When Abnormal Thyroid Function Tests Are Not Due To Thyroid Disease
While blood tests to measure thyroid hormones and thyroid stimulating hormone are widely available, it is important to remember that no all tests are useful in all circumstances and many factors including medications, supplements, and non-thyroid medical conditions can affect thyroid test results. An endocrinologist can help you make sense of thyroid test results when there is a discrepancy between your results and how you feel. A good first step is often to repeat the test and ensure there are no medications that might interfere with the test results. Below are some common reasons for mismatch between thyroid tests and thyroid disease.
Non-thyroidal illness Significant illness, such as an infection, cancer, heart failure, or kidney disease, or recent recovery from an illness can cause changes transient changes in the TSH. Fasting or starvation can also cause a low TSH. An endocrinologist can help to interpret changes in thyroid function tests in these circumstances to distinguish non-thyroid illness from true thyroid dysfunction.
Test interference Biotin, a common supplement for hair and nail growth, interferes with many thyroid function tests and can lead to inaccurate results. Endocrinologists recommend stopping biotin supplements for 3 days before having a blood test for thyroid function.
Inquire About A T3 Drug
There are many doctors who consider the addition of a T3 hormone, in the form of Cytomel , wholly unnecessary and problematic. They will point to the fact that it is prone to rapid uptake in the intestines and may quickly turn a hypothyroid problem into a hyperthyroid problem. T3 hormones can also interfere with T4 blood test results and complicate the monitoring of your disease. All of these things are true, but to a degree.
If you are able to maintain control of your TSH and T4 but are feeling unwell, the addition of Cytomel may improve your symptoms, according to research from Spain and the National Institute of Diabetes and Digestive and Kidney Diseases.
The same research suggests that the combination of Cytomel and levothyroxine may improve symptoms without any additional side effects compared to levothyroxine alone.
Normal Range For Thyroid Level
Thyroid.org describes the thyroid gland as a butterfly-shaped gland located in the lower front of the neck. It makes hormones that help each cell in the body to work right. Thyroid function tests are used to tell how well the thyroid is working 1. They are used to help diagnose hypothyroid, or underactive function hyperthyroid, or overactive function and to monitor response to thyroid medications 1.
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What Are The Common Signs Of A Thyroid Problem
Hypothyroidism, , is the most common thyroid disorder. Some of the common symptoms of hypothyroidism include:
Puffiness, especially around the eyes
On the other hand, hyperthyroidism, although less common, can still affect a variety of patients. Some of the common symptoms associated with hyperthyroidism include:
Why Do I Have Thyroid Symptoms If My Tsh Is Normal
Some people treated for hypothyroidism may still experience symptoms even if blood tests show that their thyroid stimulating hormone levels are well within the normal range. The reasons for this are complex, but the bottom line is that having a normal TSH value doesn’t necessarily mean that all of your symptoms will go away.
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How To Keep Hypothyroidism Under Control
Because youll need to take thyroid medication every day for the rest of your life, even after the right dose is found, your hormone levels will be monitored regularly to be sure that your treatment is working properly. Eventually, most people with hypothyroidism can just be seen yearly by their doctor, Doria-Medina says.
The American Thyroid Association recommends that you keep your TSH within a narrow range of 0.5 to 2.5 mU/L, but dont be alarmed if your test results vary a little. Some variation is normal because your pituitary gland sends out TSH in pulses, not a steady stream. Also, factors like the time of day youre tested can make a difference. TSH levels are likely to be higher at night and lower during the day. Some people, including those who are pregnant or those with a history of thyroid cancer, have different TSH goals. Talk to your doctor about the target TSH range thats right for you.
If you have new or worsening symptoms or your health status changes such as if you become pregnant, go through menopause, or are given another medicine that can interfere with the absorption of your thyroid hormones, such as anticonvulsants, certain antacids, or iron or calcium supplements you should see your doctor and have your blood tested again, even if its ahead of schedule.
Reference Range & Interpreting Your Lab Results
How do you know if your antibody levels are optimal?
When it comes to TSI testing youll find that there is a standard reference range.
This range is developed based on normal healthy adults and if you fall within this range you are considered to also be normal.
But lets break this down a little bit more:
If the presence of antibodies in your body mean that there is a chance that you may have an autoimmune disease, doesnt it make sense to want this number as close to zero as possible?
I would tend to agree with you on that, and therefore I tend to prefer when patients have a TSI level which as close to zero as possible.
The standard range for TSI is measured as a percentage and the cut off for normalcy is usually less than 1.4 or 1.3 .
This means that you can have a result of 130% and still be considered normal even though you are rapidly approaching the high end of that range.
The high end of the normal range is considered to be 140% which means that the closer you get to this range the closer you are to developing abnormal test results and the closer you are to a diagnosis of Gravess disease.
Because of this, it is preferable to have your percentage as far away from that high end as possible, in this case as far away from 140% as possible.
Thyroid Function Tests Associated with High TSI
If your TSI lab tests are abnormal then your doctor will also order several tests to identify the function of your thyroid gland.
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Testing Your Thyroid Levels
According to the American Thyroid Association, there isnt one test for every situation in fact, there are several kinds of thyroid tests. But if you are concerned about thyroid issues, or if your hormones are imbalanced, your doctor may provide an initial TSH level blood test. This is because the TSH level can serve as a tip-off to other, more specific issues.Whats a normal TSH level? Most lab companies have a wide reference as it relates to TSH levels , Dr. Rice says. So, if your results are somewhere between 0.4-4.0, youd be in the normal range. However, there is research that suggests that the reference range for TSH should be narrowed to 0.4 to 2.5, says Dr. Rice, which means that the normal range could be even smaller than some healthcare providers might think.Generally, healthy TSH levels are an indicator the whole system is working well, but thats an oversimplification at best. A normal T3 level might be somewhere between 100 to 200 nanograms per deciliter , while a normal T4 level falls between 5.0 to 12.0 micrograms per deciliter . Free T4, which tests for the amount of T4 that is available in the body, should range between 0.8 to 1.8 nanograms per deciliter .
What Do The Results Mean
High TSH levels can mean your thyroid is not making enough thyroid hormones, a condition called hypothyroidism. Low TSH levels can mean your thyroid is making too much of the hormones, a condition called hyperthyroidism. A TSH test does not explain why TSH levels are too high or too low. If your test results are abnormal, your health care provider will probably order additional tests to determine the cause of your thyroid problem. These tests may include:
- T4 thyroid hormone tests
Learn more about laboratory tests, reference ranges, and understanding results.
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Whats Included In A Thyroid Function Test
A thyroid function test will usually measure your levels of:
A more advanced test will also test for the presence of any thyroid antibodies that could be causing an autoimmune disease. This might check your levels of:
- thyroid peroxidase
- thyroglobulin antibodies
- TSH receptor antibodies
Its important to note that the presence of these antibodies in your blood doesnt automatically mean you have an autoimmune thyroid disease but it can indicate an increased risk of developing one in the future.
Some vitamins and minerals are essential for your thyroid to function properly like vitamin D, vitamin B12, folate , and iron. A nutrient deficiency can sometimes mimic the symptoms of a thyroid disorder. If possible, its a good idea to test your thyroid hormones and these nutrients as well.
Normal Vs Optimal And Best Thyroid Levels
This is one of the major pitfalls of lab results that I want to address. There is a cutoff that exists between normal and optimal based on an entirely biased population. Here are some relevant factors that you should consider
What optimal would ideally take into account is what we call diurnal variation. People who get thyroid tests do not have them all done at the same time. In a perfect world, we would instead be comparing values taken between 6 and 10 in the morning.
This is because, during other times of the day, your scores can be different. Many that have been tested have ultimately skewed the average because of this .
Fasting status can also result in wildly erratic scores, as can goiters .
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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.
Does Thyroxine Treatment Have Side Effects
No good-quality research is available on the side effects of treating subclinical hypothyroidism with thyroxine, but its generally considered to be a well-tolerated drug. Because the body usually produces this hormone on its own, there are no problems if the dose is correct. If its too high though, side effects cant be ruled out. Possible side effects include heart problems like or a racing heartbeat.
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How Are Thyroid Tests Done
In order to properly test the hormone levels of your thyroid, a blood draw will be performed by your doctor or at a lab.
Prior to the blood draw, you will be asked to sit in a chair, roll up your sleeves and relax while a nurse or technician prepares your arm for the draw.
A band of rubber will be tightly tied around your upper arm to force the veins to swell. This makes it easier for a vein to be found so the needle can be inserted.
Having blood drawn is mostly painless, although it is possible to feel a sharp prick when the needle is inserted. This is typically a very quick sensation.
Once the blood has been fully drawn, the needle will be removed and a small bandage will be placed over your wound.
Before your tests are performed, you should tell your doctor if youre taking any medication or if you may be pregnant. This may alter the results of your test.
How Do I Prepare For A Thyroid
The TSH test doesnt require any special preparation. However, its important to tell your doctor if youre taking medications that might interfere with the accuracy of the TSH measurement. Some medications that could interfere with a TSH test are:
- potassium iodide
You may need to avoid using these drugs before the test. However, dont stop taking your medications unless your doctor tells you to do so.
A TSH test involves taking a sample of blood. The blood is typically drawn from a vein thats inside the inner elbow.
A healthcare provider will perform the following procedure:
The entire procedure should only take a few minutes to complete. The blood sample will be sent to a lab for analysis.
Once your doctor receives the test results, theyll schedule an appointment with you to discuss the results and explain what they may mean.
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What Is A Tsh Test And What Do Your Results Mean
The thyroid-stimulating hormone test evaluates thyroid function and thyroid hormone levels. Its produced by the pituitary gland, which tells your thyroid, located in the lower front of your neck, to make and release hormones that control our body temperature, metabolism, and keep our brains, hearts, and other organs working properly.
The American Thyroid Association recommends that adults begin TSH testing at the age of 35 and repeat tests every five years if results are in the normal range. Your doctor may also order a TSH test if youre experiencing symptoms of an underactive or overactive thyroid. Symptoms of hypothyroidism can include fatigue, brain fog, extremely dry skin, hair loss, and feeling cold. Symptoms of hyperthyroidism can include sweating, a fast heart rate, muscle weakness, anxiety, and irritability. In either case, youor your healthcare providermight find that your thyroid is enlarged, which is called a goiter, or thyroid nodules, which are small lumps on the thyroid gland.
Additional Tests For Thyroid Health
Given the potential inaccuracies with TSH on its own, comprehensive screening of thyroid health should ideally include these 6 tests:
Your doctor should be aware of these tests.
About Joe Leech, Dietitian
Joe Leech is a university-qualified dietitian from Australia.
He graduated with a Bachelor’s degree in exercise science, followed by a Master’s degree in Nutrition and Dietetics in 2011.
Learn more about him on the About page.
Joe Leech, Dietitian
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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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What Are Thyroid Blood Tests And Why Are They Taken
Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. They are done by withdrawing blood from a vein in your arm. These blood tests help to diagnose thyroid diseases.
The thyroid is a butterfly-shaped gland located in the front part of your neck. Its job is to produce thyroid hormones, which travel through your bloodstream and regulate many aspects of your bodys metabolism, including temperature, weight, and energy.
Thyroid blood tests show if you have:
- Hyperthyroidism: Overactive thyroid producing more thyroid hormones than your body needs. Hyperthyroidism speeds up your metabolism, which can cause weight loss, rapid heartbeat, insomnia, puffiness around the eyes, anxiety and other symptoms. The most common cause of hyperthyroidism is Graves disease.
- Hypothyroidism: Underactive thyroid producing too few thyroid hormones. Hypothyroidism slows down your metabolism, which can cause weight gain, menstrual irregularity, dry and puffy skin, fatigue and other symptoms. The most common cause of hypothyroidism is Hashimotos disease.
Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include:
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