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: Rosemary, 65-74 Female (Patient) Published: May 14

My T4 test came back 0.60 uIU/ml. My thyroid gland was removed surgically in my 20s. My physician just reduced my dosage from 1.0 to 0.88 and I find I"m not doing as well as on a higher dosage. I"ve recently, with diet, lost 30 lb. and this is the second time a doctor has lowered my dosage when I lose weight. Doesn"t seem to understand I don"t feel as well.

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Comment from: Denverbaby24, 25-34 Female (Patient) Published: May 19

I am beyond frustrated! I got lab work done due to my symptoms. I don"t have health insurance so I did a glucose and full thyroid screening. My first levels came back incredibly low, I felt like maybe this was the answer to my weight gain, heart palpitations, breaking out, extreme fatigue. The doctor ordered an ultrasound of my thyroid, and it said I had some minor cysts on the thyroid. I was then told to have blood work done again in 4 weeks. This blood work came back all normal ranges, but they only checked the TSH and T4 unlike the first time. I am to the point that I don"t know what to do anymore, I am at a loss.

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