Thyroid Stimulating Hormone (TSH)
A diagnostic blood test measuring TSH levels to screen for thyroid dysfunction, including hypothyroidism (underactive) and hyperthyroidism (overactive).
Verified by Dr. Narayan Jethwani, MD (Hom)
Article Editorial Timeline
Intelligent Context-Aware Learning Path
Objective: Assess Thyroid Stimulating Hormone status
2 min readPatient Protocols: Fasting and prep instructions
1 min readTSH: Regulates thyroid gland hormone release
5 min readHypothyroidism: Low thyroid hormone production
5 min readHair Fall: May occur in autoimmune thyroid disease
3 min readFT4: Measures circulating thyroid storage hormone
4 min readBook Consultation
Quick Reference Facts
Evidence Summary
- •Primary thyroid gland failure (elevated TSH)
- •Pituitary adenoma or central failure (suppressed/low TSH)
"TSH fluctuates diurnally, peaking overnight. A borderline elevation should always be confirmed with an early morning repeat specimen."
Visual Body System Card
TSH Laboratory Reference Ranges & Clinical Interpretation
Note: Standard diagnostic range for adults is typically 0.45 - 4.5 mIU/L. Values outside these boundaries warrant Free T4 evaluation.
Laboratory Interpretation Workflow
1. Clinical Indication
Ordering protocols based on clinical indications, presenting symptoms, or screening guidelines.
Clinical Pearl: Order when screening for primary organ dysfunctions or monitoring active treatment efficacy.
Test Description & Overview
TSH (Thyroid Stimulating Hormone, the master regulator of metabolic rate): A specialized laboratory marker or endocrine hormone measurement used to evaluate thyroid gland function, metabolic control, and autoimmune thyroid activity.
TSH: 0.45 - 4.5 uIU/mL; Free T4: 0.8 - 1.8 ng/dL; Free T3: 2.3 - 4.2 pg/mL; Anti-TPO: < 9.0 IU/mL.
Elevated (High) Values
- Primary hypothyroidism (elevated TSH)
- Thyrotoxicosis or Graves' disease (elevated Free T4/T3)
- Active autoimmune thyroiditis (elevated Anti-TPO / Anti-Tg)
Decreased (Low) Values
- Hyperthyroidism or secondary hypothyroidism (low TSH)
- Overt hypothyroidism (low Free T4/T3)
- Non-thyroidal illness syndrome
Clinical Alignment & Significance
TSH evaluation: Elevated TSH with low Free T4 indicates primary hypothyroidism. Conversely, low TSH with high Free T4/T3 confirms hyperthyroidism. Elevated Anti-TPO indicates autoimmune thyroid disease.
Clinician TSH Interpretation Flowchart
Measure initial serum TSH level
Is TSH level elevated (> 4.5 mIU/L)?
Measure Free T4 level
Is Free T4 level decreased?
Screen for Anti-TPO autoantibodies to evaluate for autoimmune etiology (Hashimoto's)
Correlate with clinical findings (hypometabolic symptoms, bradycardia) to guide care
Diagnostic Guidance Notice
Standard laboratory reference ranges vary based on the testing facility. Significant deviations require immediate clinician review to rule out severe medical pathology.
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Reference Citations & Evidence Sources
Clinical Guidelines & Consensus Statements
- CIT-0012Jonklaas J., Bianco A. C., Bauer A. J., et al.. "Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement." Thyroid (2014).DOI PubMed
- CIT-0013Garber J. R., Cobin R. H., Gharib H., et al.. "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Endocrine Practice (2012).DOI PubMed
- CIT-0014Demers L. M., Spencer C. A.. "Laboratory Medicine Practice Guidelines: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease." National Academy of Clinical Biochemistry (NACB) (2002).
AI & Generative Search Citation Block
L0002Dr. Narayan Jethwani. "Thyroid Stimulating Hormone (TSH)." Homeo Healthcare Clinical Platform. Version 1.0.0. Reviewed: 2026-06-30T12:00:00Z. Available at: https://homeo.healthcare/knowledge/lab-tests/tsh
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