Elevated TSH

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

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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  | ↑ |

* May be accompanied by other autoimmune diseases

Thyroiditis | \+  | +/-  | \+  | ↑ | ↓ | Normal  | Normal  | N/↑ | Normal  | Normal  |

* Infectious thyroiditis associated with neck pain

Others  | \-  | +/-  | \-  | ↑ | ↓ | Normal  | Normal  | N/↑ | Normal  | Normal  |

* History of hyperthyroidism
* Drug history

Transient hypothyroidism  | +/-  | \-  | +/-  | ↑ | ↑ | Normal  | Normal  | ↑ | Normal  | Normal  |

* May present primarily with hyperthyroidism

Subclinical hypothyroidism  | \-  | \-  | \-  | ↑ | Normal  | Normal  | Normal  | ↑ | Normal  | N/↑ |

* Asymptomatic

Central Hypothyroidism  | Pituitary  | \+  | \-  | \-  | N/↓ | N/↓ | N/↓ | ↓ | Normal  | Normal  | Normal  |

* Other pituitary hormone deficiencies signs

Hypothalamus  | \+  | \-  | \-  | ↑ | Normal  | ↓  | Normal  |

* Other pituitary hormone deficiencies signs

Resistance to TSH/TRH  | \-  | \-  | \-  | ↑ | N/↓ | N/↓ | Normal  | Normal  | ↑/↓ | Normal  |

* Rare

## References

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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.