How Is Subclinical Hypothyroidism Diagnosed
Thyroid values like TSH are measured in blood tests. Because a single test can be misleading, a second test is usually done 2 or 3 months later. In both tests, the blood is taken at the same time of day because TSH levels can fluctuate over the course of 24 hours. Subclinical hypothyroidism is diagnosed when both TSH readings are high but the thyroid hormone thyroxine is still within the normal range.
Experts don’t agree on which TSH levels should be considered too high. Some suggest that TSH levels of over 2.5 milliunits per liter are abnormal, while others consider levels of TSH to be too high only after they have reached 4 to 5 mU/L.
Both children and teenagers as well as older people have somewhat higher TSH levels than middle-aged people. Because of this, thyroid specialists have been debating whether a higher threshold should be used for these age groups. Being severely overweight and certain medications can also increase TSH. TSH levels are likely to fluctuate more during pregnancy.
Mild Hypothyroidism: Who Should Be Treated
What to do about mild hypothyroidism is a subject that has been studied and debated for years. Mild hypothyroidism is also called subclinical hypothyroidism. It doesnt meet the standard definition of overt hypothyroidism. You may have no symptoms, and your thyroid function blood tests show a mixed picture.
Your free T4 level is normal, meaning your body is getting enough thyroid hormone. It is your TSH level that is above the normal range, which indicates your thyroid gland has to work harder to pump out that thyroid hormone.
One worry about mild hypothyroidism is the potential link between untreated subclinical hypothyroidism and coronary artery disease. Results of research on whether subclinical thyroid disease causes heart problems have been conflicting. However, the condition has been associated with heart and blood vessel abnormalities, and some studies suggest that treating mild hypothyroidism can improve various markers of heart structure and function.
However, there are potential downsides to treating subclinical hypothyroidism. There is the risk of overtreatment, which might cause symptoms, such as feeling jittery and insomnia. Also, long-term overtreatment can lead to loss of bone density.
If your TSH level is higher than 10 mIU/L, you should start treatment, because you will develop symptoms of an underactive thyroid, even if you dont have them now.
How Does Subclinical Hypothyroidism Develop
The way that subclinical hypothyroidism develops depends on a number of different factors including the TSH level: Slightly elevated TSH levels often return to normal on their own. But people who have highly elevated levels often develop symptomatic overt hypothyroidism within several months or years.
One study followed people with high levels of TSH over a period of two to three years. The participants didn’t have any symptoms or diagnosed thyroid disorders. They were divided into three groups depending on how high their TSH levels were. The study produced the following results:
- Slightly elevated TSH levels : Each year, 2% of the participants in this group developed overt hypothyroidism.
- Moderately elevated TSH levels : Each year, 20% of the participants in this group developed hypothyroidism with symptoms.
- Highly elevated TSH levels : Each year, 73% of the participants in this group developed overt hypothyroidism.
TSH levels that are slightly or only moderately elevated don’t necessarily need to be treated. Some people who have high TSH levels never even develop symptoms. It is also very common for TSH levels to return to normal in children and teenagers.
The probability that overt hypothyroidism develops from subclinical hypothyroidism is greater if the thyorid is enlarged and thyroid antibodies are detectable in the blood. And women generally have a higher risk than men.
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When Should I Get A Tsh Test
TSH is often the first test doctors order when they suspect a patient has a thyroid disorder. Both hypothyroidism and hyperthyroidism are common disorders. All patients with symptoms of these thyroid disorders should have their TSH checked.
If you are having symptoms of these disorders, your doctor may order a TSH or a thyroid panel test. Symptoms of hypothyroidism include:
- Rapid or irregular heartbeat
- Loose, frequent bowel movements
TSH is also used to evaluate patients who are suspected to have other thyroid disorders, such as goiter, thyroid nodule, thyroid cancer, Graves disease, or Hashimotos thyroiditis. These disorders can cause hypothyroidism or hyperthyroidism.
Screening with TSH for hypothyroidism in adults is controversial. Screening means testing in the absence of symptoms. It is most beneficial when early detection and treatment of disease helps people avoid subsequent medical problems. Some organizations, such as the American Association of Clinical Endocrinology, the American Thyroid Association, and the Endocrine Society, favor routine screening for thyroid problems in adults without symptoms.
Because thyroid disorders can complicate pregnancy, screening with a TSH test during pregnancy is recommended for some women. Pregnant women without symptoms of thyroid problems may be screened if they:
Are You On Levothyroxine And Still Experiencing Hypothyroid Symptoms
It’s never normal for you to experience hypothyroid symptoms despite taking your thyroid medication.
But, what exactly is Levothyroxine?
Levothyroxine is a form of thyroid hormone replacement medication and it is the most common medication used to treat hypothyroidism .
This thyroid medication contains the inactive thyroid hormone T4 .
If you are taking this medication to treat your sluggish thyroid, but still experiencing symptoms, then there may be a problem with your dose.
What do I mean by symptoms?
The symptoms of hypothyroidism include any or all of the following:
- Fatigue or exhaustion even after sleeping 8+ hours at night
- Weight gain or weight loss resistance
- Depression, anxiety or mood swings
- Problems with PMS, menstrual cycle or low sex drive
- Chronic pain in the muscles and joints
- Cold extremities
- Chronic constipation
These are the symptoms I am referring to whenever I mention the ‘symptoms of hypothyroidism’ and these symptoms should be going away or reducing if you are taking thyroid medication such as Levothyroxine or Synthroid.
In many cases, it’s not uncommon for patients to experience persistent symptoms of hypothyroidism despite using thyroid hormone medication.
But why is this?
This very problem exists as a result of how thyroid disease is managed.
Does Birth Control Affect My Thyroid
When youre on birth control pills, the estrogen and progesterone inside of the pills can affect your thyroid-binding proteins. This increases your levels. If you have hypothyroidism, the dose of your medications will need to be increased while youre using birth control pills. Once you stop using birth control pills, the dosage will need to be lowered.
Will Hypothyroidism Make Me Gain Weight
If your hypothyroidism is not treated, you could gain weight. Once you are treating the condition, the weight should start to lower. However, you will still need to watch your calories and exercise to lose weight. Talk to your healthcare provider about weight loss and ways to develop a diet that works for you.
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Levothyroxine Vs Armour Thyroid Vs Liothyronine
As you probably know there are several different types of thyroid hormone medications that are currently available.
Unfortunately, most Doctors give out the same medication: Levothyroxine or Synthroid.
Both of these medications contain the inactive thyroid hormone T4 and in order for it to be active in your body, it must be converted to the active T3 thyroid hormone .
So why haven’t you ever heard of this before?
Doctors operate under the assumption that all patients convert T4 to T3 at an equal rate which means that they don’t feel this conversion process should be taken into account.
But there is one problem with this philosophy:
And that’s where the other thyroid medications come in…
Many patients do very well using combination thyroid medications which contain both T4 and T3, not just T4 medication alone.
And I’m not just saying this from experience, most patients also agree that medications containing T3 are superior…
In clinical studies, many patients prefer natural desiccated thyroid hormone over T4 medication alone.
The study shown above highlights why this is the case.
As patients switch from taking LT4 medication to thyroid extract they tend to experience a better quality of life and more weight loss.
This is felt to be secondary to the increase in free T3 and free T4 levels which can remain low even if the TSH is considered to be normal .
The patients who make the switch tend to experience more energy, less hair loss, more weight loss and so on.
Can Hypothyroidism Be Prevented
Hypothyroidism cannot be prevented. The best way to prevent developing a serious form of the condition or having the symptoms impact your life in a serious way is to watch for signs of hypothyroidism. If you experience any of the symptoms of hypothyroidism, the best thing to do is talk to your healthcare provider. Hypothyroidism is very manageable if you catch it early and begin treatment.
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To Treat Or Not To Treat
Aging WellVol. 5 No. 6 P. 6
Physicians are accustomed to checking thyroid-stimulating hormone in older adults with symptoms of an over- or underactive thyroid, as its a fairly accurate and routine measure of thyroid function. But a new study suggests that for many patients, treatment for mild TSH elevations may no longer be warranted.
As increasing numbers of people live into their 80s and 90s, it is important to know how to manage their health, including thyroid function, says Anne Cappola, MD, ScM, an associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania and lead study author. We sought to describe what happens to thyroid function in older people over time and to determine the relationship between thyroid function and mortality in this population.
The study, accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism, questions the assertion that slightly elevated TSH levels are linked to an increase in mortality and suggests that such elevations may actually be a normal part of healthful aging.
Study Particulars The study first examined 5,888 men and women aged 65 and older between 1989 and 1992. Then in 2005, researchers reexamined 843 surviving participants thyroid function for any changes in physical and cognitive function. Study participants ranged in age from 77 to 102, with a mean age of 85.
How To Measure Tsh Levels
The TSH test involves a healthcare professional drawing blood from a vein in the inner arm. They then send the blood sample to a laboratory for testing.
Usually, people do not need to prepare for a TSH test. However, if the doctor is testing the blood for more than one issue, a person may need to fast or prepare in another way. The doctor will provide this information beforehand.
If a person has abnormally high or low TSH levels, the doctor needs to run at least one other diagnostic test to identify the underlying cause. These tests look at levels of specific thyroid hormones and antibodies.
How Is Hypothyroidism Treated
In most cases, hypothyroidism is treated by replacing the amount of hormone that your thyroid is no longer making. This is typically done with a medication. One medication that is commonly used is called levothyroxine. Taken orally, this medication increases the amount of thyroid hormone your body produces, evening out your levels.
Hypothyroidism is a manageable disease. However, you will need to continuously take medication to normalize the amount of hormones in your body for the rest of your life. With careful management, and follow-up appointments with your healthcare provider to make sure your treatment is working properly, you can lead a normal and healthy life.
How Tsh Levels Change
TSH levels are not very intuitive. Why does a high TSH mean you have an underactive thyroid gland? Why do low levels means the gland is overactive?
Understanding exactly how the thyroid gland works can help.
Your thyroid gland produces thyroid hormone. When it functions properly, your thyroid is part of a feedback loop with your pituitary gland that involves several actions:
First, your pituitary gland senses the level of thyroid hormone that is released into the bloodstream.
Your pituitary then releases the special messenger hormone TSH, which makes the thyroid release more thyroid hormone. From there:
- If your thyroid doesn’t produce enough thyroid hormone, your pituitary triggers your thyroid to make more.
- If your thyroid is overactive and producing too much thyroid hormone, your pituitary senses that and slows or shuts down TSH production.
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Why The Test Is Performed:
This test may be performed as part of an evaluation of thyroid function. Thyroid function is complex and depends on the action of many different hormones:
In people with normal thyroid function, having enough T3 and T4 inhibits both TSH and TRH, which prevents the body from making too much T3 and T4. Most T3 and T4 is transported by a protein called TBG , but smaller amounts are found on prealbumin and albumin. When not bound to proteins, they are called “free” T3 or T4.
Are Test Results Accurate
Although no test is 100% correct all the time, your TSH test is likely to reflect your level of thyroid-stimulating hormone accurately. Most labs now use a highly precise, third-generation testing process for TSH. This method of testing is accurate to within 0.01 mIU/L. Some labs use an older, second-generation testing method, which is accurate to within 0.1 mIU/L.
It is important to bear in mind that thyroid tests are a snapshot of what is going on in your body at the moment the test sample is taken. Your TSH levels may fluctuate based on factors discussed above, such as pregnancy, illness, and age.
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How Do I Know If My Thyroid Dose Is Correct
Monitoring thyroid levels on medication Correct dosing of thyroid hormone is usually assessed using the same tests for diagnosis of thyroid disease, including TSH and FT4. Thyroid tests are typically checked every 4-6 weeks initially and then every 6 to 12 months once stable. In special circumstances, such as pregnancy, a history of thyroid cancer, central hypothyroidism, amiodarone therapy, or use of combination T4 and T3 thyroid hormone replacement, your endocrinologist may check different thyroid tests. Additionally, your endocrinologist will evaluate for symptoms of hyperthyroidism and hypothyroidism and peform a physicial exam.
Women who are pregnant and women who may become pregnant should only be treated with levothyroxine . Only T4 efficiently crosses the placenta to provide thyroid hormone to the developing fetus. Thyroid hormone is critical in early pregnancy for brain development. Normal ranges for thyroid tests in pregnancy are different and change by trimester. Women with thyroid disease in pregnancy or who are considering pregnancy should be under the care of an endocrinologist to guide therapy.
Got Questions About Normal Thyroid Hormone Levels?
Cvd Partially Explains Link To All
byNicole Lou, Staff Writer, MedPage Today February 7, 2020
Levels of thyroid function considered “normal” were still associated with increased mortality, according to a study suggesting that cardiovascular disease plays an important role.
People considered to have subclinical hypothyroidism — serum thyrotropin levels over 5.60 mIU/L but normal serum free thyroxine — were at greater risk of all-cause mortality over more than 7 years compared to those with TSH in the middle of the normal range .
Yet even the upper end of the normal TSH range, dubbed high-normal TSH, showed greater risk of death during follow-up than the middle-normal group , reported a group led by Kosuke Inoue, MD, of the University of California Los Angeles, in a study published online in JAMA Network Open.
Statistical analysis showed that CVD indirectly mediated roughly 5% to 15% of the association between thyroid function and death — namely in women and people age 60 or older.
“igher TSH level may be a risk factor for CVD and also mortality, even when TSH levels are only modestly elevated,” the authors concluded, raising the question of whether hypothyroidism should be treated early on during the subclinical phase.
The American Thyroid Association and European Thyroid Association currently do not recommend treating subclinical hypothyroidism when TSH is 10 mIU/L, according to Inoue’s team.
Participants with subclinical hypothyroidism or high-normal TSH were generally older.
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How To Prepare For The Test:
The health care provider may advise you to stop taking drugs that may affect the test . For infants and children: The preparation you can provide for this test depends on your child’s age and experience. For specific information regarding how you can prepare your child, see the following topics:
- infant test or procedure preparation
- toddler test or procedure preparation
- preschooler test or procedure preparation
- schoolage test or procedure preparation
- adolescent test or procedure preparation
Low Thyroid Hormone Levels
Iodine â frequently found in seawater and seafood â is essential to human health. And if youâre not getting enough iodine in your diet, then you may be putting your health through the gauntlet of hypothyroidism. Hypothyroidism refers to an underactive thyroid â your thyroid gland doesnât produce enough thyroid hormones. Iodine deficiency may result in hypothyroidism TSH levels , but this is not the only possible cause of low thyroid hormone levels. For example, autoimmune disorders â as well as exposure to radiation therapy during cancer treatment â can also lead to hypothyroidism.
Symptoms of low thyroid hormone levels range from the dramatic to the somewhat more subtle. People with hypothyroidism might gain weight rapidly, for example â or find themselves wearily running on fumes all day due to excessive fatigue. Hair loss can also result â and you may be less resistant to cold temperatures. Your skin can also have a cool and dry feel to it. In women, irregular â or even completely absent â menses is another sign of low thyroid hormone levels.
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