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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).

The blood work mentioned above confirms the diagnosis of hypothyroidism, but does not point to an underlying cause. A combination of the patient's clinical history, antibody screening (as mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem more clearly. If a pituitary or hypothalamic cause is suspected, an MRI of the brain and other studies may be warranted. These investigations should be made on a case by case basis.

Return to Hypothyroidism

See what others are saying

Comment from: xrannie, 45-54 Female (Patient) Published: March 02

I was just diagnosed with hypothyroidism after going to the urgent care walk in clinic attached to our county hospital with a case of pneumonia. During the exam, I mentioned how swollen my feet and ankles had been the past month, and I had been sweating a lot, and having irregular periods (all of which I had convinced myself was the onset of menopause, so I ignored them). I was also tipping the scales at a whopping 30 extra pounds from my last visit, 6 months previously. He did a simple blood test during the visit and said the levels were off. I go tomorrow to my primary care doctor for a follow up for the blood work, now that my pneumonia has cleared up.

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Comment from: Mick, 55-64 Female (Patient) Published: April 11

I suffered from extremely heavy periods for 3 years, 2 weeks on 1 week off. I wore super tampon and overnight pad and still was changing every half hour. I went to the doctor and he wanted to put me on birth control to regulate. I went to another doctor, I was ready to have surgery, anything to stop it. She asked if I had ever had my thyroid tested. Sure enough it was low. I started on medication, it took a little while and several blood tests to get the dosage right, but my symptoms steadily improved. Three years of suffering cured by one tiny little pill a day. It's the only medication I have ever taken religiously. I wish the other doctor would have thought of this possibility and I wouldn"t have had to suffer so long. Funny thing is, the throat doctor she sent me too to prescribe and regulated my dosage refused to believe that my thyroid could have caused my horrible persistent periods. I know differently.

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Comment from: Barbie at 50, 45-54 Female (Patient) Published: January 14

At age 50 I suddenly lost 15 pounds and was elated, I had not been a size 4 in years. Then I started getting heavy periods, changing a super tampon every half hour. My hands and feet ached. At times I could not even turn the door knob. I had no memory and felt like I was getting Alzheimer's. Then came the hot flashes, night and day. I could not sleep. I gained 20 pounds in about 4 months. I thought this menopause nonsense is for the birds. I went to the doctor to get on hormone medicine. I found out it was hypothyroidism. It was at 12.97. I feel much better but tough to get the weight off.

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