Causes of elevated thyroid-stimulating hormone

Subclinical hypothyroidism
Autoimmune (Hashimoto) thyroiditis
Suboptimal treatment of overt hypothyroidism
Partial thyroidectomy
Radioactive iodine ablation
External beam radiation of head and neck
Infiltrative diseases of the thyroid (amyloidosis, sarcoidosis, hemochromatosis, Riedel thyroiditis, scleroderma)
Drugs, eg, iodine contrast, amiodarone, lithium, tyrosine kinase inhibitors (sunitinib, sorafenib), interferon alpha, or immune response modulators (ipilimumab, alemtuzumab, pembrolizumab)
Iodine deficiency
Excess iodine
Thyroid dysgenesis
Physiologic increases
Diurnal variation
Recovery phase of euthyroid sick syndrome
Recovery phase of subacute, painless, or postpartum thyroiditis
Other causes
Assay variability
Substances that interfere with TSH assays (heterophile antibodies, rheumatoid factor, biotin, macro-TSH or abnormal TSH isoforms)
Central hypothyroidism or hyperthyroidism
Thyroid hormone resistance
Impaired renal function
Adrenal insufficiency
Older age
  • Based on information in references 1, 2, and 16.