What's happening
TSH feedback (a favorite exam trick): if thyroid hormone (T4) is LOW, the pituitary senses it. It then pumps out MORE TSH to push the thyroid. So low T4 → HIGH TSH. Parathyroid caution: the parathyroids sit behind the thyroid. So after thyroid surgery, watch for hypocalcemia (hand spasm, or Trousseau's sign).