- Thyroid Blood Tests Center
- Hyperthyroidism Slideshow Pictures
- Take the Thyroid Disorder Quiz
- Thyroid Symptoms and Solutions Slideshow Pictures
- Patient Comments: Thyroid Blood Tests – Hypothyroidism Diagnosis
- Patient Comments: Thyroid Blood Tests - Why Testing
The thyroid gland produces hormones that are essential for normal body metabolism. Blood testing is now commonly available to determine the adequacy of the levels of thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or underactive.
What are thyroid hormones?
Thyroid hormones are produced by the thyroid gland. This gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus).
The thyroid gland uses iodine (mostly available from the diet in foods such as seafood, bread, and salt) to produce thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3), which account for 99.9% and 0.1% of thyroid hormones present in the blood respectively. However, the hormone with the most biological activity is T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted into T3 - the active hormone that affects the metabolism of cells.
Quick GuideThyroid Problems Explained
Thyroid hormone regulation: the chain of command
The thyroid itself is regulated by another gland that is located in the brain, called the pituitary. In turn, the pituitary is regulated in part by the thyroid (via a "feedback" effect of thyroid hormone on the pituitary gland) and by another gland called the hypothalamus.
The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If a disruption occurs at any of these levels, a defect in thyroid hormone production may result in a deficiency of thyroid hormone (hypothyroidism).
Hypothalamus - TRH
Pituitary - TSH
Thyroid - T4 and T3
The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary gland in an attempt to stimulate more thyroid hormone production. In contrast, when there is an excessive amount of circulating thyroid hormone, TSH levels fall as the pituitary attempts to decrease the production of thyroid hormone. In persons with hypothyroidism (thyroid hormone production is below normal), there is a continuously decreased level of circulating thyroid hormones. In persons with hyperthyroidism (thyroid hormone production is above normal), there is a continuously elevated level of circulating thyroid hormones.
How is hypothyroidism diagnosed?
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).
Are there other tests of the thyroid gland?
The blood tests mentioned above can confirm the presence of deficiency or an excess of thyroid hormone and, therefore, be used to diagnose hypothyroidism or hyperthyroidism. They do not point to a specific cause. In order to determine a cause of the thyroid abnormality, the doctor will consider the patient's history, physical examination, and medical condition. Further testing might be used to isolate an underlying cause. These tests might include more blood testing for thyroid antibodies, nuclear medicine thyroid scanning, ultrasound of the thyroid gland, or others.
If thyroid cancer is suspected and surgery may be required, your physician may ask for a blood test known as thyroglobulin. Thyroglobulin is a protein made only by thyroid cells. If the thyroglobulin level at baseline is detectable or elevated (this means the gland does in fact make the protein) it can be used as a tumor marker. After a total thyroidectomy for cancer (removal of the entire thyroid gland) the level should fall to an undetectable range since the cells that make thyroglobulin have been removed. If the level remains detectable after surgery, there is a possibility of thyroid tissue elsewhere in the body, and metastatic disease should be considered. If the level is undetectable for a period of time after surgery and then starts to climb, a recurrence of the cancer - either at the primary site or elsewhere in the body should be considered.
Medically reviewed by John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism
National Endocrine and Metabolic Diseases Information Service (NEMDIS).
Daily Health News
Subscribe to MedicineNet's General Health Newsletter
National Endocrine and Metabolic Diseases Information Service (NEMDIS).
Top Thyroid Blood Tests Related Articles
Fine-Needle Aspiration Biopsy of the ThyroidFine needle aspiration biopsy of the thyroid is used to obtain tissue for analysis. Fine needle aspiration is also performed to treat thyroid cysts. The fine needle aspiration biopsy procedure may be recommended to make the diagnosis and/or select therapy of a thyroid nodule. Fine needle aspiration biopsy may also be recommended to drain or shrink a thyroid cyst.
Hair LossThere are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Hashimoto's ThyroiditisHashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include:
- weight gain,
- cold intolerance,
- excessive sleepiness,
- dry or coarse hair,
- difficulty swallowing,
- a lump in the front of the throat, and
- many more.
HeadacheHeadaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
13 Hormone Imbalance Symptoms and SignsHormone imbalance involves changes in estrogen, progesterone, and other hormone levels. Hormonal imbalance may cause symptoms like weight gain, hot flashes, fatigue, and acne. Hormonal changes happen in menopause and at other times. Women with hormone imbalances can seek treatment from medications like triptan and SSRIs.
Hyperthyroidism SlidesWhat is hyperthyroidism? Hyperthyroidism occurs when an overactive thyroid gland produces an excessive amount of thyroid hormones. Learn hyperthyroidism causes, symptoms, and treatment.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the rate of thyroid hormone production is controlled by the brain by the pituitary gland. Hypothyroidism is a very common condition and the symptoms of hypothyroidism are often subtle, but may include
- memory loss,
- hair loss, and
There are a variety of causes of hypothyroidism, and treatment depends on the cause.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Sjogren's SyndromeSjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Thyroid DisordersThere are several types of thyroid disorders including hypothyroidism, hyperthyroidism, goiters, thyroid nodules, and thyroid cancer. Symptoms vary by condition. Diagnosis is made with blood tests, scans, ultrasound, or biopsy. Treatments depend on the disorder and can include medication or surgery.
Thyroid Peroxidase TestThe thyroid peroxidase test measures the level of an antibody that is directed against thyroid peroxidase (TPO). A presence of TPOAb in the blood reflects a prior attack by the body's immune system on thyroid tissue. A positive thyroid peroxidase test may signal chronic thyroiditis. Other autoimmune disorders, however, may have a positive TPOAb test.
Illustrations of ThyroidThe thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. See a picture of the Thyroid and learn more about the health topic.
Thyroid SlideshowLearn about thyroid problems such as hyperthyroidism, hypothyroidism, thyroid cancer, and more. Discover symptoms and treatments for various thyroid problems.
Thyroid ScanThyroid scanning is used to determine how active the thyroid is in manufacturing thyroid hormone. This can determine whether inflammation of the thyroid gland (thyroiditis) is present. It can also detect the presence and degree of overactivity of the gland (hyperthyroidism) or, conversely, it can determine the presence and degree of underactivity of the gland (hypothyroidism).