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What Should Your Thyroid Numbers Be

What More Should I Know About Thyroid Blood Tests

Understanding Your Thyroid Lab Ranges- Optimal Levels

Ranges noted here are approximate; your providers may differ slightly. Its important that you remember abnormal readings do not necessarily mean a thyroid disorder is present, as each test can be affected by a variety of factors.

No preparation is required for these tests. They can be taken any time of day without fasting.

Last reviewed by a Cleveland Clinic medical professional on 12/27/2019.

References

How Is A Thyroid Biopsy Performed

A thyroid biopsy, also called a fine needle aspiration , uses a small needle to take a little sample of the cells in the thyroid nodule. The possible outcomes from a biopsy are:

Non-diagnostic: Non-diagnostic is a technically failed biopsy. There were not enough cells taken during the biopsy so the cytologist was not able to determine anything. These usually need to be repeated.

Benign: Most thyroid nodule biopsies come back benign, meaning your doctor is highly re-assured that it’s not cancerous. Patients can almost always avoid surgery unless the nodule is large and pushing on adjacent structures like the airway.

Indeterminate:; Indeterminate means there was enough cells taken during the biopsy, but the cytopathologist was not sure if it is benign or malignant. Indeterminate results occur in about 20% of thyroid biopsies. This is a gray zone and means that the risk of cancer is about 10-30%. These nodules require additional work-up such as a repeat biopsy, molecular marker test, or surgical removal.

Suspicious for Malignancy or Malignant: Results categorized in these two categories are a strong indicator that there is cancer present and usually require surgical removal.

Patients usually wait one week for the cytopathologist to examine the cellular characteristic of the biopsy sample. If your doctor is reassured that it’s benign based on the biopsy result, further work-up is stopped and serial ultrasound surveillance is recommended usually once a year.

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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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.

What Does A Low Tsh Level Mean

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A TSH level below 0.5 mIU/L can mean that your thyroid gland is overactive. This is hyperthyroidism, which can cause such symptoms as , heat intolerance, increased appetite, and bulging eyes.

One of the most common causes of hyperthyroidism is Graves disease, an autoimmune disorder in which your bodys immune system mistakenly attacks the thyroid gland. also can be caused by or taking certain medications.

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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.;

Mineral Deficiency And Thyroid Function

The thyroid gland required iodine and selenium and major co-factors in its function to regulate metabolism. If these nutrients are missing, the thyroid cannot properly function.

Hypothyroidism is often very high in populations whose diet is very low in selenium but most importantly in iodine. The diet plays a very important t role in regulating thyroid function and maintenance of thyroid balance.

If you are borderline hypothyroid, where the TSH levels are within the normal range but you are experiencing common symptoms, following a good thyroid diet may be the way to go.

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What Are The Complications Of Hypothyroidism If Left Untreated

If hypothyroidism is left untreated or not treated properly, a life-threatening complication called;myxedema can occur.;Myxedema is considered a medical emergency that can also be triggered by a trauma, an infection, a surgery, uncontrolled diabetes, pregnancy or labor, or going off thyroid medications. Symptoms may include:

Understanding Thyroid Stimulating Hormone

Thyroid disease: What You Should Look For In Your Thyroid Care

As mentioned above, the thyroid stimulating hormone is produced by the pituitary gland. It works sort of like the master of the hormones, and rules the production of T3 and T4 from its control center.If you have too much TSH, it might mean that your thyroid gland isnt making enough T3 or T4. Remember, the TSH is supposed to stimulate the thyroid gland but if the gland isnt responding, then youll have too much TSH in your system.If your TSH levels are too low, it may mean that your thyroid gland is making too much thyroid hormone. This excessive thyroid production could actually suppress the TSH.

A word of warning for pregnant women: Its incredibly important that your hormones are balanced in pregnancy, as thyroid stimulating hormone plays a role in the development of a healthy fetus.

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Does Thyroxine Treatment Have Side Effects

No good-quality research is available on the side effects of treating subclinical hypothyroidism with thyroxine, but it’s 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 it’s too high though, side effects can’t be ruled out. Possible side effects include heart problems like or a racing heartbeat.

The Process Of Testing

Good testing means getting a full panel done. This is going to include a TSH, fT3, fT4 and thyroid antibodies .

You are also going to want to make sure that you are preparing the body.;This means preparing it in the best way to get tests done.

Key Insight: If you are going to have a full panel of tests done, it should be done in the morning and before you take your days thyroid tablet. This way, you are able to get the best and most meaningful results possible.

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Common Symptoms Of Thyroid Disease

Hypothyroidism

Hypothyroidism is diagnosed as a result of the under activity of the thyroid gland when high TSH levels are present.

The thyroid gland functions under its normal capacity and the pituitary gland pumps high levels of TSH in the attempt to stimulate the thyroid gland to work. Hypothyroidism is related to infertility because it causes difficulty with ovulation.

Women who suffer from underactive thyroid symptoms experience heavy bleeding during menses, anovulatory cycles, fairly long cycles. In women where the levels of serum prolactin are high, as a result of low thyroid function ,symptoms of amenorrhea can be present.

Hyperthyroidism

Hyperthyroidism seems to affect fertility in causing frequent miscarriages even in normal menstrual cycles.

Overactive thyroid symptoms are usually present when low TSH levels are present. The diagnosis of hyperthyroidism is made my measuring serum Thyroxine.

What Is Euthryoid

This is a medical term used to indicate that normal TSH levels are present but the woman is experiencing symptoms of thyroid disorder. This is also related to unexplained infertility cases.

What Are The Symptoms Of Hypothyroidism

What Your Thyroid Test Results Really Mean

Hypothyroidism is a common condition. It can go undetected if symptoms are mild. Hypothyroidism means the thyroid is underactive and making insufficient amounts of thyroid hormones. Symptoms of hypothyroidism may be mild and may start slowly. The following are the most common symptoms of hypothyroidism:

  • Feeling tired

  • Unable to stand cold temperatures

  • Hoarse voice

  • Skin and hair changes, including dry skin and loss of eyebrows

  • Carpal tunnel syndrome

  • Slow heart rate

  • Trouble concentrating

  • Irregular menstrual periods

The symptoms of hypothyroidism may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

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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.

The Thyroid: What Your Tsh Number Means

In our last blog we talked about some of the things that can happen when your thyroid is sluggish or overactive. ;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 my experience with patients, Ive found that symptoms begin to occur in my patients well within the typically accepted;range of 0.4 and 4.0; in fact, if the;TSH level is over 1.5 or 2.0, I consider that to be a sign that the thyroid isnt working well enough. ;It would be easy to think that if your TSH level was higher;it would be a sign that;youre doing ok; however, when the thyroid is underactive your body compensates for this sending your TSH levels skyrocketing. ;So even though your number might look okay in the generally accepted range, its a sign that imbalance is occurring.

If;youre feeling poorly all the time and think your thyroid might having some trouble, ask your doctor for a TSH test .

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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 Is A Normal Thyroid Level

High TSH Levels: What Should You Do?

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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Can You Still Have A Problem If Your Tsh Is Normal

The TSH test is a highly sensitive indicator of your overall thyroid health, says Brittany Henderson, MD, a board-certified endocrinologist at Charleston Thyroid Center in Mount Pleasant, South Carolina. Interpretation can be difficult because there is a wide range of normal on the TSH scale.

Medications and supplements youre currently taking can affect the results of your TSH test. One example is biotin, which can falsely show low TSH levels.

Whats considered normal is influenced by several factors:

  • Age
  • Pregnancy
  • Ethnicity

Research has shown that levels of TSH tend to increase with age, decrease with pregnancy, and vary by ethnicity.;

When Do You Need Treatment

Many hypothyroid patients feel at their best when theyre on medication and their thyroid levels are in the optimal TSH range of 0.5-2.00 , Dr. Henderson says. Since lab assays and ranges vary, the optimized levels for a patients specific lab can also vary. For elderly patients, the TSH target is in the 4.0 6.0 range.;

Most doctors commonly treat their hypothyroid patients with a daily dose of levothyroxine , a man-made version of the T4 thyroid hormone made by the body, some doctors recommend using both T4 and T3 as the treatment option. ;

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With thyroid medication, the dosing has to be just right, Dr. Henderson says. Too much or too little of the medication can lead to side effects that affect a patients health.

In patients who are diagnosed as hyperthyroid, treatment can include antithyroid medications such as methimazole, that works to control the overactive thyroid. Some patients are given radioactive iodine, which is given in pill form to gradually and safely shrink the thyroid.

If you are experiencing signs of an under- or overactive thyroid, seek professional medical advice from your doctor or a specialist in endocrinology about these tests and treatments.

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When Tsh Alone Is Not Enough

During diagnosis, most doctors use the TSH test to evaluate thyroid function and determine the optimal course of treatment. There are times, however, when knowing one’s TSH may be insufficient.

For instance, free T4 in addition to TSH is usually tested if a doctor suspects thyroid dysfunction due to disease of the pituitary gland or hypothalamus.

Likewise,;if the TSH is normal, but a person still has symptoms of being hyperthyroid or hypothyroid, free T4 may be checked.

TSH is also not necessarily sufficient to monitor hypothyroidism during pregnancy; T4 and free T4 are often recommended.

Depending on the clinical situation, other thyroid tests that may be done include triiodothyronine , free T3, reverse T3, and thyroid antibody tests.

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