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Doctor insights on: Tsh Reflex Test

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What is a "tsh reflex" test?

Weird terminology: As best i can tell, it is just a TSH with ft4. Not sure why someone calls it "tsh reflex". Maybe the lab does the tsh, and then does the ft4 if the TSH is abnormal. ...Read more

Dr. Quang Nguyen
893 doctors shared insights

Thyroid Stimulating Hormone (Definition)

A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland and tells the thyroid gland to make and release the hormones thyroxine ...Read more


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My doctor said my thyroid is enlarged and wants me to have a TSH reflex test done. What does this mean? What causes a thyroid to be enlarged?

My doctor said my thyroid is enlarged and wants me to have a TSH reflex test done. What does this mean? What causes a thyroid to be enlarged?

Thyromegaly: Thyroid could be enlarged form multiple nodules, single nodule, from inflammation, growth of benign and malignant nature. Most common reason would be multinodular goiter. The function of the thyroid is measured by Tsh and related thyroid hormones T4 and T3 (liothyronine). ...Read more

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Tsh w/ reflex test read 1.20 and the range was 0.27- 4.20. Is this low norm or healthy norm? I was already diagnosed with hypo earlier this yr.

Tsh w/ reflex test read 1.20 and the range was 0.27- 4.20. Is this low norm or healthy norm? I was already diagnosed with hypo earlier this yr.

Need more info: The TSH level needs to be looked at in the context of your other thyroid levels. If you are not on any medication this might be interpreted as normal but your level of free T4 and free T3 (liothyronine) as well as your thyroid antibodies need to be analyzed as well. If your free T4 and/or free T3 (liothyronine) levels are low, then the TSH level might not be reflecting exactly what is going on with your thyroid. ...Read more

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TSH reflex free T4 test = 2.51 (normal range 0.35-4.50). I've read hyperthyroidism still possible if TSH normal. Do I need another test?

TSH reflex free T4 test = 2.51 (normal range 0.35-4.50).  I've read hyperthyroidism still possible if TSH normal.  Do I need another test?

TSH: Highly unlikely. That said, your doctor should have ordered TSH and T3 (liothyronine) as well as T4. Please go back to him/her or if you are not satisfied have a friend or family refer you to a better doctor. ...Read more

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My TSH w/reflex to FT4 test came back at 6.73, but my free T4 came back at 1.24. I have previous has similar results to these tests.

My TSH w/reflex to FT4 test came back at 6.73, but my free T4 came back at 1.24.  I have previous has similar results to these tests.

Mild hypothyroidism: The elevated TSH means that your pituitary gland is not happy with your thyroid level, and would like to see it higher despite the "normal" free T4 level. If you do not have any symptoms of hypothyroidism, we call this "subclinical hypothyroidism". Treatment may not be needed unless you develop symptoms or the TSH goes progressively higher. You should not start treatment based on one abnormal test ...Read more

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My TSH test results 8 months ago were 1.2 but I was tested again last week and the results of TSH - REFLEX TO FT4 are 1.850. Is this Normal?

My TSH test results 8 months ago were 1.2 but I was tested again last week and the results of TSH - REFLEX TO FT4 are 1.850. Is this Normal?

Lab variation: Not only may the change in this number reflect a normal variation in the labs result without a change in your thyroid function it could represent normal variation of thyroid function within your own body . This might be as a result of variable absorption of any thyroid supplement you are taking or variation in disease activity if you have a disorder such as hashimoto's thyroiditis. ...Read more

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What does "TSH with Reflex" mean and do I have to fast for this test? I had TT 2 years ago, diagnosed w/Hashimoto's 20 years ago.

Add on test: Many laboratory tests can be ordered with 'reflex', meaning that if the particular test results are abnormal, more extensive testing is automatically run on the initial sample. This saves time and avoids repeated visits for blood draws. For thyroid testing alone, fasting is not required. ...Read more