When TSH Stays Falsely High after Proper Thyroid Hormone Replacement

(This Hub was composed from an email answer I sent to a thyroid patient.)

My first impression is that it may be that the pituitary gland which sends out TSH, may be giving a false impression of the T4 and/or T3 levels being low, when they're actually too high. TSH elevates when thyroid hormone goes low in the body and decreases to a lower level when thyroid hormone goes too high. If a patient's TSH proves to be an inaccurate test in a patient, a doctor may need to ignore TSH and test only the T4 and T3 levels in follow-up on a replacement hormone dose for monitoring it. My point being that it's possible to be over-treated for hypothyroidism if TSH stays falsely high, which can cause thyrotoxicity (induced by too high of a thyroid hormone replacement dose).

Hyperthyroidism by any cause can increase anxiety levels and cause other hyperthyroid symptoms. In my opinion if the first suggestion I make above is not the case (can be determined by testing both T4 and T3), tests for the antibodies that cause Graves' Disease should be ran. They can also be present in high titers in some Hashimoto's patients and can result in Hashitoxicosis (temporary, intermittent hyperthyroidism)). They are called the "TSI" (thyroid stimulating immunoglobulins). Every reputable medical research group recognizes Hashitoxicosis, including the U.S./Gov-National Institutes of Health.

Here's a quote:

"TSI stands for thyroid stimulating immunoglobulin. TSI stimulates the thyroid gland to enlarge and release excess amounts of thyroid hormone....Greater-than-normal levels may indicate:Graves' disease Hashitoxicosis Neonatal thyrotoxicosis"

Research Link>> http://www.nlm.nih.gov/medlineplus/ency/article/003685.htm (MedLinePlus)

I also believe for better evaluation, hypothyroid patients should be ordered a test of the T3 level as well as T4 and TSH because some patients have a TSH that elevates due to one or the other (T4 or T3) being low, while the other hormone is elevated. These type patients sometimes need a more specialized type thyroid hormone replacement dose, such as a compounded type that contains more of the one that is low, so that the ratio of them is not off. It's not common but does happen and is precisely why T3 thyroid hormone brands are also made such as "Cytomel" and brands that are combos of T4 and T3. These are just some suggestions and really can't be determined without blood testing both T4 and T3 and also testing for TSI antibodies. If your doctor won't work with you on ordering these (doctors sometimes refuse for unclear reasons), you might consider getting a second opinion or ordering tests through a firm like HealthCheckUSA that requires no doctor visit and sends results directly to you. They set up blood draws for LabCorp, one of the nations most highly used labs.

I'm only a layperson who has extensively researched but in my opinion, patients need thorough evaluation, starting with complete blood testing! I know from personal experience and from reading the stories of 100s of other patients, that things are often not zeroed-in on when all the needed blood tests are not ordered. I would be firm about it and not take "no" for an answer. It is your life and health after all and will cost a doctor nothing but a stroke-of-the-pen.