Elevated TSH

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Synonyms and keywords: Elevated thyroid stimulating hormone, High TSH, High thyroid stimulating hormone, TSH crisis, Thyroid stimulating hormone crisis.

Differentiating different causes of TSH elevation

Various kinds of diseases that cause elevated TSH (which all are categorized as hypothyroidism) can be differentiated from each other on the basis of history and symptoms and laboratory findings:[1][2][3]

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb
Primary hypothyroidism Autoimmune + +/-

Diffuse

- ↑ ↓ N/↓ Normal N/↑ Normal ↑
Thyroiditis + +/- + ↑ ↓ Normal Normal N/↑ Normal Normal
Others - +/- - ↑ ↓ Normal Normal N/↑ Normal Normal
Transient hypothyroidism +/- - +/- ↑ ↑ Normal Normal ↑ Normal Normal
Subclinical hypothyroidism - - - ↑ Normal Normal Normal ↑ Normal N/↑
  • Asymptomatic
Central Hypothyroidism Pituitary + - - N/↓ N/↓ N/↓ ↓ Normal Normal Normal
Hypothalamus + - - ↑ Normal ↓ Normal
Resistance to TSH/TRH - - - ↑ N/↓ N/↓ Normal Normal ↑/↓ Normal
  • Rare

References

  1. ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  2. ↑ Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.
  3. ↑ O'Brien T, Dinneen SF, O'Brien PC, Palumbo PJ (1993). "Hyperlipidemia in patients with primary and secondary hypothyroidism". Mayo Clin. Proc. 68 (9): 860–6. PMID 8371604.
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