Abnormal thyroid test

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Abnormal thyroid test
• Thyroid results, symptoms, growth, medications, recent illness, and family history reviewed
• Mildly elevated TSH with a normal free T4
• No goiter, slowed growth, symptoms of low thyroid such as fatigue, constipation, or cold intolerance, or symptoms of high thyroid such as weight loss, a racing heart, or tremor
• Repeat TSH and free T4 ordered in a few weeks
• Follow up after the repeat labs

A mildly high TSH with a normal free T4 often returns to normal on repeat testing, especially after an illness, and usually does not need treatment. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Title: elevated TSH, hypothyroidism, hyperthyroidism, abnormal newborn screen
Result patterns: subclinical, overt hypo, hyper, nonthyroidal illness, newborn screen
Goiter, slowed growth, low and high thyroid symptoms present or absent
Family history; Down syndrome
Repeat testing; monitor without treatment; recheck on treatment
Thyroid antibodies; ultrasound
Levothyroxine start, continue, adjust; Propranolol for symptoms
Endocrinology referral; same-day for newborn screen
Follow-up after labs, 4-6 weeks, 3 or 6 months
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Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.