TSH High (Elevated): Hypothyroidism Patterns, Symptoms, and Follow-Up
8/24/2025
A high TSH usually means the pituitary is asking the thyroid to work harder. Searches often include “TSH 6 but normal T4”, “borderline TSH”, “when to treat hypothyroidism”. Interpretation depends on free T4, symptoms, and thyroid antibodies.
Patterns you’ll see on reports
- Overt hypothyroidism: TSH high + free T4 low.
- Subclinical hypothyroidism: TSH high + free T4 normal (often re-checked before decisions).
- Central (pituitary) hypothyroidism: TSH low/normal + low free T4 — discuss urgently with a clinician.
Common symptoms & confounders
- Fatigue, weight gain, cold intolerance, constipation, dry skin, hair loss, menstrual changes.
- TSH can be altered by illness, steroids, pregnancy, biotin supplements, and lab timing.
Educational next steps
- Repeat labs in 6–8 weeks if mildly high and asymptomatic; check TPO antibodies for autoimmune thyroiditis.
- Discuss lifestyle basics: consistent sleep, iodine-sufficient diet, iron/B12 repletion if low (these affect energy).
- Medication education (not a prescription): levothyroxine is standard if a clinician diagnoses hypothyroidism; take on an empty stomach, separate from iron/calcium by 4 hours.
FAQs
Can stress or illness temporarily raise TSH?
Yes. Non-thyroidal illness and recovery periods can transiently shift TSH; repeating after recovery is common.
What TSH level is “too high”?
“Too high” depends on age, pregnancy status, symptoms, and free T4. Decisions are individualized by a clinician rather than a single cutoff.
Educational use only. Not medical advice.
Educational information only — not a diagnosis, treatment, or prescription.