High free T4 normal TSH and free T3?

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I thought I had Hashimoto's as I have goiter, intermittent hypo symptoms etc. TSH two weeks ago was 2.96

This week

TSH 1.13 (0.3-4)

Free T4 20.6 (9.8-18.8)

Free T3 4.8 (3.5-6.5)

TG Ab 30 (<60)

TPO Ab 28 (<60)

Any idea why T4 would be high when others are normal? And is there a chance it is Hashimoto's even with those levels of antibodies?

Thanks, Andrea

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14 Replies

  • Posted

    Are you on T4 replacement meds for hypothyroidism, such as levothyroxine?
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    • Posted

      Humm, do you happen to know what your TSH levels are?   T4 raises as a signal to tell your body to stop making TSH, so, it's your body saying that you actually need less TSH (Thyroid stimulating Hormone) and that it has too much.  In other words, normal TSh with a high T4, may suggest overtreatment.  Another thing that can cause normal TSH with high T4 is in which, non-compliant patients who take T4 for a few days before the clinic, thyroid function tests typically reveal normal or even elevated T4 with normal or slightly raised TSH.  So, assuming your taking your lecothyroxine as directed.. everyday, then I would say that you may be overmedicated...

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    • Posted

      Hi there,

      my boyfriend (26 years old) did some thyroid tests this week and the results are a bit confusing:

      FT4: 32.9 (9-23.2)

      TSH: 2.8

      TPO ab: 52.6 (0-60)

      TG ab: <10 (0-60)

      He doesn't take any medication and its the first time he had this kind of test.

      Why does FT4 appear so high if TSH seems normal?Is that a clue of hyperthyroidism (he is also very thin).

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    • Posted

      Look up... high T4 with a non-suppressed TSH...  Being you are not on any kind of medication for thyroid disease, this can possibly be a case of a pituitary condition?   Is the doctor saying anything yet, or is he just kind of watching for now to see what happens?
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    • Posted

      Well the doctor said that we should keep an eye on it and have new exams in one month. He found it strange for the FT4 to be high when TSH seems normal and also mentioned that the TPO antibodies price is kind of high, which i think is concerning. I can't find any explanation yet, so I guess we' ll have to wait until the next exam.

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    • Posted

      Thanks for updating!  I'm interested in knowing what may be going on..  I'll be looking forward to your next exam.

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  • Posted

    I would have to suggest that you get an ultrsound of your thyroid, as it will build a bigger picture as to what may be going on.  I do know that your T4 raises, as to tell your body to stop making TSH.  So, it seems that your body is doing just that.  Especially if you are on levothyroxine right now, then that would also be normal to have a slightly elevated t4 with normal TSH.  As the more t4 you add, the lower the TSH will be, but the higher the t4 will raise.  You should also, along with an ultrasound, get repeat blood work.  Hopefull you'll see more of what's going on.. if anything.  As far as your antibody levels.. I'm not sure.  I would keep an eye on them also though.. only because antibody levels can continually change also.  Even though they are in the normal range now, it's very possible that in a few months, they may be higher.  

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    • Posted

      Thanks very much. I did have an ultrasound which showed the multinodular goiter with solid nodules (the biggest is 5cm x 2cm) and a nuclear medicine scan showed it was cold, so now going for a biopsy. Doctor is only concerned it may be cancer but believes the thyroid is normal otherwise
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    • Posted

      Humm. interesting.  I would say that it just may well be Hashimoto's, as a multinodular goiter is actually one way doctors diagnose Hashimoto's.  I would say that your doctor does not want to give you levothyoixine yet, because your body seems to not need it yet, as it seems to be supressing the TSH okay for now, on it's own.  I would suggest posting your post in the Hypothyroidism board also.. as their are a lot more members there and you should get a lot of resposes.  People usually do on the hypothyroidism board.  They are very informative and know more then me, so they may be able to help you more and give you more advise.

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