Hello, My blood test result came back and I have both TSH AND FT4 HIGH. TSH 4.13?IU/mL 0.27-4.20 FT4 1.69 ng/dL 0.93-1.70 what does this mean?

Dr. Sajeev KumarGeneral Physician33yrs exp

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Regarding the questions--- 1-It is absolutely NORMAL to have a high normal or moderately elevated T4 when on T4 replacement, and with TSH in the normal range. With T4 levels in the normal rang e on T4 replacement, T3 levels tend to be too low. 2-That is not a combination of tests Iwould expect, except in thyroid hormone resistance syndrome, a congenital disease not present here. The TSH is the best guide for treatment in almost every instance. 3-First I would establish a consistent dose of T4 that kept TSH about 1uU/ml. If on that program he still feels bad, there is nothing against adding 25ug T3 qd. Checking TSH in 6 weeks, and considering holding course or even increasing if TSH remains around 1uU. 4-Not unless the situation was desperate, since I would be little surprised by the tests. Before we did antibodies, that history would have been typical of Graves. But since 90-95% of Graves patients have positive antibodies, a negative test now rings a small alarm, I would get a family history of thyroid disease, I would examine the thyroid (enlarged? Tender? Small?), do an 125-I uptake and scan, perhaps US, ESR or CRP, TRAb, check antibodies in a different lab, and reconsider.  

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