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How Do They Test For Thyroid Issues

Medical History And Physical Exam

Thyroid Problems – TSH Lab Test and Low Thyroid Symptoms

If you have any signs or symptoms that suggest you might have thyroid cancer, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had thyroid cancer or tumors called pheochromocytomas, it is important to tell your doctor, as you might be at high risk for this disease.

Your doctor will examine you to get more information about possible signs of thyroid cancer and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck.

What Does The Test Result Mean

If the feedback system involving the thyroid gland is not functioning properly due to one of a variety of disorders, then increased or decreased amounts of thyroid hormones may result.

  • When TSH levels are increased, the thyroid will make and release inappropriate amounts of T4 and T3 and you may experience symptoms associated with hyperthyroidism.
  • If there is decreased production of thyroid hormones, you may have symptoms of hypothyroidism.

The test results alone are not diagnostic but will prompt your healthcare practitioner to perform additional testing to investigate the cause of the excess or deficiency and thyroid disorder. As examples, the most common cause of hyperthyroidism is Graves disease and the most common cause of hypothyroidism is Hashimoto thyroiditis.

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

Note: Laboratory results must always be correlated with the clinical findings of the patient.
TSH
Hypothyroidism resulting from a problem with the hypothalamus or pituitary signals that govern the thyroid gland

What Blood Tests Are Done To Test The Thyroid

Thyroid blood tests include:

These tests alone arent meant to diagnose any illness but may prompt your healthcare provider to do additional testing to evaluate for a possible thyroid disorder.

Additional blood tests might include:

  • Thyroid antibodies: These tests help identify different types of autoimmune thyroid conditions. Common thyroid antibody tests include microsomal antibodies , thyroglobulin antibodies , and thyroid receptor antibodies .
  • Calcitonin: This test is used to diagnose C-cell hyperplasia and medullary thyroid cancer, both of which are rare thyroid disorders.
  • Thyroglobulin: This test is used to diagnose thyroiditis and to monitor treatment of thyroid cancer.

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How Do Tsh Values Change With Age

  • Newborns and childrenTSH and T4 levels are high in newborn babies. As the baby grows, the levels start dropping. T3 increases during the first year of life, but then it starts dropping .
  • AdolescentsTSH and T4 are decreasing and will reach expected adult levels at around 18 years old .
  • AdultsSeveral studies done on more than 10,000 non-diagnosed people show that for a healthy population TSH value is close to 1.5 mIU/L, and is higher in females than in males. 1 in 10 adults under 30 years has TSH higher than 2.5mIU/liter .
  • PregnancyTSH levels rapidly grow during pregnancy. They increase from the average 1.20 mIU/L in the first trimester to 2.12 mIU/L in the second and 3.30 mIU/L in the third trimester. The range of T3 is 1.74.3 nmol/L in second trimester and 0.43.9 nmol/L in third trimester. T4 range is 92.2252.8 nmol/L in second trimester and 108.2219.0 nmol/L in third trimester .
  • 70+4 in 10 people over 80 years have TSH higher than 2.5mIU/liter, and 1 in 10 has TSH higher than 4.5mIU/liter .

Some research suggests that the upper normal TSH reference range in people over 70 years old should be extended to 6.0 mIU/L . A study on more than 15,000 people in Scotland has confirmed that the TSH values should be reconsidered for different age intervals, and especially in people older than 70 years should not be considered out of normal ranges .

Knowing When To Check Your Thyroid

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  • 1Monitor for symptoms of hypothyroidism. Hypothyroidism is the condition where you have an underactive thyroid. All forms of hypothyroidism can be caused by viral infections, radiation damage, some medications, pregnancy, and other rarer causes. Symptoms of an underactive thyroid include:XResearch sourceXTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • Severe and constant fatigue
  • Changes in the menstrual cycle
  • Constipation
  • Disturbed sleep cycle, such as wanting to sleep all the time
  • Intolerance to cold
  • Muscle weakness
  • Unexplained weight gain or difficulty losing weight
  • 2Watch for symptoms of hyperthyroidism. Hyperthyroidism is the condition where you have an overactive thyroid. This condition can be a result of Graves disease, tumors, thyroiditis , thyroid nodules, and some medications.XResearch source Symptoms of an overactive thyroid include:XResearch source
  • Rapid heart rate or palpitations
  • Increased respiratory rate
  • Frequent and loose bowel movements or diarrhea
  • Fine hair that may be falling out
  • Unexplained weight loss
  • Nervousness, irritability, a feeling of high energy
  • Anxiety or panic attacks
  • Sweatiness
  • Reddish skin which may be itchy
  • 3Understand the symptoms may be due to another condition. Remember that many of these symptoms are not specific to thyroid disease. Determine if you have multiple symptoms, or just a few. If you are unsure, go to your physician for tests.XResearch sourceXResearch source
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    What Is A Tsh Test

    TSH stands for thyroid stimulating hormone. A TSH test is a blood test that measures this hormone. The thyroid is a small, butterfly-shaped gland located near your throat. Your thyroid makes hormones that regulate the way your body uses energy. It also plays an important role in regulating your weight, body temperature, muscle strength, and even your mood. TSH is made in a gland in the brain called the pituitary. When thyroid levels in your body are low, the pituitary gland makes more TSH. When thyroid levels are high, the pituitary gland makes less TSH. TSH levels that are too high or too low can indicate your thyroid isn’t working correctly.

    Other names: thyrotropin test

    Thyroid Hormone Test Results

    Other medications can interfere with thyroid laboratory measurements, but not with the actual functioning of the thyroid.

    A few examples of these medications include:

    Lastly, research has found that the supplement biotin can interfere with the measurement of thyroid blood tests. Therefore, it’s recommended that people who take biotin stop doing so two days prior to having their thyroid blood tests.

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    What Does It Mean To Have A Blood Value Out Of Range

    Medically accepted averages vary from country to country.

    If youve moved around a lot, it can be challenging to determine which countrys averages are applicable to you do the averages from your country of origin apply to you or has your averages changed to fit your new environments averages? Keep this in your mind if you are relocating.

    One measurement at one point in time will not tell you much. You should re-test one or two times for accuracy. This way you and your healthcare practitioner can actually get a solid overview of your health.

    TSH test is a first step towards the diagnosis of hypothyroidism. However it can be very misleading, as its shown to increase with age and its not an immediate sign of a disease .

    The same is true for kids. From birth to late childhood they have high TSH values, which eventually drops as they reach puberty .

    How Is Thyroid Disease Diagnosed And Evaluated

    How to Test Your Thyroid Function at Home

    Symptoms often prompt patients to visit the doctor, including fatigue, the inability to get pregnant, changes in the skin or hair, a lump in the neck, hoarseness or pain in the thyroid area. Based on these symptoms, a doctor will likely perform a physical exam to determine whether the thyroid is enlarged and order blood tests to measure thyroid hormone levels. If blood tests reveal signs of abnormal thyroid activity or thyroid cancer, further testing will be required, such as:

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    Failure To Do Full Thyroid Blood Testing

    How can doctors diagnose and treat thyroid disorders without doing a full investigation? How can they hope to understand the complexity of their patients issue while relying on TSH alone or even a combination of TSH and T4? They are missing critical pieces of the puzzle. Patients are falling through the cracks left suffering debilitating symptoms all because of an outdated medical protocol.

    When the pituitary gland in the brain releases TSH, TSH stimulates the butterfly-shaped thyroid gland at the base of our necks to produce the thyroid hormones T4 and T3. The majority of thyroid hormones produced by the thyroid are T4, however T3 is the most active useable form of thyroid hormone that can be used in the cells of the body. The conversion of T4 to T3 is a critical element in this puzzle. By testing TSH and T4 alone, doctors are assuming that our bodies are properly converting the T4 to active T3.

    Hashimotos disease is an auto-immune disease where the body has turned on itself and attacks and destroys its own thyroid gland. It is a leading cause of hypothyroidism, yet mainstream medicine fails to test patients for thyroid antibodies. You cant imagine how many followers here at Hypothyroid Mom have let me know after years of struggling with hypothyroidism they were finally diagnosed with Hashimotos after insisting on these two thyroid antibody tests Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies .

    What About Those Already On Thyroid Medications

    If youre already on thyroid meds, but still have symptoms, you may need to up your dosage so that your labs fall within the optimal range, which in turn can help you feel better.

    Please take a look at my article on TSH for a letter that you can take to your physician if he/she is not familiar with the current optimal reference range. As I mentioned earlier, I personally feel best with a TSH a bit under 1IU/mL, but you may need some trial and error to find your personal best TSH.

    Once you establish a dose of medication thats working for you and as long as your symptoms dont change you can test your thyroid hormones every six months.

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    Top 10 Thyroid Tests And How To Interpret Them

    Medically reviewed and written by Izabella Wentz, PharmD, FASCP on August 25, 2021

    Many cases of thyroid problems are missed because most doctors dont perform a comprehensive test panel. I spent almost a decade undiagnosed because I only had one marker tested. My thyroid condition was missed completely, leading me to deal with needless mystery symptoms like chronic fatigue, depression, anxiety, and many others, for far too long!

    I have a copy of my lab results from 2008, before I was diagnosed with Hashimotos and still searching for a reason behind my exhaustion, hair loss, anxiety, and digestive issues. On this lab report, my TSH is at 4.5 IU/mL, and there is a note written from the doctor: Your thyroid function is normal, no need to do anything. Perhaps a TSH of 4.5 IU/mL would have been normal for a 95-year-old woman, but I was 25 and sleeping 12+ hours a night to feel rested! Of course, even as a pharmacist, I didnt think to question the doctor and most people dont.

    If you suspect that you may have a thyroid condition, or know someone who does, this article will go over all of the most helpful tests that can help you identify a thyroid condition.

    This article will also teach you how to understand your labs so that you can advocate for proper treatment for yourself.

    In this article, Ill go over:

    What Is Thyroid Disease

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    Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired it can make your heart beat faster, cause you to lose weight without trying and even make you feel nervous. On the flip-side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.

    These two main disorders can be caused by a variety of conditions. They can also be passed down through families .

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    Why Hypothyroidism Is Not Diagnosed On Symptoms Alone

    Many of the symptoms of hypothyroidism are fairly common complaints found in people with a normally functioning thyroid gland, so it can be hard to decipher if the symptoms are related to the thyroid. One of the best ways to figure out if your symptoms could be related to a thyroid condition is to consider how long you have been experiencing them.;

    For example, have you always felt cold when others were warm? Did you just start to notice decreased energy? If you are starting to notice new signs and symptoms, it could be related to a thyroid issue. However, only a physician can diagnose a thyroid problem.

    Diagnosis Of An Underactive Thyroid Function Is Made Based On A Combination Of Thyroid Blood Test Results Symptoms And Several Other Factors

    Hypothyroidism is evaluated and diagnosed by a physician, usually an endocrinologist or your primary care doctor. Symptoms, signs, and more critically, blood testsare taken into consideration when evaluating the possibility of an underactive thyroid glandall of which help identify the cause and severity of the disease.

    A diagnosis is reached after a thorough review of the patients personal medical and family histories, any risk factors, findings on physical examination, in addition to the results of thyroid function levels. There are several types of hormones checked in a blood test to assess your thyroid statusthe most definitive one is the TSH . Often, physicians may decide to check the free thyroxine, or T4, free T4 index, or total T4 to aid in the diagnosis.

    Your doctor may check your thyroid status for an underactive thyroid by reviewing thyroid hormone levels. Photo: 123rf

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    How Is Thyroid Disease Treated

    Your healthcare providers goal is to return your thyroid hormone levels to normal. This can be done in a variety of ways and each specific treatment will depend on the cause of your thyroid condition.

    If you have high levels of thyroid hormones , treatment options can include:

    • Anti-thyroid drugs : These are medications that stop your thyroid from making hormones.
    • Radioactive iodine: This treatment damages the cells of your thyroid, preventing it from making high levels of thyroid hormones.
    • Beta blockers: These medications dont change the amount of hormones in your body, but they help control your symptoms.
    • Surgery: A more permanent form of treatment, your healthcare provider may surgically remove your thyroid . This will stop it from creating hormones. However, you will need to take thyroid replacement hormones for the rest of your life.

    If you have low levels of thyroid hormones , the main treatment option is:

    • Thyroid replacement medication: This drug is a synthetic way to add thyroid hormones back into your body. One drug thats commonly used is called levothyroxine. By using a medication, you can control thyroid disease and live a normal life.

    Lab Tests Of Biopsy Samples

    How To Test For Thyroid Imbalance The Right Way

    In some cases, doctors might use molecular tests to look for specific gene changes in the cancer cells. This might be done for different reasons:

    • If FNA biopsy results arent clear, the doctor might order lab tests on the samples to see if there are changes in the BRAF or RET/PTC genes. Finding one of these changes makes thyroid cancer much more likely.
    • For some types of thyroid cancer, molecular tests might be done to see if the cancer cells have changes in certain genes , which could mean that certain targeted drugs might be helpful in treating the cancer.

    These tests can be done on tissue taken during a biopsy or surgery for thyroid cancer. If the biopsy sample is too small and all the molecular tests cant be done, the testing may also be done on blood that is taken from a vein, just like a regular blood draw.

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    What More Should I Know About Thyroid Blood Tests

    Ranges noted here are approximate; your providers may differ slightly. Its important that you remember abnormal readings do not necessarily mean a thyroid disorder is present, as each test can be affected by a variety of factors.

    No preparation is required for these tests. They can be taken any time of day without fasting.

    Last reviewed by a Cleveland Clinic medical professional on 12/27/2019.

    References

    T3 Resin Uptake Results

    A T3 resin uptake, also known as a T3RU, is a blood test that measures the binding capacity of a hormone called thyroxin-binding globulin . If your T3 level is elevated, your TBG binding capacity should be low.

    Abnormally low levels of TBG often indicate a problem with the kidneys or with the body not getting enough protein. Abnormally high levels of TBG suggest high levels of estrogen in the body. High estrogen levels may be caused by pregnancy, eating estrogen-rich foods, obesity, or hormone replacement therapy.

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