Interpreting Thyroid Lab Work Correctly
Many doctors look just at the TSH levels when they are assessing a patient for a potential thyroid problem. However, TSH levels only begin to expose potential issues. An individual may have normal TSH levels but still not be utilizing thyroid stimulating hormone correctly, leading to a thyroid imbalance.
Your doctor should also be looking at your other values such as T3 and T4 levels. These can provide more information about how well your thyroid is actually functioning.
Additionally, it is important to realize that levels that are sometimes considered normal are actually a sign of a thyroid problem. Most doctors consider TSH levels that are between 0.5 and 5.0 normal. However, a patient who is still experiencing a range of thyroid symptoms may be hyperthyroid or hypothyroid. Many thyroid health advocates think that the range that is considered normal should be narrowed significantly so that more people who have thyroid problems can get the treatment they need.
One other value that is extremely important to examine is autoimmune factors. Both Graves disease, the most common cause of hyperthyroidism and Hashimotos disease, the most common cause of hypothyroidism, are autoimmune. By examining antibody levels, your doctor can learn whether your immune system has put your thyroid under attack. Even if you are not currently showing symptoms that have been connected to your thyroid, an autoimmune issue should be addressed to reduce the chances of long-term harm.
Misconceptions About The Thyroid Gland
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Antibodies And Thyroid Hypofunction
But then of course we have to talk about antibodies. The most common cause of thyroid hypofunction in the developed world is Hashimotos, which is an autoimmune disease that affects the thyroid gland, where the body attacks the thyroid gland and eventually decreases its ability to produce thyroid hormone. Unfortunately, in the conventional model, thyroid antibodies are rarely tested for, and thats because if the antibody test is positive, it doesnt really change their treatment. In the conventional model, the treatment for hypothyroidism is just to prescribe thyroid hormone regardless of what the cause is. And so, from their perspective, it doesnt really matter if antibodies are positive or not because its not going to change the treatment protocol.
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Ask Your Doctor If A New Tsh Target Is Appropriate
When assessing your response to treatment, many doctors will aim to get your TSH level to around 1 to 2 mU/Lthe lower end of the normal range.
While you may be told that TSH levels of 1 to 2 mU/L are “fine” if you have mild hypothyroidism, it is possible to still have symptoms, especially if your levels tend to fluctuate.
To this end, some endocrinologists have lowered the TSH threshold from the standard normal range of 0.5 to 5 mU/L to a revised normal range of 0.3 to 3.0 mU/L. By tightening your hormonal controls to the lower end of the revised range, you may be less prone to symptoms.
How Is The Test Used
A thyroid panel may be used to evaluate thyroid function and/or help diagnose thyroid disorders.
Typically, the preferred initial test for thyroid disorders is a TSH test. If the TSH level is abnormal, it will usually be followed up with a test for free T4. Sometimes a total T3 or free T3 will also be performed. Often, the laboratory will do this follow-up testing automatically. This is known as reflex testing and it saves the healthcare practitioner time from having to wait for the results of the initial test and then requesting additional testing to confirm or clarify a diagnosis. Reflex tests are typically performed on the original sample that was submitted when the initial test was requested.
As an alternative, a thyroid panel may be requested by your healthcare practitioner. This means that all three tests will be performed at the same time to get a more complete initial picture of thyroid function.
Blood Levels Of Thyroid Hormone Are Not Necessarily What We Care About
This is another huge problem so let me explain…
I explain it this way to my patients:
The bloodstream in your body is just a way to move nutrients and hormones to the places that actually need it.
Your tissues and organs.
The amount of thyroid hormone in the blood is only helpful to us if we KNOW for sure that the hormone and nutrients are making it into your cells.
Most doctors check your blood levels of hormones and assume that if blood levels are “normal” that your tissues must be getting the right amount of hormone.
But, obviously, that isn’t the case.
What’s more important than your blood levels of thyroid hormone is the answer to this question:
Are your tissues actually getting the right amount of thyroid hormone?
And we are somewhat limited in how we can actually test this, short of doing a biopsy at the target tissue and it certainly doesn’t make sense to biopsy muscle, heart tissue or brain tissue to diagnose your hypothyroidism.
Instead, we can use a couple of surrogate markers to evaluate if your tissues are getting enough thyroid hormone:
Why Your Normal Thyroid Lab Results May Not Be Normal
When lab results for thyroid function come back as normal, its easy to assume that everything is functioning well. However, there are several different reasons these results can be misleading. Today we answer a listener question and discuss the various reasons why a normal lab result may not always mean optimal thyroid function.
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What Lab Ranges Are Used For Thyroid Testing
Now the last thing to address here in this first question of whether normal labs always mean normal or optimal thyroid function is of course what ranges are being used. The conventional lab ranges are, in many cases, based on a sample of people that have received those tests, and then they simply make a bell curve of the results, and anyone who is in the middle of that bell curve is deemed as being normal. So its that these ranges are based on what the average values are in a population, rather than what the optimal values are. And lets look at the potential problems with that approach. Just focusing on TSH, or thyroid-stimulating hormone, is an example. So the initial studies to determine the range for TSH were done in the Nurses Health Study, and so they looked at a bunch of nurses. They measured their TSH and they did take steps to try to exclude people that had already been diagnosed with hypothyroidism and already had abnormal TSH. And I believe they even assessed thyroid antibodies, which is a little surprising. But what they didnt do is any ultrasound or other types of assessments to screen for people who did have hypothyroidism but hadnt yet been diagnosed. And the number of people with hypothyroidism that dont know that they have it is actually significantly higher than the number of people that have been diagnosed. And so those initial studies led to a TSH range of around 0.5 to 4.5, which is now the standard conventional range.
Need To Check Your Thyroid Maybe Not
- By , Contributor
As medical science advances, we have more tests and biomarkers available to help identify illnesses. Yet overdiagnosis and overtreatment that may occur following abnormal results can cause dangerous adverse effects and costly consequences. Hypothyroidism a lower than normal range of thyroid hormones may be the poster child for this problem because it is such a common condition.
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Reason #: The Tsh Controversy
TSH alone is not enough to manage your thyroid condition. There is a big push in the thyroid advocacy world against the blindness of doctors of using TSH to treat thyroid patients.
There are a few reasons for that. Firstly, the range used by conventional doctors is 0.5 5.0 whereby functional and integrative practitioners would want to see a healthy person to have their TSH in the 1-2 range.
You see, I also had a perfect TSH of 1.6 to 1.8 even when my body was completely shutting down. This is due to reason #2, see below.
What Do These Tests Test For
Most dtr td dgn thrd disorders b doing a simple bld tt to hk levels f TSH. Some l nlud lvl f T3 r T4. Thrd Stmultng Hormone released by a gland n the brn lld the tutr. As th nm uggt, th is the w ur brain tlk t th thrd t tmult utut. More gets rld whn thyroid function is lw and not rdung enough T4 nd T3 t regulate th body. A hgh level of TSH is th brains w of saying, hey thrd, u nd to wrk a lttl harder. Getting a TSH value thats hghr than the lb rng mn function very low nd nd a uh-mtm n th frm of mdtn.
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What Is Reverse T3
Reverse T3 is a biologically inactive form of T3. Normally, when T4 is converted to T3 in the body, a certain percentage of the T3 is in the form of RT3. When the body is under stress, such as during a serious illness, thyroid hormone levels may be outside of normal ranges even though there is no thyroid disease present. RT3 may be elevated in non-thyroidal conditions, particularly the stress of illness. It is generally recommended that thyroid testing be avoided in hospitalized patients or deferred until after a person has recovered from an acute illness. Use of the RT3 test remains controversial, and it is not widely requested.
You Need To Be Your Own Advocate Dont Expect To Have All The Labs Done Right Away
Most doctors will not automatically test you for the below labs even though they are standard and insurance would pay for them .
Most doctors just order the TSH and Total T4 which I explained above, are useless. It is therefore paramount that you print out and take the checklist with you to the doctors office and insist on getting the full panel. Explain your symptoms and share with your doctor why TSH alone is not good enough. Back up your claim with a medical source and you can use Dr Izabella Wentzs book to do so.
If the doctor refuses, move on and find a doctor who would. They do exist.
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How Does The Thyroid Gland Function
The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. To exert its effects, T4 is converted to triiodothyronine by the removal of an iodine atom. This occurs mainly in the liver and in certain tissues where T3 acts, such as in the brain. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone . The amount of TSH that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees. If the pituitary sees very little T4, then it produces more TSH to tell the thyroid gland to produce more T4. Once the T4 in the bloodstream goes above a certain level, the pituitarys production of TSH is shut off. In fact, the thyroid and pituitary act in many ways like a heater and a thermostat. When the heater is off and it becomes cold, the thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. This is illustrated in the figure below.
Summary Of Combination Therapy Trials
Stimulated by the knowledge that the native thyroid gland directly produces T3, and the finding that some individuals being treated for hypothyroidism may have low T3 levels, fourteen trials comparing combination therapy with LT4 and LT3 to monotherapy with LT4 have been conducted . Despite this extensive body of evidence, clear benefit from combination therapy has not yet been shown. These trials have not shown improvement in a variety of outcome measures with the use of combination therapy. For example, thyroid-related symptoms were not different between treatment groups, and body weight was not lower during combination therapy, except in one study using a combination therapy dose that suppressed serum TSH. Health-related quality of life or mood was not improved in the majority of trials, although 2 trials showed improvement in a few measures , and 2 trials showed improvement in a majority of measures . Similarly, with neurocognitive function, most trials showed no improvement, one trial showed improvement in a few measures , and one trial showed improvement in several measures . A preference for synthetic combination therapy was seen in 4 out the 5 crossover trials in which preference was assessed . Patients preferred combination therapy in one of the trials with a parallel design . However, the largest trial, which had a parallel design, was not associated with patient preference for combination therapy .
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Is There Anything Else I Should Know
In the past, panels of tests were more common. More recently, however, the practice has been to order, where possible, one initial or screening test and then follow up with additional testing, if needed, to reduce the number of unnecessary tests. With thyroid testing, one strategy is to screen with a TSH test and then order additional tests if the results are abnormal or if clinical suspicions warrant.
Your thyroid hormone test results can be affected by:
- Increases, decreases, and changes in the proteins that bind T4 and T3
Magnetic Resonance Imaging Scan
MRI scans use magnets instead of radiation to create detailed cross-sectional images of your body. MRI can be used to look for cancer in the thyroid, or cancer that has spread to nearby or distant parts of the body. But ultrasound is usually the first choice for looking at the thyroid. MRI can provide very detailed images of soft tissues such as the thyroid gland. MRI scans are also very helpful in looking at the brain and spinal cord.
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What Are Thyroid Hormones
The thyroid gland produces hormones that are essential for normal body metabolism. Blood testing is now commonly available to determine the adequacy of the levels of thyroid hormones. These blood tests can define whether the thyroid gland’s hormone production is normal, overactive, or underactive.
The thyroid gland is located in the lower part of the neck, below the Adam’s apple.The gland wraps around the windpipe and has a shape that is similar to a butterfly – formed by two wings and attached by a middle part .
The thyroid gland uses iodine to produce thyroid hormones.
- The two most important thyroid hormones are thyroxine and triiodothyronine , which account for 99.9% and 0.1% of thyroid hormones present in the blood respectively.
- However, the hormone with the most biological activity is T3.
- Once released from the thyroid gland into the blood, a large amount of T4 is converted into T3 – the active hormone that affects the metabolism of cells.
Why Not Check Thyroid Hormones Directly
Why not check the thyroid hormones themselves, to see if the gland is not functioning properly?
The thyroid only makes small amounts of T3. Even in cases of severe hypothyroidism, T3 levels dont go down that much. T4 is produced in large quantities by the thyroid. However, TSH is a far superior screening test because small changes in T4 cause large TSH spikes. Usually when a person has hypothyroidism, TSH levels become very high way before T4 levels fall below normal. So, in our analogy, the thermostat is very sensitive to small variations in temperature.
Thats why a normal TSH almost always means the thyroid gland is healthy and producing enough thyroid hormones. Research finds that a simple TSH test is enough to identify hypothyroidism in 99.6% of the tests performed.
You may have heard of expanded or full thyroid panels, which often include tests for TSH, total T3, total T4, free T3, free T4, anti-TPO antibodies, thyroglobulin, and reverse T3. There is no evidence these extra tests help to diagnose and manage thyroid disease, although they definitely add to health care costs. Proponents of expanded thyroid analysis believe more data may support a personalized intervention plan. However, what happens in a lab test often fails to mirror the elaborate dance of hormones in the body. Additionally, findings are highly variable. What happens in your body today may change in a matter of days or weeks, even without significant interventions.
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