High TSH & Normal T4: What Does it Mean? + Other Thyroid Lab Patterns

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Are you experiencing a high TSH but normal T4?

Are you confused about interpreting these values?

Is your Doctor telling you that your tests are normal even though you are experiencing abnormal symptoms?

This article will help shed light on this thyroid lab pattern and help you understand what it means. 

You’ll learn more about the symptoms associated with this pattern (and other patterns) and how to treat them below : 

Is This Thyroid Lab Testing Pattern Bad?

The first thing you should know is that having a high TSH, even if accompanied by a normal T4, is never a normal sign. 

A high TSH is a marker that the connection between your brain and your thyroid may not be functioning at 100%. 

What do I mean?

In order to understand this concept, you have to understand how TSH functions in your body. 

TSH (also known as thyroid stimulating hormone) is a hormone that is produced by the pituitary gland. 

Its job is to act on your thyroid gland (in your neck) to tell your thyroid to produce more thyroid hormone. 

If your TSH is elevated this means your brain is trying to increase the “stimulus” to your thyroid gland in an attempt to compensate for decreased thyroid hormone (1).

This process is how your brain and your thyroid gland regulate thyroid hormones in your blood. 

As thyroid hormones drop your TSH will rise to compensate to tell your gland to produce more. 

This rise in TSH is almost always seen as an early and sensitive marker for thyroid dysfunction! 

So, while TSH tells you how responsive your thyroid gland is to thyroid hormone it doesn’t give information on your free thyroid hormone levels. 

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What your Free Thyroid Hormones Mean for You (Free T3 & Free T4)

Most physicians (Doctors) tend to order what is known as a TSH with reflex to free T4 . 

This lab test is supposed to only order the free T4 IF the TSH is abnormal (2).

The idea is that it saves on the cost of unnecessary lab tests because why would you need to see the free T4 if the TSH is normal? 

So, what ends up happening, is many patients get their thyroid “checked” which results in this TSH with reflex to free T4. 

When they find that their TSH is abnormal the lab company will automatically order free T4. 

But they might get confused when the free T4 comes back as “normal” or within the normal range. 

How can this be if your TSH is high?

Several things may account for this phenomenon. 

#1. Your thyroid gland is struggling but still able to keep up… for now . 

The rise in your TSH is a normal physiologic response for lower-than-normal free thyroid hormones and it indicates that everything is working properly. 

But as TSH rises it means that your thyroid gland is no longer responsive to the lower doses of TSH that it once was. 

This usually indicates an early problem with the thyroid gland itself. 

Because your thyroid gland is getting the stimulus from the brain to produce more thyroid hormone (hence the high TSH) but it’s only capable of producing a “normal” amount of T4. 

We know this because we know what a HEALTHY TSH level is supposed to be (3).

We also know that a high TSH is not necessary to produce adequate thyroid hormones. 

So this early rise in TSH can be used as a sensitive marker for early thyroid GLAND dysfunction. 

By the way, you may find that both your free T3 and free T4 stay “normal” despite having a very high TSH. 

This is seen as your body is attempting to compensate for the early problems described above but it does NOT mean that this is “normal”. 

Eventually, your thyroid will be unable to meet the demand and you will experience severe symptoms (if you aren’t already) . 

#2. The lab tests may not be accurate . 

This one is rare but it certainly does happen. 

It is estimated that up to 5% of all lab tests may be inaccurate or spurious. 

This is as high as 1 in 20 lab tests and if you get a full panel of lab tests you can count that at least a few of those results are not 100% accurate. 

This inaccuracy stems from the fact that lab testing machines must be calibrated to normal each and every day. 

If there is something wrong with the machine for one test or the calibration is not done accurately, then some of the lab tests may not be accurate. 

So what should you do if you feel that your results are not accurate?

The best thing to do is to simply re-test your TSH and free T4 within 1-2 weeks. 

The chances of your lab tests being inaccurate are very low, but it’s worth going through this song and dance if you don’t have any symptoms and feel great. 

#3. You may have Hashimoto’s Thyroiditis . 

Another possibility is that you have an autoimmune disease known as Hashimoto’s thyroiditis . 

It is well known that this thyroid condition can cause changes to thyroid lab tests which are not considered to be “normal” (4).

In fact, many patients with Hashimoto’s are not treated sufficiently because their symptoms do not always correlate with their lab results. 

When in doubt, make sure that you always look at your body and your symptoms and don’t focus solely on your lab tests. 

If you suspect that you may have Hashimoto’s you can easily check for this condition with a blood test which checks for thyroid antibodies. 

#4. You may not be converting T4 to T3 . 

Lastly, it’s possible that you may not be seeing the “whole picture” when it comes to your thyroid. 

While your TSH and free T4 are important measures of thyroid function they do not test every facet of thyroid function in your body. 

One of the most important (if not the most important) lab test to look at when it comes to your thyroid is known as free T3 . 

Free T3 is the ACTIVE thyroid hormone and it is created through a process known as thyroid conversion . 

In this process, your body takes free T4 and turns it into free T3. 

So, why does free T3 matter? 

Consider this scenario:

Imagine that your TSH is high and your free T4 is normal but you decide to check your free T3 as well. 

You may find that your free T3 is actually quite low which indicates that your body can produce some amount of T4 but it’s not able to convert that T4 into T3. 

This is known as a problem with thyroid conversion and can be entirely missed unless you also check for your free T3 .

For this reason, I always recommend that you look at a complete thyroid panel (if you suspect you have thyroid disease). 

If you didn’t get a full thyroid panel to start with you can always go back and get everything retested. 

Symptoms Associated with a High TSH

Will you have symptoms if you have a high TSH and a normal T4?

You might expect that you would be without symptoms if your free thyroid level is “normal” but that isn’t always the case. 

In fact, most patients with a high TSH (regardless of their free thyroid hormone levels) may be symptomatic. 

A handful of patients may be asymptomatic (meaning they won’t experience symptoms) most likely due to their body having a “reserve” level which can keep them going for some time. 

But, if you are like most people, you may start to experience certain symptoms. 

In fact, these symptoms may be the reason you went to your Doctor in the first place and had your blood work checked. 

The symptoms associated with a high TSH are easy to identify because they are the symptoms of low thyroid function or hypothyroidism. 

Symptoms of a high TSH and normal T4 include:

  • Mild weight gain (usually no more than 2-5 pounds)
  • Cold intolerance or feeling like you are cold all the time
  • Mild constipation
  • Feeling “down” or “depressed”
  • Mild brain fog or clouded thinking/judgment

The degree of symptoms that you will experience will depend on the degree of elevation of your TSH (5).

Put simply:

The higher your TSH, the more your thyroid gland is compromised and the more severe your symptoms will be.

So, you may experience only mild weight gain if your TSH is in the 3-5 range, but that weight gain will be more severe if your TSH is 5-10, and so on. 

These symptoms are an indication that your thyroid is NOT functioning properly and are a sign that you should seek out therapies to try and fix the problem. 

Treatment Options + What to do next

So what should you do if you have a high TSH? What therapies are available to you?

The first thing you should do is to make sure that your test results are indeed legitimate. 

That means that your lab results should match your clinical appearance. 

If you are completely asymptomatic, meaning you are not experiencing any of the symptoms listed above, then it may be reasonable to simply recheck your blood work in 6-8 weeks to see if your test was accurate. 

If you are symptomatic, however, then you can safely assume that your thyroid is not functioning appropriately. 

This would be an indication that some sort of intervention is warranted. 

In terms of the type of treatment available you really have a couple of options: 

#1. Treatment with thyroid medication

The most common treatment for a high TSH is to take thyroid hormone replacement medication. 

This medication, usually in the form of T4 such as Levothyroxine , will help supplement your body with extra T4 which will, in turn, drive down your TSH to normal levels . 

This is the theory behind using thyroid medication to help if you have thyroid dysfunction. 

The problem is that not everyone will do well on T4-only thyroid medications (even though they are the most commonly prescribed). 

Previously, I mentioned that you may have an issue with thyroid conversion which leads to low free T3. 

If you fit this category then you may need to use a thyroid medication that contains both T4 and T3. 

These therapies should always be combined with #2…

#2. Treatment with Alternative Therapies Including Diet and supplements. 

These therapies shouldn’t be considered “alternative” at all because they are really the single best way to improve your thyroid and other hormones. 

Using basic therapies which include eating a more healthy diet, taking vitamins and nutrients which you may be deficient in, and exercising regularly should never be ignored if you have a thyroid issue!

Study after study has shown that these therapies do indeed help to reduce inflammation (6) and promote hormone balance (7).

The problem is that many patients forgo these therapies in favor of taking medications!

This behavior only reinforces future problems and never actually allows your body time to improve. 

In terms of your diet, you can read more about the type of healthy foods you should be eating in this article . 

For supplements, you’ll want to focus on nutrients and vitamins which have been shown in scientific studies to improve your thyroid. 

I recommend a supplement such as this one which contains all of these nutrients . 

In addition to these therapies, you’ll also want to ensure that you are sleeping 8 hours each night and managing your stress appropriately!

Doing these things, in conjunction with thyroid medication (if necessary) will go a long way toward helping you feel better. 

What if you have a High TSH and a Low T4?

Does anything change if you have a high TSH and a low T4 or low T3? 

The answer is no. 

The difference between those who have a high TSH and a low or normal T4 likely has to do with their “reserve capacity” for thyroid function. 

In other words, some people are probably able to tolerate different levels of T4 without becoming symptomatic due to either the number of thyroid receptors they have on their cells or due to receptor sensitivity (they may be more or less sensitive to thyroid hormone than you). 

So, don’t be too concerned with your absolute T4 or T3 level, instead, try to focus on whether or not you have both a lab abnormality combined with symptoms. 

The combination of these two factors will give you the most information and help you zone in on a diagnosis. 

If you have low T4 you can read more about that condition here . 

Other Thyroid Lab Patterns which May Result in Hypothyroid Symptoms

Are your lab tests slightly different than what we discussed here?

Don’t worry!

I’ve included a list of various other lab tests below and how they may present in terms of your symptoms:

  • High TSH, normal T4, normal T3 = This is the pattern we’ve been discussing in this post and will usually present with hypothyroid symptoms. 
  • High TSH, normal T4, low T3 = This pattern may be an indication that you are having issues with thyroid conversion and most often presents with hypothyroid symptoms. 
  • Normal TSH, low T4, low T3 = This pattern is usually what is seen in those with chronic illness and in those who are taking multiple medications. If you have this pattern you will most likely be symptomatic. 
  • Normal TSH, normal T4, low T3 = This pattern may be consistent with low T3 syndrome or euthyroid sick syndrome and may present with hypothyroid symptoms but not always. 
  • Normal TSH, normal T4, normal T3, positive thyroid antibodies = This is a classic presentation for early Hashimoto’s, and most patients with this pattern will be symptomatic. If you are symptomatic this is a valid reason to consider a trial of thyroid medication even though your lab tests are “normal”. 
  • Normal TSH, normal T4, normal T3, high reverse T3 = This pattern is most often seen immediately after calorie restriction or after dieting and weight loss. This pattern usually indicates an adaptive response from your body and one that shows your metabolism will be slowing over the next few months (not ideal for weight loss). 

This isn’t a comprehensive list of all of the thyroid patterns available, but it should really give you a good starting point if you aren’t sure where you “fit in”. 

Lastly, if you have any questions about your labs feel free to leave a question or a comment below and I can try to direct you further! 

The bottom line?

Your TSH and your free T4 are connected and changes in one will often time result in a change in the other. 

Don’t let a single “normal” lab result in a sea of abnormal results alter how you look at your thyroid lab tests. 

It’s not abnormal for one result to be “normal” even though many others are obviously abnormal. 

Lastly, make sure that you listen to your body and your symptoms. 

You are more than just your lab results!

Now I want to hear from you:

Do you have a high TSH with a normal T4? 

What about your free T3 levels?

Have you had a complete thyroid lab panel?

Leave your questions, comments, or answers below! 

#1. https://www.ncbi.nlm.nih.gov/pubmed/402379

#2. https://www.ncbi.nlm.nih.gov/pubmed/28938415

#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245392/

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075814/

#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497160/

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629815/

#7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811358/

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

P.S. Here are 4 ways you can get more help right now:

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Why is My T4 Low (and What Can I Do About It)?

  • Lab Tests     Thyroid
  • / By Dr. Jeff Whelchel
  • / 46 COMMENTS

Do your lab tests show that your T4 level is low?

What does that mean exactly?

Do you also have symptoms such as fatigue, weight gain, hair loss, constipation, and depression?

If you answered yes, you most likely have hypothyroidism which usually causes a low T4 level.

In this article, I will discuss the T4 lab test, what it means when it is low, symptoms that may be associated with a low T4 level, and I will also give some treatment tips that will help raise it to an optimal level.

Let's get started...

What is T4?

So what is T4 anyway? 

In order to answer that question, we need to talk about the thyroid gland and how it works.

The thyroid gland primarily produces 2 types of thyroid hormone - Thyroxine (T4) and Triiodothyronine (T3) .

The vast majority of the thyroid hormone produced is thyroxine (T4).  Not nearly as much triiodothyronine (T3) is produced.

Both of these hormones are produced in response to a hormone secreted by the pituitary gland called Thyroid Stimulating Hormone (TSH).

The association of TSH and T4 gives us valuable information about how well the thyroid gland is working. That is why these tests should always be tested together.

So what is the purpose of T4 in the body?

T4 is not nearly as biologically active as T3 , but it still helps regulate how much T3 is available in the body.  

Most of the T3 in the body is actually produced from peripheral conversion of T4.  

More specifically, as the body needs T3, an enzyme called a deiodinase will cleave off an iodine molecule from T4 which converts it into T3.

You can therefore think of T4 as a storage reservoir for the body to use to make T3 as it needs it.  This is the primary purpose of T4.

Causes of Low T4

So what happens if the T4 level is low?

If the reservoir of T4 becomes low in the body (sort of like most of the lakes in the Texas Panhandle where I live), then there is not enough substrate that the body can use to produce T3.

The T3 levels then also drop, and symptoms of hypothyroidism develop.

Why does the T4 level drop?

Let's discuss the most common causes:

1.  Autoimmune Thyroiditis (Hashimoto's) -

There are many theories about how and why autoimmune disorders develop.

It is generally accepted that 3 things must be in place for an autoimmune disorder to develop.

  • Genetic Predisposition - You have a variation in one of your genes that may make it more likely to develop an autoimmune condition.
  • Leaky Gut - The bacterial levels and types of bacteria in your GI tract may be inadequate.  Also, gaps between the cells in your intestines may widen which allows foreign proteins and toxins to enter the bloodstream that wouldn't normally get through.
  • Trigger - A physical or emotional event may occur (injury, surgery, major life stress, etc.), or you may be exposed to an environmental toxic of some sort which can damage your immune system and cause it to function improperly.

A common theory is that some of these foreign proteins that enter our bloodstream look similar to proteins in our body.  As a result, as our immune system makes antibodies against these foreign proteins, it in effect also unintentionally makes antibodies against parts of our body.

This is called molecular mimicry .

This appears to be what happens in Hashimoto's Thyroiditis.

The result is these auto-antibodies continuously attack parts of our thyroid gland, gradually destroying it.

As the cells of the thyroid gland are destroyed, its ability to produce thyroid hormone is impaired and hypothyroidism will develop.

This typically occurs slowly over many years.

Often patients will have classic symptoms of hypothyroidism, but their labs will remain relatively normal until late in the process.

Hashimoto's is an extremely common condition .  In fact, in my medical practice I typically diagnose one or more people with it every week!  It is by far the most common autoimmune disorder.

Many experts believe that the vast majority (over 90%) of hypothyroidism in the United States is actually caused by Hashimoto's.

If you have hypothyroidism, you should periodically have your thyroid antibody levels checked.

Click here to read more .

2.  Hypothyroidism -

Hypothyroidism refers to the condition of low levels of thyroid hormone in the body.

The majority of cases are due to issues with the thyroid gland itself.  Rarely, it can be caused by issues in the brain ( hypothalamic dysfunction ).

Since most thyroid hormone in the body is T4, if you are hypothyroid, you will have low levels of T4.

That, however, does not give you enough information.  You need to investigate WHY you have hypothyroidism so that you can be appropriately treated.

As we discussed earlier, the majority of hypothyroidism is caused by Hashimoto's Thyroiditis.

3.  Nutrient Deficiencies -

There are multiple (at least 13) nutrients that are needed for proper thyroid hormone production and conversion.

A deficiency of even one of them can result in a significant reduction in thyroid levels which will cause symptoms of hypothyroidism.  It can also cause an increase in thyroid antibody levels if you have Hashimoto's.

These nutrient deficiencies can include (click on the names for my preferred brands):

  • Vitamin B12 - up to 40% of hypothyroid patients are deficient in vitamin B12 .
  • Iodine - Iodine deficiency is common in the US due to the Standard American Diet and soil depletion from over-farming.  Iodine is essential for normal thyroid production.
  • Iron - Iron deficiency is common in women due to menstrual issues and poor gut absorption.
  • Selenium - a selenium deficiency impairs conversion of T4 to T3 .  Supplementing selenium can also help reduce thyroid antibodies if you have Hashimoto's.  Read more about it here .
  • Zinc - Zinc is required for T4 to T3 conversion.  A deficiency causes elevated reverse T3 levels which can reduce thyroid function .  It is also a great anti-inflammatory and boosts immune function .  It should usually be taken with selenium.
  • Vitamin D - Vitamin D deficiency has been associated with several autoimmune disorders , including Hashimoto's.
  • Magnesium - Magnesium is essential for thyroid hormone production and conversion of T4 to T3.

So, should you just blindly supplement with all or most of these supplements if you have thyroid issues?

Of course not!

You should always see your doctor and be tested for any nutrient deficiencies before supplementing, or at least look for common symptoms associated with particular deficiencies.  If you have a symptom or symptoms commonly seen with one of these nutrient deficiencies, then a trial of supplementation is reasonable to consider.

It is also always best to start with your diet.  Eat a diet high in nutrient-dense, organic foods which will contain a much higher nutrient content than the Standard American Diet.

4.  Taking a T3 Only Medication -

If you are taking a T3 only medication, it will often result in a drop in your T4 level.

T3 only medications include Cytomel and liothyroinine.  

Why?  It makes sense if you think about it.

Like we learned earlier, T4 acts as the storage reservoir for T3 in the body.

If you are taking a T3 only medication, then your need for that reserve of T4 decreases because you have bypassed the conversion process.  This therefore results in less T4 production by the thyroid gland.

Taking a T3 only medication will typically cause the free T4 level to decrease, the TSH level to decrease, the reverse T3 level to decrease, and the total T3 and free T3 levels to increase.

This can also happen to a lesser extent if you are taking a natural dessicated thyroid (NDT) such as Armour Thyroid, NP Thyroid, or Nature-throid.  That is because these medications contain about 20% T3 and about 80% T4.

The drop in T4 level in this case is expected and what you want.   It is not a sign of inadequate thyroid levels like it is in the other situations.

Symptoms of Low T4

Having a low T4 level typically results in all of the classic symptoms of hypothyroidism.  

The list of symptoms can be quite exhaustive, but the most common include:

  • Weight Gain
  • Constipation
  • Cold Intolerance
  • Brittle Nails
  • Menstrual Irregularities
  • Infertility

For a more extensive list, click here .

The vast majority of doctors have been taught to use the TSH as their sole means of evaluating thyroid function.

In many cases of hypothyroidism, the TSH will remain normal until it has been present for many years. This is true with Hashimoto's as well.

The T4 and T3 levels will typically drop earlier in the process than will the TSH.

That is another reason why you should ALWAYS ask for a complete thyroid panel when your thyroid is being evaluated.

How to Raise Your T4

Fortunately, raising your T4 level is usually straight-forward.

Reversing what is causing your low T4 is the key to successful treatment.

You will either want to increase the thyroid hormone your body produces itself, or you will need to supplement what your body produces with a thyroid hormone medication.

1.  Lifestyle Interventions -

Improving your diet, beginning an exercise program, improving gut function, and reducing stress should always be the first steps taken when treating ANY condition.  The thyroid is no exception.

2.  Correct Any Nutrient Deficiencies -

Identifying and correcting any of the nutrient deficiencies we discussed earlier will result in an increase in your body's natural thyroid production and T4 to T3 conversion.

3.  Supplement with a T4 Thyroid Hormone - 

Taking a T4 only medication such as levothyroxine, Synthroid, or Tyrosint will result in an increase in the T4 level in the body.  

Keep in mind that if you have T4 to T3 conversion issues because of a nutrient deficiency or inflammation in the body (insulin resistance, leptin resistance, an autoimmune condition, etc), raising your T4 level may still not result in adequate T3 levels reaching the cells.  Symptoms of hypothyroidism may still not improve.

4.  Reduce Thyroid Antibody Levels -

If you have Hashimoto's, there are dietary, supplement, and medication therapies that can help reduce thyroid antibody levels.  This will improve thyroid function and will help to raise the T4 to an optimal level.

5.  Take T3 Thyroid Hormone -

In addition to or even in place of T4 thyroid hormone, T3 hormone medication can be taken.

That may cause the T4 level to drop, but that is not a bad thing in this case.

There is an art to using T3 medication, so it is important that you find a medical provider with experience in using it.

Click here to read more.

A low T4 level is commonly seen in hypothyroidism.  It is often present before the TSH level becomes abnormal.

A low T4 is associated with several symptoms that can dramatically alter your quality of life.

Treatment to increase T4 levels typically involves correcting nutritient deficiencies, reducing inflammation, and taking thyroid medication.

Now it's your turn...

Is your T4 level low?

Is your TSH level low, normal, or high?

Are you having symptoms of hypothyroidism?

What treatment plan are you using?

Leave any questions or comments below.

About the Author Dr. Jeff Whelchel

Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.

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46 comments

Please add me to your comments when posting new thyroid updates.I had my thyroid taken out because of cold nodule

Hi Janice. If you will click on an article on my website, a popup window should appear asking if you want to join my newsletter for free. If you will sign up there you will get an email every time a release a new article. Take care.

On levothyroxine…levels better but symptoms continue. Have all symptoms. Advice? Doctor only checks TSH and T4.

My advice is to ask your doctor to also check a free T3, reverse T3, TPO antibodies, and thyroglobulin antibodies. If they won’t, then find a different doctor. Your thyroid hasn’t been fully assessed yet.

You have simplified the answers I have been looking for. Thank you so much much for this!!

Diagnosed Hashimoto for 12 years. 42 years old. My tsh is 1.68, free t4 0.7, ft3 2.73, total t3 108. I am on np thyroid and lots of vitamins. My hair is thinning I feel anxious and have some insomnia. I stopped the selenium and iron for a bit bc I was on the high end but thjnking I should add back in. I also take a low dose of algazim (kelp iodine). My question is where should my free t4 be. Are my symptoms bc of the low free t4?

I think your issues are more low t3 which I like >3.5. You need to sit down with your doctor about it. I hope you feel better soon.

i have just been informed that my T4, free is 0.78 results low….what does this mean?

It is impossible for me to interpret just a single lab result. I would need to see the complete thyroid panel plus get a history of symptoms and other medical issues.

Thankyou for your thoughtful discussion of the delicate balance – I am using NP thyroid and now my all my levels are low TSH as well so my symp are hypo. And I’ve been treated for hypo but now my TSH seems to indicate Hyper! I need to find a good specialist to get on track and am not sure if I should just stop the NP thyroid until I do get to doctor -as it hasn’t been effective and it has been 6 months. I am at 90 mg . Do you think I should stop it I’ve now heard verybad reports 0f that particular drug.

Hi Christine. I would NOT stop the NP thyroid. In my experience, your TSH may have to be suppressed in order to get your free T3 and free T4 levels in the optimal range. Please follow up with you doctor and communicate any symptoms or side effects that you are having.

Dear Dr Whelchel, I understand what you said about T4 not being relevant if you are on T3, but I have not found this to be the case. i am hypopituitary and my T4 went down to 1 (the lowest in the Uk range is 12) and I have been very unwell for several years, thinking that my T4 did not matter. A new endicronologist said that this was not true and I was in real danger. I have now added T4 (as well as T3) and been working for months to bring myself into range (still not there) and still suffer extreme fatigue. I would be interested to know your thoughts. Kindest, Sophie

Hi Sophie. I did not mean that T4 is irrelevant. My intent was to say that I am not concerned if the T4 level drops a bit when someone it taking a T3 medication. Everyone is unique and different. If keeping your T4 level higher helps you, then great! I’m glad you found something that helps.

Hi my T4 levels are in 2013 8.9, in 2014 10.1, and in 2019 11.2, do you think this is low? my doctors are dismissive as the other level is normal, but i do have a few of the symptoms suggested and my mother was also given thyroid medication in her 60ies. I am 66.

Hello. It’s really impossible for me to answer that without knowing more of your history and seeing all of the lab results.

DR Jeff: Excellent article and really helped my understand the likely treatment path for my high TSH/low T-4 levels!

Thank you for the compliment. I’m glad it helped you.

Really enjoyed this article on thyroid levels. You explained it very well.

Is Armour Thyroid a T-3 only medication? I do not have Hashimoto’s and Synthroid and levothyroxine have not resolved issue of low T4. Switched to Armour Thyroid, but still low T4, so your helpful article caused me to wonder if it is a T3 only medication. Thank You for this helpful article.

Armour Thyroid is about 80% T4 and 20% T3. You likely need to increase the dose of your thyroid medication, even if it makes your TSH become suppressed.

my free t4 is 0.7 and my tsh 1.92 what should i be eating to get my free t4 up to normal

Diet alone may not be enough to raise your free T4 level. I would also recommend that you get a complete thyroid panel drawn – TSH, free T4, free T3, reverse T3, TPO antibodies, and thyroglobulin antibodies. The 2 lab results just don’t give enough information to know what is going on with your thyroid.

Hi Dr Whelchel, My free t4 is .6, tsh .010, thyriod perixdase antibody 198, free t3 is 3.8. I am on 25mcg of lio, 75mcg of levo both one per day. I am still flaring and get horrible facial swelling. What are your thoughts?

Sorry you are still flaring. Your lab results aren’t surprising in light of your Hashimoto’s and taking T3. I would be focusing on lifestyle issues – gluten-free, dairy-free, good sleep hygiene, stress management, etc. All of that should help.

I’m 35, and I had diagnosed with hypothyroidism five years. Though, the TSH level was 149. I had no symptoms of hypothyroidism. I repeated the test in different laboratories, but the result was the same. My doctor advised me to take thyroxin (100Mg) for three months, and I started medication based on that. Then the doctor advised me to check my TSH after one week. Surprisingly the TSH level dropped to 4.0. ( FreeT3 and T4 were also in the normal range). The doctor then advised me to stop the medication. Two days back, I again had a check-up. In the report, my TSH level was 93.97. But, still, I do not have any symptoms. Also, I have a deficiency of sodium and VitaminB12.

Below is my test report,

Thyroid Stimulating Hormone (TSH) 93.97ulU/mL (Ref range:0.450 – 5.330) Tri-iodothyronine – Total (TT3) 1.67nmol/L (Ref range:1.34 – 2.73) Thyroxine- Total (TT4) 54.69nmol/L (Ref range:78.38 – 157.40) Testosterone – Total 3.62ng/mL (Ref range:1.75 – 7.81)

I seek your advice.

Hello. I would need several other lab results before I could accurately assess your situation. I would need to know the free T4, free T3, reverse T3, TPO antibodies and thyroglobulin antibodies. Based on just the TSH alone you are hypothyroid, but more workup is needed.

Thank you, Dr Jeff. I will be back with the suggested test reports.

The requested lab reports are ;

Tri-iodothyronine – Free (FT3) 5.38 pmol/L(Ref3.80 – 6.00)

Thyroxine – Free (FT4) 5.00 pmol/L(Ref 7.86- 14.41)

Thyroid Stimulating Hormone (TSH) 78.480 ulU/mL(Ref 0.450- 5.330)

Thyroglobulin Ab (Anti-Tg) >2500 (Ref10000 (Ref<9)

The result, after appropriate dilution, is above the Clinically Reportable Range(CRR) of the assay. The upper limit of detection which is 10000 IU/mL have been Reported

Your labs look like severe Hashimoto’s thyroiditis with secondary hypothyroidism. You need to see someone near you that is a thyroid specialist.

I have hashimotos I take 75 mcg Tirosint and 40 mcg liothyronine .. my labs showed my free T 4 is below range . .. Do I increase the Tirosint ..? Thank you

That all depends on what the other labs show. Liothyronine tends to suppress T4 levels, so it may not be needed. However, in order to answer your question, I would need to know the TSH, free T3, and reverse T3 levels.

thx, very informative in layman’s terms.

Thank you for the compliment.

Is it normal for my FT4 to drop after starting Tirosint? I was at .82 and 6 weeks in it had dropped to .79. My FT3 did rise from 2.36 to 2.76 though. It just seems strange thistle I’m taking T4 meds and yet mt T4 is dropping. Some symptoms are still there, others seem to be a little better.

I would suspect that the slight drop in your FT4 is likely due to lab variance. If anything, taking T4 medication should raise your FT4.

My first results were high TSH and low FreeT-4, I had never been tested for this before, so before starting medication I requested a retest, My Dr. agreed, re-tested and free T-4 , .064, and TSH 10.3072, but I see nothing for T-3, reverse T-3, TPO, and thyroglobulin anti-bodies. Are these necessary for treatment?

Those results definitely fall in the hypothyroid range. I would insist on getting the other lab tests before starting any treatment, however. They will influence what your best treatment would be.

My tsh 8.600 , free T4 0.47, free T3 3.3 take np thyroid 60 because others side effects cant T the right level. Called Dr. today waiting for answer iam 83 , since fall 99 is 60 too high of mg or what

60mg is a very common dose. I have some patients that have to take 180mg or more. Just be careful at your age and notify your doctor if you develop any symptoms of hyperthyroidism – palpitations, shakiness, tremor, etc.

Hi Dr Whelchel , this are my recent labs, my t4 levels go up and down all the time and my Pcp doctor don’t see the necessity to treat it, so I went to an endocrinologist, and we will see what happen. I would like to know your opinion though, thank you. Trans. Growth Fact. beta 1* 01 7525 High, T4,Free(Direct) 02 0.77 Low, TSH02 3.470 ,Complement C4a03 1063.0 High, Reverse T3, Serum A, 03 10.6,MTHFR, DNA Analysis 04 Result: c.665C>T (p. Ala222Val), legacy name: C677T – Detected, Thyroid Peroxidase (TPO) Ab02 <9 ,Thyroglobulin Antibody 02 <1.0 ,Triiodothyronine (T3), Free 02 2.3

Hi Andrea, Those results would definitely fall into the hypothyroid range. If your doctor won’t offer a treatment, you may need to seek another medical provider.

Very informative easy to understand. Thank you!!!

I am on levothyroxin and Liothyronine. My new primary care physician reduced my levoththyroxin after lab results showed my T4 was “suppressed”. He said it would help my fatigue. My impression from this article is that information may not be correct. Am I interpreting it correctly?

Do you do phone consultations? No one can seem to get my hypothyroidism under control.

Hello, I have hashimotos, my TPO antibodies are well above 900 (labs max). I take NP thyroid 60mg daily. My question is would NP thyroid cause further increase in TPO antibodies? Since it’s similar to thyroid tissue. Wondering if going to levothyroxine would help reduce TPO for me. Thank you.

In all my seventy plus yrs on earth . No physician had taken time to break things down like Dr Whelchel.

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T4, Total (Thyroxine)

Thyroxine (T4) is a hormone produced by the thyroid gland. It is sometimes called total thyroxine because it includes both free T4 and T4 bound to proteins. Thyroxine is only one-tenth as potent as the other major thyroid hormone, triiodothyronine (T3). Moreover, the portion of thyroxine that is biologically active is free T4, that is, the portion of T4 that is not bound to proteins in the blood. Greater than 99% of thyroxine is bound to serum proteins. Thyroxine acts on almost every cell in the body. It sets the metabolic tone of cells. Thyroxine is critically important for the growth and development of fetuses, neonates, and children. The thyroid gland produces and stores thyroxine until it is needed for release. The thyroid gland releases T4 when it is stimulated by thyroid-stimulating hormone, also known as TSH or thyrotropin. Free thyroxine is often more useful than total thyroxine (total T4) in assessing thyroid function, but total T4 can be a useful biomarker in some cases.

Normal Ranges for Total T4:

Adults: 4.5-111.7mcg/dL

0-5 days: 5.0-18.5 mcg/dL

6 days-2 months: 5.4-17.0 mcg/dL

3-11 months: 5.7-16.0 mcg/dL

1-5 years: 6.0-14.7 mcg/dL

6-10 years: 6.0-13.8 mcg/dL

11-19 years: 5.9-13.2 mcg/dL

http://www.ncbi.nlm.nih.gov/books/NBK285568/

http://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function

http://www.ncbi.nlm.nih.gov/pubmed/12625976

https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8724

http://dx.doi.org/10.1001/jama.1990.03440110095035

http://www.uptodate.com/contents/thyroid-function-in-nonthyroidal-illness

http://www.ncbi.nlm.nih.gov/pubmed?term=7920008

http://www.ncbi.nlm.nih.gov/pubmed/6687730

http://www.uptodate.com/contents/overview-of-thyroid-disease-in-pregnancy

http://www.uptodate.com/contents/diagnosis-of-and-screening-for-hypothyroidism-in-nonpregnant-adults

https://www.uptodate.com/contents/diagnosis-of-hyperthyroidism

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Elevated thyroxine levels may indicate hyperthyroidism, thyroid hormone resistance syndrome, or thyroxine toxicosis. Elevated thyroxine may cause symptoms of hyperthyroidism including excessive appetite, anxiety, heart palpitations, sweating, shortness of breath, weight loss, and intolerance to heat. 

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  • Today's Posts
  • New Holland/Ford
  • New Holland Owning/Operating

Brand New T4.75 already having major issues

  • Thread starter voltedge
  • Start date Mar 24, 2016

Hi, I have progressively moved up in tractor size from the start 20 years ago with my Kubota B Series up through the JD 4105 and now the NH T4.75 Cab. I went all out and ordered the tractor last October after attending the Sunbelt Ag Expo and actually drooling over all of the latest tractors. Well, we just picked up the new T4.75 2 1/2 weeks ago and it was pretty much awesome from the onset, on the surface that is. I finally got my new 3 pt tiller hooked up and attempted to till a trial 1/2 acre vegetable plot on Monday. It worked fine for about 45 minutes, although I hate the manual engaged PTO lever. I had to stop and take a phone call, and when I restarted, the PTO would not restart! Again, I actually hate the manual PTO, heck, my lawn mowers even have an electric engaged system! Why would NH put all of the bells and whistles on this cab tractor and skimp here? Anyway, I am 50 miles to the closest two dealers and they're both backed up two weeks plus. That's not including the wait for parts etc. We are a growing vegetable farm and don't have two weeks to wait, considering that we must get the spring cool weather crops sewn asap before it gets too hot here in N GA. Both dealers agreed that I could and should remove the left side trim panel and check the lever and cable mechanism for any issues. I attached a pic of the unit and I adjusted the cable both ways and it still seems to engage the PTO whenever it feels like it. I got under the tractor and traced the cable to the point that it enters into the trans/case and there is no visible adjustment there. Unfortunately, while under the tractor, I found a fairly messy fluid leak where the diff/trans housings join together. It has blown fluid all over the underside of the tractor, but not enough that it has visible dripping on the ground. It does have fluid accumulated that is ready to drip though. Anyway, for a brand new tractor that msrp was $66k and I paid $52k, I am not at all happy at only 13.6 hours! I ordered this tractor specifically with every available option and this is what I end up with! Is there any type of lemon law such as vehicles on tractors? Anyone else have similar issues and what did you do to resolve them? Thanks for your time and input.  

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Gary Fowler

Super star member.

Perhaps the dealer will loan you a tractor to do the tilling with while he works on yours. Little small problems can sometime be aggravating and costly due to down time. Sometime it is better to buy a slightly used tractor that already has all these small issues fixed. I would be talking to the dealer quickly and see about getting your tractor in and a loaner while he works on it. Even if a lemon law existed for tractors (I don't think they come under a lemon law) you haven't had enough problems to even be considered a lemon. Lemon laws affect repetitive problems that don't get fixed satisfactorily. You problems might all be fixed at your farm by a service guy. I would discuss that with the dealer first before hauling it in.  

TSO

Elite Member

I wouldn't call it a lemon yet! It's very likely that these are very minor issues, and this is what you have a warranty for. Let the dealer fix out and enjoy your new tractor... those are nice looking machines.  

  • Thread Starter

I love forums! Always gotta be a smart mouth with something to say about how someone posts. If you don't like it, don't read it and move on. Thank You for your advice.  

kf4uda

Veteran Member

I too would check with the dealer that you purchased from and see if they will loan you a tractor to get your work done while they resolve your issues. If you cant get any satisfaction from the dealer, I would contact New Holland and discuss your problems with them. Good Luck  

voltedge said: I love forums! Always gotta be a smart mouth with something to say about how someone posts. If you don't like it, don't read it and move on. Thank You for your advice. Click to expand...

I think he meant the person who commented about "paragraphs" Edit: looks like that post was already deleted  

ovrszd

Epic Contributor

mkr7734

Gold Member

Jerry/MT

voltedge said: Hi, I have progressively moved up in tractor size from the start 20 years ago with my Kubota B Series up through the JD 4105 and now the NH T4.75 Cab. I went all out and ordered the tractor last October after attending the Sunbelt Ag Expo and actually drooling over all of the latest tractors. Well, we just picked up the new T4.75 2 1/2 weeks ago and it was pretty much awesome from the onset, on the surface that is. I finally got my new 3 pt tiller hooked up and attempted to till a trial 1/2 acre vegetable plot on Monday. It worked fine for about 45 minutes, although I hate the manual engaged PTO lever. I had to stop and take a phone call, and when I restarted, the PTO would not restart! Again, I actually hate the manual PTO, heck, my lawn mowers even have an electric engaged system! Why would NH put all of the bells and whistles on this cab tractor and skimp here? Anyway, I am 50 miles to the closest two dealers and they're both backed up two weeks plus. That's not including the wait for parts etc. We are a growing vegetable farm and don't have two weeks to wait, considering that we must get the spring cool weather crops sewn asap before it gets too hot here in N GA. Both dealers agreed that I could and should remove the left side trim panel and check the lever and cable mechanism for any issues. I attached a pic of the unit and I adjusted the cable both ways and it still seems to engage the PTO whenever it feels like it. I got under the tractor and traced the cable to the point that it enters into the trans/case and there is no visible adjustment there. Unfortunately, while under the tractor, I found a fairly messy fluid leak where the diff/trans housings join together. It has blown fluid all over the underside of the tractor, but not enough that it has visible dripping on the ground. It does have fluid accumulated that is ready to drip though. Anyway, for a brand new tractor that msrp was $66k and I paid $52k, I am not at all happy at only 13.6 hours! I ordered this tractor specifically with every available option and this is what I end up with! Is there any type of lemon law such as vehicles on tractors? Anyone else have similar issues and what did you do to resolve them? Thanks for your time and input. Click to expand...

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