High TSH, low fT3. What does it mean?

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My lab results just came back...


4.54 (0.27 - 4.20) uIU/mL

T3, free

3.6 (2.0 - 4.4) pg/mL

T4, free

1.24 (0.93 - 1.70) ng/dL

My body temperature is at 96.9

What is the above result an indication of?

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  • Posted

    Hello Exclix

    My name is Shelly and I am a nurse in the USA.  I have Hashimoto's thyroid disease since 1987.

    You have Hypothyroid as your TSH on the high end of the scale.  The low end is Hyper. So you are at 4.54 and that means not enough hormone in you. It  should be 1.0 to 3.0  reduce symptoms.  It takes replacement hormone to bring it down.

    T3 Free is the amount of free Liothyronine (which is T3)  in your system.  This is the useable hormone in the body. Your level is okay as per your blood report above.

    T4 free is the amount of thyroxine (called T4) in your system.  that is good per your blood.

     Low body temp and normal is 98.6 F. Most thyroid people are low temp. It is a symptom.

    So you have Hypothyroidism  are you on Sythroid or Levothyroxine?

    Any questions just ask,



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  • Posted

    Thanks for your input Shelly!

    For some reason I thought hypothyroidism is when fT3 is low. Learned something new, thanks!

    So im hypo. Or as a quick Google search says... Subclinical hypothyroidism.

    What's the next step? How to find out the cause?

    I'm not on anything, never have been.

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    • Posted

      Hello Exclix:

      Hypothyroidism can come from a lot of reasons such as:  A virus called Mono or now called Epstein-Barr  and a lack of iodine in the diet, also a family trait or runs in a family line, abuse or stress placed on the body and other conditions like cancer or lupus or even treatments for cancer.

      Subclinical means not enough symptoms but it is just a word.  Next step would be seeing an Endocrinologist and that doctor knows the thyroid well.  They can place you on a low dose of hormone and you will be okay. The medication ost commonly used is Levothyroxine.

      Check with your GP for a referal, and any questions just ask.

      Keep me posted,



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  • Posted

    What does the medication do exactly? Lower my TSH? Increase my T3? Both?

    Also what exactly is the harm from elevated TSH if my fT3 is normal?

    Appreciate your input!

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    • Posted

      Hello Exclix:

      Thyroid hormone replaces the under active thyroid, it replaces what you do not make and stops teh stress on the gland.  If left untreated the gland will fail and will cause your body more and worse symptoms to occur.

      Myxedema is a condition in which the body has not enough thyroid hormone and it can cause severe cognitive brain problems.  Now in modern medicine we do not see that as people are put on hormone replacement fairly soon.

      TSH is a sensor and gives an overview of the health of the gland. Harm from a high TSH means your bodies thyroid is not working well, and it is a WARNING to do something to fix it.

      So if you were a CAR, and the dashboard light cam on and said "CHECK THE ENGINE" - this is the body telling you "hey check me out!"  HELP!!!!

      T3 is the hormone needed and can appear normal but underneath it all, the body has a slow problem.  If left untreated T3 will slowly go down and the thyroid will make a goiter around your neck, you will be sleepy, brain foggy and weight gain, all symptoms will get worse then Myxedema will happen.

      Any questions just ask, BTW, great question!


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  • Posted

    Hi exclix

    Your T3 and T4 results look fairly normal to me but Tsh is high which suggests hypo. However, some people still have hypo symptoms when their levels are within normal ranges (some people need the t4 and t3 to be at the top end to feel good).

    I would say that shelly is right- get referred to an endocrinologist,especially if you are suffering with the hypo symptoms. They usually put people on levothyroxine initially, but further down the line if this does not reduce your symptoms you may require additional t3 medication (liothyonine).

    I would start of with low doses of medication and work your way up gradually if you need to (your body is still producing it's own natural hormones, just maybe not enough and high levels of medication will suppress your own thryoids hormone production). Natural hormones will often be better for you and make you feel better than taking synthetic so you don't want to stop your own thyroid making its own (this happened to me).

    Also get your thryoid antibodies tested. The primary cause of hypothyroidism is hashimotos disease. If you don't have this, ask for a thryoid ultrasound - this will determine any structural issues with your thryoid and see whether you have thryoid nodules (which reduce thryoid function). A high Tsh may also be caused by something temporary like a virus, so if you don't have hashimotos, get them to monitor it closely as you may not need medication permanently (or only a small dose). The reason I say get these tests done is that my Tsh was borderline high eight years ago (similar scenario to yourself) and my symptoms never went away with levothyroxine so was put on more and more and it's now damaged my thryoid. They say I may never have needed medication. Unfortunately, thryoid stuff if often poorly understood by GPs (and some endos), so it is important to do your own research.

    I hope the above helps.

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  • Posted

    Thanks for your input sayhitocaz!

    I don't have any of the hypothyroidism symptoms, except maybe for weight gain and difficulty losing fat.

    Are people usually treated based on their lab results or is treatment prescribed only to manage the symptoms?

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