Also Known As
Thyrotropin
Formal Name
Thyroid-stimulating Hormone
This article was last reviewed on
This article waslast modified on November 2, 2018.
At a Glance
Why Get Tested?

To screen for and help diagnose thyroid disorders; to monitor treatment of hypothyroidism and hyperthyroidism

When To Get Tested?

For screening: Newborn screening is widely recommended; however, there is no consensus within the medical community as to the age adult screening should begin or whether screening should be done.
For monitoring treatment: as directed by your healthcare provider
Otherwise: when a person has symptoms of hyperthyroidism or hypothyroidism and/or an enlarged thyroid

Sample Required?

A blood sample drawn from a vein in your arm or from pricking the heel of an infant

Test Preparation Needed?

None needed; however, certain medications can interfere with the TSH test, so tell your health practitioner about any drugs that you are taking. If you take thyroid hormone as treatment for thyroid disease, it is recommended that your blood sample be drawn before you take your dose for that day.

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, a tiny organ located below the brain and behind the sinus cavities. TSH stimulates the thyroid gland to release the hormones thyroxine (T4) and triiodothyronine (T3) into the blood. These thyroid hormones help control the rate at which the body uses energy. This test measures the amount of TSH in the blood.

TSH, along with its regulatory hormone thyrotropin releasing hormone (TRH), which comes from the hypothalamus, is part of the feedback system that the body uses to maintain stable amounts of thyroid hormones in the blood. When thyroid hormone concentrations decrease, the production of TSH by the pituitary gland is increased. TSH in turn stimulates the production and release of T4 and T3 by the thyroid gland, a small butterfly-shaped gland that lies at the base of the throat flat against the windpipe. When all three organs are functioning normally, thyroid production turns on and off to maintain relatively stable levels of thyroid hormones in the blood.

If the thyroid releases inappropriately large amounts of T4 and T3, the affected person may experience symptoms associated with hyperthyroidism, such as rapid heart rate, weight loss, nervousness, hand tremors, irritated eyes, and difficulty sleeping. Graves disease is the most common cause of hyperthyroidism. It is a chronic autoimmune disorder in which the affected person's immune system produces antibodies that act like TSH, leading to the production of excessive amounts of thyroid hormone. In response, the pituitary may produce less TSH, usually leading to a low level in the blood.

If there is decreased production of thyroid hormones by the thyroid (hypothyroidism), the person may experience symptoms such as weight gain, dry skin, constipation, cold intolerance, and fatigue. Hashimoto thyroiditis is the most common cause of hypothyroidism in the U.S. It is a chronic autoimmune condition in which the immune response causes inflammation and damage to the thyroid as well as the production of autoantibodies. With Hashimoto thyroiditis, the thyroid produces low levels of thyroid hormone. The pituitary may produce more TSH, usually resulting in a high level in the blood.

However, the level of TSH does not always predict or reflect thyroid hormone levels. Some people produce an abnormal form of TSH that does not function properly. They often have hypothyroidism despite having normal or even mildly elevated TSH levels. In a variety of thyroid diseases, thyroid hormone levels may be high or low, regardless of the amount of TSH present in the blood.

Rarely, pituitary dysfunction may result in increased or decreased amounts of TSH. In addition to pituitary dysfunction, hyperthyroidism or hypothyroidism can occur if there is a problem with the hypothalamus (insufficient or excessive TRH).

How is the sample collected for testing?

A blood sample is obtained from a needle placed in a vein in the arm or from pricking the heel of an infant.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed. Certain medications can interfere with the TSH test, so tell your health practitioner about any drugs that you are taking. If you take thyroid hormone as treatment for thyroid disease, it is recommended that your blood sample be drawn before you take your dose for that day.

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Common Questions
  • How is it used?

    The thyroid-stimulating hormone (TSH) test is often the test of choice for evaluating thyroid function and/or symptoms of a thyroid disorder, including hyperthyroidism or hypothyroidism.

    TSH is produced by the pituitary gland, a tiny organ located below the brain and behind the sinus cavities. It is part of the body's feedback system to maintain stable amounts of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) in the blood and to help control the rate at which the body uses energy.

    A TSH test is frequently ordered along with or preceding a free T4 test. Other thyroid tests that may be ordered include a free T3 test and thyroid antibodies (if autoimmune-related thyroid disease is suspected). Sometimes TSH, free T4 and free T3 are ordered together as a thyroid panel.

    TSH testing is used to:

    • Diagnose a thyroid disorder in a person with symptoms
    • Screen newborns for an underactive thyroid
    • Monitor thyroid replacement therapy in people with hypothyroidism
    • Monitor anti-thyroid treatment in people with hyperthyroidism
    • Help diagnose and monitor infertility problems in women
    • Help evaluate the function of the pituitary gland (occasionally)
    • Screen adults for thyroid disorders, although expert opinions vary on who can benefit from screening and at what age to begin
  • When is it ordered?

    A health practitioner may order a TSH test when someone has symptoms of hyperthyroidism or hypothyroidism and/or when a person has an enlarged thyroid gland (goiter).

    Signs and symptoms of hyperthyroidism may include:

    • Increased heart rate
    • Anxiety
    • Weight loss
    • Difficulty sleeping
    • Tremors in the hands
    • Weakness
    • Diarrhea (sometimes)
    • Light sensitivity, visual disturbances
    • The eyes may be affected: puffiness around the eyes, dryness, irritation, and, in some cases, bulging of the eyes.

    Signs and symptoms of hypothyroidism may include:

    • Weight gain
    • Dry skin
    • Constipation
    • Cold intolerance
    • Puffy skin
    • Hair loss
    • Fatigue
    • Menstrual irregularity in women

    TSH may be ordered at regular intervals when an individual is being treated for a known thyroid disorder. When a person's dose of thyroid medication is adjusted, the American Thyroid Association recommends waiting 6-8 weeks before testing the level of TSH again.

    TSH screening is routinely performed in the United States on newborns soon after birth as part of each state's newborn screening program.

    In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for thyroid disease in asymptomatic adults. However, the American Thyroid Association and the American Association of Clinical Endocrinologists released clinical practice guidelines in 2012 that recommend that screening for hypothyroidism should be considered in people over the age of 60. Because the signs and symptoms of both hypothyroidism and hyperthyroidism are so similar to those seen in many common disorders, health practitioners often need to rule out thyroid disease even though the patient has another problem.

  • What does the test result mean?

    A high TSH result may mean that:

    • The person tested has an underactive thyroid gland that is not responding adequately to the stimulation of TSH due to some type of acute or chronic thyroid dysfunction
    • A person with hypothyroidism or who has had their thyroid gland removed is receiving too little thyroid hormone replacement medication and the dose may need to be adjusted
    • A person with hyperthyroidism is receiving too much anti-thyroid medication and the dose needs adjusting
    • There is a problem with the pituitary gland, such as a tumor producing unregulated levels of TSH

    A low TSH result may indicate:

    • An overactive thyroid gland (hyperthyroidism)
    • Excessive amounts of thyroid hormone medication in those who are being treated for an underactive (or removed) thyroid gland
    • Insufficient anti-thyroid medication in a person being treated for hyperthyroidism; however, it may take a while for TSH production to resume after successful anti-thyroid treatment. This is why the American Thyroid Association recommends monitoring this treatment with tests for thyroid hormones (T4 and T3) as well as TSH levels.
    • Damage to the pituitary gland that prevents it from producing adequate amounts of TSH

    Whether high or low, an abnormal TSH indicates an excess or deficiency in the amount of thyroid hormone available to the body, but it does not indicate the reason why. An abnormal TSH test result is usually followed by additional testing to investigate the cause of the increase or decrease.

    The following table summarizes some examples of typical test results and their potential meaning.

    TSH  Free T4 Free or total T3 Probable Interpretation
    High Normal Normal Mild (subclinical) hypothyroidism
    High Low Low or normal Hypothyroidism
    Low Normal Normal Mild (subclinical) hyperthyroidism
    Low High or normal High or normal Hyperthyroidism
    Low Low or normal Low or normal Non-thyroidal illness; pituitary (secondary) hypothyroidism
    Normal High High Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)
  • Is there anything else I should know?

    It is important to note that TSH, free T4, and free T3 tests are a "snapshot" of what is occurring within a dynamic system. An individual person's thyroid testing results may vary and may be affected by:

    • Increases, decreases, and changes (inherited or acquired) in the proteins that bind T4 and T3
    • Pregnancy
    • Estrogen and other drugs
    • Liver disease
    • Systemic illness
    • Resistance to thyroid hormones

    Many medications — including aspirin and thyroid-hormone replacement therapy — may affect thyroid gland function test results and their use should be discussed with the health practitioner prior to testing.

    Illnesses not directly related to the thyroid, "nonthyroidal illnesses," can affect thyroid hormones levels. In particular, the level of T3 can be low in nonthyroidal illness (NTI). Typically, the thyroid hormone levels return to normal after a person recovers from the nonthyroidal illness. Historically, this condition was referred to as "euthyroid sick syndrome" but that term is controversial because there is some question as to whether those affected have a thyroid gland that is functioning normally (euthyroid).

    When a health practitioner adjusts a person's thyroid hormone replacement dosage, it is important to wait at least one to two months before checking the TSH again so that the new dose can have its full effect.

    Extreme stress and acute illness may affect TSH test results. It is generally recommended that thyroid testing be avoided in hospitalized patients or deferred until after a person has recovered from an acute illness.

    Results may be low during the first trimester of pregnancy.

  • Do health practitioners test TSH during pregnancy?

    Health practitioners do not generally test asymptomatic women, but those with symptoms and/or a known thyroid disorder may be tested at intervals to detect and evaluate hyperthyroidism or hypothyroidism both during pregnancy and after. For more information, see the National Endocrine and Metabolic Diseases Information Service webpage: Pregnancy and Thyroid Disease.

  • Are there things that I can do to raise or lower my TSH level?

    In general, TSH does not respond to lifestyle changes. What is important is that the pituitary and thyroid glands are healthy and working together to produce appropriate amounts of thyroid hormone.

  • What is a 3rd generation TSH and an ultrasensitive TSH?

    The original immunoassays for TSH were not sensitive enough to differentiate the very low levels seen in patients with hyperthyroidism from levels seen in normal euthyroid individuals. In the 1980s, more sensitive assays ("second generation") were developed and these were able to identify patients with TSH levels that were suppressed due to the excess amounts of free T4 present in hyperthyroidism. In the 1990s, TSH assays were made even more sensitive and, although these were able to measure even lower levels, they were widely adopted because they performed much better than the second generation assays in the range that was important for differentiating normal from hyperthyroid. Almost all laboratories currently use so-called "third generation" or "ultrasensitive" TSH assays today.

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Related Content

On This Site

Tests: Free T4, Free T3 and Total T3, Thyroid Panel, Thyroid Antibodies
Conditions: Thyroid Diseases, Infertility, Endocrine System and Syndromes, Pituitary Disorders
Screening: Newborns, Thyroid dysfunction - Adults (50 and up)

Elsewhere On The Web

EndocrineWeb: How Your Thyroid Works 
FamilyDoctor.org: Hyperthyroidism 
FamilyDoctor.org: Hypothyroidism 
KidsHealth: Thyroid Disease 
American Association of Clinical Endocrinologists: About Your Thyroid 
Hormone Health Network: Thyroid Disorders
American Thyroid Association: Patients & The Public - Thyroid Information 
American Thyroid Association: Thyroid Function Tests 
American Thyroid Association: Frequently Asked Questions - Thyroid Disease 
National Endocrine and Metabolic Diseases Information Service: Hyperthyroidism

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View Sources

Sources Used in Current Review

(Updated 2014 May 14). Thyroid Tests. National Endocrine and Metabolic Diseases Information Service [On-line information]. Available online at http://endocrine.niddk.nih.gov/pubs/thyroidtests/index.aspx through http://endocrine.niddk.nih.gov. Accessed June 2014.

Topiwala, S. (Updated 2012 June 26). TSH test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003684.htm through http://www.nlm.nih.gov. Accessed June 2014.

(© 1995–2014). Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8939 through http://www.mayomedicallaboratories.com. Accessed June 2014.

Lin, J. (Updated 2012 February 17). Thyroid-Stimulating Hormone. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2074091-overview through http://emedicine.medscape.com. Accessed June 2014.

Meikle, A. W. and Straseski, J. (Updated 2014 April). Thyroid Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ThyroidDz.html?client_ID=LTD through http://www.arupconsult.com. Accessed June 2014.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 949-950.

McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pg 376.

©2014 American Thyroid Association. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. If antithyroid drugs are chosen as initial management of GD, how should the therapy be managed? Available online at http://www.thyroid.org/thyroid-guidelines/hyperthyroidism/resultse/ through http://www.thyroid.org. Accessed September 2014.

(April 4, 2014) Aytug S. Euthyroid Sick Syndrome. Medscape. Available online at http://emedicine.medscape.com/article/118651-overview through http://emedicine.medscape.com. Accessed September 2014.

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Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

U.S. Preventive Services Task Force (2004 May 15). Screening for Thyroid Disease: Recommendation Statement. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20040515/us.html through http://www.aafp.org.

MedlinePlus Medical Encyclopedia. TSH. (Updated 10/24/07). [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003684.htm.

(© 2005). Thyroid Stimulating Hormone (TSH). ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_239b.jsp#1149154 through http://www.aruplab.com.

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Ladenson,PW et al, for the American Thyroid Association. American Thyroid Association guidelines for detection of thyroid dysfunction. 12 Jun 2000. Arch Intern Med 60:1573-1575.

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Meikle, A. and Roberts, W. (Updated 2010 October). Thyroid Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ThyroidDz.html through http://www.arupconsult.com. Accessed February 2011.

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