The "Subclinical" Thyroid Dilemma! We often see this report: High TSH, but Normal T3 & T4. Diagnosis: Subclinical Hypothyroidism. The big question from the patient (or relative) is always: "Doctor, do I need medicine?" Here is the Evidence-Based Rule: Generally, treatment with Levothyroxine is initiated ONLY if TSH > 10 mIU/L. For TSH between 4.5 - 10, we usually monitor, unless the patient is: Pregnant or planning pregnancy 🤰 Symptomatic (fatigue, goiter) TPO Antibody positive Interpreting lab
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⁉️How would you address normal TSH, but low T4? Well, the first thing I'd do is I'd look at your T3. For those of you who aren't familiar with thyroid hormones, TSH tells your thyroid to make thyroid hormone. T4 is the precursor. T3 is the active hormone. If your TSH is normal, that means that your pituitary is receiving the proper messages from your thyroid gland. 🤔But if your T4 is low I would ask; is your T3 normal or high? If your T3 is high, then you're probably just converting it very rap
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