrotropin-releasing hormone). The TRH acts at the level of the anterior part of the pituitary gland, increasing its production of TSH, which in turn goes to act at the level of the thyroid, stimulating the production of thyroid hormones starting from the molecule thyroglobulinuntil their normal value is restored.

There thyroid it is a butterfly-shaped gland located at the anterior base of the neck, in front of the trachea. Its main function is to produce two types of hormones, the hormone thyroxine (T4) and the hormone triiodothyronine (T3). These hormones then spread through the blood throughout the body, work together to maintain balance and body temperature, contributing to the growth of our body and to the production of energy in the form of heat. When thyroid hormones have reached normal values, the pituitary gland decreases the production of thyroid stimulating hormone, and consequently the thyroid is less stimulated to produce T3 and T4. This mechanism is called "negative feedback".

The production of TSH follows a daytime rhythm, and has a peak in the late evening, and a lower production in the mid-morning hours. The TSH measurement in blood tests is the main test to understand how the thyroid is working: it can be measured alone, or in association with the thyroid hormone T4. When we are in the presence of thyroid hormones and thyrotropin within normal values, it can be assumed with reasonable certainty that the thyroid is normal functioning.

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What is TSH and why the exam is carried out

The thyrotropic hormone is dosed for evaluate thyroid function and identify any alterations in hormonal secretion. TSH, fT3, fT4 are the three hormones that are part of the basic blood analysis panel when you want to investigate the efficiency of the thyroid gland. The altered function linked to an overactive thyroid generates a clinical picture of hyperthyroidism, often with feedback from Low TSH and high fT3 fT4 in the case of overt hyperthyroidism, or Low TSH and normal fT3 fT4 in case of subclinical hyperthyroidism, in the initial phase). A hypofunction of the thyroid instead generates a clinical picture of hypothyroidism,  both overt type with high TSH and low fT3 and low fT4, and mild and not yet manifest type (subclinical hypothyroidism, high TSH and normal fT3 fT4); measuring the TSH also serves to monitor the effectiveness of therapy in case of hypothyroidism (monitoring of the thyroid hormone replacement therapy) or hyperthyroidism (monitoring of thyroid suppressive therapy).

TSH analysis is also performed in newborns as a screening test for the diagnosis of congenital thyroid pathologies (the most frequent is thecongenital hypothyroidism). The diagnosis is made through an analysis on a blood sample obtained with a venous sample, which measures the concentration of the TSH hormone. Usually with the same sample the doctor also recommends the dosage of thyroid hormones (T3 and T4, as already mentioned, often indicated in their free or "free" form with the initials fT3 and fT4), which are essential in order to establish the possible cause of altered levels of thyrotropic hormone.

Often these tests are associated with other blood tests: the most frequent are blood count, kidney function (urea and creatinine), mineral salts in the blood (sodium, potassium, less frequently calcium and magnesium), and inflammation parameters, i.e. the erythrocyte sedimentation rate (VES) and the C-reactive protein (PCR). In the suspicion of thyroid autoimmune diseases, anti-thyroid antibodies are usually required, namely the antibody anti thyroglobulin (ab anti-TG), which is a substance from which thyroid hormones are produced, theanti-TSH receptor antibody (ab anti-TSH), and the antibody anti thyroid peroxidase (ab anti-TPO), directed against thyroperoxidase, an enzyme that regulates the synthesis of hormones produced by the thyroid.

From the radiological point of view, if there is an evident morphological alteration (for example a nodule palpable or visible, or a thyroid goiter), or if you want to investigate any alterations in blood tests, the first level exam and aultrasound of the thyroid gland. Only secondarily, if necessary, will it be possible to make one thyroid scintigraphy and possibly a fine needle aspiration.

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TSH - Thyrotropin

Hypothalamus pituitary thyroid axis, mechanism of action and influence of TSH.

High TSH

TSH above normal is associated with a number of medical conditions: in case of high TSH it is always necessary to measure at least one of the two types of thyroid hormones, fT3 or fT4. This allows us to understand if, as happens in most cases, there is a reduced function of the thyroid, ie a hypothyroidism, or if, less frequently, there is a hyperfunction of the thyroid, and therefore a hyperthyroidism. 

High TSH causes

A High TSH it can be found both in response to a reduced production of thyroid hormones by the thyroid gland (condition of hypothyroidism), and in the presence of an increased production of TSH, in the pituitary or in other sites (condition of hyperthyroidism). However, it must be said that in the vast majority of cases the High TSH goes with normal or low fT3 and fT4. 

Below we will explain what are the main causes of high TSH and differentiate those that lead to a condition of hyperthyroidism (TSH high fT3 fT4 high), from those, more frequent, that lead to a condition of hypothyroidism, initially subclinical (High TSH fT3 normal fT4) and then overt hypothyroidism (TSH high fT3 fT4 low).

Do you want to deepen the topic? We have selected this book that addresses the problem of hypo and hyperthyroidism.

Living without thyroid problems. How to deal with hypo and hyperthyroidism through nutrition, movement, integration

High TSH and normal fT3 fT4: subclinical hypothyroidism

Hypothyroidism it is a disease characterized by a reduced function of the thyroid gland, which therefore produces the thyroid hormones fT3 and fT4 in insufficient quantities. To compensate for this deficiency, the pituitary gland produces greater quantities of TSH, which will therefore be elevated in blood tests. Initially, the increase in thyrotropin production will be enough to stimulate the thyroid more, obtaining a normalization of thyroid hormone levels. At this stage, said subclinical hypothyroidism, blood tests will result High TSH with normal fT3 and fT4.

High TSH and low fT3 fT4: hypothyroidism

When you are in a more advanced stage, the increased levels of TSH will no longer be enough to maintain normal levels of the hormones produced and secreted by the thyroid. In this situation we speak of real or hypothyroidism overt hypothyroidism, and on blood tests we will have high TSH and low values of fT3 and fT4. Often hypothyroidism, if neglected, leads to the formation of thyroid goiter, that is the enlargement of the thyroid gland linked to a continuous stimulation by TSH.

Here are a few causes of high TSH associated with hypothyroidism:

  • Congenital hypothyroidism: in 85% of cases due to a structural defect of the thyroid gland, as for thethyroid agenesis (lack of formation of the thyroid gland), for the thyroid dysgenesis (abnormal thyroid development), thethyroid ectopia (thyroid in abnormal location compared to the normal anterior pretracheal position) or for thyroid hypoplasia (poorly represented thyroid tissue). In another 10% of cases it concerns a defect in hormone production, which can be linked to a thyroid difficulty concentrate iodine internally due to the presence of a mutation in the iodine / sodium transporter, to a defect of the intrathyroid peroxidase, rather than a defect of the oxidative condensation of MIT and DIT in thyroxine and triiodothyronine, or to a deficiency of desiodation of iodotyrosines, or finally to the production of abnormal iodized compounds which are metabolically hypoactive. All these cases are characterized by Elevated TSH and reduced or absent thyroid hormones.
  • Acute thyroiditis:  the acute thyroiditis they are usually related to bacterial or parasitic infections: in children and adolescents they are often linked to structural thyroid abnormalities such as fistulas in the piriform sinus or residues of the thyroglossal duct in adults they are more often caused by the spread of an infection by proximity of the affected site (infection by contiguity from pharyngitis, tonsillitis, mumps etc.) or by blood dissemination (pulmonary, gastrointestinal, soft tissue infections). The most common symptoms are fever and the appearance of latorecervical adenopathies (swelling and / or pain of the lymph nodes in the neck). The therapy is obviously antibiotic which in most cases causes the thyroiditis to regress and restore normal hormone production by the thyroid.
  • De Quervain's thyroiditis and subacute thyroiditis: the De Quervain's thyroiditis o granulomatous thyroiditis, often occurs following a viral infection, and sometimes requires cortisone therapy. The most common symptoms are fever, asthenia (tiredness), myalgia (muscle aches). It usually resolves with one restitutio ad integrum,  that is, with a return to normal thyroid function. In a 5% of cases, however, a condition of hypothyroidism remains which will require replacement therapy.
  • Hashimoto's thyroiditis e chronic thyroiditis: are the most common forms of thyroiditis, in particular the Hashimoto's thyroiditis it represents by far the most frequent inflammatory thyroid disease (in women 3.5 cases per 1000 people). It is a chronic inflammation of the thyroid gland with autoimmune origin, which leads to chronic damage with residual final hypothyroidism. Symptoms may be absent, or be related to the hypothyroidism that develops in this pathology. Diagnosis is based on the finding of anti-thyroid antibodies: antibodies to thyroperoxidase (anti-TPO) and antibodies to thyroglobulin (anti-TGB), as well as low levels of fT3 and fT4 in the blood. Therapy is essentially replacement with levothyroxine (LT4). Other forms of chronic thyroiditis are the postpartum thyroiditis, the silent tyrolidite and the Riedel's thyroiditis. These inflammatory pathologies are characterized by High TSH, low triiodothyronine and thyroxine and possible presence of anti-thyroid antibodies.
  • Subtotal or total thyroidectomy (partial or complete removal of the thyroid gland): when a part of the thyroid gland is removed, inadequate production of thyroid hormones by the residual gland is generated. This is even more evident with the removal of the entire thyroid, with a total deficiency of hormones. As a compensation mechanism there is an increase in the pituitary production of TSH. The feedback from High TSH after thyroidectomy it is therefore obvious, and is the signal that drug replacement therapy is not yet at optimal doses.
  • Presence of resistance to TSH: resistance to TSH is a pathology that determines a permanent thyroid deficit present at birth. Resistance to TSH is determined by the presence of mutations in the TSH receptor (TSHR; 14q31), which cause a reduced production of thyroid hormones. In this condition then we can find blood tests High TSH and low fT3 fT4.
  • Storage diseases: they are rare pathologies, in which substances that damage the tissues and compromise its function accumulate in the thyroid. As a consequence the production of thorium hormones will be deficient, causing a secondary response at the level of the pituitary gland overproduction of TSH. Among the diseases that deposit in the thyroid we remember hemochromatosis, characterized by iron deposition, and amyloidosis, which causes the deposit of low molecular weight proteins produced in an anomalous and unregulated way by the organism that accumulate between the intracellular spaces of the gland by damaging it.
  • Insufficient thyroid replacement hormone therapy:  it seems obvious but in reality there are many misunderstandings on the subject: patients with a recognized hypothyroidism, who are on thyroid hormone replacement therapy (the most used drug is Eutirox), must carry out periodic blood checks, to regulate therapy. Often the dose of thyroid hormones taken is even slightly insufficient, and this is reflected at the pituitary level with a greater production of thyrotropin, which will be higher than normal. A contrary case, one too high Ft4 dose will tend to lower the levels of thyroid stimulating hormone in the blood. Even with normal thyroid hormones, in the presence of a high TSH it is necessary to consult your doctor or endocrinologist to evaluate whether to slightly modify the dose of thyroid hormones taken daily.

High TSH and high fT3 fT4: hyperthyroidism

Hyperthyroidism is a disease linked to an increased production of thyroid hormones by the thyroid. In the case of a primary hyperthyroidism, in the face of high concentrations of thyroxine and triiodothyronine the pituitary will decrease the production of TSH in order to reduce thyroid activity (low TSH and high thyroxine and triiodothyronine).

In thesecondary hyperthyroidism, it will instead be an excessive production of TSH by the pituitary to stimulate the thyroid in an uncontrolled way: in this situation we will have High TSH and high thyroid hormones. It is this last type of hyperthyroidism which is characterized by high levels of thyrotropin and which we will describe in the next paragraphs.

Here are the causes more frequent than High TSH with hyperthyroidism:

  • Hyperpituitarism (increased pituitary TSH production): it may happen that the pituitary gland produces an abnormal amount of hormones, unregulated with respect to the normal pituitary-target organ control mechanism. Hyperpituitarism can be primitive, if the overproduction of hormones is due to secreting masses such as a pituitary adenoma, or it can be, more rarely, secondary, if the excessive hormone production derives from the lack of negative feedback from the hypothalamus. This occurs in rare cases of hypothalamic secreting tumors (TRH producers in our case). The decisive therapy is the surgical one. This condition is characterized by High TSH and high fT3 and fT4.
  • Ectopic TSH production: paraneoplastic syndrome which determines the production, at the level of non-pituitary neoplasms (lung, breast, uterus, prostate, gastrointestinal), of a substance similar to TSH.

Medicines

There are some drug therapies that can inhibit the secretion of hormones by the gland thyroid, consequently inducing an increase in blood levels of thyrotropin (TSH). Among these the most frequent is amiodarone, an iodine-rich antiarrhythmic drug that can cause both the development of hyperthyroidism but also hypothyroidism. Other common drugs that can generate this side effect are interferon (used in antiviral therapy and in immunohematological therapy), and the lithium, a psychiatric drug used in the treatment of psychiatric conditions such as bipolar disorder or certain types of headache.

High TSH in pregnancy

Usually the TSH during pregnancy is normal or slightly below the classical reference values: this is because during pregnancy there are some physiological alterations (increase in TBG (Thyroxin Binding Globulin), presence of chorionic gonadotropin) which tend to slightly reduce TSH values.

The finding of a High TSH in pregnancy it must be carefully evaluated, as it can indicate the presence of hypothyroidism, a metabolic state very harmful for the future newborn, since it can compromise the correct somato-neural development. If the thyroid is unable to provide adequate production of T3 and T4, it will be necessary to compensate with supplementary therapy with supportive levothyroxine (Eutirox, Tirosint, etc. ..).

There are particular conditions that must be carefully monitored and which have an increased probability of leading to gestational hypothyroidism. Given that a TSH check before conceiving a child should be done in all cases, the major ones instructions to perform the TSH check during pregnancy are as follows:

  • Over 30 years of age
  • History of family or personal thyroid dysfunction
  • History of previous thyroid surgery.
  • Symptoms of thyroid dysfunction or presence of thyroid goiter
  • Positivity of antibodies to thyroperoxidase (anti TPO).
  • Type 1 diabetes mellitus and / or other autoimmune disorders.
  • History of miscarriage or preterm labor.
  • History of radiation therapy with irradiation to the head or neck.
  • Severe obesity with body mass index (BMI) greater than 40 kg / m2.
  • Use of drugs such as amiodarone or lithium
  • Recent administration of iodinated contrast medium.
  • Residence in an area known to have moderate to severe iodine deficiency.

The feedback from High TSH in pregnancy should always be investigated: the most frequent cause of high TSH in pregnancy is the Hashimoto's thyroiditis.

The TSH values to define a hypothyroidism during gestation are:

Full-blown hypothyroidism in pregnancy:

  1. TSH greater than or equal to 2.5 mIU / L with reduced FT4; or
  2. a TSH greater than or equal to 10 mIU / L with any FT4.

Subclinical hypothyroidism in pregnancy:

TSH between 2.5 and 10 mIU / L with normal FT4 concentration.

In case of overt hypothyroidism during the pregnancy, there's a increased risk of: preterm birth, low weight and delayed neurocognitive development of the child at birth and above all increased risk of miscarriage (60% of spontaneous abortions in severe untreated hypothyroidism). It also increases the frequency of arterial hypertension for the mother. There replacement therapy with levothyroxine it is highly recommended to reduce the incidence of all these complications.

In case there is only subclinical hypothyroidism during the pregnancy, an increased risk of complications has been noted in women with anti-thyroperoxidase (anti-tpo) antibodies. Replacement therapy should be considered in this case.

Please note: for the women who were already in replacement therapy with levothyroxine, the dose should be increased during pregnancy, usually by 30% in autoimmune hypothyroidism and by 50% in people with hypothyroidism after partial or total removal of the thyroid (partial or total thyroidectomy).

High TSH symptoms

As already mentioned, high TSH is often not accompanied by particular symptoms, especially if the thyroid hormones are still normal, as in the case ofsubclinical hypothyroidism. In the phase of overt hypothyroidism, however, high TSH is associated with a condition of low fT3 and fT4, which may manifest itself with various signs and symptoms. The main symptoms of high TSH and low fT3 fT4 (hypothyroidism) are listed below:

  • Less tolerance to cold
  • Mood instability and tendency to depression
  • Fatigue
  • Weight gain
  • Dry and fragile skin
  • Loss of eyebrows (especially the outer part)
  • Finer and more fragile nails
  • Constipation (constipation)
  • Carpal tunnel syndrome,
  • Irregularity of the menstrual cycle,
  • Increase of cholesterol,
  • Memory loss.

In other, less frequent cases, when the High TSH is associated with high levels of thyroid hormones, we will have the classic symptoms hyperthyroidism, related to the increased dose of circulating thyroxine and triiodothyronine. The main symptoms of high TSH with high fT3 fT4 are listed below:

    • Palpitations
    • Tachycardia
    • Agitation and anxiety
    • Nervousness and irritability
    • Tremor, especially in the hands
    • Alopecia
    • Alterations at the menstrual level
    • Diarrhea
    • Presence of exophthalmos
    • Possible presence of eyelid swelling
    • Sweats
    • Slimming
    • itch
    • Hot flashes

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Low TSH

Below normal TSH is associated with a number of medical conditions: in case of low TSH it is always necessary to measure at least one of the two types of thyroid hormones, fT3 or fT4. This allows us to understand if, as happens in most cases, there is an increased function of the thyroid, ie a hyperthyroidism accompanied by high fT4 and T4, or if there is reduced thyroid function, and therefore a hypothyroidism, accompanied by low T3 and fT3 and low T4 and fT4.

Low TSH causes

A Reduced TSH it can be found both in response to an increased production of thyroid hormones by the thyroid gland (condition of hyperthyroidism), and in the presence of a reduced production of TSH, caused by a hypofunction in the pituitary or hypothalamic level. However, it must be said that in the vast majority of cases the Low TSH goes with high fT3 and fT4. 

Below we will explain what are the main causes of low TSH and differentiate those that lead to a condition of hyperthyroidism (Low TSH fT3 high fT4) from those that lead to a condition of hypothyroidism (TSH low fT3 fT4 low).

Low TSH and high fT3 fT4: hyperthyroidism

Here are some conditions with Low TSH and hyperthyroidism:

  • Basedow-Graves disease: it is a pathology characterized by hyperthyroidism with the presence of abnormal antibodies, aimed at the TSH receptor (TSH receptor antibodies or ab anti-TSH). These antibodies cause persistent stimulation of the thyroid receptors for the TSH hormone resulting in overactivity of the thyroid with increased production of thyroxine and triiodothyronine. Therapy can be pharmacological, with drugs such as propityluracil or methimazole (Tapazole) which reduce the activity of the thyroid gland, or based on radioiodine, that is of a radioactive isotope of iodine (iodine 131) which irreversibly damages the thyroid cells, and finally surgical, with partial or total removal of the tyrosis. In addition to the typical symptoms of hyperthyroidism, ocular pathology (ophthalmopathy or basedowian exophthalmosor, with protruding eyeballs) and a skin pathology (dermopathy or pretibial myxedema).
  • Thyroiditis in the stage of thyrotoxicosis: thyroiditis is an inflammatory process in the thyroid gland, which can be infectious (such as acute or sub-acute thyroiditis) or autoimmune (such as chronic thyroiditis). In autoimmune thyroiditis there is a frequent finding of antibodies to thyroperoxidase and antibodies to thyroglobulin, and are characterized by Low TSH and high values of fT3 and fT4. The most frequent forms are Hashimoto's thyroiditis, postpartum thyroiditis and silent lymphocytic thyroiditis. In non-autoimmune thyroiditis (e.g. acute bacterial thyroiditis or De Quervain's subacute thyroiditis), anti-thyroid antibodies are found much less frequently.
  • Toxic nodular goiterGoiter is an enlargement of the thyroid volume, which can be generalized (diffuse thyroid struma or diffuse goiter) or nodular (uninodular or multinodular). Toxic nodular goiter consists of a thyroid nodule that no longer responds to intra-thyroid regulation mechanisms or to pituitary TSH control. The toxic goiter nodule can secrete large amounts of thyroid hormones causing the typical symptoms of hyperthyroidism. At this juncture we will have High T3 and T4 and reduced TSH.
  • Too high doses of hormone replacement therapy or other drug therapy:  incorrect intake of thyroid replacement therapy, (the most commonly used drug, Levothyroxine or L-thyroxine, carries the trade name of Eutirox, Tiracrin, Tirosint, Tiche, Syntroxine), can lead to the finding of elevated thyroid hormone levels and reduced TSH . Classic example, the finding of Low TSH after thyroidectomy it is often linked to an exaggerated dose of replacement therapy. Even patients on lithium therapy for psychoactive therapy, or with amiodarone, for the control of cardiac arrhythmias, may have a hormonal imbalance in the hyperthyroid sense.
  • Ovarian teratoma: it is a neoplasm composed of embryonic tissues and therefore potentially also of thyroid type tissue, with ovarian localization. This tumor can also be benign, and causes hyperthyroidism for production not thyroid of T3 and T4, resulting in TSH reduction.
  • Familial non-autoimmune hyperthyroidism: this disorder is linked to the mutation of a gene that codes for the TSH receptor, and is transmitted in an inherited manner. The thyroid then escapes the pituitary hormone control, and begins to produce thyroid hormones in an uncontrolled way. As a result, the pituitary will decrease TSH production to attempt to limit the elevated levels of fT3 and fT4. We'll have blood tests then Low TSH and normal ft3 ft4.
  • Hyperemesis gravidarum: the suppression of TSH by hCG may be part of the picture of hyperemesis gravidarum, a pathology responsible for many hospitalizations in the first months of pregnancy. From the thyroid hormonal point of view there is a reduction up to the complete suppression of TSH, elevated concentrations of FT4 and disabling symptoms such as severe recurrent vomiting, weight loss, dehydration, dysionemia (alterations in the level of blood minerals) and ketonuria.
  • Subclinical hyperthyroidism: in the initial phase, hyperthyroidism occurs only with low thyrotropin values which are accompanied by normal levels of T3 and T4: then low TSH and normal Ft3 and fT4.

Low TSH and low fT3 fT4: hypothyroidism

Here are the causes of Low TSH with hypothyroidism:

Dysfunctions of the pituitary gland: if the pituitary, despite good thyroid function, does not produce adequate levels of thyrotropin (TSH), the production of fT3 and fT4 will be negatively affected. In this case we speak of secondary hypothyroidism, characterized by low levels of TSH, fT3 and fT4 .

Dysfunction of the hypothalamus: it can rarely happen that the hypothalamus does not function properly, not producing adequate levels of TRH. Consequently, the pituitary is not adequately stimulated to produce the right amount of TSH. Again we will have Low TRH, low TSH and low fT3 and fT4.

Low TSH in pregnancy

The finding of a Low TSH in pregnancy is often physiological: the TBG (Thyroxin Binding Globulin or thyroxine binding protein), which is none other than the transporter protein of thyroid hormones in the blood, due to the increased circulating levels of estrogen, in turn increases its plasma concentrations. The increased levels of circulating T3 and T4 exert a mild suppressive effect on TSH.

At the same time, the chorionic gonadotropin (hCG or human Chorionic Gonadotropin) produced by the placenta has an inhibiting effect on TSH production. This happens because hCG has a molecular structure that resembles that of the thyroid stimulating hormone and therefore acts on the thyroid TSH receptors activating the production of thyroid hormones, which in turn inhibit the release of TSH at the pituitary level. Here are the two reasons why physiologically is found Low TSH in pregnancy.

Having adequate levels of thyroid hormones circulating during gestation is important to ensure proper neurological and somatic development of the fetus. For this reason the thyrotropic hormone should be checked periodically, and the finding of Low TSH during pregnancy it must always be deepened with further analysis.

In fact, a percentage ranging from 0.1 to 3% of pregnancies may be subject, during the course, to the appearance of gestational hyperthyroidism, often associated with hyperemesis gravidarum. The other most frequent causes of hyperthyroidism in pregnancy are the Graves' disease and toxic uninodular or multinodular goiter.

L'gradually increasing hyperthyroidism increases the risk of perinatal death, the risk of preterm birth or even miscarriage, the development of hypertension in pregnancy, and a low birth weight of the baby. It is also dangerous for the mother as it increases the incidence of maternal heart failure. For this reason hyperthyroidism during pregnancy should always be investigated to distinguish the cause and start the most appropriate therapy, checking the TSH every 2-4 weeks at the start of therapy, every 4-6 weeks after reaching the target value.

Low TSH symptoms

Low TSH, if not accompanied by elevated thyroid hormone values (therefore a condition of subclinical hyperthyroidism), often does not involve particular symptoms. If, on the other hand, there are high values of fT3 and fT4, it will manifest itself with the typical symptoms of hyperthyroidism. So here are the main ones symptoms of low TSH with  fT3 fT4 high:

  • Nervousness
  • Easy Irritability
  • State of anxiety
  • Presence of palpitations (presence of extrasystoles or ectopic beats, up to real arrhythmias)
  • Tachycardia
  • Tremor in the limbs
  • Alopecia
  • Changes in the menstrual cycle
  • Diarrhea
  • Exophthalmos (eye protruding)
  • Possible presence of eyelid swelling
  • Hyperhidrosis (profuse sweating)
  • Thinness and weight loss
  • itch
  • Hot flashes

In the less frequent case of low TSH levels associated with reduced fT3 and fT4, we may have the classic symptoms hypothyroidism. Here are the main ones symptoms of low TSH with low fT3 fT4:

  • Instability of mood
  • Depression
  • Less tolerance to cold
  • Weight gain
  • Fatigue
  • Fragility of skin and nails
  • Loss of eyebrows (especially the outer part)
  • Constipation (constipation)
  • Irregularity of the menstrual cycle,
  • Increase in blood cholesterol levels
  • Memory loss.

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TSH reflex (TSH reflex or TSH-r)

The TSH reflex, Reflex TSH or TSH-r, is nothing more than a diagnostic protocol that provides for the execution of the TSH blood assay initially without the simultaneous analysis of the thyroid hormones: in case the TSH should be altered, with the same blood draw the dosage of thyroid hormones is then performed.

If you detect a TSH low reflex, i.e. less than 0.5 mIU / l, thyroxine (T4) is also dosed in its free form fT4, and then, if this falls within normal values, also triiodothyronine (T3).

If, on the other hand, a TSH high reflex, that is higher than 4 mIU / l, the dosages of free thyroxine fT4 and antibodies to thyroperoxidase (anti-TPO) are added. If the anti-thyroperoxidase antibodies are found to be normal, proceed with the third step, that is the dosage of the anti-thyroglobulin antibodies (anti-TGB).

Conversely, a TSH relfex (TSH-r) with normal values it does not require the execution of further tests. This allows you to avoid the expense of the dosage of thyroid hormones in case they are found normal values of TSH relfex.

But be careful: use the protocol TSH reflex, with a cascade sequence of examinations, is useful and effective in people without a diagnosis of known thyroid disease, who carry out the examination because they belong to a population at risk, or because they suffer from non-specific symptoms, or for simple screening.

It is not appropriate run the TSH reflex for people who already know they have a thyroid problem or who in any case have a strong suspicion of thyroid disease: in these cases it is useless to resort to TSH reflex protocol: are performed directly thyrotropin, thyroxine and triiodothyronine without delay.

Back to the introduction

Recombinant TSH (hr TSH)

The Recombinant TSH (hr TSH) is a synthetic TSH obtained with the recombinant DNA technique and is used as a drug in a test that involves the dosage of thyroglobulin. In patients undergoing thyroidectomy there is a tendency to keep the TSH in the low levels of the norm, to avoid an excessive stimulus by the latter on any thyroid cells left after the operation. In this way, however, the production of thyroglobulin by any residual tumor cells could also be masked (because it is too low).

The recombinant TSH test serves to solve this problem by temporarily stimulating any residual cells to produce thyroglobulin, which is then measured with blood analysis. The test involves the administration of Thyrogen (thyrotropin alfa) in two intramuscular administrations 24 h apart from each other, with subsequent blood sampling to measure thyroglobulin.

TSH how it is measured

How is the TSH test performed?

 

The examination is carried out starting from a blood sample obtained with a venous sampling. It is not necessary to fast before the exam. As some medications can interfere with TSH measurement, you should warn your doctor about all ongoing drug therapy.

Back to the introduction

Drugs that can alter TSH

Certain drugs or substances can alter the TSH measurement, either by increasing or decreasing the blood concentrations.

As for the drugs that can increase TSH on blood tests, here are the main ones:

  • Amiodarone (amiodarone-induced hypothyroidism): amiodarone is an iodine-rich drug used for the treatment and prophylaxis of ventricular cardiac arrhythmias, supraventricular cardiac arrhythmias such as paroxysmal supraventricular tachycardias, atrial fibrillation and atrial flutter. Amiodarone can lead to an excess of iodine in the circulation resulting in a thyroid defense mechanism that leads to a decrease or blockage of the functionality of the thyroid gland (Wolff-Chaikoff effect). The pituitary in turn will respond to thyroid deficiency with increased TSH secretion.
  • Dopamine antagonists: for example the antiemetics domperidone and metoclopramide, dopaminergic D2 receptor antagonists.
  • Chlorpromazine: antipsychotic of the phenothiazine class, used in various psychiatric diseases such as schizophrenia, the manic phase of bipolar disorder and other psychoses.
  • Haloperidol: neuroleptic of the butyrophenones family, it is also an antagonist of the dopaminergic D2 receptor, as well as an antagonist of alpha-adrenergic receptors.

THE medications which can decrease the levels of TSH instead they are the following:

  • Thyroxine exogenous: e.g. levothyroxine (L-T4), which is the left-handed isomer of thyroxine (T4),  is the main drug used for the treatment of hypothyroidism, whose main trade name is Eutirox)
  • Amiodarone (therapy amiordarone early; thyrotoxicosis induced byamiodarone): as already mentioned above, amiodarone is an antiarrhythmic drug rich in iodine, with a structure similar to the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Amiodarone can cause a state of hyperthyroidism (AIT: amiodaroneinduced thyrotoxicosis) resulting in a reduction in TSH due to two different mechanisms: an excessive synthesis of thyroid hormones induced by the increased intake of iodine from amiodarone in people with a thyroid already with pre-existing subclinical dysfunction (AIT type 1), while the second is a release of thyroid hormones previously formed during a destructive thyroid inflammatory process, caused by the therapy with amiodarone itself (AIT type 2).
  • Glucocorticoids: class of steroid hormones, naturally produced in humans in the fasciculated area of the adrenal cortex. Synthetic glucocorticoids are drugs with powerful anti-inflammatory and immunosuppressive action, used in a wide range of pathologies, including rheumatological, immunological diseases, allergic reactions, eye diseases, chronic inflammatory gastro-intestinal diseases, therapy against rejection in transplants. organ, skin diseases, treatment of bronchial asthma and chronic obstructive pulmonary disease.
  • Dopamine: neurotransmitter substance produced by the body, it belongs to the catecholamine family. It is used as a drug with haemodynamic activity and vasoconstrictor and inotropic effect.
  • Levodopa: L-dopa or 3,4-dihydroxy-1-phenylalanine, is an intermediate product of the dopamine synthesis pathway. In pharmacology it is used as a dopamine prodrug for Parkinson's disease therapy.
  • Dopamine agonists: drugs with action on dopaminergic receptors, used in many clinical contexts, first of all Parkinson's disease (among the most used thel ropinirole, trade name Requip, and pramipexole, trade name Mirapexin). Another dopamine agonist drug is apomorphine (trade names Uprima, Ixensee, Taluvian), which is often used as a cure for erectile dysfunction.
  • Pyridoxine: pyridine derivative of the dell familyto vitamin B (vitamin B6, sometimes also called pyridoxamine). Present in supplements and multivitamin concentrates.
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136 Comments
  1. Elizabeth 3 years ago

    Hello, I'm a 25 year old girl
    I wanted to ask you about, S-THS (Thyroid Stimulating Hormone)
    With measured values [0.350 - 5.500]

    And my value is 1.553 uUI / mL
    With this value, is there a probability that I am pregnant?

    • Author
      Testlevels 3 years ago

      Hi, TSH is normal but this has no correlation with pregnancy. If you think you may be pregnant, take a pregnancy test as soon as possible.

  2. CHIARA 4 years ago

    Hello, I'm a 34 year old girl. In March 2013, I underwent a total thyroidectomy for bilateral papillary carcinoma of 3 and 4 mm with BRAF positive. I did not ablate with 131I and it was always negative. Negative echo neck. Currently I take eutorix 75 x 5 days and 100 x 2 days. Here are the results of my exams: TSH 0.19, FT3 3.3, FT4 9.8. According to her, 4 years after the operation I am clinically cured and can I return to normal TSH values or do I still have to keep it suppressed ???

    • Testlevels 4 years ago

      Hi, suppression is recommended for at least 3 years (see this study), the duration is then deisa by the endocrinologist based on the risk of recurrence of the disease. talk to your doctor or the specialist who follows you. Best regards.

  3. Carmen 4 years ago

    Good morning doctors

    I need help as I have been suffering from hypothyroidism for several years and have just entered the 4th month of pregnancy (twin with natural fertilization)

    The dosages of tsh in the blood up to 15 days before conception were 0.56 taking the tiche 125 while 150 only on Saturday and Sunday.

    In the first month of pregnancy then I went to my endocrinologist who I lower the dose of tics to 125 every day as the tsh was low even if made aware of a pregnancy in progress.

    Last week I repeated the tests but the tsh jumped to 14 and this is worrying me so much because I have read that high tsh values bring neuropsychic and motor delays to the fetus.

    I would like more information and if I have to be worried, as I am already very much, that something irreversible may have happened to the fetus with this value of tsh or it is to be considered high but not such as to think something bad

    I would be grateful for your answer because I am in a very high state of anxiety.
    Thanks

    • Testlevels 4 years ago

      Hi, how were the values of fT4 and fT3? Do not worry, show the tests to your doctor who will be able to indicate the appropriate therapeutic changes, if necessary. Best regards

  4. Anna Maria 4 years ago

    Good morning!
    My mother has been diagnosed with hypothyroidism for a few decades. Currently, he is 89 years old, and a tsh of 23.85; for some months he has been injecting himself with CVC and taking absolutely nothing orally. Is it possible to administer Eutirox intramuscularly or intravenously, or drip?
    What is the maximum limit that the tsh can reach? what consequences can it cause?

  5. anna 5 years ago

    hi I did the tests for the thyroid and since I am booked for the long run, meli can read thanks… .tsh 3 generation 1.77 value 0.400-3.500

  6. clear 5 years ago

    Hi I'm a 36 year old woman. A few days before my period I always have a few lines of fever and it lasts about a week. The doctor prescribed me thyroid tests and these are the values: TSH 1.83
    TIREOGLOBULINA <2.0
    TIREOPEROSSIDASE <1.0
    What do you think are the values?
    Do I need to make further inquiries?
    Thanks

    • Testlevels 5 years ago

      Normal TSH and negative anti-thyroid antibodies, perfectly normal values. Best regards

  7. Giorgia 5 years ago

    Good evening, I am 35 years old I am 11 weeks pregnant, I have been taking eutirox 50 for years because I am hypothyroid. Before conception the tsh was within 2.5 today 3.45. I have already had a miscarriage. I would like to know: Should I have increased the euthirox of 30% from the onset of conception? What are the right values during the trimesters of pregnancy? What are the risks in case the practice had been wrong up to now ..? Thanks

    • Testlevels 5 years ago

      Indicatively, the dosage of Eutirox should be increased immediately, and the TSH kept below 2, 5. In any case, before undertaking any therapeutic change, consult with your doctor or the endocrinologist who follows you. Best regards.

  8. Martina 5 years ago

    Hello.

    Following tachycadias and other symptoms, among the different analyzes performed, I underwent the thyroid examination with these results:

    FT3 2.77 (reference values) 2.18-3.98
    FT4 0.92 0.76-146
    TSH 3.76 0.36-3.74

    As you can see, only the thyrotropic hormone has slightly high values, which my GP did not consider as abnormal.

    I would like further advice on this and whether this result can be considered acceptable.

    • Testlevels 5 years ago

      Hi, laboratories may have units of measurement that differ slightly, usually a TSH below 4 is absolutely normal, as your doctor will have told you. Best regards

  9. Paola Mosca 5 years ago

    Good morning thyroid tests tsh 4.72
    Ft4 12
    Ani TG 0.59 antibodies
    Antibodies advance your <0 • 16

    What do you mean, check x Mediastinal stage 3 Hodgkin's lymphoma

    • Testlevels 5 years ago

      There are no units of measurement, the TSH is still within the normal limits. The last antibodies I assume are anti TSH, and they are negative. Nothing relevant as far as interpretable is concerned. Always refer to your doctor. Best regards.

  10. Giulia 5 years ago

    Hello,
    two years ago the general practitioner prescribed me tests for a suspected enlarged thyroid. I was 23 and these were the results:

    AA Thyroid peroxidase (TPO): 7.7 IU / ml with a range of values 0.0 - 34.0
    AA Thyroglobulin: 16 IU / ml with a range 0.0 - 115.0
    FT3: 3.2 pg / ml with a range of 2.3 - 4.2
    FT4: 12.24 pg / ml with range 8.90 - 17.60
    TSH: 2.408 μUI / ml with range 0.550 - 4.780
    Thyroglobulin: 9.09 ng / ml with a range of 0.00 - 78.00

    In the same analysis they calculated the values of calcium and vitamin D (25-OH-D):
    Calcium 9.4 mg / dl with range 8.5 - 10, 1
    Vitamin D 11.6 ng / ml <20 Deficiency (21-29 insufficiency; 30-100 insufficiency).

    I took the tests to an endocrinologist and he gave me a therapy for vitamin D deficiency, for the rest he told me nothing else.
    Not even the thyroid echocolordoppler reported anomalies.
    However, I continue to feel most of the symptoms described for both hyper- and hypothyroidism: mood swings, depression, myalgia, memory problems, sudden weight gain and / or decrease, and hair loss (I performed recent & #039; hair analysis and I was diagnosed with alopecia). Finally, too frequent sore throats and a perennial sensation of "lump in the throat", but at the thyroid level.

    I will definitely repeat the analysis shortly, but I just found this site and wanted to have a reading of this data to get started, because I don't really know how to move.
    Thank you in advance for your reply.

    • Testlevels 5 years ago

      Dear Gulia, the tests for the thyroid were absolutely normal, so it is difficult to trace the symptoms she described to a faulty functioning of the thyroid gland. In any case, he can repeat the analyzes and verify that TSH and thyroid hormones are confirmed as normal. However, please refer to your doctor. Best regards

  11. SABRINA ARCANGELI 5 years ago

    GOOD MORNING,
    TSH VALUE 6.290 ON THE REFERENCE INTERVAL 0.200 / 4.600.
    FT4 REFLEX 12.6 ON VALUE OF 8.0 / 17.0
    I CAN'T UNDERSTAND …… IPO OR IPER…. SYMPTOMS OF BOTH WITH A SENSE OF MARRIEDNESS, INAPPETENCE AND GENERALIZED BONE PAIN.
    THANKS

    • Testlevels 5 years ago

      Hi, it seems to be a subclinical hypothyroidism with reduced TSH and free thyroxine still normal. Did you search for antibodies to thyroglobulin, anti TSH receptors and anti thyroperoxidase? Show the tests to your doctor or the specialist who follows you, best regards.

  12. Giuseppe P. 5 years ago

    Good morning.
    Following routine blood tests, the report gives these results:

    TSH Reflex 0.190 Val ref. 0.45 - 3.5
    FT3 2.83 Val ref. 1.71 - 3.71
    FT4 0.99 Val ref. 0.7 - 1.48

    I notice that tsh-r is very low compared to the reference values. Could I kindly have your opinion on what this may indicate?

    Thanks

    Giuseppe P.

    • Testlevels 5 years ago

      Hi, the reflex TSH is low but the thyroid hormones are normal, it is subclinical hyperthyroidism, to be confirmed with repetition of the tests and measurement of anti TSH, anti TBG and anti TPO antibodies. Show the tests to your doctor or endocrinologist. Best regards.

  13. Luigi 5 years ago

    Good morning,
    for a very slight suspicion of neck enlargement I did the tests prescribed by my doctor from whom I pass in the next few days, here is the result:
    TSH 22.85 ųUi / ml>!
    Free T3 3.35 pg / ml within the limits
    Free T4 7.16 pg / ml!
    Thyroperoxidase antibodies> 600>!
    almost everything busted! hypothyroidism?
    However, after my doctor I will definitely go to an endocrinologist (if it is possible to have indications on names in the Udine / Gorizia / Trieste area it would be great), let's see if my doctor will prescribe an echo first.
    If you can give me an opinion or an indication of course in general, thank you.
    Luigi

    • Testlevels 5 years ago

      Hi, it is a picture of full-blown hypothyroidism with high TSH and low free T4. The origin of hypothyroidism is probably of the autoimmune type. The endocrinologist will be able to indicate the most appropriate procedure. Sincerely

  14. Thyroid profile July 2016 - High TPO 5 years ago

    Good morning,
    in July I carried out the blood test in the areas HEMATOLOGY (Sg-Hemocromocytometric - Formula and Leukocyte), CLINICAL CHEMISTRY (S-Creatinine, S-Sodium, S-Potassium, S-Electrophoretic Protidogram), ENDOCRINOLOGY (S-Gonadotropin LH, S-Follitropin FSH, S-Prolactin (PRL), S-Progesterone, S-17 Beta Estradiol (eE2), S-Cortisol, P-Adrenocorticotropin (ACTH) - All these tests gave NORMAL VALUES.

    Specifically for the THYROID:
    THYROID PROFILE:
    Sh ULTRASENSITIVE TSH 2.276 mcU / mL (0.550 - 4.780)
    S-FT3 (Free Triiodothyronine) 2.88 pg / mL (2.30 - 4.20)
    S-FT4 (Free thyroxine) 1.190 ng / dL (0.890 - 1.760)
    S-ANTI THIREOPEROXIDASE 796.30 IU / mL (<60.00)
    S-ANTI THYREOGLOBULIN 19.70 U / mL (<60.00)

    I add the following considerations: the tests were requested by the general practitioner following a period of strong stress and the onset of menstrual irregularities with a spotting phenomenon already controlled by a thorough gynecological examination and everything in the norm. Verification of the possible onset of premenopause, not confirmed by tests. Age 49. Thank you very much

    • Testlevels 5 years ago

      Hi, thyroid hormones and TSH are normal. There is an alteration of anti-thyroid antibodies, which can be asymptomatic and not associated with particular anomalies. Trust your doctor, if necessary he will have you recheck fT3 and fT4 periodically. Best regards.

  15. Myle 5 years ago

    Hi I need a medical opinion as I have just done the tests regarding the thyroid and I need someone to compare them with the previous ones about 4 months ago so below I will put the results in the meantime I meant that I am currently taking an alternating dose between 100 and 125 mg under the advice of my doctor who has seen the previous analyzes now after a few months I have repeated the test to see the difference and also because I have noticed weight gain, I would like to have your advice for regarding the exact dose and should i take i think these tests give a complete picture of my significant situation i hope for your opinion thank you in advance

    Previous exams in February 2016

    Ft3 3.55
    Ft4 15.94
    Tsh 1.26

    Exams of the month of June 2016 that is current

    Ft3 3.95
    Ft4 18.04
    Tsh 0.10

    Reference values

    Ft3. 4-8.3
    Ft4. 10.6-19.4
    Tsh. 0.25-5. 7

    • Testlevels 5 years ago

      Probably the dose should be reduced slightly, in any case it is not possible to make medical prescriptions through the site, the advice is to contact the treating doctor and / or an endocrinologist specialist who will indicate the correct dose. Sincerely

  16. GIANNA 5 years ago

    HI I HAVE JUST WITHDRAWN THE ANALYSIS AND I HAVE:
    TSH A 2.239 (PARAMETERS FROM 0.220 TO 3.700)
    FT3 A 4.20 (PARAMETERS FROM 1.90 TO 4.20)
    FT4 A 1.26 (PARAMETERS FROM 0.76 TO 1.70)

    WHAT CAN YOU SAY ME?

    • Testlevels 5 years ago

      If I'm not mistaken, all tests are normal. Why did you make them?

  17. Nicola 5 years ago

    Hello, I kindly ask you for an opinion, I am 42 years old and a few days ago I found the following values:
    fT3 7.08
    fT4 2.56
    TSH 0.00
    TSH 2.07 receptor antibodies
    Ab Anti Thyroperoxidase 139.8
    Ab Anti Thyroglobulin 502.5
    What can it be related to?
    Thanks for your kindness.

    • Testlevels 5 years ago

      Hi, 1) the units of measurement are missing, 2) for that reason did you perform the tests ?, 3) by chance are you already on replacement therapy with Levothyroxine (Eutirox, Tirosint, ect ..)?

  18. roberta scarra 5 years ago

    Hello, I kindly ask for your opinion.
    TSH 5.52
    FT3 3.39
    FT4 1.23
    ANTI-TIRREOGLOBULIN antibodies 201.9
    TSH ANTIRECECTORS 0.58
    THYROID ANTIPROXIDASE 5377.0

    CURRENTLY I DO NOT FOLLOW ANY PHARMACOLOGICAL THERAPY
    nb IN 2003 with PREGNANCY I had some problems and I was prescribed Propylthiouracil which I stopped taking after giving birth.

    • Testlevels 5 years ago

      If the unit of measurement is pg / ml, I would say that thyroid hormones are normal, with a modest increase in TSH. The increase in anti-TPO and anti-TGB antibodies requires periodic monitoring of thyroid function, even in the absence of symptoms. Please rely on an endocrinologist specialist who will indicate the most appropriate timing.

  19. Rosanna B. 5 years ago

    Hi, I am writing because I am trying to understand the values of the analyzes I have just done.
    rTSH 5.33 (0 .20 3.50)
    FT4 7.9 (6.3 15.3)
    ab thyroid ANTIPEROXIDASE> 1.000 (0.00 35.0)
    To cure I was prescribed EUTIROX 25 one tablet per day.
    Please I would like to know if with these values I am IPO or HYPER as all the symptoms I have correspond to those of HYPER. In less than six months I had a weight loss of 12 kg. (from 75 to 63) while those who are IPO have a tendency to gain weight. I am a 65 year old woman, I do not take drugs for other diseases (heart pressure ect) Thank you so much for your reply.

    • Testlevels 5 years ago

      The tests show a tendency to hypothyroidism in a picture of autoimmune thyroid disease, the proof is that she has been prescribed euthyrox. One hypothesis (but it's difficult not having all the data available) is that she has thyroiditis that has had an IPER phase (which made her lose weight), but which has now resulted in classical hypothyroidism. Always and in any case rely on the doctor who follows you, best regards.

      • Mattia 5 years ago

        Hello, I also kindly ask for your opinion.
        I try to summarize my situation.

        In September 2015 I carried out a hormonal check as I was experiencing a period of emotional and psychological stress (I only had high prolactin and cortisol data from this situation, but then I returned anyway).

        Thyroid values showed:
        TSH 4.08 mcUi / ml (from 0.25 to 5.00)
        FT3 3.47 pg / ml (2.50 to 5.40)
        FT4 17.30 pmol / L (10.60 to 19.90)

        I also did the other thyroid tests with antibodies etc which did not find any problems.
        My endocrinologist told me everything was ok and gave me a simple iodine supplement, THIRODIUM 100.

        In January according to check:
        TSH 4.25 (0.25 to 5.00)
        FT3 2.12 (from 2.50 to 5.40)
        FT4 14.85 (from 10.60 to 19.90)

        I was worried because even if the values were normal I saw the TSH towards the upper edge and FT3 towards the lower.

        A few days ago yet another check:
        TSH 3.94 (0.25 to 5.00)
        FT3 2.38 (from 2.50 to 5.40)
        FT4 14.43 (from 10.60 to 19.90)
        I turned to get another opinion from a sports doctor who said he would be ready to start pharmaceutical therapy.
        My endocrinologist told me that I do not have anything abnormal, that the values can vary from day to day and that a drug therapy in my condition is "crazy stuff and a complaint"!

        May I kindly know your opinion.
        I am confused and scared.

        • Testlevels 5 years ago

          Hi, I would say that for the data you presented, I would definitely rely on what the endocrinologist specialist said!

          • Mattia 5 years ago

            Thank you for your attention.
            The next week I have a check-up by my endocrinologist and we hear what he says even though I already expect it.
            He will confirm that the therapy in my case would be "gamble and crazy stuff".

            Thank you again and if I had any doubts I would rewrite them.

  20. SELY 5 years ago

    I AM IN THE 6 WEEK OF PREGNANCY
    THE ANALYSIS SAY SO:
    HORMONES
    S-FT4 (Free Thyroxine) 16.29 pmol / L 9.00 - 22.00
    S-TSH * 4.39 mIU / L 0.20 - 4.00

    WHAT SHOULD I DO?

    • Testlevels 5 years ago

      First of all, show the examinations to the doctor who follows you, who probably, if not already performed, will advise you to search for anti-thyroid antibodies. Best regards

  21. Stephen 5 years ago

    good morning I would like to know if at an amateur and competitive level (football) eutirox is a doping substance and therefore prohibited and if it affects the daily life of the person. I am 20 years old and my tsh value is 3.79 (0.5- 3.60) and I have a small lump.

    • Testlevels 5 years ago

      Eutirox should not be included in the tables of doping substances, if taken for an established thyroid disease. TSH is on the verge of normal, she doesn't explain why she has to take it. In any case, contact your doctor and / or endocrinologist specialist.

  22. federico 5 years ago

    except my tsh values (0.5-3.60) are May 2015 2.85, January 2016 3.60, April 2016 3.79. Do you think I need to use eutirox? I am 21 years old

    • Testlevels 5 years ago

      It is not possible to respond without thyroid hormone values. Usually a TSH of just above the reference ranges is not sufficient reason to start substitution therapy.

  23. Vincenzo Oliva 5 years ago

    Hello everyone, I am writing because looking for information on thyroid and its values for reading the results of the analyzes, I found myself on this fabulous page.
    My girlfriend has these results:
    TSH = 24.77
    FT4 (s) = 9.0 (Ref. Pmol / L 10.30 - 21.80)
    FT3 (s) = 4.1 (Ref.value pmol / L 3.1 - 6.1)
    CALCITONIN (s) = 1.1 (Ref.value ng / L <15)
    Anti Thyroglobulin Antibodies (s) = 229 (Ref.value kUI / L 0 - 115)
    ANTI TPO Antibodies (s) = 221 (Ref.value kUI / L 0 - 34)

    I cannot understand the TSH reference values for his age 32.
    It should be less than 4.20mUI / L if I understand correctly… could it be that it has such a high TSH value?
    What could such a high value (almost 6 times the maximum value) mean?
    Obviously we have booked a new visit to consult with the doctor but the waiting times are very long and I would like to understand (always as far as possible) if c & #039; is to worry more than necessary or not
    Thank you very much for the time you dedicate to us all and heartfelt congratulations for the always effective and clarifying explanations

    • Testlevels 5 years ago

      Hi, from the values reported in the exams it is probably a picture of initial hypothyroidism on an autoimmune basis (Hashimoto's thyroiditis?). Such high TSH values are possible and not so infrequent in those with insufficient thyroid hormone production: the thyroid gland produces few thyroid hormones and the pituitary gland to try to compensate produces TSH in an exaggerated way. Nothing irreparable, a visit with the specialist will be essential to evaluate the start of a replacement therapy with levothyroxine.

  24. Francesca 5 years ago

    Good evening…
    I am a 25 year old girl and I am in the 8th week of pregnancy ... I withdrew the tests and my gynecologist had also prescribed me a thyroid profile as in adolescence they diagnosed me with growth hormone deficiency and therefore for safety he also had these analyzes done. The results are:
    S-THYREOTROPINE (tsh): 4.33 uUl / ml (0.34-3.80)
    FREE S-T4 (ft4): 11.43 pmoli / l (7.50-21.10)
    FREE S-T3 (ft3): 5.34 pmoli / l (3.00-6.00)

    Do you think I need to worry?

    • Testlevels 5 years ago

      Hi, absolutely not to worry. Ft3 and fT4 are normal, the TSH is slightly higher than the reference range (which in the laboratory where you performed the analyzes is a little lower than that commonly used). What she needs to do is show the tests to the gynecologist who will prescribe a checkup later in the pregnancy. Best regards

  25. life 5 years ago

    hi I am 42 years old and I would like some advice.sn in total chaos .about 2 years fs I had breast cancer with surgery and chemotherapy and radiotherapy making some thyroid conntrolli I have the FT3 (4.10) the FT4 (9.70) and the FTH (2 , 00) the doctor caught me 25g of thyroxin is right. Can you explain the situation a little.

    • Testlevels 5 years ago

      Hi, if the units of measurement are those normally used by our laboratories, your thyroid function is normal, as are the levels of thyrotropin (TSH). Your doctor probably has some extra information that motivates you to take levothyroxine.

  26. gilberto 5 years ago

    my TSH is 4.85… ..I have to worry… .thank you

    • Testlevels 5 years ago

      He does not have to worry, however, in addition to TSH, he must measure the thyroid hormones and possibly the thyroid autoimmunity profile. Trust your doctor who will surely know how to advise you

  27. Saretta 5 years ago

    Dear Doctor,
    I am writing to bring you my problem,
    a year ago after withdrawing the analyzes my tsh was 4.86 with a limit of 4.5, so I repeated the analysis after a few months and it was 3.78. In the meantime, I had an ultrasound on the neck which was normal apart from a small lump to be checked every 6 months.
    A few days ago I did the analysis again and the tsh was 5.06 and ft4 and ft3 in the norm (as well as in the other times) I am 33 years old, and nobody in the family with thyroid problems.
    Do you think the tsh can have these fluctuations and still be normal? Or, once the value goes up, you're bound to have hypothyroid problems?
    Thank you

    • Testlevels 5 years ago

      Dear user, they may also be normal tsh fluctuations without clinical significance. Did you check for thyroid antibodies?

      • Saretta 5 years ago

        Yes, everything is normal:
        Ft4 1.30
        Abtpo <60
        Abhtg <60
        So you think it's not certain that he might suffer from hypothyroidism in the future?
        Thank you so much, your answer calmed me.
        Thank you for answering me like this & #039; quickly.

        • Testlevels 5 years ago

          I confirm that it is not absolutely certain that we will go towards hypothyrpidism .. in any case it will be done with periodic trills of tsh and ormo the thyroid, all referring to the attending physician. Best regards

  28. Marco 5 years ago

    Hi, I'm 30 and I'm 1.77 tall
    In November 2014 I weighed 74 kg I started a few months after becoming a vegetarian and I have been weighing 65 kg for 6 months
    I am always frozen, I am always cold, hands always frozen body temperature of average 35.5-36.0, I suffer a lot oer this and also because
    I have face skin (subjected to very intense and long tretinoin treatments in adolescence, wrongly) and lips are always very dry, it almost seems that the skin abrasion is destroyed and that does not restore even with creams. and painful intercostal pangs but very drunk inexplicable having excluded problems of a high nature. I have been getting very little sun for several years.
    The other values:

    vitamin D 25oh 13 (30-100)
    total ige 72 (0-15)
    Tsh are 0.90 iu (0.27-4)
    FT3 3.97 PG / Ml (2.0-4.4)
    FT4 1.29 (0.90-1.70)
    Anti Thyroglubulin <10.00ul (0 to 115)
    TPO 10.88 (0 to 34)
    Thyroglobulin 18.8 (1.4-7.8)
    Calcemia 10.0 (8.8-10)
    BUN 22 (0-59)
    Total cholesterol 167 130-220
    Calcemia 10.0 (8.8-10)
    Triglycerides 97 (40-170)
    Creatinemia 1.0 (0.6-1.45)
    Blood sugar 98 val ref 80-110

    • Testlevels 5 years ago

      Hi, difficult to frame all these symptoms. Is it safe to feed properly? Are you getting an adequate amount of protein?

  29. Analysis 5 years ago

    Hi I have recently had a baby I have TSH: 7.4 I have withdrawn the tests now. I am gaining weight will I have to have a cure?

    • Testlevels 5 years ago

      I don't know how to answer you with these data, please contact an endocrinologist who will be able to advise you appropriately

  30. Chiara 5 years ago

    Hi I wanted to know some information. I had a baby 9 months ago I had gained 13kg some kg lost after giving birth I was fine. The midwife advised me to do the TSH analysis which was 7.44. I eat less things than when I was pregnant without gluten and I am careful with sweets but I am leavened and I sleep little. Do I have to do other tests? I cannot lose weight .thanks

    • Testlevels 5 years ago

      Of course, he must check thyroid function with ft3 and ft4, in addition to thyroid auto antibodies and, if necessary, a thyroid ultrasound.

  31. Antonio 6 years ago

    my 6 year old son from exams has:
    FT3 3.8
    TSH 6.86
    what does it mean? thanks

    • Testlevels 5 years ago

      Hi, the TSH is high, the fT3 depends on which unit of measurement is indicated in the report (pg / ml or pmol / l?). In the first case it would be a normal free triiodothyronine, in the second case it would be low. the FT4? antibodies to thyroglobulin, antiperoxidase, anti TSH?

  32. lorenza raguso 6 years ago

    Dear Doctors,
    I am 63 years old, in 2003 I underwent a thyroidectomy, after almost 6 years I was able to find the right dosage with eutirox (5 days 125, 2 days 100). In those years it was an ordeal, the TSH in a moment was high, after dosage change of only 25/50 mg per week, it was low. Now it's a year and a half that the values have changed, the TSH has reached 0.220, after the dosage change several times, now 100 every day is 0.500 (2 months ago) I know it's in the limit, but lately I feel more nervous, I sleep badly, I have more bulging eyes, I have less memory and strangely in the last 2 years I have gained 3 kg, keeping the same diet. I am afraid that the values have dropped. I assume that 3 years ago I stopped taking cortisone, which I had been taking for 10 years (rheumatoid arthritis, osteoarthritis and Raynaud's disease) and for 3 weeks I stopped the pantoprazole (advice of the gastroenterologist) that I was taking for years. Could they have affected TSH? Thank you very much! Lorenza

    • Testlevels 6 years ago

      Dear Madam, it is difficult to say if the symptoms are related to thyroid function, also because the last TSH is in order. The picture is wider and must also take into account its other problems, 3 kg in two years is not a worrying thing that cannot be solved with diet and physical activity. Your endocrinologist, possibly assisted by a nutritionist, will be able to advise you on the optimal therapy.

  33. Claudia 6 years ago

    Hi, my blood tests show
    TSH 4.22 (reference values 0.2-4.5)
    T3 and t4 in the norm
    Do I have to worry? TSH is not a bit high, as far as within the limit?
    Thank you in advance

    • Testlevels 6 years ago

      Hi, TSH is perfectly normal don't worry. If your doctor deems it appropriate, you can check it again after a year.

  34. gingin 6 years ago

    I am taking thyroxine in drops instead of tablets (ie Tirosint instead of eutirox). Can the tsh thyroid hormone be affected? they told me that the stsh is lowered if I eat together with the drops is it true?

    • Testlevels 6 years ago

      Dear user, the study TICO just published has shown that liquid replacement therapy (in drops) is equally effective compared to thyroxine in tablets, and also can be taken during breakfast instead of having to wait the classic 15-20 minutes from taking.

      • riccardo 6 years ago

        I was diagnosed with hashimoto's thyroid. with the first blood test they found the TSH reflected at very high values 101 uIU / ml and the FT4 lower than 0.30. the second blood test was used precisely to be sure and was specific:
        antithyreoperoxidase 5152 ul / ml and ABTG at 684. the endocrinologist gave me 100 TICHE drug (I started on 01-28-16) and had me retake the tests after a month. now the FT3 and FT4 are within the norm or 3.40 and 0.91 but the TSH (not the reflected one) is still high 32.90 mcU / ml. (should be between 0.4 and 4). now the endocrinologist told me that the general practitioner managed everything and he told me that the values are fine and that the TSH will always be high ... the problem is that I am however tired, mood swings etc. I would like your opinion ... if TSH is normal like this or if my GP is wrong ...

        • Testlevels 6 years ago

          Dear user, to say TSH, TSH reflex or TSH reflex is the same thing. The data you reported show a high TSH, even if in reduction compared to the first value. I cannot comment on the considerations of the practitioner as I do not have all the elements available, the ideal would still be to have a TSH that approaches the reference values. He may require a new endocrinological consultation if the TSH values do not drop in the next few months.

  35. Franco 6 years ago

    Hello,

    I am a 56 year old man, I have withdrawn the thyroid tests which I had not done for a long time.
    These are the values:
    TSH 5.39
    FT4 10.9
    are these values altered or is everything normal? how to proceed? Thanks

    • Testlevels 6 years ago

      The TSH is high, the fT4 depends on the unit of measurement and the reference values used by the laboratory where the analyzes were carried out

  36. Maria 6 years ago

    I have the TSH-R 3.38 values to be considered normal? The references are
    0,47. 4,68
    Thanks

    • Testlevels 6 years ago

      The TSH is absolutely within the reference values and therefore normal. Sincerely

  37. mirella 6 years ago

    Hi I would like to know why I no longer have the thyroid and taking the euturox for almost 20 years the tsh suddenly dropped .. I take it from 125/2 times from 150 !!

    • Testlevels 6 years ago

      The absorption of eutirox can vary for numerous reasons (type of diet, intestinal motility and many others), which justifies fluctuations in TSH values. Refer to the endocrinologist and in any case to the doctor who follows you.

  38. Dario 6 years ago

    Dear Doctors,
    I just had a general blood test as I was having too much tiredness and persistent sleep lately. I assume I have lost my job and am having a hard time. (This is the same thing I told my GP).
    All the values both blood and urine are in spec, I only point out that the red blood cells and blood count are close to the limit and that is:
    RED GLOBULES: 4.66 (REF 4.50 - 5.90)
    MCHC: 33.8 (REF VALUES 33 - 36)
    HEMATOCRIT 41.9 (VALUES REF 40 - 50)
    HEMOGLOBIN 14.2 (VALUES REF 13.5 - 17)
    The values that have slightly worried the doctor are the following:
    TSH 3.970 (REF values 0.360 - 3.740)
    FT4 1.020 (REF values 0.76 - 1.46)
    I ask her, if the value of tsh can be a wake-up call for a visit to an endocrinologist, or if it is enough to monitor it at a next examination.
    The doctor thinks that my tiredness could be due to that value.
    I am not a doctor, but perhaps it is not so serious, I suppose it is negligible, to keep an eye on but not to perform a visit now, also I have read that in some laboratories the range goes up to 4 - 4.2, so my 3.9 would fall (but it's my guess).
    What do you think?

    • Testlevels 6 years ago

      On the basis of the reference ranges for thyroid function, his TSH and FT4 values are perfectly normal. However, nothing prevents you from checking them soon. Best regards

  39. Daisy 6 years ago

    Hello,
    I am 23 years old and I have been taking the pill for a year and it has always given me enough problems especially with fibrinogen.
    I have repeated the tests (complete blood count included)
    Here are the results obtained:
    - Neutrophil granulocytes 53.4% (reference value 55 - 70)
    -Fibrinogen 672 mg / dl (reference value 150 - 469)
    -GOT 59 Ul / l (reference value 0 - 31)
    GPT 42 Ul / l (reference value 0 - 31)
    TSH 6.16 uU / ml (reference value 0.27 - 4.20)
    all returns are perfectly normal.
    Can you reassure me by telling me that all of this could simply be linked to the pill which is definitely not properly supported by my body?

    • Testlevels 6 years ago

      Hi, a complete thrombophilic screening and hepatological evaluation would be indicated for altered transaminases and fibrinogen. The high TSH must be monitored and related to the values of thyroid hormones. In any case, show the investigations to the attending physician and gynecologist who will be able to advise you adequately.

  40. Finger 6 years ago

    Hi, I am a 45-year-old person, for 15 years I have been on Eutirox therapy for Hashimoto's thyroiditis, over the years I have had various changes in thyroid function with very high tsh, I quote a high s-tsh value two years ago : TSH 16! last year it had always been high but with almost normal values: TSH 5.5 in February, TSH 6 in June, then normal in September, in short, it seemed that despite the mild high tsh the thyroid gland (indeed thyroid replacement therapy) was fine the endocrinologist who follows me also confirmed it. PS in all reports TSH was evaluated with the eclia method).
    On January 2nd I took the exams again and here is an altered TSH, at 40! then the doctor increased my eutirox to 75 and resumed the tests, redone the day before yesterday and here is the report: TSH 30, fT4 0.7, fT3 2.2. So it seems to me a picture of high TSH and hypothyroidism, what could be the consequences? Thank you

    • Testlevels 6 years ago

      The consequences can be found in the article at this point. You probably need to increase Eutirox a little more, but before making any changes to your therapy, consult your endocrinologist.

  41. Gianluigi 6 years ago

    Good evening! I have for a long time Hashimoto's thyroiditis in therapy with Eutirox first and then with Tirosint I am a little worried because at the last TSH check (eclia method), they found me TSH 0.03 and two weeks before TSH 0.05. Did I take too much medication? the previous value, even if measured with another method (3rd generation TSH with chemiluminescence TSH) was 3.5 so in my normal home .. am I perhaps taking too many thyroid hormones? I don't know I have also seen the TSH and thyrotropin values on wikipedia as you say that now TSH is too low. should i have symptoms of thyroid hormone dysfunction? how do i get TSH back to normal type 3-4? thanks let me know

    • Testlevels 6 years ago

      Given the low TSH, I would say almost suppressed, the dose of levothyroxine you are taking is probably too high. Consult your endocrinologist who will give you directions for adequate thyroid replacement therapy.

  42. dario 6 years ago

    hello, I am a subject who underwent total thyroidectomy in 1996 for follicular variant papillary carcinoma, in the last few days I carried out routine analyzes of the tsh values and strangely it turned out that the value is 1.29 in the absence of euthyrox. What does it mean??
    thanks

    • Testlevels 6 years ago

      If you have had a total thyroidectomy, I imagine you are taking some type of replacement therapy, even if it may not be called Eutirox. What therapy do you take?

  43. Jessica 6 years ago

    Hi, I'm 24 years old, woman, 1.70m tall and weighing 50kg ... I did blood tests following a pain in my chest (which I then passed on my own) and it is TSH 0.26 / fT4 0.9 / fT3 3.0
    My doctor has prescribed me a visit to the endocrinologist to find out if I have something wrong (TSH being low and below the minimum threshold of 0.35). In the meantime, however, I would like to know what it can be ... For two months I have stopped taking the Yaz pill that I took for 5 years to take a break (I don't know if that could affect) and now I don't take any drugs. I work out (weightlifting only but at a low level) I have always been thin, in summer I lose 2 kg and in winter I take them back… I noticed that I don't have much memory lately (even if in reality I have never had a lot).
    Thank you in advance for your kindness

    • Testlevels 6 years ago

      Hi, the picture you report seems to be that of a subclinical hyperthyroidism (low TSH but normal fT3 and fT4). It doesn't seem likely that chest pain is related to thyroid function. In any case, to frame the thyroid situation upon completion, I would say that the execution of anti-thyroid antibodies is indicated, in addition to a thyroid ultrasound. As for chest pain, did it also have associated shortness of breath? I recommend that if you ever want to take the pill again, you have a thrombophilic screening before starting again. Best regards

  44. Anna 6 years ago

    Hi, I'm a 33 year old girl yesterday I withdrew the tests:
    Anti-microsome antibodies 13.20 IU / ml reference value 0-40;
    (ft3) 3.79 pg / ml Reference value 1.58-4.1
    (ft4) 11.10pg / ml reference values 8-20;
    tsh 3.17 IU / ml reference values 0.20-4.00
    antibodies to thyroglobulin 98.50 IU / ml 0-40;
    peroxidase antibodies 10.70U / i ref values 0-35.
    Given that I have made an appointment with the endocrinologist for the next month, I would kindly like to know what this value means and if it affects the search for a pregnancy (for 2 years we have been trying to have a child after having a miscarriage in the first weeks of the year last). Thanks for your attention, greetings.

    • Testlevels 6 years ago

      Dear Anna, your TSH and thyroid hormone values are perfectly normal. Auto antibodies, except for a slight positivity of anti thyroglobulin, are also substantially normal. It is unlikely that the thyroid gland will affect your search for a child, I think the picture will need to be deepened with other hormonal tests, and with the spermiogram (if not already performed). The endocrinologist will surely be able to show you the next step. Best wishes and good luck for your family projects

  45. stefania 6 years ago

    Hi, my husband in 2011-2012 suffered from hyperthyroidism successfully treated with tapazole. Every year at the controls everything is normal, but the tests carried out last week show tshu low 0.29 and ft3 and ft4 normal. I wonder: is hyperthyroidism starting again?

    • Testlevels 6 years ago

      Hi, in the presence of low TSH with normal fT3 and fT4 we are in a situation of subclinical hyperthyroidism. It could simply be an isolated value or caused by food / other drugs that interfered with the absorption of tapazole, or there could be a resurgence of the underlying pathology of hyperthyroidism. Repeat the exams shortly and consult your trusted endocrinologist who will be able to indicate the best strategy.

  46. luca 6 years ago

    Hello
    I am a 40 year old man
    I did the analysis in mid-July with these results

    TSH 4.18
    FT4 1.41
    FT3 2.70
    ANTI TG 155
    ANTI TPO 24

    after a specialist visit the endocrinologist found me a thyroid called HASCIMOTO's
    the doctor gives me a treatment of 4 months so arranged
    treatment starts in August with TICHE 25
    I switch to TICHE 50 in September
    October at TICHE 75 except Sundays
    novebre TICHE 75 except Sundays
    the first two months everything is fine but at the end of October my problems begin.
    the first days of November I start to suffer from insomnia, in the morning I always wake up around 4/5, around 5 November in the evening I have a tachycardia attack, I run to the hospital and after various routine tests, ecg, blood, enzymes, everything is normal and I have sinus tachycardia
    my values were high blood pressure 160 min 90 bpm 120.
    insomnia has been with me for the whole month, sometimes I always get tachycardia attacks and I also start to suffer from anxiety attacks and high blood pressure
    in the month of November alone I also lost about 6 kilos without dieting
    I state that I have never had the problems listed before
    my blood pressure has always been 80/120 with 74 bpm
    I repeat the analysis in mid-November with these results
    TSH 3,27 VALUES REF 0.30-3.60
    FT4 1.25 0.80-1.70
    FT3 2.46 2.2-4.20
    ANTI TG 175 <100
    ANTI TPO 21 <16
    now i would like to know if the cure i am doing is too strong for me to cause this undesirable effects or there may be other problems, i would not have gone from hypo to hyper in a short time
    my endocrinologist has lowered the dosage for me x hour to make me feel comfortable but anyway I don't notice big difference on my health.I am not a doctor but in three months of treatment the TSH values have dropped a lot and I would not want the dosage given to be been assimilated too well by my body
    I also wonder how long it takes for the pill to take effect
    I ask for advice and information on this problem
    thanks

    • Testlevels 6 years ago

      The last tests he did show a normal thyroid profile, it does not seem that the replacement therapy with levothyroxine is the cause of his problems. Follow the instructions of the endocrinologist and keep blood pressure and weight under control.

    • Alexander 5 years ago

      Sorry Luca but I'm going through the same problem too I ended up in the emergency room 7 9 times I got a heart attack but the Doctors say the end is all right but my heart is okay but I shit on me I did all the health tests and I'm fine exams my thyroid are similar to yours I wanted to know if something solved let me know if it is possible

  47. Daniela 6 years ago

    Hello,
    For a while now, I have been monitoring my thyroid values, the doctor says that sooner or later I will have to start with eutirox, but the later it will be better.
    My tsh is always at the limits of the reference value, and lately it is a little dancer beyond those limits. These are the latest analyzes:
    27.02.15
    Tsh reflex 6,926
    Ft4 0.67
    Antibodies anti.tpo 238.3
    0.0 anti.htg antibodies

    08.07.15
    Tsh 5,652
    Ft4 0.69
    Ft3 3.0

    04.11.15
    Tsh reflex 6,281
    Ft4 0.78

    Do you think eutirox should start? Is the tsh worrying? I also say that in recent years I have been gaining a lot of weight and I cannot lose weight, even if it is true that I do not do physical activity. I have tried many diets, but I do not lose much weight and above all I get it back immediately. I also noticed a loss of memory. Do you think all of this could be due to the thyroid gland?

    • Testlevels 6 years ago

      Maybe, the values you report show TSH persistently above normal limits and a free thyroxine (fT4) always below normal. Therapy with Eutirox should be evaluated. Trust your doctor who will certainly be able to advise you, at most you can always request a second consultation from another endocrinologist.

  48. clear 6 years ago

    hello, I am a 41 year old girl since 2008 I underwent an operation with total removal of the thyroid.
    at first I was fine I had also improved in "mood", in the sense much calmer and less nervous. I TAKE EUTIROX
    In the last year, however, I oscillate every three months with a change of dosage because my TSH values are very low
    AUGUST:
    TSH 0.02
    FT4 1.31
    FT3 3.03
    AFTER THESE ANALYSIS MY DOSAGE BECAME:
    FROM MONDAY TO FRIDAY 100MG
    SATURDAY AND SUNDAY 125MG

    I did the tests again this week
    RESULTS:
    TSH 0.27
    FT4 1.15
    FT3 3.01
    Reading around according to these analyzes I would be IPER .... BUT I HAVE ALL THE OPPOSITE SYMPTOMS:
    I'm always tired
    I have little memory
    I can't lose even 1kg
    every time I eat something bloated
    I'm very nervous
    and after meals I am always cold .... frozen hands and feet
    Can you give me some advice?
    thanks a lot

    • Testlevels 6 years ago

      Tests show slightly suppressed TSH and normal fT4 and fT3. The dose should probably be reduced slightly, but this obviously needs to be confirmed by the doctor following you. I would look for another cause in the symptoms you describe.

  49. Valentina 6 years ago

    Good evening I am a 28 year old girl following an echo in the neck with chronic hypothyroid conclusion I carried out blood tests with the following values:
    - antibodies to thyroperoxidase 2769 (values up to 60)
    - blood count 34.7 (minimum value 37)
    - cell Neutrophil peroxidase positive 46/100 (values 50-70)
    -exophilic cell peroxidase positive 5 (up to 4)
    - albumin 3.84 (min 4.62)
    The other values are normal

    I lost 2 kg according to the pharmacy scale, while mine was 5 kg less after I removed gluten
    I find it hard to swallow
    Is it thyroid or is there something else? Thanks

    • Testlevels 6 years ago

      How are the TSH and free thyroxine values? Did you test for transglutaminase antibodies before removing gluten from your diet?

  50. Antonella Nobilio 6 years ago

    Hello, I need a first wise answer before meeting the specialist.
    I am 49 years old and I was diagnosed with sarcoidosis, however asymptomatic. Since the PET scan gave tracer around both thyroid lobes, I did an ultrasound which indicated chronic inflammation. TSH tests are high: 14.028, free thyroxine is normal: 1.03, while antibodies to thyroperoxidase and anti-thyroid globulin are very high:> 1300.0 the first is> 500.0 the second. From what I have read in these pages of yours it could be that I also have a tumor in the hypothalamus ... or what else could it be? Thank you warmly

    • Testlevels 6 years ago

      Hi, it could simply be chronic thyroiditis with subclinical hypothyroidism (high TSH but normal free thyroxine). It should be noted that the finding of anti-thyroid antibodies in sarcoidosis is relatively frequent. Consult the endocrinologist who will surely be able to help you.

  51. Arianna 6 years ago

    Good evening, in May I underwent a total thyroidectomy, in July I checked the tsh value of 1.39 (normal values ųUi / ml 0.2-4); in November after a delay of about two months I discover that I am pregnant checked the bhcg with a value of 7 and the tsh with a value of 3.71 (normal values ųUi / ml 0.2-4); not even time to book a medical visit i had a very early abortion without even needing a curettage, now i wonder is the tsh too high to start a new pregnancy?

    • Testlevels 6 years ago

      If the values of fT4 are within the norm, the TSH is fine. In any case, the last word is always with the treating doctor or the endocrinologist who follows you. Best regards

  52. Jade 6 years ago

    Good morning,
    I am a 25-year-old girl, the last tests performed a few days ago showed a TSH value of 6.44, with T4 of 1.31, and a normal blood count.
    I repeat these tests every 6 months or so and each time the TSH is always a little higher than the previous time. Why?
    The first tests related to the thyroid gland date back to two years ago, when, following a visit to the gynecologist who gave me an ultrasound of the thyroid, I was advised to investigate better: I made RICAb Anti TIREOGLOBULINA with a value of 560 Ul / mL and RAb Anti THYROID PEROXIDASE equal to 449 Ul / mL, with TSH equal to 5.3.
    I take Eutirox 25 during the week and 50 on Saturdays and Sundays, Ferrograd (ferritin which has proved to be within the limits in these last tests), and I take the contraceptive pill. My doctor always says everything is fine, but I would also like another opinion if possible!
    Thanks a lot!

    • Testlevels 6 years ago

      Hi, the picture that you report seems to be that of autoimmune hypothyroidism (Hashimoto's Thyroiditis?), With high TSH and antibodies to thyroglobulin and thyroperoxidase positive. If the 1.31 you report really refers to T4, the therapy is not adequate. If instead, as I imagine, you are actually referring to fT4, hypothyroidism seems well compensated by replacement therapy.

  53. stefania 6 years ago

    except the result of my tests is t4fraction free 0.98, ng / dl t3fraction free 4.15pg / ml and ultrasensitive tsh4mcUI / ml, the doctor in charge the one who visits the company did not show me anything pathological. Are they okay? I am 51 years old. thank you so much.

    • admin 6 years ago

      Hi, the exams you report are normal. The values of fT4 are normal but close to the low threshold of normal range, while TSH is normal but close to the high threshold of the normal range. In the absence of symptoms there is no indication to repeat the tests, at the limit can check the TSH in 6-12 months.

  54. ANGELA 6 years ago

    Hi, I'm 53 years old and my thyroid has not worked properly for about ten years. I have always had low TSH and normal Ft3 and Ft4. Treated with tapazole for years and then periodically interrupted the treatment every time the value stabilized, today I am at the third relapse with TSH 0.140, Ft3 3.26 and Ft4 0.79. I have a slight exophthalmos but I am advised to have a thyroidectomy because the treatment with tapazole is toxic in the long run. I was initially told it was Hashimoto's thyroiditis, then Graves' disease, but what kind of thyroid disease exactly do I suffer from? Is it really necessary to remove the thyroid in this case?
    Thanks

    • Testlevels 6 years ago

      Hi, it is not possible to give an answer with the data you provided: the picture you report seems to be that of hyperthyroidism (subclinical or not?). The question arises: apart from exophthalmos, did you have any other symptoms of hyperthyroidism (e.g. tachycardia, sweating, frequent episodes of diarrhea, weight loss)? Permanent causes of hyperthyroidism are primarily Graves' disease, toxic multinodular goiter, or single thyroid hormone-secreting nodule. The transient causes are instead thyroiditis in the hyperthyroidism phase (but if the situation has persisted for ten years this hypothesis is not so probable). I imagine that he will certainly have performed an ultrasound of the thyroid gland and a search for antibodies to thyroglobulin, antibodies to TSH receptor and antibodies to thyroid peroxidase. What emerged from these tests?

    • ramzan 6 years ago

      I always nervous about what and sick I went to my doctor he sent me to visit what I do the result S-TSH 0.560 uUI / ml 0.4: 4

      • Testlevels 6 years ago

        TSH is normal.

  55. Mariella 6 years ago

    Hello. I have been suffering from autoimmune hypothyroidism for 10 years. I have been taking eutirox ever since and have had two children. I repeat the analysis a few days ago because I felt a strong tiredness and a general malaise and the tsh is very low. I am always hungry, I am not able to do physical activity due to fatigue as in the past months, nor to follow the diet that the dietician gave me and that last year had made me lose 6 kg in a balanced way (4 of which I recovered in a year). at the moment I weigh 74.5 kg. From the analyzes, the TSH is 0.088 - FT3 4.40 - FT4 1.13. Could you tell me what's happening to my thyroid? Besides the general malaise, I notice a strong memory loss. Thanks and best regards.

    • Testlevels 6 years ago

      Thyroid hormones are normal, it's hard to tell if your symptoms are related to your thyroid. Have you done any other blood tests?

  56. VICTORY 6 years ago

    Hi, I am 23 years old and after a preventive visit a doctor, seeing mine a bit "uneven", advised me to do the following analyzes ...
    while waiting for the endocrinologist to read the analyzes I wanted to ask for information ...
    I did the following analysis in 2011
    TSH 2.39 (0.92-4.6)
    ABPTO 210 (<35)
    ABHTG 305 (<40)

    I have repeated these analyzes now and it turns out
    TSH 1.63 (0.92-4.6)
    ABPTO 274 (<35)
    ABHTG 1003 (<40)

    I know I have antibodies "against the thyroid" but I have not practically understood ... What does it mean ... That is, what do I have? What can provoke me?
    Since I am thinking of having a baby what should I do?

    • admin 6 years ago

      Hi, the picture shows markedly positive antibodies to thyroperoxidase and thyroglobulin antibodies, but a normal TSH. The presence of thyroid autoantibodies does not automatically mean the presence of disease, especially in the absence of an alteration in thyroid function and specific symptoms. Did you also perform the free thyroxine (fT4) and free triiodothyronine (fT3) measurements? In any case, the altered anti-thyroid antibodies as in your case can be accompanied by a greater propensity to develop thyroid pathologies in the future. Periodic monitoring of the tests performed by you is indicated, with the addition of fT3 and fT4, in order to discover in time any alterations in thyroid hormones and TSH, even more so if you want to become pregnant. For the moment, do not worry, consult the endocrinologist anyway and rely on his indications. Best regards

  57. Anthony 6 years ago

    Does the TSH reflex exam if the tsh is in the standard does not measure ft3 and ft4? If if they were not dosed and I had already carried out the tests and I am waiting for the results, would you not be able to contact them to eventually dose them?

    • admin 6 years ago

      Laboratories usually adopt the protocol which states that if the reflex TSH is normal, the dosages of fT3 and fT4 are not carried out as they are superfluous. He should contact the laboratory where he performed the tests and hear what diagnostic algorithm they adopt. Best regards

  58. Sara 6 years ago

    Hello, I have just withdrawn the tests carried out in the ninth week of pregnancy. The following values were found: TSH reflex 0.063; FT4 1.41; FT3 3.55. Should I worry about the SLR THS value so low? Could it be due to a recent pregnancy?
    Thanks in advance for your attention, best regards.

    • admin 6 years ago

      Hi, during gestation a physiological lowering of TSH is normal, but the thyroid function must be monitored to detect and treat in time the possible onset of hyperthyroidism. Your gynecologist will certainly be able to give you the appropriate information. I refer you to the section of the article that talks about this Low TSH in pregnancy. Best regards and good luck for your pregnancy

  59. Maria Rescaldani 6 years ago

    83 year old person. Two years ago my thyroid was removed. My TSH is: February 0.164, June 0.067, September 0.113. I take Eutirox 100. For some time I have gone from high hypertension to the following pressure values: 119, 65, 73. Does it depend on my thyroid or is it necessary to do other serious tests? I apologize and thank you in advance.

    • admin 6 years ago

      Dear Madam, it can depend on many things. The TSH values she described are low, and it is likely that replacement therapy needs modulation. how are fT3 and fT4? Also, if you have hypertension and are taking antihypertensive therapy, that may need to be fixed as well. definitely rely on your endocrinologist and attending physician and keep a diary measuring your blood pressure at the same time every day for at least a week.

  60. Daria 6 years ago

    Hello, I am a 40 year old woman. Over the past couple of years, for no apparent reason, I have gained a lot of weight and it seems that exercise and diet are not able to solve my problem. Last year I did the tests (blood count and thyroid values) and everything was ok. This year, feeling very tired, I repeated the tests and the result was a high TSH value (5.1.) And TF3 and TF4 within the normal range even if at the limit. A week after the first blood test, I repeated the blood test, double-checking the TSH and antibodies. To my surprise the TSH is back to normal (3.8) and the antibodies are ok too. I wonder ... is it possible that the thyroid gland works badly giving different values depending on the day? I tend to exclude any laboratory errors as in both cases the analyzes were done in a hospital environment.

    • admin 6 years ago

      Hi, TSH values can have small fluctuations even if repeated at close range. In his case, in the face of repeated checks, the only altered data is a TSH just above the reference values, which is then not confirmed at the next check .. it does not seem that fatigue and weight gain therefore depend on the thyroid. If it is an early stage of subclinical hypothyroidism, it will be seen by repeating the check months later. In any case, show the tests to your doctor or an endocrinologist. Best regards

  61. Simona 6 years ago

    Thank you for elucidating information on thyroid, you are very comprehensive.
    Thanks again for shedding some light on some possibilities of our symptoms, finally thanks for the linguistic simplicity, understandable to everything. Thanks for existing. :)

  62. MARIAELENA 6 years ago

    Thanks for the medical articles: they are clear and understandable even for non-professionals ... they stimulate a more informed conversation with your GP.

    • admin 6 years ago

      Thanks for the comment, that was the intention ..

  63. Carolina 6 years ago

    I am a 25 year old girl. The blood tests ft 3 and 4 are low, while the tsh values are normal. I have high transaminases and other high values, including mild anemia with enlarged red blood cells. What could be the causes? given that for some months now I have had a strong weight loss: I am underweight and I have other high values including low red blood cells, low proteins, and uricemia.

    • admin 6 years ago

      Hello, given that the following site has an exclusively informative and informative character and must in no way be understood as a substitute for medical opinions, and that therefore the complete picture can only be obtained by your doctor, everything could derive from an inadequate income. or a reduced absorption of nutrients (low protein, low vitamin B12 which causes anemia with red blood cells larger than normal). As for the thyroid, he should complete the tests by performing, in addition to TSH and ft3-ft4, also anti-thyroid antibodies (anti thyroglobulin, anti TSH, anti thyroperoxidase). Given the young age and the symptoms, celiac disease should also be excluded.

  64. anisoara Balan 6 years ago

    Thyrotropic hormone 0.774
    What a semnigica

    • admin 6 years ago

      Its thyrotropic hormone (TSH) has a normal value, in fact it is between 0.5 and 4 mIU / L. It should also dose fT3 and fT4.

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