Onno Mets and Robin Smithuis
Department of Radiology of the Academical Medical Centre, Amsterdam and the Alrijne Hospital, Leiderdorp, the Netherlands
Publicationdate
This is a summary of the 8th Edition of TNM in Lung Cancer, which is the standard of non-small cell lung cancer staging since January 1st, 2017.
It is issued by the IASLC (International Association for the Study of Lung Cancer) and replaces the TNM 7th edition.
TNM-8
TNM-staging 8th edition. Changes to 7th edition in red.
The 8th edition of the TNM classification for non-small lung cancer is shown in the table.
Conform previous editions there are three components that describe the anatomic extent of the tumor: T for the extent of the primary tumor, N for lymph node involvement, and M for metastatic disease.
T-classification is performed using CT, the N- and M-classification using CT and PET-CT.
It can be used in the pre-operative imaging and clinical classification iTNM/cTNM, but it is also applicable for definitive pathological staging pTNM, re-staging after therapy yTNM and staging of a recurrence rTNM.
Differences with the 7th edition are presented in red.
What is new in the TNM 8th edition
In the new TNM 8th edition the size went down for several T-categories, and some new pathology based categories were introduced.
Also, new M-categories were introduced regarding extrathoracic metastatic disease.
Size of a solid lesion is defined as maximum diameter in any of the three orthogonal planes in lung window.
In subsolid lesions T-classification is defined by the diameter of the solid component and not the diameter of the complete groundglass lesion.
Stages of lung cancer adapted from the 8th Edition of TNM in Lung Cancer
Non-small lung cancer stages
Subsets of T, N and M categories are grouped into certain stages, because these patients share similar prognosis [1].
For example cT1N0 disease (stage IA) has a 5-year survival of 77-92%.
On the other end of the spectrum is any M1c disease (stage IVB) that has a 5-year survival of 0%.
Lungcancer with evident transfissural growth on both the coronal and sagittal reconstructions; lobectomy is no longer possible.
Lobectomy is generally not possible if there is:
- Transfissural growth.
- Pulmonary vascular invasion.
- Invasion of main bronchus.
- Involvement of upper and lower lobe bronchi.
These are specific items to report.
Thin-slice images and three-plane reconstructions are necessary to best demonstrate the relation with surrounding structures.
In case of indeterminate invasion, the multidisciplinary oncology board should decide whether the benefit of doubt is given, depending on the individual case and co-morbidity.
T-classification
T0
- There is no primary tumor on imaging
Tis
- Carcinoma in situ, irrespective of size.
This can only be diagnosed after resection of the tumor.
T1 tumor – A typical T1 tumor in the left lower lobe, completely surrounded by pulmonary parenchyma.
T1
Tumor size ≤3cm
- Tumor ≤1cm => T1a
- Tumor >1cm but ≤2cm =>T1b
- Tumor >2cm but ≤3cm => T1c
T1a(mi) is pathology proven 'minimally invasive', irrespective of size.
T1a(ss) is a superficial spreading tumor in the central airways, irrespective of location.
T2 tumor - A typical T2 tumor with atelectasis/pneumonitis of the left lower lobe up to the hilum, due to involvement of the left main bronchus.
T2
- Tumor size >3cm to ≤5cm or
- Tumor of any size that
- invades the visceral pleura
- involves main bronchus, but not the carina
- shows an atelectasis or obstructive pneumonitis that extends to the hilum
T2a= >3 to 4cm
T2b= >4 to 5cm
T3 tumor - A typical T3 tumor in the right upper lobe with invasion of the chest wall.
T3
- Tumor size >5cm to 7cm or
- Pancoast that involves thoracic nerve roots T1 and T2 only.
- Tumor of any size that
- invades the chest wall
- invades the pericardium
- invades the phrenic nerve
- shows one or more satellite nodules in the same lung lobe
T4 tumor – A typical T4 tumor in the right upper lobe with invasion of the mediastinum.
T4
- Tumor size >7cm or
- Pancoast tumor that involves C8 or higher nerve roots, brachial plexus, subclavian vessels or spine
- Tumor of any size that
- invades mediastinal fat or mediastinal structures
- invades the diaphragm
- involves the carina
- shows one or more satellite nodules in another lobe on the ipsilateral side
Pancoast tumor
Pancoast tumor. Scroll through the images
A Pancoast tumor is a tumor of the superior pulmonary sulcus characterized by pain due to invasion of the brachial plexus, Horner's syndrome and destruction of bone due to chest wall invasion.
MR is superior to CT for local staging.
Pancoast tumor. (Courtesy of Wouter van Es, MD. St. Antonius Hospital Nieuwegein, The Netherlands)
An operable T3 Pancoast tumor on a sagittal contrast-enhanced T1-weighted image.
The tumor abuts the root T1 (white arrow), but other nerve roots are not involved (green arrow).
A = subclavian artery, ASM = anterior scalene muscle.
(Courtesy of Wouter van Es, MD. St. Antonius Hospital Nieuwegein, The Netherlands)
Pancoast tumor. (Courtesy of Wouter van Es, MD. St. Antonius Hospital Nieuwegein, The Netherlands)
Here an inoperable T4 Pancoast tumor on a sagittal contrast-enhanced T1-weighted image.
Evident invasion of brachial plexus (white arrow) and encasement of the subclavian artery (A).
ASM = anterior scalene muscle.
N - Staging
Adapted from the American Thoracic Society mapping scheme
Regional Lymph Node Classification System
Lymph node staging is done according to the American Thoracic Society mapping scheme.
Supraclavicular nodes
- 1. Low cervical, supraclavicular and sternal notch nodes
Superior mediastinal nodes
- 2. Upper Paratracheal: above the aortic arch, but below the clavicles.
- 3A. Pre-vascular: nodes not adjacent to the trachea like the nodes in station 2, but anterior to the vessels.
- 3P. Pre-vertebral: nodes not adjacent to the trachea, but behind the esophagus, which is prevertebral (3P).
Inferior Mediastinal nodes
- 4. Lower Paratracheal (including Azygos Nodes): below upper margin of aortic arch down to level of main bronchus.
Aortic nodes
- 5. Subaortic (A-P window): nodes lateral to ligamentum arteriosum. These nodes are not located between the aorta and the pulmonary trunk, but lateral to these vessels.
- 6. Para-aortic (ascending aorta or phrenic): nodes lying anterior and lateral to the ascending aorta and the aortic arch.
Subcarinal nodes
- 7. Subcarinal.
Inferior Mediastinal nodes
- 8. Paraesophageal (below carina).
- 9. Pulmonary Ligament: nodes lying within the pulmonary ligaments.
Pulmonary nodes
- 10-14. N1-nodes: these are located outside of the mediastinum.
The boundary between level 10 and level 4 is on the right the lower border of the azygos vein and on the left the upper border of the pulmonary artery (N1 vs. N2).
There is an important separation to be made between level 1 and level 2/3 nodes, because it is N3-stage versus N2.
The lower border of level 1 is the clavicles bilaterally and, in the midline, the upper border of the manubrium.
The boundary between level 4R and 4L is the left lateral border of the trachea, and not the anatomic midline.
Paracardial, internal mammarian, diaphragmatic, axillary and intercostal lymph nodes are not described in the IALSC lymph node map.
Occasionally these can be present.
It is proposed to regard these non-regional nodes as metastastic disease [2].
CT is unrealiable in staging lymph nodes in patients with NSCLC regardless of the threshold size that is chosen.
PET-CT is much more reliable in determining the N-status.
False-positives occur in patients with sarcoid, tuberculosis and other infections.
Because of the high negative predictive value, PET scanning should be performed in all patients considered for surgery.
T2 tumor (> 3cm) in the right lower lobe with ipsilateral hilar node (N1)
N1 - Nodes
N1-nodes are ipsilateral nodes within the lung up to hilar nodes.
N1 alters the prognosis but not the management.
N2-disease – Right sided tumor with ipsilateral mediastinal nodes
N2 - Nodes
N2-nodes represent ipsilateral mediastinal or subcarinal lymphadenopathy.
There is only a subset of patients with N2 disease that benefits from resection.
Those are the patients who -after a negative mediastinoscopy- are found to have microscopic metastatic disease at the time of thoracotomy.
These patients have a better prognosis than those with evident N2-disease.
N3-stage disease.
N3 - Nodes
N3-nodes represent contralateral mediastinal or contralateral hilar lymphadenopathy or scalene or supraclavicular nodes.
These are irresectable.
Two patients with N3-disease.
The images show two patients with lung cancer on the right and contralateral nodes.
If these lymph nodes contain tumor cells, this means inoperable stage IIIB-disease.
N3-nodes on contralateral side and in supraclavicular region. Scroll through the images.
N3 - Nodes
N3-nodes represent contralateral mediastinal or contralateral hilar lymphadenopathy or any scalene or supraclavicular nodes.
These are irresectable.
For a tumor in the right lung the N-stages are:
N1
Ipsilateral peribronchial and/or hilar lymph nodes 10R-14R
N2
Ipsilateral mediastinal and/or subcarinal lymph nodes 2R, 3aR, 3p, 4R, 7, 8R, 9R
N3
Contralateral mediastinal and/or hilar, as well as any supraclavicular lymph nodes 1, 2L, 3aL, 4L, 5, 6, 8L, 9L, 10L-14L
For a tumor in the left lung the N-stages are:
N1
Ipsilateral peribronchial and/or hilar lymph nodes 10L-14L
N2
Ipsilateral mediastinal and/or subcarinal lymph nodes 2L, 3aL, 4L, 5, 6, 7, 8L, 9L
N3
Contralateral mediastinal and/or hilar, as well as any supraclavicular lymph nodes 1, 2R, 3aR, 3pR, 4R, 8R, 9R, 10-14R
M-Staging
Almost every organ may be involved in metastatic disease.
Common are adrenal, nodal, brain, bone and liver involvement.
M-staging in the current edition is based on the presence of metastases, their location and multiplicity.
A distinction is made between regional metastatic disease (M1a) and solitary (M1b) or multiple (M1c) distant metastatic disease:
- M0: No distant metastases
- M1: Distant metastases
- M1a: Regional metastatic disease defined as malignant pleural or pericardial effusion/nodules, as well as contralateral or bilateral pulmonary nodules.
- M1b:solitary extrathoracic metastasis
- M1c:Multiple extrathoracic metastases, either in a single organ or in multiple organs
FAQs
How do you memorize TNM staging? ›
- Tx: Tumor can not be assessed. ...
- T0: No evidence of primary tumor. ...
- Tis: Carcinoma in situ. ...
- T1: Tumor ≤ 2 cm in greatest dimension. ...
- T1a: Tumor > 0.1 cm but ≤ 0.5 cm in greatest dimension. ...
- T2:Tumor > 2 cm but ≤ 5 cm in greatest dimension.
T4a. N0. M0. The cancer has grown through the wall of the colon or rectum but has not grown into other nearby tissues or organs (T4a). It has not yet spread to nearby lymph nodes (N0) or to distant sites (M0).
What does T4 N3 M1 mean? ›The TNM staging system
Or a more advanced cancer that has spread may be T4 N3 M1. Sometimes doctors use the letters a, b or c to further divide the categories. For example, stage M1a lung cancer is a cancer that has spread to the other lung. Stage M1b lung cancer has spread to one other part of the body.
Stage 4 is part of the number staging system. It means that the cancer has spread. It is divided into stage 4A and 4B. It is also called advanced lung cancer.
Why is TNM staging important? ›The TNM Classification is a system for classifying a malignancy. It is primarily used in solid tumors and can be used to assist in prognostic cancer staging. A standard classification system improves communication between providers and allows for better information sharing and research across populations.
What is prognostic staging? ›A Clinical Prognostic Stage is assigned to all patients regardless of the type of therapy used; in contrast, a Pathologic Prognosis Stage is assigned to patients in whom surgery is the initial treatment. In a few situations, low Oncotype DX recurrence scores can change the prognostic stage.
What stage is a 2 cm tumor? ›T1 (includes T1a, T1b, and T1c): Tumor is 2 cm (3/4 of an inch) or less across. T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across. T3: Tumor is more than 5 cm across. T4 (includes T4a, T4b, T4c, and T4d): Tumor of any size growing into the chest wall or skin.
What does T3 no mo mean? ›For example your diagnosis may be 'T3N1M0'. This means the cancer has grown into the outer lining of the bowel to up to three nearby lymph nodes, but has not spread to other parts of the body. You will sometimes see the TNM staging report written with a lower case letter in front of it.
What does T4 N1 M1 mean? ›Stage IV prostate cancer, consisting of stage T4 (invasion of adjacent organs), N1 (regional nodal spread), or M1 (metastatic spread) disease [1], is a relatively rare diagnosis, accounting for approximately 5 % of prostate cancer diagnoses [2].
What does T1 N1 M0 mean? ›It has not spread to distant parts of the body (T0, N1, M0). The tumor is 20 mm or smaller and has spread to 1 to 3 axillary lymph nodes (T1, N1, M0). The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0).
Does tumor size determine stage? ›
The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells. If you're diagnosed with cancer, you may have more tests to help determine how far it has progressed.
How big is a T4 tumor? ›Tumor diameter of 2 cm or less was designated as T1, 2.1-4 cm as T2, 4.1-6 cm as T3, and 6.1 cm or more as T4.
Is T4 a terminal of cancer? ›Is stage 4 cancer always terminal? Stage 4 cancer is not always terminal. It is usually advanced and requires more aggressive treatment. Terminal cancer refers to cancer that is not curable and eventually results in death.
Can you recover stage 4 lung cancer? ›There is currently no cure for stage 4 lung cancer. However, certain treatments can alleviate the symptoms and prolong a person's life. The best approach to treatment depends partly on the type of lung cancer. There are two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
What is the longest you can live with stage 4 lung cancer? ›The median survival time for stage 4 lung cancer is about four months. Research shows that factors such as age, sex, smoking status, and type of cancer may influence survival rates.
What is a large tumor size? ›T1a: Tumor is larger than 0.1 cm, but no larger than 0.5 cm. T1b: Tumor is larger than 0.5 cm, but no larger than 1 cm. T1c: Tumor is larger than 1 cm, but no larger than 2 cm. T2: Tumor is larger than 2 cm, but no larger than 5 cm. T3: Tumor is larger than 5 cm.
What is a T1 tumor? ›This is a very early cancer where cancer cells are found only in 1 layer of tissue. T1: The tumor is 2 cm or less at its greatest dimension. The tumor has invaded nearby tissues to a depth of 5 mm or less; this is called depth of invasion.
What is a benign tumor? ›Benign Tumors. Benign tumors are those that stay in their primary location without invading other sites of the body. They do not spread to local structures or to distant parts of the body. Benign tumors tend to grow slowly and have distinct borders. Benign tumors are not usually problematic.
What does Y mean in tumor staging? ›y: stage assessed after chemotherapy and/or radiation therapy; in other words, the individual had neoadjuvant therapy. r: stage for a recurrent tumor in an individual that had some period of time free from the disease.
What does prognostic stage 1B mean? ›Stage 1B means that small areas of breast cancer cells are found in the lymph nodes close to the breast and that: no tumour is found in the breast or. the breast tumour is 2cm or smaller.
What is a staging CT scan? ›
When a breast cancer has been diagnosed, some people have a CT scan of their chest and tummy (abdomen) to stage the breast cancer. Staging tells the doctor how big a cancer is and whether it has spread. Knowing the stage helps your doctor decide which treatment you need.
Is a 3 cm tumor considered large? ›The study defined tumors less than 3 cm as small tumors, and those that are more than 3 cm as large tumors, in 720 EGC patients.
How big is a 7 cm tumor? ›Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
How big is a 1.5 cm tumor? ›The smallest lesion that can be felt by hand is typically 1.5 to 2 centimeters (about 1/2 to 3/4 inch) in diameter. Sometimes tumors that are 5 centimeters (about 2 inches) — or even larger — can be found in the breast.
What is T3 tumor? ›T3 means the tumour has grown into the outer lining of the bowel wall but has not grown through it. T4 is split into 2 stages, T4a and T4b: T4a means the tumour has grown through the outer lining of the bowel wall and has spread into the tissue layer (peritoneum) covering the organs in the tummy (abdomen)
What is N1 disease? ›Clinical N1 (cN1) disease of non-small cell lung cancer (NSCLC) represents the subset suggestive of ipsilateral hilar and/or intrapulmonary lymph node metastasis. 1 Although cN1 disease is considered to be locoregional, surgical resection often fails to cure patients with cN1.
What does pT2 mean? ›The definition of pT2 stage finding depends on the particular type of cancer that it refers to; for example, for breast cancer, pT2 stage finding is defined as follows: cancer with tumor size more than 2.0 cm, but not more than 5.0 cm in greatest dimension; for colorectal cancer, pT2 stage finding is defined as follows ...
How serious is a Gleason score of 8? ›Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.
Is a 2 cm breast lump big? ›Cancers of exactly 2 cm in size occupy a special niche in breast oncology. That size is the one at which breast cancer is most commonly diagnosed (the “modal size”) and 2.0 cm marks the boundary between stage i and ii for node-negative breast cancers and between stage ii and iii for node-positive breast cancers.
Can a Gleason 7 metastasize? ›According to Dr. Klotz, the likelihood of metastases was mainly dependent on the amounts of Gleason 7 cancer in the prostate, and whether a man's PSA levels doubled quickly. He expects that a few more men in the study will develop metastatic cancer with age and longer-term follow-up.
How big is a 3 cm tumor? ›
3 cm is about the size of a grape. 4 cm is about the size of a walnut. 5 cm is about the size of a lime. 6 cm is about the size of an egg.
What stage is t3n1m0? ›In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer.
Is Stage 3 squamous cell carcinoma curable? ›Squamous cell carcinoma is considered curable when caught early. Stage 3 skin cancer has spread to nearby tissues and lymph nodes and, thus, is more difficult to treat. This type of cancer is treatable with surgery and other treatment options, like chemotherapy and radiation therapy.
Does biopsy increase risk of metastasis? ›A long-held belief by a number of patients and even some physicians has been that a biopsy can cause some cancer cells to spread. While there have been a few case reports that suggest this can happen — but very rarely — there is no need for patients to be concerned about biopsies, says Dr. Wallace.
How big is a 1 cm mass? ›Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
Is a mass a tumor? ›A tumor is a mass or group of abnormal cells that form in the body. If you have a tumor, it isn't necessarily cancer. Many tumors are benign (not cancerous). Tumors can form throughout the body.
How big is a 10 mm tumor? ›Tumor sizes are often measured in millimeters (mm) or centimeters. Common items that can be used to show tumor size in mm include: a sharp pencil point (1 mm), a new crayon point (2 mm), a pencil-top eraser (5 mm), a pea (10 mm), a peanut (20 mm), and a lime (50 mm).
Is a 10mm breast lump big? ›Background: Small invasive breast cancers up to 10 mm in size have an excellent prognosis and are being detected in increasing numbers by mammographic screening, yet optimal treatment remains controversial.
How serious is invasive ductal carcinoma? ›Without prompt treatment, invasive ductal carcinoma can spread to lymph nodes or blood vessels and metastasize (spread) throughout the body. Identifying characteristics of the tumor, such as whether or not the cells are sensitive to certain hormones, can help your doctor choose the best treatment.
What is the highest stage of cancer? ›Cancer is typically labeled in stages from I to IV, with IV being the most serious. Those broad groups are based on a much more detailed system that includes specific information about the tumor and how it affects the rest of your body.
When cancer spreads to lymph nodes what stage is it? ›
"In general, cancers that have spread to the lymph nodes are typically stage 2 or 3," says Juan Santamaria, MD, Nebraska Medicine surgical oncologist. "Many of these cancers are still treatable and even curable at this stage.
Is Stage 0 considered cancer? ›Stage 0 breast cancers are often called pre-cancers, pre-invasive cancers or breast carcinoma in situ. With stage 0, abnormal cells in the breast have some cancer characteristics, but they have not yet spread into other tissues or organs.
What stage of lung cancer is curable? ›Stage I is also called early-stage lung cancer. It often can be cured, and most people can expect to live 5 years or longer.
How quickly does lung cancer spread? ›Rapid growing, with a doubling time of less than 183 days: 15.8% Typical, with a doubling time of 183 to 365 days: 36.5% Slow growing, with a doubling time of over 365 days: 47.6%
Can chemo cure lung cancer? ›In some cases, cancer cells in the lymph nodes can be completely killed off before surgery. Neoadjuvant chemotherapy has doubled the cure rate for people with stage 3 non-small cell lung cancer. It has cured people with some forms of lung cancer who would not have been cured by surgery alone.
How do you know death is near with lung cancer? ›Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family.
Which cancer has the lowest survival rate? ›The cancers with the lowest five-year survival estimates are mesothelioma (7.2%), pancreatic cancer (7.3%) and brain cancer (12.8%). The highest five-year survival estimates are seen in patients with testicular cancer (97%), melanoma of skin (92.3%) and prostate cancer (88%).
What is the newest treatment for lung cancer? ›An immune checkpoint inhibitor is a drug that blocks proteins on immune system cells which then allows them to fight cancer. Several immune checkpoint inhibitors have recently been approved for advanced lung cancer.
What is normal T4 range? ›A typical normal range is 0.9 to 2.3 nanograms per deciliter (ng/dL), or 12 to 30 picomoles per liter (pmol/L). Normal value ranges may vary slightly among different laboratories. Some laboratories use different measurements or may test different specimens.
Is a free T4 level of 1.0 Low? ›The normal range for free T 4 in adults is 0.8 to 1.8 nanograms per deciliter (ng/dL). A level of free T 4 that is higher than normal could mean you have an overactive thyroid. Conditions linked to hyperthyroidism include Graves disease, an autoimmune disorder.
What is an abnormal T4 level? ›
Abnormally high test results
Elevated T4 levels may indicate hyperthyroidism. They may also indicate other thyroid problems, such as thyroiditis or toxic multinodular goiter. Other reasons for abnormal results may include: high levels of protein in the blood. too much iodine.
A normal Total T4 level in adults ranges from 5.0 to 12.0μg/dL.
Which is more important T3 T4 or TSH? ›Because T4 is converted into another thyroid hormone called T3 (triiodothyronine), free T4 is the more important hormone to measure. Any changes show up in T4 first. T3 and T4 help to control how your body stores and uses energy to do its work (metabolism).
Which is more important T4 or TSH? ›Across many clinical studies it seems clear that the physiologic effects of low or high thyroid function correlate much more strongly to free T4 and free T3 levels than to TSH levels. In fact, correcting for changes in T4 and T3 levels there appeared to be no correlation between TSH level and body function.
What is a dangerously high TSH level? ›A TSH over 10 mIU/L has been linked to an increased risk of coronary heart disease and heart failure, which is why you'll probably want to seek treatment if your TSH is close to (but still under) that upper limit.
Why is my TSH low but my T3 and T4 are normal? ›Diagnosis and Tests
If you had thyroid blood tests and the results indicate that your TSH levels are low or undetectable (0.1 to 0.4 mIU/L) and your thyroxine (T4) and triiodothyronine (T3) levels are in the normal range, it means you have subclinical hyperthyroidism.
An optimal TSH level in a woman is 0.4-2.5 mIU/L. For pregnant women, that upper limit is stricter than if you are not pregnant. A dangerously high level of TSH is above 5.0 mIU/L. High TSH means low thyroid hormones.
Can you have normal TSH and low T4? ›If the pituitary fails to make enough TSH then free T4 levels in the blood will fall – but since the problem is at pituitary level then TSH levels in the blood do not rise appropriately. In severe cases free T4 will fall below the normal range, while TSH levels can be normal or low (see diagram).
What is normal TSH level for age? ›| Age | Free T4* (ng/dL) | TSH (mU/L) |
|---|---|---|
| 1 to 12 months | 0.9 to 2.3 | 0.6 to 7.3 |
| 1 to 5 years | 0.8 to 1.8 | 0.7 to 6.6 |
| 6 to 10 years | 1.0 to 2.1 | 0.8 to 6.0 |
| 11 to 18 years | 0.8 to 1.9 | 0.6 to 5.8 |
Normal TSH + normal T4 = normal thyroid function. High TSH + normal T4 = you may have a higher risk of developing an underactive thyroid. Low TSH + high T4 = overactive thyroid.
What are early warning signs of thyroid problems? ›
The most common early warning signs of a thyroid problem include unexplained tiredness, constipation, dry skin, body temperature problems, weight gain, hoarseness, and mood imbalances. These symptoms may seem unrelated, but when taken together, can amount to thyroid concerns.
Can borderline thyroid be cured? ›Because borderline cases can progress to overt hypothyroidism, some healthcare providers say it's useful to take medication. This is especially true if you also have a risk of heart disease as even mild hypothyroidism can lead to elevated cholesterol levels.
What is T3 normal range? ›Normal Results
The range for normal values are: Total T3 -- 60 to 180 nanograms per deciliter (ng/dL), or 0.9 to 2.8 nanomoles per liter (nmol/L) Free T3 -- 130 to 450 picograms per deciliter (pg/dL), or 2.0 to 7.0 picomoles per liter (pmol/L)
Normal levels in adults
In adults, normal levels of total T4 range from 5–12 micrograms per deciliter (mcg/dl) of blood.