How Tsh Levels Change
TSH levels seem counterintuitive. Why does a high TSH mean you have an underactive thyroid gland? And why do low levels mean it’s overactive?
To answer that, you have to know that TSH and thyroid hormones are different things. The thyroid hormones are:
Your body uses thyroid hormones to regulate all kinds of processes. That includes how fast you burn calories, your heart rate, and many other automatic functions.
When thyroid hormones are low, your pituitary makes more TSH. That signals the thyroid to increase production. When levels are high, the pituitary releases less TSH. That signals the thyroid to slow down. This is why high TSH indicates low thyroid function and vice versa.
Thyroid : Hypothyroidism And Hyperthyroidism
More than 20 million Americans have thyroid disease, but 60% dont know it. A Michigan Medicine endocrinologist discusses whos at risk, signs to look for and how to seek treatment.
Theres a small, butterfly shaped gland in your lower neck, the thyroid, that secretes hormones and affects almost every organ in the body, regulating metabolic processes and controlling body temperature.
When the thyroid doesnt produce a normal hormone level, either not enough or too much, thyroid disease occurs. And according to Michigan Medicine endocrinologist its actually more common than heart disease or diabetes.
An estimated 20 million Americans have some form of thyroid disease, but up to 60% of those that have it are unaware of the condition, according to the American Thyroid Association, with autoimmune diseases like Hashimotos disease and Graves disease among the most common culprits of hypothyroidism and hyperthyroidism, respectively.
If the thyroid hormone levels are too low, referred to as hypothyroidism or underactive thyroid, the brains pituitary gland will produce more thyroid stimulating hormone . TSH prompts the thyroid to make more thyroid hormones in response to low levels.
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Milder Forms Of Hypothyroidism Are Harder To Diagnose
Although the majority of cases of hypothyroidism will be easy to diagnose with these simple blood tests, many millions of people will have this disease in mild to moderate forms which are more difficult to diagnose. The solution for these patients is more complex and this is due to several factors.
First, we must realize that not all people with hypothyroidism are the same. There are many degrees of this disorder from very severe to very mild. Additionally, and very importantly, we cannot always predict just how bad an individual patient will feel just by examining his or her thyroid hormone levels. Blood levels have normal ranges, but other factors need to be taken into account as well, such as the presence or absence of symptoms.
In other words, some patients with what would be considered mild deviations in their thyroid laboratory test results will feel just fine while others will be quite symptomatic. The degree of thyroid hormone abnormalities often, but NOT ALWAYS, will correlate with the degree of symptoms.
It is important for both you and your physician to keep this in mind since the goal is not necessarily to make the lab tests go into the normal range, but to make you feel better as well! We must also keep in mind that even the normal thyroid hormone levels in the blood have a fairly large range, so even if a patient is in the normal range for the general population, it may not be the normal level for them.
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High Tsh: Causes Symptoms And How It Affects T3 And T4
High level of TSH usually indicates that you have an underactive thyroid and that it doesnt produce enough thyroid hormones. Thyroid-stimulating hormone directly affects how much T3 and T4 hormones the thyroid secretes. If there is not enough T3 and T4 in the blood, your pituitary gland will increase levels of TSH as a result. Elevated TSH levels usually cause symptoms of hypothyroidism like fatigue, constipation, joint pain, a puffy face, or heavy menstrual bleeding .
The reasons for levels of TSH being higher than the normal range can include dysfunction of your thyroid, an autoimmune disease, or a side effect of some medications. Sometimes pregnancy can cause T3 and T4 to increase which will affect levels of TSH. If you are showing signs of an underactive thyroid and your TSH levels are too high, doctors will usually arrange for blood tests to check for levels of free T3 and T4.
To treat symptoms of high TSH, doctors usually prescribe thyroxine to lower TSH levels and treat hypothyroidism. Blood tests are then regularly taken to monitor levels of TSH and regulate thyroid therapy.
In this article, you will find out about the important role thyroid hormones play in your general health. I will also examine what medical literature says about how high TSH levels affect the thyroid hormones T3 and T4 . This will help you to spot the signs and symptoms of an underactive thyroid.
Thyroxine Triiodothyronine And Tsh Levels
The main job of the thyroid gland is to make the hormone thyroxine, also known as T4 because it has four iodine molecules. The thyroid also makes the hormone triiodothyronine, known as T3 because it has three iodine molecules, but in smaller amounts, explains Cathy Doria-Medina, MD, an endocrinologist with HealthCare Partners Medical Group in Torrance, California. The thyroid gland makes mostly T4, the T4 has to be converted to T3, because T3 is the part of thyroxine that actually does the work, she says.
The pituitary gland at the base of the brain controls hormone production in your body. It makes thyroid-stimulating hormone , which tells the thyroid gland how much T4 and T3 to produce. The TSH level in your blood reveals how much T4 your pituitary gland is asking your thyroid gland to make. If your TSH levels are abnormally high, it could mean you have an underactive thyroid, or hypothyroidism. Thats because it indicates your pituitary gland is producing more TSH in an effort to stimulate your thyroid to produce thyroid hormone, according to the Mayo Clinic.
TSH levels go in the opposite direction of your thyroid hormone, Dr. Doria-Medina explains. If youre making too little thyroid hormone, your TSH will go up. If youre making too much thyroid hormone, your TSH will go down.
If your TSH is higher than 4.0 mU/L on repeat tests, you probably have hypothyroidism.
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No One Size Fits All Approach
For the majority of people with hypothyroidism, taking some form of thyroid hormone replacement will make the thyroid function tests return to the normal range, AND this is accompanied by a general improvement in symptoms. Because of this, physicians will often rely on test results to determine when a patient is on the appropriate dose and therefore doing well.
But this simple approach does not hold true for everybody. Occasionally the correct dosage is a bit difficult to pinpoint and therefore you may need an exam and blood tests more frequently. Also, some patients just don’t do well on some thyroid medications but will feel better with other options. So its important to need to find an endocrinologist who is willing to listen to you and to spend the time you need to explore different dosages and to consider other types of medications .
Bottom line: Many factors must be considered in establishing a personalized plan for treating hypothyroidism, and it is different for every individual.
Remember, thyroid tests have a wide normal range. You want to work with a doctor who helps make you FEEL better, not just make your labs better because once given this diagnosis, you are likely to carry it for a long, long time. There is more than one drug, there is more than one lab test, and there is a just right doctor for everybody.
How Is Hyperthyroidism Diagnosed
If your physician suspects that you have hyperthyroidism, diagnosis is usually a simple matter. A physical examination usually detects an enlarged thyroid gland and a rapid pulse. The physician will also look for moist, smooth skin and a tremor of your fingers. Your reflexes are likely to be fast, and your eyes may have some abnormalities if you have Graves disease.
The diagnosis of hyperthyroidism will be confirmed by laboratory tests that measure the amount of thyroid hormones thyroxine and triiodothyronine and thyroid-stimulating hormone in your blood. A high level of thyroid hormone in the blood plus a low level of TSH is common with an overactive thyroid gland. If blood tests show that your thyroid is overactive, your doctor may want to measure levels of thyrotropin receptor antibodies , which when elevated confirm the diagnosis of Graves disease. Your doctor may also want to obtain a picture of your thyroid . The scan will find out if your entire thyroid gland is overactive or whether you have a toxic nodular goiter or thyroiditis . A test that measures the ability of the gland to collect iodine may be done at the same time.
What Are T3 And Ft3
Triiodothyronine is usually referred to as T3 and is one of the hormones that the thyroid secretes. Doctors from the American Association for Clinical Chemistry say that T3 is more active than the more abundant T4 and is a powerful thyroid hormone in the body. Free T3 is the amount of triiodothyronine that is not bound to protein and can still be used by the body. Doctors sometimes run tests for total T3 or just FT3 to check thyroid function.3
What Is Thyroid Hormone
Thyroid hormone is made by the thyroid gland, a butterfly-shaped endocrine gland normally located in the lower front of the neck. Thyroid hormone is released into the blood where it is carried to all the tissues in the body. It helps the body use energy, stay warm and keeps the brain, heart, muscles, and other organs working as they should.
Thyroid hormone exists in two main forms: thyroxine and triiodothyronine . T4 is the primary form of thyroid hormone circulating in the blood . To exert its effects, T4 is converted to T3 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. T3 normally accounts for about 5% of thyroid hormone circulating in the blood.
Most thyroid hormone in the blood is bound by protein, while only a small fraction is “free” to enter tissues and have a biologic effect. Thyroid tests may measure total or free hormone levels.
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The Easiest Way To Test Your Thyroid
If your doctor doesnt know about, refuses to check your thyroid or thyroid antibodies levels or doesnt order any other tests besides standard thyroid tests like TSH or TSH plus total T4, the easiest way to have your blood work done and get the answers is to order your Thyroid Home Test Kit online from a private lab.
The best part is you dont need doctors referral or medical insurance and dont even need to go to the lab . The thyroid test kit will be mailed to you and you mail it back to the lab and access your test results right after they are ready.
All lab tests are easy to order, have FREE shipping , with results sent directly to you within days. All from the safety of your home.
Hypothyroidism Tests: A Measure Of Treatment Success
Hypothyroidism is treated with daily medication. Taking synthetic thyroid hormone medication can bring your T4 and TSH levels back to their normal ranges. Once youre on the right dose, your symptoms should subside.
When you first start taking medication, your doctor will need to monitor your blood to fine-tune the dosage. Initially you will need to be tested more frequently, Doria-Medina says. A person who is newly diagnosed and taking medication for hypothyroidism should be tested every six weeks until the dosage is just right.
The dose you start with is your doctors educated guess about whats best for you most likely the lowest dose possible to avoid side effects, which can include a rapid heartbeat and restlessness.
Medication for hypothyroidism is slow acting, and it can take several weeks for your body to adjust. If your TSH is still high and your symptoms havent subsided after 6 to 10 weeks, your doctor will likely increase the dose, and youll need your blood tested again after another 6 to 10 weeks.
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When To See A Gp
See a GP if you have symptoms of an overactive thyroid.
Theyll ask about your symptoms and if they think you might have a thyroid problem, they can arrange for a blood test to check how well your thyroid is working.
If the blood test shows that you have an overactive thyroid, you may be referred for further tests to identify the cause.
How Do Doctors Treat Hyperthyroidism
Your doctor will treat your hyperthyroidism to bring your thyroid hormone levels back to normal. Treating the disease will prevent long-term health problems, and it will relieve uncomfortable symptoms. No single treatment works for everyone.
Your treatment depends on whats causing your hyperthyroidism and how severe it is. When recommending a treatment, your doctor will consider
- your age
- When part of the thyroid is removed, your thyroid hormone levels may return to normal.
When part of your thyroid is removed, you may develop hypothyroidism after surgery and need to take thyroid hormone medicine. If your whole thyroid is removed, you will need to take thyroid hormone medicine for life. After surgery, your doctor will continue to check your thyroid hormone levels.
Researchers are looking into new ways to treat hyperthyroidism. An example is radiofrequency ablation , a new approach to treating thyroid nodules that cause hyperthyroidism.5,6 RFA is used mainly in cases where medicines or surgery wont help, and is not yet widely available.
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What Therapies Treat Shaky Hands
Your doctor may recommend one or more lifestyle changes as a way to possibly help ease the symptoms of essential tremor. Suggestions may include to:
- Use heavier objects. You may need to replace lightweight or delicate objects, such as glasses, silverware, or plates, with heavier versions. The extra weight may make the item easier to handle.
- Use specially designed utensils and tools. Gripping and controlling pens, pencils, garden tools, and kitchen utensils may be difficult if you have shaky hands. You may need to seek out versions of these items that are designed for individuals with grip and control issues. For example, there are many adaptive utensil options available on .
- Wear wrist weights. The extra weight on your arm may make control easier. Find a great selection of wrist weights here.
High Tsh But Normal Free T4
What does it mean if your TSH levels are too high but you have normal FT4?
The journal American Family Physician says that levels of TSH over 4.0 mIU/L and free T4 levels within the normal range could be an indicator of subclinical hypothyroidism. This means that a person is at risk of developing hypothyroidism but is not yet showing any noticeable symptoms.12
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Spread Out Other Supplements
Make sure to wait for at least three to four hours between taking thyroid medication and any fiber, calcium, or iron supplements. These nutrients can prevent you from absorbing your full dose of medication.
Ultimately, when it comes to taking your thyroid hormone drug, consistency is essential. If you plan to change how you take your thyroid medication, make sure you clear it with your healthcare provider first.
Surgical Removal Of The Thyroid Gland Or Nodule
Also known as a thyroidectomy, surgery to remove the thyroid can be an effective and permanent treatment for hyperthyroidism.
A potential downside of the surgical approach is that there is a small risk of injury to structures near the thyroid gland in the neck, including the nerve to the voice box . The incidence of this is about 1%. Other possible complications include hypocalcemia and airway obstruction, though both occur in under 5% of surgeries.
Concerns about long hospitalizations following thyroid surgery have been all but alleviated over the past few years, since many surgeons are now sending their patients home the day following surgery. Of course, this depends on the underlying health of the patient and their age, among other factors. Some surgeons now are even treating partial thyroidectomy as an outpatient procedure where healthy patients go home a few hours after the surgery.
When hypothyroidism occurs after treatment of an overactive thyroid gland, it can be effectively treated with levothyroxine, a synthetic form of thyroid hormone thats usually taken as one small pill a day. When used in the correct dose, levothyroxine can be safely taken for the remainder of a persons life.
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Controversy Over Optimal Tsh
While most laboratories define a normal TSH as between roughly 0.5 mU/l and 5.0 mU/l, some experts argue that the upper limit of a normal TSH should be loweraround 2.5 mU/l.
The reasoning behind this is that the vast majority of adults without thyroid disease have a TSH value between 0.45 and 4.12 mU/l.
In addition, some physicians believe older patients should have a TSH level that is greater than 4.0 mU/l or 5.0 mU/l, since TSH normally increases with age.
Doctors can avoid some of this controversy simply by looking at each person as an individual. For example, a person who still has significant symptoms of hypothyroidism at a TSH of 4.0 mU/l may do better with a goal TSH of around 1.0 mU/l.
In contrast, someone who has health riskssuch as heart disease or osteoporosismay benefit from having a goal TSH that is higher, perhaps around 5.0 mU/l or 6.0 mU/l.
In pregnancy, TSH should not be allowed to rise above 3.0 mU/l for the health of both the baby and mother.
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