My TSH is high — what should I do?
Elevated TSH suggests hypothyroidism. Confirm with free T4 and TPO antibodies. Overt hypothyroidism (high TSH, low free T4) is treated with levothyroxine under provider review.
Full answer
An elevated TSH with normal free T4 is subclinical hypothyroidism; elevated TSH with low free T4 is overt hypothyroidism. The workup includes free T4, TPO antibodies (to identify Hashimoto's), and free T3 when symptoms are prominent. Overt hypothyroidism is treated with levothyroxine, titrated to a target TSH range under provider review. Subclinical disease is treated selectively based on TSH magnitude, symptoms, antibody status, pregnancy plans, and cardiovascular context. Hormone optimization decisions are made after the thyroid axis is characterized because SHBG, lipids, and weight are confounded.
Educational. Not a substitute for individualized provider review.
- Methodology — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-06-03