In People Without Known Thyroid Disease
A high TSH in people who are not undergoing thyroid disease treatment usually indicates the presence of primary hypothyroidism.
This is by far the most common form of hypothyroidism, and it occurs because the thyroid gland produces an inadequate amount of thyroid hormones. The pituitary gland senses these low levels and increases the production of TSH.
An elevated TSH may also occur with normal thyroid function due to the presence of antibodies, proteins made by the immune system.
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What Are Normal T4 And T3 Levels
T4 and T3 can be measured by blood test.
Specifically, Total T4 and T3 and/or Free T4 and T3 can be tested.
Total T4 and T3 refers to the total amount of circulating T4 and T3 in your blood. However this includes hormone that is bound to protein, which makes it inactive.
Therefore the more useful reading is a measurement called Free T4 and Free T3, or FT4 and FT3. This measures the amount of active hormone in the blood.
The normal range for T4 and T3 will vary depending on the lab analyzing the sample. Test results need to be compared to the reference range of that specific lab.
Normal ranges for adults generally fall between these values .
Total T4 5.0-12 g/dL
There are also specific reference values for children.
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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.
Can T4 And T3 Be Normal When Tsh Is Elevated
The simple answer is yes.
This is known as subclinical hypothyroidism.
Currently there is no scientific consensus on whether treatment with medication is helpful. This is because the active hormones are still at normal levels.
Although TSH is elevated, the thyroid is still able to produce enough T4 and T3 to meet demand. Therefore, hypothyroid symptoms are not present.
Often active surveillance is the only management undertaken. This involves careful monitoring of signs and symptoms and repeat blood tests.
If TSH levels are significantly raised medication may be prescribed .
Summary: Subclinical hypothyroidism occurs when TSH levels are high but T4 and T3 are normal. Usually there are no symptoms.
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Can I Take The Test At Home
Several test kits are commercially available that allow you to provide a sample for TSH testing at home. Some kits test only TSH, and others test TSH in combination with other thyroid hormones or additional hormones, such as cortisol and free testosterone.
These kits may be purchased online and include the materials you need to take a finger prick sample of blood and return it to the company for testing. Your test results will be reported to you via a secure online platform.
At-home testing is convenient and can help you participate in your health care. But at-home tests cannot replace working with a health care provider. If you have symptoms or are concerned that your thyroid is not functioning properly, be sure to share your concerns with your doctor. If an at-home test detects an abnormal TSH level, your doctor is likely to retest the TSH and follow-up with additional testing if the second TSH test is also abnormal.
How Hypothyroidisms Effect On Periods Can Impact Fertility
Hypothyroidism could disrupt your plans to get pregnant. To conceive, you need to ovulate and have a good endometrial lining of the uterus for an embryo to implant.
Women with hypothyroidism may develop a short luteal phase, which is the time between ovulation and the start of your period, says McConnell. If a woman has a short luteal phase, implantation of an embryo may not occur. You might also have abnormal ovulation or none at all.
Changes in periods do not always mean reduced fertility but should be evaluated by a physician if they persist, says Spencer.
Untreated hypothyroidism may also increase a womans risk of miscarriage, so its important to have your thyroid checked if you are struggling to conceive or have a history of miscarriages, Spencer says.
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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?
What Are Other Lab Tests Used To Assess Thyroid Function
The most common way to check for autoimmune thyroiditis is to test for the presence of thyroperoxidase antibodies . Like TgAB, your immune system also creates TPO antibodies to attack your thyroid gland.
Thyroid peroxidase is a key enzyme involved in the production of thyroid hormone. Specifically, the TPO enzyme facilitates the chemical reaction where iodine bonds to the thyroglobulin protein. This critical step helps to create thyroxine .
When your immune system sends out antibodies to disrupt this chemical reaction, it prevents thyroid hormones from being made. Over time, it can lead to chronic inflammation and eventual hypothyroidism and organ failure.
The American Thyroid Association recommends your doctor test for either TPO antibodies or TgAB in patients with hypothyroidism because autoimmune disease is most often the culprit.
However, the ATA specifies that the TPO antibody test is more sensitive and specific than the TgAB test for autoimmune thyroid disease like Hashimoto’s thyroiditis.
Thyroid-stimulating hormone is the primary marker your doctor will look at to assess your thyroid function. TSH is a hormone released by the pituitary gland that tells your thyroid how much thyroid hormone to make. When thyroid hormone levels are low, the pituitary releases more TSH to signal the thyroid to produce more hormones. Alternatively, when thyroid hormone levels are high, TSH levels fall.
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Treating Hypothyroidism With Replacement T4 And T3
Hypothyroidism is usually treated with synthetic T4 called levothyroxine or synthroid.
Desiccated thyroid can also be used effectively, which is a mix of T4 and T3 made from animal thyroid glands. However, there is no evidence desiccated thyroid is more beneficial than levothyroxine .
Some doctors may also prescribe T3 alongside T4 medications when treating a stubborn case of hypothyroidism. This is uncommon but often useful.
Summary: Synthetic T4 is the usual treatment for hypothyroidism. Desiccated animal thyroid is an effective alternative.
If Part Of My Thyroid Is Surgically Removed Will The Other Part Be Able To Make Enough Thyroid Hormones To Keep Me Off Of Medication
Sometimes, your surgeon may be able to remove part of your thyroid and leave the other part so that it can continue to create and release thyroid hormones. This is most likely in situations where you have a nodule thats causing your thyroid problem. About 75% of people who have only one side of the thyroid removed are able to make enough thyroid hormone after surgery without hormone replacement therapy.
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What Causes Hypothyroidism
Hypothyroidism has several causes. They include
- Hashimoto’s disease, an autoimmune disorder where your immune system attacks your thyroid. This is the most common cause.
- Thyroiditis, inflammation of the thyroid
- Congenital hypothyroidism, hypothyroidism that is present at birth
- Surgical removal of part or all of the thyroid
- Slowed heart rate
- Goiter, an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing.
Because hypothyroidism develops slowly, many people don’t notice symptoms of the disease for months or even years.
Why Do I Need A Tsh Test
You may need a TSH test if you have symptoms of too much thyroid hormone in your blood , or too little thyroid hormone .
Symptoms of hyperthyroidism, also known as overactive thyroid, include:
Symptoms of hypothyroidism, also known as underactive thyroid, include:
- Weight gain
- Low tolerance for cold temperatures
- Irregular menstrual periods
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Hypothyroidism Can Make Periods Heavy Absent Or Irregular
Hypothyroidism can put the brakes on ovulation a phenomenon known as anovulation resulting in heavy periods. In some women with uncontrolled hypothyroidism, this anovulation can lead to disordered growth and shedding of the uterine lining, causing unpredictable bouts of heavy bleeding from the uterus, says Jessica Spencer, MD, an associate professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. This can be monthly in some women and far apart in others.
Changes in prolactin levels can lead to thinning of the uterine lining and changes in how the pituitary gland controls the ovaries both can result in periods stopping completely, says Dr. Spencer.
Hypothyroidism can also change coagulation factors, increasing the risk of heavy bleeding.
Women of reproductive age with hypothyroidism may experience heavy periods, absent periods, or irregular periods, says McConnell, and the symptoms of menstrual irregularities will depend on the severity of the hypothyroidism.
Menstrual irregularities tend to be more common in women with severe hypothyroidism compared to mild hypothyroidism, says McConnell.
Exposure To Toxic Metals
Certain heavy metals can be toxic to humans. Cadmium, in particular, can disrupt the bodys balance of thyroid hormones .
Research suggests that exposure to even low levels of cadmium can cause the thyroid gland to become hyperactive and secrete more T3 and T4. Cadmium exposure is also linked to thyroid tumors, which further increase the levels of thyroid hormones .
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Why Might Your Doctor Test Your Thyroglobulin Antibodies Levels
Your doctor may check your TgAB levels if they suspect you have an underlying autoimmune condition causing thyroid dysfunction. A doctor may want to see the results of a TGAb test if they see specific clinical findings on your lab work and physical exam, including:
- A goiter
- Inflammation of the thyroid
- Abnormalities in other thyroid function tests like T4 and T3
While this may be a test occasionally used to detect autoimmune thyroiditis, it is more common to use this test to determine if treatment for thyroid cancer has been effective or not. Indeed, providers often use TgAB as a tumor marker because your body will only continue to produce TgAB’s if you still have thyroid tissue in your body. Thus, after thyroid cancer treatment, the goal is to have no TgAB’s in your lab work after your thyroid has been removed.
What Is A Normal Thyroid Level
Tests often used to assess thyroid hormone status include TSH and FT4 tests. The normal value for a laboratory test is determined by measuring the hormone in a large population of healthy individuals and finding the normal reference range. Normal ranges for thyroid tests may vary slightly among different laboratories, and typical ranges for common tests are given below.
TSH normal values are 0.5 to 5.0 mIU/L. Pregnancy, a history of thyroid cancer, history of pituitary gland disease, and older age are some situations when TSH is optimally maintained in different range as guided by an endocrinologist.
FT4 normal values are 0.7 to 1.9ng/dL. Individuals taking medications that modify thyroid hormone metabolism and those with a history of thyroid cancer or pituitary disease may be optimally managed with a different normal FT4 range.
Total T4 and Total T3 levels measure bound and free thyroid hormone in the blood. These levels are influenced by many factors that affect protein levels in the body, including medications, sex hormones, and liver disease. A normal Total T4 level in adults ranges from 5.0 to 12.0g/dL. A normal Total T3 level in adults ranges from 80-220 ng/dL.
Free T3 assays are often unreliable and not routinely used to assess thyroid function.
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Patterns Of Thyroid Tests Associated With Thyroid Disease
Primary Hypothyroidism A high TSH and low thyroid hormone level can indicate primary hypothyroidism. Primary hypothyroidism occurs when the thyroid gland makes too little thyroid hormone. Symptoms of hypothyroidism can include feeling cold, constipation, weight gain, slowed thinking, and decreased energy. Causes of primary hypothyroidism include:
- Autoimmune thyroid disease, including Hashimoto’s thyroiditis
- Thyroid gland dysfunction due to a medication
- Removal of all or part of the thyroid gland
- Radiation injury to the thyroid
- Excess treatment with anti-thyroid medications
Early or mild hypothyroidism may present as a persistently elevated TSH and a normal FT4 hormone level. This pattern is called subclinical hypothyroidism and your doctor may recommend treatment. Over time, untreated subclinical hypothyroidism can contribute to heart disease.
It is important to remember that normal TSH levels in older individuals are higher than the normal ranges for younger individuals.
Primary Hyperthyroidism A low TSH and a high thyroid hormone level can indicate primary hyperthyroidism. Primary hyperthyroidism occurs when the thyroid gland makes or releases too much thyroid hormone. Symptoms of hyperthyroidism can include tremors, palpitations, restlessness, feeling too warm, frequent bowel movements, disrupted sleep, and unintentional weight loss. Causes of primary hyperthyroidism include:
Can I Live A Normal Life With A Thyroid Disease
A thyroid disease is often a life-long medical condition that you will need to manage constantly. This often involves a daily medication. Your healthcare provider will monitor your treatments and make adjustments over time. However, you can usually live a normal life with a thyroid disease. It may take some time to find the right treatment option for you and control your hormone levels, but then people with these types of conditions can usually live life without many restrictions.
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Normal T3 And T4 Levels
What are normal T3 and T4 levels when your thyroid is functioning properly?
Dr. Jayita Poduval who specializes in neck and throat disorders says that normal free T3 levels are 125 250 ng/dL in children and 80 200 ng/dL in adults.21
The reference range for free T4 is 0.7 1 ng/dL in adults and 0.8 2 ng/dL in children and adolescents.22
Possible Health Risks Of High T3
In the section below, well discuss some potential health risks of high T3 levels in the blood. This is not a comprehensive list. Having high T3 levels does not necessarily mean these health risks will occur. If you have abnormal thyroid hormone levels, speak to your doctor about how they may affect you.
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Treatments For High Tsh Levels
If your TSH level is high, the treatment is usually to prescribe pure synthetic T4 , which is a manufactured version of the T4 hormone your thyroid produces. If your T3 level is low, the doctor can give you Liothyronine, which is only a short-term treatment for low T3 levels.
Balancing your thyroid hormone levels, including T4 and T3, should restore the feedback loop to the pituitary gland, prompting it to produce less TSH.
Tests For Measuring T4 And T3
There are a number of tests available that record T4 and T3 levels.
In addition to total T4 and T3, and Free T4 and T3, further tests may be required when the cause of issue is complex.
Thyroglobulin and thyroid antibody tests are also frequently used to help diagnose thyroid disease.
About Eleise Britt
Eleise is a university qualified Nutritionist from Melbourne, Australia.
After studying a Bachelor of Health Science , she later went on to follow her passion for nutrition science and completed a Master of Human Nutrition at Deakin University.
Learn more about her on the About page.
Joe Leech, Dietitian
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What Do The Results Of Tpo Antibodies Test Mean
The TPO antibodies test results may show one of the following options:
- Negative as you can already conclude negative TPO antibodies test result indicates that no thyroid antibodies were found. This result also implies that thyroid problems and symptoms a patient experiences are not caused by an autoimmune condition
- Positive antibodies to TPO and/or Tg this result indicate a patient may have Hashimotos thyroiditis
- Positive antibodies to TPO and/or TSH may indicate the presence of Graves disease
The higher the level of antibodies, the more likely it is that a patient has an autoimmune disease of the thyroid e.g., Hashimotos or Graves disease. Blood test results for TPO antibodies are positive in 95% of patients with Hashimotos thyroiditis and in 50% to 80% of people with Graves disease.
When it comes to TPOAbs, the reference value is < 9.0 IU/ml . Values above 9.0 are typically associated with autoimmune thyroid disease, but elevations are also observed in some other autoimmune conditions. The most commonly mentioned TPOAb reference range is less than 35 IU/ml.
The presence of TPOAbs in patients with subclinical hypothyroidism predicts an elevated risk of overt hypothyroidism. Moreover, this also shows that those patients could be at a higher risk of developing other autoimmune conditions like type 1 diabetes.
As mentioned above in the article, some people may be positive to TPO antibodies, but they do not have a thyroid condition.