High TSH Levels: Lab Interpretation for New Nurse Practitioners

TSH tends to be the mystifying lab. When do you really have to worry? When and how to treat?

In this video I'll cover:
- The three steps to managing high TSH
- How to treat and adjust medications
- The drugs that can cause hypothyroidism
- Pearls of practice with treatment and dosing

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More Resources:

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Come follow along for even more tips and inspiration:

[teddychannel]

Love your teaching style and I’m learning so much from your videos

[foodgroupie]

Thank you so much for taking the time to help your fellow NPs out!!

[Meechka]

Hey total T4 is still an important test if Ft4 is low. You Shouldn't rule out the usefulness of a Total T4 test just because 99% of it is bound to transport proteins. If Ft4 is low and Total T4 is low it tells you there is something wrong with the overall production of T4. Likely there is something wrong with the Thyroid. If Ft4 is low and Total T4 is normal, then it tells you the problem isn't in the production of the hormone but is likely in the transport proteins or binding globulins. Then Testosterone, estrogen, or cortisol levels as well as birth control, cortisone meds, prednisone or estrogen replacement could be the cause of the problem. Just prescribing T4 meds such as synthroid without looking deeper into the cause of the problem is no longer acceptable to patients. SO YES, TOTAL T4 is still a valid test to be running. You need to know what is the cause of the problem. Quit letting pharmaceutical run schools dictate how you treat the patient. Just prescribing meds based on incomplete lab work is not acceptable to those of us who have a health issue.

[aprilg]

I was told to go with standard dosing as well. I usually do

[PrincessAisha]

I am really excited for the lab interpretation class! When can we expect it!?

Great video again, helps reinforce the topic esp this is soo common in primary care.

[hibye]

Identify the changes in TSH and TRH secretion that you would expect to see in a patient with hypothyroidism due to iodine deficiency, can you please explain this question?

[Tonnie]

Thank you your videos are sooo helpful

[MonicaDiaz-jucj]

Do you have a video for hyperthyroidism?

[usamaragab]

Thanks
Very informative talk
Go on...

[Tonnie]

Thank you so much Liz this was very helpful

[johnmontana]

If thyroid is not producing, is the TSH useless?

[divinedigitalpro]

I received my results and wast tested for TSH w/reflex to FT4 is
0.83
Is that normal?

[olexiia]

Hi, What are the optimal levels for TSH, T3 free, T4free and other thyroid biomarkers@

[wendye]

I would love to know more about fatigue work up.

[lisahuang]

Thank you Liz. Your videos have been very helpful to me. If a patient has repeated elevated Tsh in 2 months, but normal free T4 and total t3, and they are asymptomatic. How often do you ask the patient to come back and check her thyroid? Thank you

[gary-gt-tsang]

Thank you Liz, your videos have been very helpful and informative. I have a case that I am not sure. A 35yo female has 14 lbs gain over 10months. States she has been eating a lot during covid. Denies constipation, hair thinning, brittle nail, or cold intolerance, does endorse usual 8days menstruation with 2 extra spotting days after intercourse with her spouse in the past 2 months. Her tsh Twas 5.1normal free t4 and total t3. has ldl 150. Hdl and triglycerides normal. Does not feel depress. Would you start treatment on her? Does hypothyroidism cause sudden or gradual weight gain? Thank you

[akhilaakhi]

Tsh level above 100.what should i do😥

[lisailg]

Love the information. However, your speech is so fast it is difficult to understand.. Could be the speakers? Not certain, but when explaining it would greatly help to slow down and not abbreviate please. Those of us rubies need clear explanations. Lol..