Is Your Tsh Normal
This is probably one of the most common questions I get on a daily basis .
Just take a look at the comment section of any post and you will find plenty of people posting their labs with that exact question.
So let’s answer it once and for all.
Is your TSH actually normal?
In order to find out if it is normal, we have to first understand what this test is actually testing for.
TSH stands for Thyroid Stimulating Hormone and it comes from your pituitary gland .
The pituitary is a gland in your brain that attempts to tell your thyroid how much thyroid hormone to produce.
So why do Doctors care what the pituitary is telling your thyroid gland?
Well TSH turns out to be a quick and dirty way to diagnose both hypothyroidism and hyperthyroidism but it falls short when things get a little more complex.
In the case of standard hypothyroidism, your TSH increases.
In the case of standard hyperthyroidism, your TSH decreases.
But what about the non-standard cases?
What about patients who have normal TSH levels but every hypothyroid symptom?
Does the TSH work for everyone?
Not really and here’s why:
When we talk about any hormone we really need to understand how and where the hormone has action in the body.
Thyroid hormone is activated inside the cell of the target tissues and it does this through a nuclear receptor .
In simple words, it means that thyroid hormone gets inside the cell and directly turns on genetic transcription .
Again, let’s put this into simple terms…
What Happens If Hypothyroidism Is Not Treated
Hypothyroidism can become a serious and life-threatening medical condition if you do not get treatment from a healthcare provider. If you are not treated, your symptoms can become more severe and can include:
- Developing mental health problems.
- Not being able to maintain a normal body temperature.
- Having heart problems.
- Developing a goiter .
You can also develop a serious medical condition called myxedema coma. This can happen when hypothyroidism isnt treated.
Definition Of A High Tsh
So what defines a “high” TSH?
If your TSH is higher than 5.0 then the lab will flag you as “high” and you may experience the symptoms listed above.
You can see a clear example of this below:
The reference range in this example is 0.3 to 5.00 uIU/ml and the result is 7.024.
Having said all of this, there’s actually a good case to make that you can still have a “high” TSH but still be inside of the reference range.
So how do we get there?
Well, newer studies have shed light on the fact that some of the original tests that helped determine our “standard normal” TSH values may not have have been full of “healthy” people.
When you are being compared to some standard you want to make sure that the standard you are being compared to is actually healthy!
It doesn’t make sense to compare your TSH as a 25-year-old to that of an 86-year-old .
Using this logic some newer studies have suggested that a more “normal” TSH reference range is somewhere between 1.0 and 2.5 uIU/ml and anything higher than 2.5 is considered “high” .
With this logic you can have a “high” TSH anywhere between 2.5 and 5.5, even though it technically falls within the “normal” range:
In addition, other studies have suggested we use the African American population as the standard for TSH testing because they have one of the lowest rates of autoimmune disease compared to other populations and their TSH is somewhere around 1.0.
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Normal Vs Optimal Tsh Range
Now having said all of those things it doesn’t mean that the TSH is entirely useless .
But in order to understand how to evaluate your TSH, you need to understand that there is a huge difference between being “normal” and being “optimal”.
To start with I have never seen a healthy individual with a TSH > 1.0.
This would indicate, at least subjectively, that the ideal TSH is somewhere around 1.0.
Nowadays due to the Standard American Diet , decreased activity levels, absurd rates of insulin resistance and many other factors, it is truly rare to see a “healthy” person.
That means we need to change our definition of “normal”.
If you look at laboratory tests you will see that a normal TSH level generally falls within 0.5 to 4.5 .
You can see the range from different lab tests below:
As you can see the TSH reference range is 0.35 to 5.5.
You can see we have a problem here.
Truly “healthy” people have a TSH < 1.0 and yet the “normal” range extends all the way out beyond 5 in this case.
That means your Doctor won’t flag your TSH as abnormal unless it falls outside of those reference ranges.
But as I mentioned above it is important to consider that your pituitary is the MOST sensitive tissue to thyroid hormone in your body.
That means it is entirely possible to have a “normal” but less than “optimal” TSH.
By these new standards, you can consider a TSH which is greater than 2.0 to be an early indicator of some thyroid dysfunction in the body.
These conditions include:
What Should My Tsh Number Be For My Thyroid
Today were going to talk about the TSH test and its results. TSH stands for Thyroid Stimulating Hormone a standard blood test will produce a number of how well your thyroid is performing. Normal range for an adult is typically considered to be between .4 and 4.0 however, in my practice I would say ideal is between 0.5 and 1.5.
In addition, TSH tests are used to help diagnose a condition called subclinical hypothyroidism, which usually causes no outward signs or symptoms. In this condition, you have normal blood levels of triiodothyronine and thyroxine, but higher than normal levels of TSH.
TSH is often the first test doctors use to determine whether you have too little or too much thyroid hormones. High TSH is often linked to an underactive thyroid or hypothyroidism. Read on to learn about the causes, symptoms, and health effects of high TSH levels.
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What Is The Normal Range Of Tsh
There are a range of levels that your TSH levels can be. Learning what these levels mean will help you work with your doctor to address your condition adequately.
- Normal TSH – Adults should have TSH hormone levels that range from 0.4-4.2 mU/L. This indicates that the signals from your pituitary gland match the activity of your thyroid gland. Your doctor will use this hormone level alongside the other signals and side affects you may be showing to determine if there is an underlying health issue at hand.
- Low TSH – Low TSH levels can be a sign that you are dealing with an overactive thyroid gland from conditions such as goiter, noncancerous tumors or Graves’s disease. The thyroid may also become overactive during the first trimester of pregnancy. If you are already being treated for thyroid issues, you may develop low TSH levels if you are taking too much thyroid medication. If you are not showing signs of overactive thyroid, you may have damaged the pituitary gland, causing it to produce less TSH.
- High TSH – High levels of TSH are typically caused by an underactive thyroid or hypothyroidism. This is typically caused by Hashimoto’s thyroiditis. If you are already being treated for a thyroid disorder this can be a sign that you need to increase your medication. In rare cases, you may be showing high than normal TSH levels because you have developed a tumor that is causing the pituitary gland to over-produce TSH.
Who Is At Risk For Thyroid Cancer
About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.
Thyroid cancer is more common in women who:
- Are between the ages of 25 and 65
- Had radiation therapy to the head or neck, especially in childhood, to treat cancer
- Have a history of
- Have a family history of thyroid cancer
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What Happens If The Tsh Level Is High
An elevation in the thyroid-stimulating hormone level indicates that the thyroid gland is not functioning properly. The TSH hormone controls the level of T3 and T4 hormones in the body, which in turn carry out various cell functions.
A high TSH level is often found in conditions where T3 and T4 levels go down, and the brain compensates by increasing the serum TSH levels. This condition is called hypothyroidism.
The symptoms may include:
The standard reference range for the TSH level is anywhere between 0.30 and 5.0 uIU/mL. If your TSH level is higher than 5.0 uIU/mL, then the lab will flag you as high, and you may experience the symptoms listed above 5.0 uIU/mL. Values of the TSH level more than 10.0 uIU/mL need long-term thyroid supplements.
Subclinical hypothyroidism is seen where TSH levels are between 5.0 and 10.0 uIU/mL but T4 levels are normal. This may need to be treated with supplements if it causes symptoms or if the woman is at present pregnant. Often subclinical hypothyroidism settles on its own with lifestyle changes, diet, and stress management.
Causes for a high TSH level:
Treatment for hypothyroidism or high TSH levels:
Is There Anything Else I Need To Know About A Tsh Test
Thyroid changes can happen during pregnancy. These changes are usually not significant, but some women can develop thyroid disease during pregnancy. Hyperthyroidism occurs in about one in every 500 pregnancies, while hypothyroidism occurs in approximately one in every 250 pregnancies. Hyperthyroidism, and less often, hypothyroidism, may remain after pregnancy. If you develop a thyroid condition during pregnancy, your health care provider will monitor your condition after your baby is born. If you have a history of thyroid disease, be sure to talk with your health care provider if you are pregnant or are thinking of becoming pregnant.
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Persistently Elevated Tsh Despite Thyroid Hormone Replacement
Poor compliance is the most common reason for continued elevation of the TSH level in patients receiving presumably adequate thyroid hormone replacement. Patients who do not regularly take their replacement medication and then try to catch up just before a physician visit may restore their free T4 levels to normal but continue to have an elevated TSH level.
Very rarely, patients have tissue-level unresponsiveness to thyroid hormone. This condition reflects a mutation in the gene that controls a receptor for T3, rendering it unable to bind with the hormone. The genetic mutation has been identified in only 300 families.22 In these patients, adequate amounts of thyroid hormone are produced but are ineffective. Consequently, the TSH level remains elevated, and the patients continue to have symptoms of hypothyroidism. These patients should be referred to an endocrinologist for further evaluation and management.
Recap + What To Do Next
Let’s wrap this long post up with a recap and some direction if you feel you fall into any of the categories listed above.
TSH can be a helpful test but it really falls short under many circumstances in both the diagnosis and management of hypothyroidism.
For several reasons measuring the TSH isn’t the most accurate thyroid lab test.
In fact, even with the combination of all thyroid lab tests, sometimes a diagnosis can still be difficult to obtain .
If you feel that your TSH doesn’t reflect your thyroid status then your best step is to look for a knowledgeable provider to order all of the tests necessary for diagnosis.
Generally, this means you will have to look outside of the insurance model because most Doctors practice what is known as the “standard of care” and that standard is to test only the TSH.
If you are working with someone and they don’t order the tests or balk when you ask for certain tests that is a good indication they are not the provider for you.
I’ve created a resource designed to help you find knowledgeable doctors which you can use here.
Now it’s your turn:
Do you feel the TSH has been helpful in diagnosing or managing your thyroid condition?
Why or why not?
Have you had your other lab tests evaluated? Tests like free T3 and total T3?
What is your healthy TSH range?
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The Benefits Of Thyroid Hormone Replacement Therapy
The first thing you can do if you are worried about hypothyroidism is to get a comprehensive panel of thyroid tests. This is a simple matter of bloodwork and will allow your health care practitioner to quickly assess your levels. If high TSH is detected and hypothyroidism is diagnosed, your practitioner can then design a treatment plan to help you restore balance and address your symptoms.
The centerpiece of treatment for hypothyroidism is hormone replacement therapy, which will compensate for your bodys diminished thyroid hormone levels. Because finding the right dosage is critical to ensuring you receive optimal therapeutic benefit, it is important to partner with a practitioner who specializes in hormone health throughout the treatment process. They will have the training and experience necessary to create a tailored treatment plan and provide ongoing monitoring to keep you feeling your best. They can also offer nutrition, fitness, and lifestyle counseling that could help you address symptoms like weight gain and mood disturbances while promoting greater overall wellness.
Low TSH and hypothyroidism can be devastatingfor your mind and your body. But hormone replacement therapy can harness theconnectedness of the body to help you feel like yourself again.
What Is A T4 Test
T4 Tests A Total T4 test measures the bound and free thyroxine hormone in the blood. A Free T4 measures what is not bound and able to freely enter and affect the body tissues.
What does it mean if T4 levels are abnormal? Importantly, Total T4 levels are affected by medications and medical conditions that change thyroid hormone binding proteins. Estrogen, oral contraceptive pills, pregnancy, liver disease, and hepatitis C virus infection are common causes of increased thyroid hormone binding proteins and will result in a high Total T4. Testosterone or androgens and anabolic steroids are common causes of thyroid hormone binding proteins and will result in a low Total T4.
In some circumstances, like pregnancy, a person may have normal thyroid function but Total T4 levels outside of the normal reference range. Tests measuring free T4 either a free T4 or free T4 index may more accurately reflect how the thyroid gland is functioning in these circumstances. An endocrinologist can determine when thyroid disease is present in the context of abnormal thyroid binding proteins.
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How Tsh Affects T3 And T4 Levels
Levels of thyroid-stimulating hormone directly influence the amount of T4 and T3 your thyroid secretes.
The journal Acta Endocrinologica says that there is a positive relation between TSH serum levels and serum levels of T3 and T4.20
TSH stimulates your thyroid gland to produce T3 and T4 hormones. Obviously when TSH is high, your thyroid will be stimulated to generate more thyroid hormones. When TSH levels are low, your thyroid will generate less T3 and T4.
Possible Causes Of Hypothyroidism
There is no one cause of hypothyroidism, nor isthere always a direct linear path between one of the precipitating events andits onset. However, it is important to know the potential causes so that youcan connect the dots with possible symptoms.
Major causes of hypothyroidism include:
- Hashimotos thyroiditis. This autoimmune disease produces antibodies that attack the tissues of the thyroid, causing it to produce less thyroid hormone.
- Medication. Certain medications, including lithium, can lower thyroid hormone production.
- Hyperthyroidism treatment. A number of treatments for hyperthyroidism, including radioactive iodine treatment, can impair thyroid function.
- Radiation therapy. Radiation therapy for conditions unrelated to the thyroid may cause the thyroid to shrink.
There are a few other possible causes, includingiodine disorders and some pregnancy-related risks. Well take a look at thedangers of the latter just below. But it is important to know that if you fallinto any of these risk categories, the seemingly-mild symptoms might be so muchmore.
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Reduce Hypothyroidism Symptoms By Supporting Your Metabolism
To reduce hypothyroidism symptoms by supporting your metabolism, you want to focus on the following four areas:
- Getting good quality sleep
Now, as a Nutritionist and Womens Wellness Coach, this is an area that interests me greatly. A low metabolic rate can affect all aspects of your wellbeing from your energy levels to your mood and mindset. If your metabolism is slow, you can also find it difficult to lose weight despite eating healthily and exercising. So focusing on improving metabolic rate can have a wide range of benefits as well as helping to reduce hypothyroidism symptoms.
I will be continuing to share more details on how to do this over the next weeks and months. So make sure to follow my blog by adding your email to the Subscribe by email panel on the right to be updated by email when I post.
Questions For Your Doctor About Test Results
When you review the results of your TSH test with your doctor, it could be helpful to ask specific questions, such as the following:
- Is my level of TSH within the normal range?
- Do my test results suggest that my thyroid is overactive or underactive?
- What additional tests will you be ordering, if any?
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