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Doctor insights on: Tsh With Reflex T4

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My free T4 is high 19.30 pmol/l and my TSH is also high 4.530 mlu/l. What does this mean?

My free T4 is high 19.30 pmol/l and my TSH is also high 4.530 mlu/l. What does this mean?

Few possibilities: These labs seem at odds, with TSH suggesting overactive thyroid and ft4 underactive thyroid. Free T4 tests can be inaccurate in some people who have interfering substances present. Another possibility is a tumor in the pituitary secreting too much TSH resulting in thyroid overactivity, and high thyroid hormone levels. This is quite rare, however. Your doctor can help sort this out. ...Read more

Dr. Quang Nguyen
938 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 t4 free is 0.70 and my tsh reflex free t4 is 29.2. What does this mean and what do I need to do?

My t4 free is 0.70 and my tsh reflex free t4 is 29.2. What does this mean and what do I need to do?

Hypothyroidism: This is diagnostic of hypothyroidism and should be treated with thyroid hormone replacement which hopefully was done by the doctor who got these labs. While without a little more history is there is the remote chance of thyroiditis, it is unlikely with a TSH in this range. While EASILY TREATABLE, hypothyroidism can be a serious and even eventually a life threatening disease. ...Read more

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TSH W REFLEX FREE T4 TSH, 3RD GENERATION (0.40-4.00) uIU/ML My results are 1.10 I had this test taken. Can you explain what the results mean?

TSH W REFLEX FREE T4 TSH, 3RD GENERATION (0.40-4.00) uIU/ML My results are 1.10 I had this test taken. Can you explain what the results mean?

Normal, but...: THIS IS A NORMAL THYROID SCREENING TESTS. There are rare diseases thyroid that can happen with an normal normal TSH, but you would have symptoms of thyroid disease or other evidence of central hypothyroidism or thyroiditis in a "euthyroid phase, " which would be rare and require much more history. If there is ongoing concern see an endocrinologist. IF YOU GENERALLY FEEL WELL GREAT, IT IS NORMAL! ...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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TSH w/reflex to T4 was 0.25. T4 free 1.2. T3 free 2.7. Tsh level was higher and synthroid (thyroxine) 137mg. Still on same dosage. Would this cause fatigue?

TSH w/reflex to T4 was 0.25. T4 free 1.2. T3 free 2.7. Tsh level was higher and synthroid (thyroxine) 137mg. Still on same dosage. Would this cause fatigue?

Possibly.: The low TSH with associated normal free T4 and free T3, (liothyronine) suggests borderline hyperthyroidism (overactive thyroid) which can cause fatigue. However, one should seek a thorough medical exam prior to concluding that the symptom of fatigue is not due to some other problem. ...Read more

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Tsh with reflex free T4 1.09, free T4 1.00 t3 (liothyronine) total 91. Feel horrible very weak, hair falling, weight gain endo and GP said I'm fine no further tests?

Tsh with reflex free T4 1.09, free T4 1.00 t3 (liothyronine) total 91. Feel horrible very weak, hair falling, weight gain endo and GP said I'm fine no further tests?

Thyroid: The lab numbers look OK.
Weight gain is no good for you as you know.
Please go online and look up the many articles about food. My favorite is "NuVal" - look it up.

Also consider seeing an athletic trainer. ...Read more

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TSH w/reflex to T4 was 0.25. T4 free 1.2. T3 free 2.7. 4 months ago TSH 2.01. Synthroid (thyroxine) 137mg year. Fatigue weight gain hair loss. Suggestions?

TSH w/reflex to T4 was 0.25. T4 free 1.2. T3 free 2.7. 4 months ago TSH 2.01. Synthroid (thyroxine) 137mg year. Fatigue weight gain hair loss. Suggestions?

Not hypothyroid: Your TSH was within normal range (0.4-0.6) 4 months ago indicating you were not hypothyroid then and were on the proper dose of Synthroid (thyroxine). Your current Free T4 is within normal limits. However your TSH is slightly low which suggests that your current dose of Synthroid (thyroxine) is slightly too high and can be reduced. YOU ARE NOT HYPOTHYROID and your symptoms are not due to this. ...Read more

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Tsh w\reflex to free t4 is. 22. Free t4 is 1.65 is this normal. I take 75 synthroid?

Tsh w\reflex to free t4 is. 22. Free t4 is 1.65 is this normal. I take 75 synthroid?

Yes.: All laboratory results need to be interpreted in the clinical context and the doctor who ordered the tests is usually in the best position to do that. Having said that, free T4 value is normal. The low TSH suggests need for a discussion with your doctor about reducing the dose of synthroid.
For good health - Have a diet rich in fresh vegetables, fruits, whole grains, milk and milk products, nuts, beans, legumes, lentils and small amounts of lean meats. Avoid saturated fats. Drink enough water daily, so that your urine is mostly colorless. Exercise at least 150 minutes/week and increase the intensity of exercise gradually. Do not use tobacco, alcohol, weed or street drugs in any form.
Practice safe sex, if you have sex.
Get HPV vaccine, if you are under 27 years of age. ...Read more

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I have a blood test done and my TSH reflex to free T4 is 4.53. 50-4.30 miu/l is that bad?

I have a blood test done and my TSH reflex to free T4 is 4.53. 50-4.30 miu/l is that bad?

I agree to a point!: Tsh slightly elevated. Your body thinks your thyroid is low. The most common cause for hypothyroidism is hashimoto's thyroiditis, which can be indentified by the presence of anti-thyroglobulin antibodies and anti-TPO antibodies. Have these tests. If positive, I would place you on thyroid immediately. I would also have my free-t3 checked as well. Some do not convert T4 to t3! ...Read more

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What to do if I had a blood test done and my TSH reflex to free T4 is 4.53. 50-4.30 miu/l is that bad?

What to do if I had a blood test done and my TSH reflex to free T4 is 4.53. 50-4.30 miu/l is that bad?

Further workup: A TSH above normal indicates that your brain is telling your thyroid it needs better thyroid function. Have your free T4, free T3 (liothyronine), (liothyronine) Reverse T3 (liothyronine), (liothyronine) thyroglobulin and TPO antibodies, Ferritin, and SHBG levels checked to ensure the thyroid and tissue utilization/conversion to active thyroid is occurring. Furthermore, these levels should be optimized...TSH 3.6, low Rev T3 (liothyronine) ...Read more

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I had a TSH REFLEX TO FREE T4 blood test done, my result is 3.70 (0.40-4.50 mIU/L), is this normal? Thank you.

I had a TSH REFLEX TO FREE T4 blood test done, my result is 3.70 (0.40-4.50 mIU/L), is this normal? Thank you.

Thyroid function: That appears to be within the normal range, based on the laboratory standard you provided. ...Read more

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My TSH is 9 & my TSH Reflex to Free T4 is 1.29, I still feel Fatigued & I don't feel well should I have my Dosage of Levothyroxine increase to 100 MCG?

My TSH is 9 & my TSH Reflex to Free T4 is 1.29, I still feel Fatigued & I don't feel well should I have my Dosage of Levothyroxine increase to 100 MCG?

TSH values: The TSH is your pituitary gland at the bottom of your brain talking to your thyroid gland saying "I don't see enough thyroid hormone around here." It stands for Thyroid Stimulating Hormone. You should speak to a good endocrinologist about your situation pronto and yes you should be on a higher dose of thyroid replacement hormone. ...Read more

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Tsh w reflex to free t4 component results value std range 2.55 0.45-4.5 is my test results good or bad at 2.55?

Normal: The value for TSH in the scenario you decribed is normal. However, like all lab tests, interpretation must be done with attention to the bigger picture. ...Read more

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Blood results came back with a 4.27 (h). Tsh, reflex to free T4 tsh, highly sensitive. Leukocyte esterase - moderate hemoglobin - trace / WBC 6 (h)?

Blood results came back with a 4.27 (h). Tsh, reflex to free T4 tsh, highly sensitive. Leukocyte esterase - moderate hemoglobin - trace / WBC 6 (h)?

Reverse T3 (liothyronine): Check free T3 and reverse t3. Ft3 should be in upper range and rt3 in lower range. If your ratio is off, you may need Armour Thyroid or t3, and synthroid (thyroxine) would be the wrong med for you. Also consider checking thyroid antibodies. ...Read more

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My TSH with reflex to free T4 and T3 (liothyronine) came out to a range of 1.0. Is that normal? Been feeling horrific since I gave birth 5 months ago.

My TSH with reflex to free T4 and T3 (liothyronine) came out to a range of 1.0. Is that normal? Been feeling horrific since I gave birth 5 months ago.

That's a normal TSH: Hi. That's a normal TSH, but testing TSH alone only tests dysfunction of the thyroid gland itself. You need to get a TSH AND a free T4 (i.e., NOT "reflex") to see pituitary hypothyroidism (which, btw, can occur in rare cases associated with a particularly bloody delivery). Of course many problems can make you feel horrific. Can you make milk? I don't know what is wrong, but you need further eval. ...Read more

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Hi, I am a 37 year old female. History of excessive thinning hair. My TSH reflex to free T4=. 9. My ferritin= 17. My calc % Iron Sat= 20. Thoughts?

Hi, I am a 37 year old female. History of excessive thinning hair. My TSH reflex to free T4=. 9. My ferritin= 17. My calc % Iron Sat= 20. Thoughts?

Normal: Hair thinning is a very common complaint. Usually one can find no particular cause, though many medical conditions, medications, stress, age, genetics, nutrition, all influence hair growth. Your thyroid, and iron levels appear normal and are therefore unlikely to be a cause for hair loss. ...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.

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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Blood test shows TSH w/ reflex to FT4 is 13.62 (high) & Free T4 is 1.1 (normal). How would you describe what these results mean?

Thyroid tests: 26F US had TSH 13.6 and Ft4 1.1. Asks: How could you describe what these results mean? ANS: Need 2 know lot more about U which ur Drs already knows so better to ask them. Such as 1. U on BCP? 2. Why was test done? 3. Hx of thyroid problems n past? 4. Taking thyroid meds? 5. Pregnant? As TSH is high, u did not give normal lab range for FT4 but it seems lowest range of normal. Hypothyroid? ...Read more

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My T4 free was 1.0. TSH w/reflex to FT4 was 7.97. I have been on various doses of Synthroid (thyroxine) for years. Now is 112mg. Should it be higher dose?

My T4 free was 1.0. TSH w/reflex to FT4 was 7.97. I have been on various doses of Synthroid (thyroxine) for years. Now is 112mg. Should it be higher dose?

Yes: Ideal level of TSH is 0.3 -3.0 mIU/ML. You might consider to increase Synthroid (thyroxine) (No substation) to 125 mcg/d. Make sure you to take Synthroid (thyroxine) on empty stomach, 30 min. Before breakfast and 4 hours before Calcium, Iron, Vitamins and stool softners. Recheck TSH in 4 weeks. ...Read more

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"T4 Free" is 0.7 & "TSH W/REFLEX TO FT4" is 48.46.LDL cholesterol is 158. Doctor gave pills for hypothyroid & told lowering TSH will adress LDL. True?

"T4 Free" is 0.7 & "TSH W/REFLEX TO FT4" is 48.46.LDL cholesterol is 158. Doctor gave pills for hypothyroid & told lowering TSH will adress LDL. True?

Yes: Hypothyroid is associated with elevated cholesterol. Normalizing thyroid can lower cholesterol. You will have to check it later when your thyroid is normal and see. ...Read more

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I'm on Levothyroxine and Cytomel (liothyronine) for T3 and T4 and my blood work came back TSH w/Reflex to FT4 is 0.01 L and T4, FREE is 0.6 L. What does this mean?

Several things: Hi. Without seeing your thyroid function over time, I'd say the fact that you have a goiter & 2 cm nodule (same thing, or different?) AND taking T4 AND T3 (liothyronine), (liothyronine) you may be over-treated with T3 (liothyronine) so that your TSH is suppressed and that causes low free T4, which is not made up for by the levothyroxine you're taking. I suggest you talk with your doctor, who won't have to guess like we do! Good luck! ...Read more

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I seen a thyroid specialist my TSH is low but my T4 and T3 are normal he told me that my thyroid gland is bigger then normal also I have slow reflex. My hair is thinning really bad. I'm tired all the time but he won't put me in thyroid medication why?

I seen a thyroid specialist my TSH is low but my T4 and T3 are normal he told me that my thyroid gland is bigger then normal also I have slow reflex. My hair is thinning really bad. I'm tired all the time but he won't put me in thyroid medication why?

High TSH: Current guideline for thyroid replacement if T4 and T3 normal is TSH >10. Positive antibodies against thyroid would help decision. In young women especially after pregnancy enlarged thyroid is not unusual. Sick euthyroid syndrome implies other disease (anemia, inflammation, hidden infection) that may change thyroid hormone metabolism and cause high TSH. So there are likely outstanding issues. ...Read more

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Tsh w/reflex to ft4 level is low at. 07 T4, FREE Level is with in range at 1.5 Thyroid peroxidase antibodies level high at 18 I had my thyroid removed 9 months ago due to cancer and am taking levothyroxin 125. With my latest blood results should I be con

Tsh w/reflex to ft4 level is low at. 07 T4, FREE Level is with in range at 1.5 Thyroid peroxidase antibodies level high at 18 I had my thyroid removed 9 months ago due to cancer and am taking levothyroxin 125. With my latest blood results should I be con

Post op thyroid: Surgery for cancer the replacement thyroxine should be dosed sufficient to keep TSH low to avoid stimulating any tumor remnants. Most Endocrinologists advise suppressing tsh for about 5 years. Thyroglobulin levels and antibodies should also be measured. Your TSH level appears adequately suppressed. Thanks for trusting HealthTap! ...Read more

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My TSH with Reflex was 0.011 - does this mean I need more Synthroid (thyroxine) or less. I had my gland removed several years ago. I currently take 112 mcg synthr?

My TSH with Reflex was 0.011 - does this mean I need more Synthroid (thyroxine) or less. I had my gland removed several years ago. I currently take 112 mcg synthr?

Synthroid (thyroxine) dosage: The low TSH usually means that you need less thyroid supplementation. The caveat is that your doctor may be suppressing your TSH with higher synthroid (thyroxine) dosing for other reasons eg if there was worry of thyroid cancer etc. Please check with the prescribing physician. ...Read more

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T4 free is. 87 and TSH is 1.95?

Thyroid labs: Thyroid labs are done at different institutions.
You need to ask your doctor whether your results are or are not within the reference range. ...Read more

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Hi wats does T4 and TSH measures plse? Thanks!

Hi wats does T4 and TSH measures plse? Thanks!

T4 & TSH : Thyroid: T4 & TSH are blood tests to measure thyroid activities. Thyroid, a gland in the neck area responsible for body's metabolism. When T4 is high & TSH is low, have too much thyroid hormone (hyperactive gland or taking too much thyroid supplements). If T4 is low & TSH is high, not enough thyroid hormone (thyroid not functonning well or need more thyroid supplements). ...Read more

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On 2/15 my tsh w/t4 ref was. 96 on 5/2 it was.77 should I be worried?

No: The difference in two readings is not meaningful.
For good health - Have a diet rich in fresh vegetables, fruits, whole grains, low fat milk and milk products, nuts, beans, legumes, lentils and small amounts of lean meats. Avoid saturated fats. Exercise at least 150 minutes/week and increase the intensity of exercise gradually. Do not use tobacco, alcohol, weed or street drugs in any form.
Practice safe sex.
Get HPV vaccine. ...Read more

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What is the normal T4 and TSH levels in infants?

What is the normal T4 and TSH levels in infants?

Tsh > 40 mU/L: All infants with a low T4 concentration and a TSH concentration greater than 40 mU per L are considered to have congenital hypothyroidism and should have immediate confirmatory serum testing. Replacement levothyroxine (LT4) treatment should be initiated as soon as confirmatory samples have been taken, without waiting for the results ...Read more

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What does normal tsh, but high free T4 mean?

Recheck the labs: Normally, if the ft4 is high, either due to hyperthyroidism or taking too much synthroid, (thyroxine) your TSH is low. Mistakes in labs can occur, so first have them rechecked. Rarely, you can have a pituitary tumor that makes TSH and causes hyperthyroidism, giving you both increased TSH and ft4. But this is rare, and more likely there is a simple explanation. ...Read more

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What does this test result mean? Suppressed TSH free t4?

Confusing: TSH and Free T4 are two different tests. A suppressed TSH is seen when the FT4 is too high, either due to hyperthyroidism or from taking too much levothyroxine. the FT4 should be high, although these changes can be subtle. ...Read more

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What's the difference between TSH blood test and T4 free?

What's the difference between TSH blood test and T4 free?

Free T4 is a: Measure of unbound and active thyroid hormone in the blood; it goes up as your thyroid hormone level goes up, TSH measures your pituitary gland's response to your current thyroid level. Tsh goes up when your body thinks you need more thyroid hormone. ...Read more

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What does a normal TSH level with an elevated T4 level mean?

What does a normal TSH level with an elevated T4 level mean?

Nothing: The TSH is more accurate. A free T4 is more accurate than a t4, which can be affected by many factors such as estrogen. Are you on any form of estrogen, bcp's etc? ...Read more

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What meds should I be on if my free T4 is abnormal, but my TSH normal?

What meds should I be on if my free T4 is abnormal, but my TSH normal?

How Abnormal?: Not knowing if your free T4 abnormality is high or low, I am not able to give you more information. Please provide any details you may have about your thyroid testing. Thanks! ...Read more

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Are these results normal serum free T4 level 12 and TSH 0.6 many thanks?

Are these results normal serum free T4 level 12 and TSH 0.6 many thanks?

T4: Different labs use different methods for measuring T4. Please check with your doctor whether this level of 12 is within normal range for the test or whether it is high. I suspect that the T4 at 12 is within range. Please let me know. ...Read more

Dr. David Sneid
1,420 Doctors shared insights

Thyroxine (Definition)

Thyroxine is a thyroid agent. ...Read more