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Low TSH, raised free thyroid hormones

Authoring team

A depressed TSH with elevated free T3 or T4 is characteristic of primary hyperthyroidism. In most cases the radioiodine thyroid scan will show increased signal.

The common causes of primary hyperthyroidism are:

  • Grave's disease:
    • 90% have antithyroid antibodies
    • diffuse uptake on an radioiodine scan

  • multinodular goitre

  • toxic nodule

Other diagnoses to consider are:

  • transient thyroiditis:
    • may be subacute, silent or post-partum
    • usually a short history
    • rapid return to euthyroidism with treatment

  • De Quervain's thyroiditis:
    • raised ESR and a tender thyroid are supportive

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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