31 May Did Your Doctor Consider This? [Part 2: High TSH With Normal T4 and T3]
A research study published in December 2012 sheds some light on a phenomenon we see often …
A patient has elevated TSH but normal T4 and T3.
If that person also has symptoms of fatigue do they have hypothyroidism?
By standard definition any elevation of TSH indicates hypothyroidism. Usually this elevated level of TSH corresponds with a decrease in T4. That is the way it normally works in the body.
In this case it may not be a thyroid problem at all.
One of the things we look at in all our patients is dysglycemia (abnormal blood sugar).
Many thyroid patients have undiagnosed pre-diabetes and as this newly published article points out, pre-diabetes can lead to elevations in TSH.
And guess what?
Pre-diabetes causes many of the same symptoms as low thyroid.
So most patients that go to the doctor with fatigue and the doctor sees elevated TSH then they immediately get put on thyroid hormone.
The underlying blood sugar problem never gets fully investigated and the patient continues to suffer with symptoms because a lab marker was treated and not the patient.
That is why we take a whole person approach and make sure we understand the problems and mechanisms so we can help our patients feel and function well.
Indian J Endocrinol Metab. 2012 Nov-Dec; 16(6): 958–961. doi: 10.4103/2230-8210.102999