Thyroid Blood Tests Hypothyroidism Diagnosis

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How is hypothyroidism diagnosed?

A diagnosis of hypothyroidism can be suspected in patients with fatigue, cold intolerance, constipation, and dry, flaky skin. A blood test is needed to confirm the diagnosis.

When hypothyroidism is present, the blood levels of thyroid hormones can be measured directly and are usually decreased. However, in early hypothyroidism, the level of thyroid hormones (T3 and T4) may be normal. Therefore, the main tool for the detection of hyperthyroidism is the measurement of the TSH, the thyroid stimulating hormone. As mentioned earlier, TSH is secreted by the pituitary gland. If a decrease of thyroid hormone occurs, the pituitary gland reacts by producing more TSH and the blood TSH level increases in an attempt to encourage thyroid hormone production. This increase in TSH can actually precede the fall in thyroid hormones by months or years (see the section on Subclinical Hypothyroidism below). Thus, the measurement of TSH should be elevated in cases of hypothyroidism. However, there is one exception. If the decrease in thyroid hormone is actually due to a defect of the pituitary or hypothalamus, then the levels of TSH are abnormally low. As noted above, this kind of thyroid disease is known as "secondary" or "tertiary" hypothyroidism. A special test, known as the TRH test, can help distinguish if the disease is caused by a defect in the pituitary or the hypothalamus. This test requires an injection of the TRH hormone and is performed by an endocrinologist (hormone specialist).

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See what others are saying

Comment from: lindalou, 45-54 Female (Patient) Published: November 03

On 5-28-14 I was diagnosed with hypothyroidism. TSH is 20.76, T4 0.84 and T3-82. May of this year only TSH test done and it is 1.12 now, and that is quite a drop.

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Comment from: Avira9, 55-64 Female (Patient) Published: November 17

I finally found a doctor who would listen. For probably 30 years I have had Hashimoto's disease, and have only just discovered it. Conservative doctors do not order the right blood tests, or hear the word 'fatigue'. My TSH is in the normal range, therefore, end of story. Testing my T4 and T3 was never an option after that, nor was testing for thyroid antibodies. Now I have it in print from the pathology service that high levels of thyroid antibodies are characteristic of Hashimoto's disease. My thyroglobulin antibody is 866 percent higher than normal and the thyroid peroxidase is 97 percent (so just within the normal range). Just find a doctor who will listen; not necessarily an endocrinologist either.

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