What does a normal TSH level indicate. How can low TSH levels affect your health. Why do high TSH levels often signal an underactive thyroid. What symptoms are associated with abnormal TSH ranges.

What is TSH and Why is it Important for Thyroid Function?

Thyroid-stimulating hormone (TSH) plays a crucial role in regulating thyroid function. Produced by the pituitary gland, TSH controls the production and release of thyroid hormones thyroxine (T4) and triiodothyronine (T3) from the thyroid gland. These hormones are essential for maintaining various bodily functions, including metabolism, heart rate, digestion, muscle control, brain development, and bone health.

How does TSH work? When TSH binds to receptors on thyroid cells, it stimulates the production and release of T4 and T3 into the bloodstream. In turn, these thyroid hormones have a negative feedback effect on the pituitary gland, inhibiting further TSH production when levels are sufficient. This intricate balance helps maintain optimal thyroid function.

The TSH Test: A Window into Thyroid Health

A TSH blood test is a valuable diagnostic tool for assessing thyroid function. By measuring the amount of TSH circulating in the bloodstream, healthcare providers can gain insights into how well the thyroid gland is functioning. Abnormal TSH levels can indicate various thyroid disorders, prompting further investigation and potential treatment.

Decoding TSH Test Results: What Do the Numbers Mean?

Interpreting TSH test results can be counterintuitive, as high readings often indicate an underactive thyroid. When the thyroid gland fails to produce adequate amounts of T3 and T4 hormones, the pituitary gland responds by releasing more TSH to stimulate thyroid function. Consequently, elevated TSH levels typically suggest an underactive thyroid (hypothyroidism).

What is considered a normal TSH range? The reference range for normal TSH levels generally falls between 0.5 to 5.0 milli-international units per liter (mIU/L) of blood. However, it’s important to note that this range can vary based on factors such as age and overall health status. For instance, older adults may have slightly higher TSH levels that are still considered normal for their age group.

Factors Influencing TSH Interpretation

• Age
• Overall health status
• Presence of thyroid antibodies
• Pregnancy
• Certain medications

Is a TSH level of 4.5 mIU/L considered normal? While some healthcare providers may view this as within the normal range, others might consider it borderline high and indicative of subclinical hypothyroidism. It’s crucial to discuss your specific results with your healthcare provider, as they will consider your TSH levels in conjunction with other factors, such as symptoms and additional thyroid function tests.

Low TSH Levels: Causes and Implications

A TSH level below 0.5 mIU/L typically indicates an overactive thyroid, a condition known as hyperthyroidism. This occurs when the thyroid gland produces excess thyroid hormones, leading to various symptoms and health issues.

Common Causes of Low TSH

1. Graves’ disease (an autoimmune disorder)
2. Toxic nodular goiter
3. Thyroiditis (inflammation of the thyroid gland)
4. Excessive iodine intake
5. Certain medications (e.g., high doses of thyroid hormone replacement)

What symptoms might someone with low TSH experience? Hyperthyroidism can manifest in various ways, including:

• Unexplained weight loss despite increased appetite
• Heat intolerance and excessive sweating
• Rapid heartbeat or palpitations
• Anxiety and irritability
• Tremors in hands and fingers
• Sleep disturbances
• Changes in menstrual patterns
• Bulging eyes (in Graves’ disease)

High TSH Levels: Understanding the Implications for Thyroid Function

When TSH levels exceed 5.0 mIU/L, it typically indicates an underactive thyroid gland, a condition known as hypothyroidism. In this scenario, the pituitary gland produces more TSH in an attempt to stimulate the thyroid gland to produce adequate amounts of thyroid hormones.

Common Causes of High TSH

1. Hashimoto’s thyroiditis (an autoimmune disorder)
2. Iodine deficiency
3. Surgical removal of the thyroid gland
4. Radiation therapy to the neck area
5. Certain medications (e.g., lithium, amiodarone)

How does hypothyroidism affect the body? Individuals with high TSH levels and an underactive thyroid may experience a range of symptoms, including:

• Fatigue and weakness
• Weight gain and difficulty losing weight
• Cold intolerance
• Dry skin and hair
• Constipation
• Depression
• Muscle aches and joint pain
• Irregular or heavy menstrual periods
• Difficulty concentrating or “brain fog”

Can high TSH levels be a sign of other health issues? While hypothyroidism is the most common cause of elevated TSH, other factors can influence TSH levels. These may include pituitary tumors, certain medications, and recovery from severe illness. It’s essential to consult with a healthcare provider for a comprehensive evaluation.

The Importance of Proper TSH Interpretation and Further Testing

Interpreting TSH results requires a nuanced approach, as levels can be influenced by various factors. Healthcare providers often consider TSH levels in conjunction with other thyroid function tests, such as free T4 and free T3, to gain a more comprehensive understanding of thyroid health.

Additional Tests for Thyroid Function

• Free T4 (thyroxine) test
• Free T3 (triiodothyronine) test
• Thyroid antibody tests
• Thyroid ultrasound
• Radioactive iodine uptake test

Why might a healthcare provider order additional tests? While TSH is an excellent screening tool for thyroid function, it doesn’t provide a complete picture on its own. Additional tests can help confirm a diagnosis, determine the underlying cause of thyroid dysfunction, and guide treatment decisions.

Managing Abnormal TSH Levels: Treatment Options and Considerations

Treatment for abnormal TSH levels depends on the underlying cause and the severity of symptoms. For hypothyroidism, the most common treatment is thyroid hormone replacement therapy, typically with levothyroxine. This medication helps restore normal thyroid hormone levels and alleviate symptoms.

How is hyperthyroidism treated? Treatment options for an overactive thyroid may include:

• Anti-thyroid medications (e.g., methimazole, propylthiouracil)
• Radioactive iodine therapy
• Beta-blockers to manage symptoms
• Surgery (thyroidectomy) in severe cases

Is long-term management necessary for thyroid disorders? Many thyroid conditions require ongoing management and regular monitoring of TSH and thyroid hormone levels. This helps ensure that treatment remains effective and allows for adjustments as needed.

Lifestyle Factors and TSH Levels: What You Can Do

While thyroid disorders often require medical intervention, certain lifestyle factors can support thyroid health and help maintain optimal TSH levels.

Tips for Supporting Thyroid Function

1. Maintain a balanced diet rich in iodine, selenium, and zinc
2. Manage stress through relaxation techniques and regular exercise
3. Avoid excessive consumption of goitrogenic foods (e.g., raw cruciferous vegetables)
4. Limit exposure to environmental toxins
5. Get adequate sleep and rest
6. Stay hydrated
7. Consider vitamin D supplementation if deficient

Can lifestyle changes alone normalize TSH levels? While lifestyle modifications can support overall thyroid health, they are typically not sufficient to treat diagnosed thyroid disorders. Always work with a healthcare provider to develop a comprehensive treatment plan.

The Future of TSH Testing and Thyroid Management

As our understanding of thyroid function continues to evolve, so do the approaches to TSH testing and thyroid management. Emerging research is exploring more personalized reference ranges for TSH, taking into account factors such as age, sex, and ethnicity.

Promising Developments in Thyroid Care

• Improved sensitivity and specificity of TSH assays
• Development of novel biomarkers for thyroid function
• Advancements in genetic testing for thyroid disorders
• Exploration of targeted therapies for autoimmune thyroid conditions
• Integration of artificial intelligence in thyroid image analysis

How might these advancements impact thyroid care? As diagnostic tools become more refined and treatment options expand, individuals with thyroid disorders may benefit from more personalized and effective management strategies. This could lead to improved quality of life and better long-term health outcomes.

Understanding TSH levels and their implications for thyroid health is crucial for effective diagnosis and management of thyroid disorders. By working closely with healthcare providers, staying informed about emerging research, and adopting healthy lifestyle habits, individuals can take an active role in maintaining optimal thyroid function. Regular monitoring and open communication with medical professionals remain key to navigating the complex landscape of thyroid health and ensuring the best possible outcomes.

What Normal, Low & High Ranges Mean

Your doctor may order a blood test to check your body’s levels of thyroid stimulating hormone (TSH). The amount of TSH circulating in your bloodstream indicates how well your thyroid gland is functioning. TSH levels that are too high or too low can tell your doctor if you have a thyroid disorder or not. Learn more about what normal, high and low TSH levels mean.

How to interpret a TSH test result

Interpreting the results of a TSH test can be confusing, because high readings indicate a low–performing thyroid. When the thyroid gland is not producing adequate amounts of T3 and T4 hormones, the pituitary gland repeatedly releases TSH into the bloodstream to stimulate the thyroid gland. Thus, high levels of TSH indicate that the pituitary gland is frequently stimulating an underactive thyroid.

The reference range for normal TSH can vary by age and overall health status. In older adults, for example, a higher-than-normal TSH reading may, in fact, be normal. If your TSH lab result is flagged as “abnormal,” talk with your doctor about it, because the reading may not be abnormal for you.

What is a normal TSH level?

TSH levels are measured in ranges. In general, the normal reference range for TSH levels is 0.5 to 5.0 milli-international units per liter (mIU/L) of blood. A TSH reading in this range indicates the thyroid gland is functioning normally.

However, doctors do not all agree on the precise TSH range of a normal-functioning thyroid gland. Some doctors consider a TSH level of 4.5 mIU/L to be an indication of an underactive thyroid. Before diagnosing you with any type of thyroid disorder, your doctor will consider not only your TSH level but any signs or symptoms you’re exhibiting, such as an enlarged thyroid gland.

What does a low TSH level mean?

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 unexplained weight loss, heat intolerance, increased appetite, and bulging eyes.

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

What does a high TSH level mean?

A TSH level above 5.0 mIU/L usually indicates an underactive thyroid gland, or hypothyroidism. High TSH levels can cause symptoms that include:

• Difficulty focusing or concentrating (“brain fog”)

• Irregular menstrual periods

A great many medical issues can cause hypothyroidism. The most common cause is Hashimoto’s disease (an autoimmune disorder). Underactive thyroid usually is treated with supplemental thyroid hormone (levothyroxine).

What should I do about an abnormal TSH test?

If your TSH levels are outside the normal range, talk with your doctor about what may have caused this. Be sure to mention any health symptoms you’re experiencing. Also provide your doctor with a list of all medicines and vitamins, minerals, herbs, or other dietary supplements you take. Some of these products can alter your thyroid function and cause an abnormal test result.

After an abnormal TSH test, your doctor may recommend further testing, such as a thyroid ultrasound, to rule out a serious disorder like thyroid cancer. Most of the time, however, hyperthyroidism and hypothyroidism both can be treated with medication.

Thyroid stimulating hormone | You and Your Hormones from the Society for Endocrinology

Alternative names for thyroid stimulating hormone

TSH; thyrotropin, thyrotrophin

What is thyroid stimulating hormone?  

Thyroid stimulating hormone is produced and released into the bloodstream by the pituitary gland. It controls production of the thyroid hormones, thyroxine and triiodothyronine, by the thyroid gland by binding to receptors located on cells in the thyroid gland. Thyroxine and triiodothyronine are essential to maintaining the body’s metabolic rate, heart and digestive functions, muscle control, brain development and maintenance of bones. 

How is thyroid stimulating hormone controlled?  

When thyroid stimulating hormone binds to the receptor on the thyroid cells, this causes these cells to produce thyroxine and triiodothyronine and release them into the bloodstream. These hormones have a negative effect on the pituitary gland and stop the production of thyroid stimulating hormone if the levels of thyroxine and triiodothyronine are too high. They also switch off production of a hormone called thyrotropin-releasing hormone. This hormone is produced by the hypothalamus and it also stimulates the pituitary gland to make thyroid stimulating hormone. 

What happens if I have too much thyroid stimulating hormone?

A simple blood test can measure thyroid stimulating hormone in the circulation. If a person has too much, this may indicate that their thyroid gland is not making enough thyroid hormone, that is, they have an underactive thyroid gland or hypothyroidism. People with an underactive thyroid often feel lethargic, experience weight gain and feel the cold. Their thyroid gland may enlarge to produce a goitre. Treatment is medication in the form of tablets to bring the level of thyroid hormones back to normal. This also reduces the amount of thyroid stimulating hormone in circulation. It is particularly important for pregnant women to have the correct amounts of thyroid stimulating hormone and thyroid hormones to ensure the healthy development of their babies. Thyroid stimulating hormone is one of the hormones measured in newborns. Rarely, problems from the pitutiary gland or rare genetic conditions can result in inappropriately high thyroid stimulating hormones, and high free thyroid hormone levels.

What happens if I have too little thyroid stimulating hormone?

If a person has too little thyroid stimulating hormone, it is most likely that their thyroid gland is making too much thyroid hormone, that is, they have an overactive thyroid or hyperthyroidism, which is suppressing the thyroid stimulating hormone.  People with an overactive thyroid have the opposite symptoms to those with hypothyroidism, i.e. they lose weight (despite increasing the amount they eat), feel too hot and can experience palpitations or anxiety. They may also have a slightly enlarged thyroid gland. Treatment is medication in the form of tablets, which reduce the activity of the thyroid gland and return all thyroid hormone levels to normal. Rarely, problems in the pituitary gland can also result in a low thyroid stimulating hormone, and low free thyroid hormone levels. 

Last reviewed: Mar 2018

Thyroid Stimulating Hormone (TSH) Levels: High, Low, Normal Meaning

• A TSH test measures blood levels of the thyroid stimulating hormone to diagnose a thyroid disorder.
• Your doctor will order a TSH test if you exhibit thyroid disorder symptoms like hair loss or fatigue.
• High TSH levels could be a sign of hypothyroidism while low TSH levels may signal hyperthyroidism.
• Visit Insider’s Health Reference library for more advice.

Thyroid disorders, which affect about 20 million Americans, can be diagnosed with a TSH test, which measures levels of what is called the thyroid stimulating hormone (TSH) in your blood.

TSH is a hormone produced in the brain’s pituitary gland that supports thyroid function, says Juan Jaume, MD, an endocrinologist and professor at the University of Toledo College of Medicine and Life Sciences. 

Thyroid function is important because it helps control your metabolism as well as basic growth and development. So, if you have a thyroid disorder, it can lead to all sorts of issues like weight gain, fatigue, hair loss, and much more.

Here’s a look at how the TSH test works and how to interpret its results. 

What is a TSH test? 

A TSH test is designed to identify abnormal levels of TSH in your blood, which may indicate a thyroid disorder, says Aleem Kanji, MD, an endocrinologist with Ethos Endocrinology, a private practice.  

Related

About 60% of people with a thyroid disorder don’t know they have one – here’s how to recognize common symptoms

Typically, your doctor will order a TSH test if you’re exhibiting key symptoms of thyroid dysfunction, like excessive hair loss or changes in weight.

The test will involve a blood draw, usually first thing in the morning, and results take around 24 hours. 

Interpreting TSH levels 

Generally, normal TSH levels are between 0.5 to 5.0 mIU/L. However, this may vary for pregnant people as TSH levels naturally change as pregnancy progresses, Jaume says.

TSH levels below 0.5 mIU/L or greater than 5.0 mIU/L may indicate different types of thyroid disorders that often require additional tests to diagnose. Here’s a look at what abnormal TSH levels can mean. 

High TSH levels 

A high TSH level is anything greater than 5.0 mIU/L and may suggest an underactive thyroid, aka hypothyroidism.

“A significantly elevated TSH isn’t dangerous in itself,” Kanji says. “However, the significant elevation indicates a concerning or potentially dangerous thyroid disorder.”

If you do have hypothyroidism, there are a few different things that could be causing it, but the most common is an autoimmune disorder known as Hashimoto’s disease. 

To confirm hypothyroidism, a doctor will typically perform a follow-up test that measures your levels of T4, the main form of thyroid hormone circulating in the blood. A high TSH level and a low T4 level may indicate you have an underactive thyroid. 

Low TSH levels

A low TSH is anything less than 0. 5 mIU/L and typically occurs when thyroid hormone levels in the blood are too high, Kanji says. 

That’s because, as the brain detects high levels of thyroid hormones, it produces less TSH to stop the thyroid glands from producing more thyroid hormone.

As a result, a low TSH level suggests hyperthyroidism, or an overactive thyroid. There can be a few different causes of hyperthyroidism, but one of the most common is an autoimmune disorder known as Graves’ disease. 

If your TSH levels are low, your doctor will likely order another test to evaluate your levels of T4 or T3 — another type of thyroid hormone. An elevated T4 or T3 along with a low TSH indicates hyperthyroidism, Kanji says. 

How to treat thyroid dysfunction

You can’t increase or decrease TSH levels on your own. Therefore, whether you have hypothyroidism or hyperthyroidism, treatment will probably require some form of medical aid.  

Treating hypothyroidism

Treatment options for hypothyroidism most often include medication that restores adequate hormone levels. 

“There’s nothing you can do on your own to lower your TSH levels,”  Jaume says. “Thyroid autoimmune hypothyroidism requires thyroid hormone replacement.”

Treating hyperthyroidism

If your doctor finds other markers of hyperthyroidism, they may suggest different treatment options, including:

• Anti-thyroid medication
• Beta-blockers
• Radioactive iodine
• Surgery to remove the thyroid 

Insider’s takeaway 

A TSH test is one of the first tests used to determine whether or not someone has a thyroid disorder. This test measures the levels of TSH produced by the pituitary gland in your brain.  

A high TSH level could indicate hypothyroidism, or an underactive thyroid, while a low TSH level could indicate hyperthyroidism, or an overactive thyroid. If your TSH levels are abnormal, your doctor will likely order more tests to determine the root cause. 

Hyperthyroidism and Graves’ Disease | Michigan Medicine

Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone. This disorder occurs in about 1% of all Americans and affects women much more often than men. In its mildest form, hyperthyroidism may not cause noticeable symptoms; however, in some patients, excess thyroid hormone and the resulting effects on the body can have significant consequences.

Causes of Hyperthyroidism

Hyperthyroidism can be caused by a number of things:

• Toxic nodule – A single nodule or lump in the thyroid can produce more thyroid hormone than the body needs and lead to hyperthyroidism.
• Toxic multinodular goiter – If the thyroid gland has several nodules, those nodules can sometimes produce too much thyroid hormone causing hyperthyroidism. This is most often found in patients over 50 years old. In many cases, a person may have had a multinodular goiter for several years before it starts to produce excess amounts of thyroid hormone.
• Graves’ disease – Graves’ disease is an autoimmune disorder in which the body’s immune system attacks the thyroid. Patients with Graves’ disease often have enlargement of the thyroid gland and become hyperthyroid. In some patients, the eyes may be affected. Patients may notice the eyes become more prominent, the eyelids do not close properly, a gritty sensation and general irritation of the eyes, increased tear production, or double vision. Like other autoimmune diseases, this condition may occur in other family members and is much more common in women than in men.
• Sub-acute thyroiditis – This type of hyperthyroidism can follow a viral infection which causes inflammation of the thyroid gland. This inflammation causes the thyroid to release excess amounts of thyroid hormone into the blood stream which leads to hyperthyroidism. Over time the thyroid usually returns to its normal state. Because the stored thyroid hormone has been released, patients may become hypothyroid (where their thyroid gland produces too little thyroid hormone) for a period of time until the thyroid gland can build up new stores of thyroid hormone.
• Postpartum thyroiditis – Some women develop mild to moderate hyperthyroidism within several months of giving birth, which usually lasts 1 to 2 months. This is often followed by several months of hypothyroidism. Most women recover and have normal thyroid function.
• Excessive Iodine ingestion – Some food sources with high concentrations of iodine, such as over the counter supplements, kelp tablets, some expectorants, amiodarone (a medication used to treat certain heart rhythm problems) and x-ray dyes, may occasionally cause hyperthyroidism in some patients. In most cases, the hyperthyroidism usually resolves when the supplement is discontinued.
• Overmedication with thyroid hormone – Patients who take too much thyroid hormone replacement can also develop hyperthyroidism. Patients should have their thyroid hormone levels evaluated by a physician at least once each year and should NEVER give themselves “extra” doses unless directed by a physician. Changes in thyroid medication should always be guided by thyroid function testing.

Symptoms of Hyperthyroidism

When hyperthyroidism develops, patients may experience some of the following signs or symptoms:

• fast or irregular heartbeat
• anxiety or irritability
• trembling of the hands
• weight loss despite eating the same amount or even more than usual
• hot flashes and increased perspiration
• loss of scalp hair
• separation of fingernails from the nail bed
• muscle weakness, especially in the upper arms and thighs
• loose or frequent bowel movements
• skin changes
• an unexplainable change in the menstrual cycle in women
• an increased chance of miscarriage
• irregular heart rhythm or palpitations
• loss of calcium from the bones leading to decreased bone density

How is Hyperthyroidism Diagnosed?

There are signs and symptoms of hyperthyroidism that can be identified by a physician. Signs and symptoms of hyperthyroidism are often non-specific and can also be associated with many other causes. Laboratory tests are used to confirm the diagnosis of hyperthyroidism and probable cause. A primary care physician may make the diagnosis of hyperthyroidism, but help may be needed from an endocrinologist, a physician who is a specialist in thyroid and other endocrine diseases.

The best test to determine overall thyroid function is the thyroid stimulating hormone (TSH) level. TSH is produced in the brain and travels to the thyroid gland to stimulate the thyroid to produce and release more thyroid hormone. A high TSH level indicates that the body does not have enough thyroid hormone. A TSH level lower than normal indicates there is usually more than enough thyroid hormone in the body and may indicate hyperthyroidism. When hyperthyroidism develops, free thyroxine (T4) and free triiodothyronine (T3) levels rise above normal. Other laboratory studies may help identify the cause of hyperthyroidism. Thyroid-stimulating immunoglobulins (TSI) can be identified in the blood when Graves’ disease is the cause of hyperthyroidism. Thyroid peroxidase antibodies and other anti-thyroid antibodies are also seen in some disorders leading to hyperthyroidism.

Treatments for Hyperthyroidism

Currently, there are several effective treatments available for hyperthyroidism depending on the cause, severity, and several other factors. The most common treatments for hyperthyroidism include antithyroid medications, radioactive iodine, and thyroid surgery.

Antithyroid medication (most often methimazole) decreases thyroid hormone production. Antithyroid medicine does not cure the disease but works while the patient takes the medication. It is not usually recommended as a long term solution, although in some patients the hyperthyroidism does go into remission and the medication can be discontinued. If the hyperthyroidism does not go into remission after two years, a more definitive treatment is often recommended (thyroidectomy or radioactive iodine).

Radioactive iodine (RAI) is a common treatment for hyperthyroidism. The thyroid is one of the few organs in the body that avidly takes up iodine. This allows radioactive iodine to selectively damage the thyroid gland without affecting other parts of the body. The thyroid gland is eventually destroyed and disappears and the body no longer produces its own thyroid hormone. In general, this treatment can be used in patients with Graves’ disease or in those patients with nodules in the thyroid gland causing hyperthyroidism. Not all cases of hyperthyroidism respond well to radioactive iodine.

After radioactive iodine most patients will require thyroid hormone replacement with levothyroxine (Synthroid, Levothroid, and other brand names). Thyroid hormone levels will be checked frequently at the beginning, and then often are only checked once a year after the correct dose of thyroid hormone for the patient has been determined.

Some patients will have their hyperthyroidism treated by having part or all of their thyroid surgically removed.

Deciding which treatment for hyperthyroidism is the right treatment is made on a case by case basis according to each individual patient’s medical, social, and family history. Often, surgical thyroidectomy is recommended over RAI in the following circumstances:

• Large thyroid causing compressive symptoms unlikely to be treated adequately with RAI
• Significant compression of adjacent structures and compressive symptoms
• Moderate to severe Graves’ eye disease
• Failed medical therapy
• Adverse reaction to antithyroid medications
• Need for rapid reversal of hyperthyroidism
• Fear of radiation exposure, inability to comply with radiation safety guidelines
• Co-existent thyroid nodules and need to rule out possibility of thyroid cancer
• Small children at home
• Pregnancy, desire for pregnancy within next 4-6 months, or lactation
• Patient desire

What’s Special About University of Michigan’s Treatment of Graves’ Disease?

UM is one of the few places in the country that has a multidisciplinary group dedicated to the treatment of patients with Graves’ disease. UM’s multidisciplinary group consists of endocrinologists, endocrine surgeons, ophthalmologists, nuclear medicine physicians, rheumatologists and psychiatric professionals. Our group sees Graves’ disease patients from around the country and is involved with one of the most well-known national organizations concentrating on helping patients and families coping with Graves’ disease and Graves’ eye disease. Our group routinely publishes papers with new research results on Graves’ disease. 

The ophthalmologists in our group specialize in the treatment of Graves’ eye disease which can require complex management. Most ophthalmologists have little experience treating patients with Graves’ disease and Graves’ eye disease. For those patients with Graves’ eye disease, it is the severity of the eye disease which drives the selection of the type of treatment for hyperthyroidism if these two problems occur together.

While those patients with no Graves’ eye disease or only mild eye disease may be candidates for any of the three types of treatments for hyperthyroidism, those who have moderate to severe eye disease are often referred for surgical thyroidectomy as RAI has a higher chance of worsening the eye disease than surgery does.

Thyroid Diseases – Causes, Symptoms, Treatment, Diagnosis

The Facts

The thyroid is a small gland located below the Adam’s apple in your neck. It releases hormones, thyroxine (T4) and triiodothyronine (T3), which increase the amount of oxygen your body uses and stimulate your cells to produce new proteins. By controlling the release of these hormones, the thyroid determines the metabolic rate of most of your body’s organs.

The thyroid gland is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. Normally, when thyroid hormone levels in the body are high, they will “switch off” the production of TSH, which in turn stops the thyroid from making more T4 and T3.

Problems occur when the thyroid gland becomes either underactive (hypothyroidism) or overactive (hyperthyroidism). Thyroid problems are more common in women than men. Cancer may also develop in the thyroid gland.

Causes

Thyroid diseases sometimes result from inappropriate TSH levels, or may be caused by problems in the thyroid gland itself.

The most common cause of hypothyroidism is Hashimoto’s thyroiditis,an autoimmune condition where the body makes antibodies that destroy parts of the thyroid gland. Surgical removal and certain medications (e.g., amiodarone, lithium) can also cause hypothyroidism. Treatment for hyperthyroidism can cause hypothyroidism as well.

Other causes of hypothyroidism include pituitary problems, hypothalamus problems, and iodine deficiency (rare in North America, but affects nearly 2 billion people worldwide). Some babies are born with hypothyroidism – this is called congenital hypothyroidism.

There are different causes of hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism. This condition occurs when the immune system produces an antibody that stimulates the entire thyroid gland; this leads to overactivity and higher levels of thyroid hormones.

Another form of hyperthyroidism is called toxic nodular goiter or toxic thyroid adenoma. Adenomas, abnormal nodules of tissue in the thyroid, constantly produce thyroid hormones even when they are not needed.

Secondary hyperthyroidism is caused when the pituitary gland makes too much TSH, leading to constant stimulation of the thyroid gland. A pituitary tumour may cause TSH levels to rise. More rarely, the pituitary gland becomes insensitive to thyroid hormones, no longer responding to high levels.

Another possible cause of hyperthyroidism is a condition called thyroiditis. This condition occurs when the thyroid gland becomes inflamed. Depending on the type of thyroiditis, this may lead to temporary hyperthyroidism that might be followed by hypothyroidism.

There are four types of thyroid cancers: papillary, follicular, anaplastic, and medullary cancer. These are associated with radiation treatment to the head, neck, or chest. Radiation treatment for benign (non-cancerous) conditions is no longer carried out in these areas, but was more common in the past. In other cases, a genetic mutation might be associated with thyroid cancer, either alone or in conjunction with other types of cancers (e.g., multiple endocrine neoplasia, BRAF gene mutations). Less commonly, other cancers might metastasize to the thyroid (e.g., lymphoma, breast cancer).

Symptoms and Complications

Hypothyroidism results in low levels of T4 and T3 in the blood. Not having enough T4 and T3 in the blood causes your metabolism to slow down.

Common symptoms include:

• coarse and dry hair
• confusion or forgetfulness (often mistaken for dementia in seniors)
• constipation
• depression
• droopy eyelids
• dry, scaly skin
• fatigue or a feeling of sluggishness
• facial puffiness
• hair loss
• hoarse speech
• increased menstrual flow (women)
• intolerance to cold temperatures
• irritability
• muscle cramps
• slower heart rate
• weakness
• weight gain

If hypothyroidism isn’t treated, the symptoms will progress. Rarely, a severe form of hypothyroidism, called myxedema, can develop. Symptoms of myxedema include:

• low body temperature
• dulled mental processes
• congestive heart failure, a condition where the heart cannot pump enough blood to meet the body’s needs

Myxedema coma occurs in people with severe hypothyroidism who have been exposed to additional physical stresses such as infections, cold temperatures, trauma, or the use of sedatives. Symptoms include loss of consciousness, seizures, and slowed breathing.

Hyperthyroidism results in high levels of T4 and T3 circulating in the blood. These hormones speed up your metabolism. Some of the most common symptoms include:

• increased heart rate with abnormal rhythm or pounding (palpitations)
• high blood pressure
• increased body temperature (feeling unusually warm)
• increased sweating
• clamminess
• feeling agitated or nervous
• tremors in the hands
• feeling of restlessness even though the person is tired or weak
• increased appetite accompanied by weight loss
• interrupted sleep
• frequent bowel movements, sometimes with diarrhea
• puffiness around the eyes, increased tears, sensitivity to light, or an intense stare
• bone loss (osteoporosis)
• stopped menstrual cycles

Graves’ disease, in addition to the common symptoms of hyperthyroidism, may cause a bulge in the neck (goiter) at the location of the enlarged thyroid gland. It also might cause the eyes to bulge out, which may result in double vision. Sometimes, the skin over the shins becomes raised.

If hyperthyroidism is left untreated or is not treated properly, a life-threatening complication called thyroid storm (extreme overactivity of the thyroid gland) can occur. Symptoms include:

• confusion
• coma
• diarrhea
• fever
• high blood pressure
• irregular heartbeat, which can be fatal
• jaundice associated with liver enlargement
• mood swings
• muscle wasting
• nausea
• psychosis
• restlessness
• shock
• vomiting
• weakness

Thyroid storm, considered a medical emergency, can also be triggered by trauma, infection, surgery, uncontrolled diabetes, pregnancy or labour, or taking too much thyroid medication.

Making the Diagnosis

Thyroid disease suspected by clinical history and physical exam is confirmed by laboratory tests. Laboratory tests usually measure levels of TSH and thyroid hormones. Serology tests can measure the levels of antibodies associated with hypothyroidism and hyperthyroidism. If your doctor suspects thyroid cancer, a biopsy can be used to sample the thyroid tissue and test for cancer.

Another method called a functional stimulation test can be used to distinguish whether the pituitary and thyroid glands are the source of medical symptoms. Ultrasounds and nuclear thyroid scans allow for visual and functional examination of the thyroid gland or of nodules.

Treatment and Prevention

The usual treatment for hypothyroidism is thyroid hormone replacement therapy. With this treatment, synthetic thyroid hormone (e.g., levothyroxine*) is taken by mouth to replace the missing thyroid hormone. Treatment is usually life-long.

Most people who take thyroid replacement therapy do not experience side effects. However, if too much thyroid hormone is taken, symptoms can include shakiness, heart palpitations, and difficulty sleeping. Women who are pregnant may require an increase in their thyroid replacement by up to 50%. It takes about 4 to 6 weeks for the effect of an initial dose or change in dose to be reflected in laboratory tests.

Hyperthyroidism can be treated with iodine (including radioactive iodine), anti-thyroid medications or surgery.

Radioactive iodine can destroy parts of the thyroid gland. This may be enough to get hyperthyroidism under control. In at least 80% of cases, one dose of radioactive iodine is able to cure hyperthyroidism. However, if too much of the thyroid is destroyed, the result is hypothyroidism. Radioactive iodine is used at low enough levels so that no damage is caused to the rest of the body. It isn’t given to pregnant women because it may destroy the thyroid gland of the developing fetus.

Larger doses of regular iodine, which does not destroy the thyroid gland, help block the release of thyroid hormones. It is used for the emergency treatment of thyroid storm, and to reduce the excess production of thyroid hormones before surgery.

Anti-thyroid medications (e.g., propylthiouracil* or methimazole) can bring hyperthyroidism under control within 6 weeks to 3 months. These medications cause a decrease in the production of new thyroid hormones by the thyroid gland. Larger doses will work more quickly, but may cause side effects including skin rashes, nausea, loss of taste sensation, liver cell injury, and, rarely, a decrease of blood cell production in the bone marrow.

Surgical removal of the thyroid gland, called thyroidectomy, is sometimes necessary. It may be required if there are cancerous nodules; if a non-cancerous nodule is causing problems breathing or swallowing; if the person cannot take radioactive iodine or antithyroid medications, or if these do not work; or if a nodule that contains fluid continues to cause problems. Removing the thyroid gland leads to hypothyroidism, which must then be treated with thyroid hormone therapy for the rest of a person’s life.

Sometimes your doctor may recommend other medications to help control symptoms of hyperthyroidism, such as shakiness, increased heart rate, anxiety, and nervousness. However, these won’t cure thyroid dysfunction.

Treatment for thyroid cancers often involves some combination of thyroidectomy (surgical removal of the thyroid gland), radioactive iodine, radiation therapy (less common), anticancer medications, and hormone suppression.

High TSH Symptoms, Causes & What it Means

Have you been told, or are you suspicious, that you have a high TSH?

If so there are many things you want to consider before pursuing treatment.

While your TSH is important for assessing thyroid function it’s certainly not the only test, or the best way, to identify thyroid disease. 

We are going to take an updated, scientific dive into TSH including what a high TSH means, what kind of symptoms are associated with this condition and the top 5 causes… 

More…

What does your TSH Really Mean?

Many physicians consider TSH to be the most accurate marker of thyroid status in your body. 

With that in mind, it makes sense to talk about what it actually does in your body. 

TSH stands for thyroid stimulating hormone and it is a hormone secreted by your pituitary gland. 

Thyroid physiology is quite complex (1) but we can break it down to an easy to understand sequence:

Your hypothalamus (part of your brain) pumps out a hormone called TRH (thyrotropin-releasing hormone). 

TRH then acts on your pituitary gland (another portion of your brain) to stimulate the release of TSH (thyroid stimulating hormone). 

TSH then enters your bloodstream and lands on receptors directly on your thyroid gland which then causes the release of thyroid hormones – T3 and T4. 

T3 and T4 then enter the bloodstream and target specific cells in the body (almost every cell has a thyroid receptor) to alter genetic transcription, increase energy production and so forth. 

This complex system is regulated at several steps and one step that we use to assess the stability of this entire system is the serum concentration of TSH. 

This isn’t the best marker of thyroid function by itself (2), but it can give you a quick idea of what is happening in the body. 

So what does a high TSH actually mean?

An elevation in TSH is an indicator that the system is not working properly, and in this case, it means that thyroid function in the serum (T3 and T4) is low. 

Low levels of T3 and T4 circulate back up to the pituitary gland which tells the body that not enough thyroid hormone is being produced. 

Your pituitary gland compensates by increasing TSH levels in the serum because it is trying to tell your thyroid gland to produce more thyroid hormone. 

Hopefully, this is making sense. 

It can be confusing because a high TSH level actually means that there is not ENOUGH thyroid hormone in the blood and this condition is known as hypothyroidism. 

Hypothyroidism = low thyroid function = sluggish thyroid = low T3 and T4 levels of thyroid hormone in the blood = high TSH (all of these terms are ways to describe the same condition).

The exact opposite is true when the TSH is low. 

A low TSH is an indicator that your body has enough T3 and T4 in the body and so your pituitary responds by reducing the production of TSH from the pituitary gland. 

Hyperthyroidism = excessive thyroid production = high T3 and/or T4 levels of thyroid hormone in the blood = low TSH.

This isn’t the complete picture because certain medications can actually reduce TSH but still leave T3 and T4 levels low in the body, but it gives you a general idea of what is actually happening in the body and what your TSH actually stands for. 

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This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

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So How do Doctors Use TSH?

TSH is primarily used as a marker of thyroid hormone status in the entire body. 

Checking your TSH can be used as a quick measure to determine if your thyroid is functioning properly or not. 

A high TSH (defined below) tells your Doctor that your thyroid is not working properly which means that you may need the use of thyroid hormone medications to increase and normalize thyroid function. 

After starting thyroid medication (if necessary) the TSH can be used to “track” your progress. 

As you take thyroid medication your TSH should be reduced back to the “normal” range. 

As this occurs you are said to once again become “euthyroid”. 

This is how everything is supposed to work, but is it really that easy?

This is where Doctors and patients tend to disagree (3).

Even though you can “normalize” the TSH with thyroid medications, many of the symptoms of hypothyroidism may actually still persist. 

This, along with many studies, may indicate that TSH may not be the best marker for thyroid function in the body (4).

We will discuss more of that below, but for now, let’s discuss what kind of symptoms you may experience if your TSH is elevated. 

High TSH Symptoms

As your TSH increases it is a sign that circulating levels of thyroid hormones are dropping. 

Therefore, the symptoms associated with high TSH levels present as the symptoms of hypothyroidism. 

Symptoms do not stem from the TSH itself but from the lack of circulating T3 and T4 and their influence on your cells.

In addition, symptom severity is dependent, at least somewhat, on the degree of elevation of TSH. 

Higher levels of TSH, those greater than  

The degree of elevation of your TSH will also help determine the severity of your symptoms. 

People who have a TSH of 5.0 will likely experience symptoms that aren’t quite as severe as someone who has a TSH of 7.0 or higher. 

You can find a list of the symptoms that one might experience with a high TSH below: 

• Weight gain or difficulty losing weight (the degree of weight gain and inability to lose weight depends on the severity of thyroid lab studies)
• Fatigue or decreased energy
• Insomnia or inability to sleep
• Changes to menstrual cycle or changes to sex hormones (reduced testosterone in both men and women and changes to progesterone/estradiol in women)
• Drop in body temperature – cold hands/feet
• Slower than normal metabolism
• Changes to skin that include dry or cracking of the skin
• Changes to hair, skin and nails quality and texture – brittle hair, dry hair, hair loss, etc.
• Slowing down of the intestines which manifest as constipation or acid reflux
• Mental changes to include depression, anxiety, poor concentration or poor memory
• Swelling of the face or extremities (puffy eyes)

Why are these symptoms important?

Symptoms reduction, along with TSH, can also be used as a marker to determine if your therapy or treatment is working. 

If you take medication to lower your TSH and your TSH lowers but your symptoms remain, then there may be another issue you are missing. 

You can find a more complete list of thyroid symptoms that women may experience in this post and a complete list of thyroid symptoms that men experience in this post. 

Definition of a “High” TSH (Reference Ranges)

So what defines a “high” TSH?

By definition, the standard reference range for TSH is anywhere between 0.30 to 5.0 uIU/mL. 

If your TSH is higher than 5.0 then the lab will flag you as “high” and you may experience the symptoms listed above. 

You can see a clear example of this below: 

The reference range in this example is 0.3 to 5.00 uIU/ml and the result is 7.024. 

Having said all of this, there’s actually a good case to make that you can still have a “high” TSH but still be inside of the reference range. 

So how do we get there?

Well, newer studies (5) have shed light on the fact that some of the original tests that helped determine our “standard normal” TSH values may not have have been full of “healthy” people. 

When you are being compared to some standard you want to make sure that the standard you are being compared to is actually healthy!

It doesn’t make sense to compare your TSH as a 25-year-old to that of an 86-year-old (6).

Using this logic some newer studies have suggested that a more “normal” TSH reference range is somewhere between 1.0 and 2.5 uIU/ml and anything higher than 2.5 is considered “high” (7).

With this logic you can have a “high” TSH anywhere between 2.5 and 5.5, even though it technically falls within the “normal” range: 

In addition, other studies have suggested we use the African American population as the standard for TSH testing because they have one of the lowest rates of autoimmune disease compared to other populations and their TSH is somewhere around 1.0. 

It’s important to realize that many physicians are not aware of these studies or these concepts so they may use the “standard” laboratory reference range instead of these newer guidelines. 

5 Causes of High TSH

Having a high TSH is never normal. 

An elevated TSH (as defined by the reference ranges listed above) is an indication that your body is working overtime to try and increase the amount of thyroid hormone that it can produce. 

In most cases, your TSH is simply a warning sign that indicates your body is under stress and increased pressure. 

While knowing that your TSH is elevated is important, your TSH itself does not tell you WHY it is increased. 

That’s why it’s important to understand the potential causes because each of these causes has a different treatment. 

#1. Hashimoto’s Thyroiditis

Probably the most common cause of slightly elevated and high TSH levels is an autoimmune disease known as Hashimoto’s Thyroiditis. 

It is estimated that anywhere between 50% and 90% of all cases of hypothyroidism may be caused by this condition in the United States. 

Hashimoto’s thyroiditis is a condition where your body begins to attack its own thyroid gland, through an autoimmune process, which results in long-term and potentially permanent damage to your thyroid gland over time (8).

As your thyroid gland becomes damaged the amount of thyroid hormone it produces will be reduced over time. 

As this happens your pituitary compensates by increasing TSH levels slowly over time. 

In a sense, it’s like trying to squeeze water out of a rock. 

How can your thyroid gland produce thyroid hormone if it is permanently damaged?

It can’t. 

The good news is that diagnosing Hashimoto’s thyroiditis is not very difficult and can be assessed by checking for thyroid antibodies in the serum. 

The presence of clinical thyroid damage (symptoms) combined with elevated antibodies is sufficient to diagnose the disease. 

Your Doctor should know to check for the following antibodies:

If they are contributing to your TSH then your labs may look something like the example listed below: 

Identifying that you have Hashimoto’s is important because it means you may be able to influence the course of the disease and reduce the autoimmune damage if you take steps as soon as possible. 

Note, though, that in some cases by the time the diagnosis is made it may be too late – there may already be permanent damage to your thyroid gland, especially if the autoimmune process has been going on for decades. 

You can learn more about treating, identifying and managing Hashimoto’s in this post. 

#2. Iodine Deficiency

While overt iodine deficiency is no longer a huge issue in the United States, many people may still have what I refer to as “sub-optimal” iodine levels. 

The main method that we get iodine is through our diets, but unfortunately, many factors may be influencing how much we actually get. 

For starters, many people simply aren’t consuming enough iodine because they don’t consume sea vegetables regularly. 

This is worsened by the fact that the iodine concentration in the soil is dropping as well, so foods that would normally contain iodine may vary in their concentration. 

In addition, other factors such as the lack of utilization (from goitrogens) in certain foods may limit the activity of iodine that you do consume. 

Taking this one step further…

Studies have shown that the average person should be consuming 150 ug of iodine per day (up to 250-290 if you are lactating or pregnant) (10), while other studies show that the average consumption varies between 120-130 ug per day (11).

You can compare this to the 1970s where the average consumption of iodine was up to 294 ug/day. 

Putting all this together you can make a case that many people simply may not be getting sufficient iodine even though we live in an iodine “replete” environment. 

How does this impact TSH?

Iodine is required for the production of thyroid hormone in your body (12).

Therefore, low iodine will result in low circulating thyroid hormone in the serum. 

This will trigger a feedback loop which will result in an increase in TSH from your pituitary. 

Low iodine = high TSH. 

The good news is that replacing iodine through dietary means will rapidly result in improvement in your thyroid function. 

You can learn more about using iodine safely and correctly in this detailed guide. 

#3. Obesity & Metabolic Damage

Most people assume that hypothyroidism (low thyroid function) causes obesity, but what they don’t realize is that obesity can actually decrease thyroid function as well. 

The cause vs effect has not been settled but we will most likely find that while hypothyroidism can cause obesity, obesity can also reduce thyroid function and increase TSH. 

Why does this matter?

For starters, it means that if obesity is the cause of low thyroid function (and therefore an elevated TSH) it means that if you lose weight you will improve your thyroid status. 

And this is what studies have shown. 

As you lose weight TSH tends to drop and FT3 and FT4 levels tend to normalize (13).

Another important implication of the obesity-thyroid connection is that due to the widespread increase in obesity we may need to alter TSH reference ranges (14).

Our current understanding of obesity and thyroid function is that obesity is the RESULT of hypothyroidism. 

But if obesity causes hypothyroidism then that means we need to create a “normal” TSH based on the reference ranges of people that have a normal body weight and who do NOT have Hashimoto’s thyroiditis. 

This may impact our definition of the “ideal” or “normal” TSH. 

Moral of the story?

Obesity, weight gain, and metabolic damage may all potentially increase your TSH and lead to hypothyroidism. 

#4. Stress & Increased Cortisol

Another important cause of high TSH is due to stress and increased cortisol. 

Cortisol is considered our stress hormone which is released to help our body “tolerate” excessively stressful situations. 

Stressful situations range from lack of sleep to social pressure from jobs and back to the food we put in our body. 

The idea here is that all of these factors influence this stress hormone and may result in chronic elevations in serum cortisol. 

High cortisol is positively correlated with TSH levels in the serum (15).

This means that as cortisol increases so too does TSH. 

What isn’t clear is whether or not this relationship is physiologic or pathologic. 

In my experience, I tend to lean more to the pathologic side as patients with both high TSH and high cortisol exhibit higher rates of depression, anxiety, and poor cognitive function. 

These symptoms lead me to believe that stress, excessive stress which is chronic in nature, most likely results in an increased TSH which reduces thyroid function in the body. 

The treatment for this condition is to focus on limiting the impact that stress has on your physiology by taking targeted supplements and practicing specific therapies. 

You can learn more about addressing cortisol to improve thyroid function here. 

#5. Thyroidectomy (Partial or Complete) & RAI

Next up is really any condition that results in damage or removal of your thyroid gland. 

It makes sense that if you damage your thyroid gland or completely remove it that you won’t be producing as much thyroid hormone as you were before. 

Most people who undergo complete thyroidectomy (meaning complete removal of their thyroid gland) are given thyroid medication right away. 

The same is not necessarily true for those who have only had a portion or partial thyroidectomy (partial removal of their thyroid gland). 

Patients who undergo RAI or radioactive iodine ablation therapy may also still have some thyroid gland function, but this function may not be sufficient to provide adequate thyroid hormone to the entire body. 

In both cases, these patients may still have somewhat “normal” thyroid lab studies but tend to present with MANY of the symptoms of hypothyroidism. 

The bottom line?

Damage to your thyroid gland or removal of your thyroid gland (16) (even part of it) may result in an increase in TSH levels. 

The treatment for patients in cases such as these is the replacement of thyroid hormone with thyroid hormone medication. 

Treatment Options

If you have a high or high-normal TSH then your next step should be to focus on ways to bring it down. 

This can be accomplished by focusing on several areas: 

#1. Using thyroid hormone replacement medication. 

Using thyroid hormone will help to reduce your TSH due to the feedback loops that exist in your body. 

Remember:

As you put thyroid hormone into your body, your brain will “sense” this thyroid hormone and respond by normalizing your TSH. 

This will result in a reduction in your TSH, provided that the dose of thyroid medication that you are taking is sufficient for your needs. 

This is exactly how many Doctors use the TSH to help guide their treatment. 

The idea is to bring down your TSH to a “normal” level based on your lab results and to stop the titration of medication once you get there. 

This sounds fairly easy, but it doesn’t quite work this way in all patients. 

Some people will feel great as they take thyroid medication such as Levothyroxine to help lower their TSH. 

In other people, it may not be quite that simple. 

Up to 15% of people may suffer from genetic changes in their body which limit their ability to utilize or “convert” thyroid medication appropriately. 

If you have this genetic defect (which is a problem with a deiodinase enzyme) then you may not respond very well to standard thyroid medication. 

This problem can be overcome through the use of different types of thyroid medications. 

Even though thyroid medication may be helpful to lower TSH it may not be required in each person. 

#2. Addressing the primary cause of your high TSH. 

Another area of focus should be on the CAUSE of your high TSH. 

As I discussed with you previously, not all causes of high TSH are permanent. 

In fact, some causes, such as iodine deficiency, can completely be reversed if you treat it appropriately. 

In the case of iodine deficiency, this problem can be easily treated with iodine supplementation. 

In the case of stress, you may be able to improve your TSH by completely removing the stress in your body or by attempting to lower your cortisol. 

Other conditions, such as Hashimoto’s thyroiditis, may be more difficult to treat because they indicate a deeper problem. 

Hashimoto’s is a result of autoimmune dysfunction and is not readily reversible (at least not in the majority of cases). 

#3. The use of targeted supplementation. 

We’ve already established that nutrient deficiencies, such as iodine deficiency, may play a role in altering thyroid function (17).

This idea extends to more than just iodine. 

Other nutrients, such as Zinc and Selenium (18), also play an important role in regulating thyroid function in your body. 

One study showed that using the combination of zinc and selenium helped to reduce TSH, increase free T3 and free T4 levels in overweight female obese hypothyroid patients. 

What’s really interesting is that these patients didn’t experience an increase in serum zinc or selenium levels. 

The use of supplements which contain both Zinc and Selenium have been shown to improve thyroid function in those who have deficiencies. 

The good news is that this is a potentially reversible cause of high TSH, the bad news is that it will probably only work if you are deficient. 

But, as a potential therapy with very little downside, it’s always worth evaluating for these simple deficiencies. 

Using a supplement such as this one may be beneficial and has worked well for other hypothyroid patients. 

Is it Possible to Have a High TSH and Normal T3 & T4? 

Yes!

In some cases, the serum T3 and T4 levels can be relatively preserved despite elevation in TSH levels. 

Some people assume this is a reactive response but you must realize that serum concentrations of thyroid hormone do not necessarily reflect tissue levels of thyroid hormone. 

What’s important is not the serum concentration but the amount of thyroid hormone that enters the cells and activates genetic transcription. 

TSH reflects the tissue concentration of the pituitary gland, but it does not reflect the concentration of say your liver. 

We can use SHBG as an indirect marker for assessing the concentration of thyroid function in the liver (19) and this can actually be used as a somewhat sensitive marker for tissue levels elsewhere in the body. 

You can learn more about using the SHBG for this purpose in this guide. 

Just realize for now that in order to get a “complete” picture of thyroid function in the body, you should evaluate TSH in the presence of other thyroid lab studies such as free T3, total T3, free T4, sex hormone binding globulin and of course thyroid antibodies. 

Conclusion

A high TSH level may indicate that you have sub-optimal levels of circulating thyroid hormone in your body. 

This condition is known as hypothyroidism and presents with MANY diverse symptoms. 

If you find that you have a high TSH then your next step should be to look into the potential causes of the disease and treat that issue, if possible. 

Treating can then be focused on several areas:

#1. Thyroid medication. 

#2. The underlying cause.

#3. The use of Supplements.  

This approach will ensure that you cover all of your bases and will provide you with the most relief. 

You will also want to consider if thyroid medication is right for you or if taking a more conservative approach may be the best fit. 

Once you start thyroid medication you may be taking it for life so you may not want to jump into it. 

Lastly, when evaluating your TSH make sure that you are looking at your value with the “optimal” level in mind and not just the standard reference range. 

Looking at your TSH in this way will help you get back to your 100%. 

Now I want to hear from you:

Is your TSH high? 

If so, have you been able to find appropriate treatment?

If not, why not?

Leave your comments below! 

References (Click to Expand)

#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1544601/

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480274/

#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169863/

#4. https://www.ncbi.nlm.nih.gov/pubmed/16416346

#5. https://www.ncbi.nlm.nih.gov/pubmed/16148345

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877984/

#7. https://www.ncbi.nlm.nih.gov/pubmed/16148345

#8. https://www.ncbi.nlm.nih.gov/pubmed/7794089

#9. https://www.ncbi.nlm.nih.gov/pubmed/20135568

#10. https://www.ncbi.nlm.nih.gov/pubmed/19178515

#11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266621/

#12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063534/

#13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/

#14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/

#15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/

#16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737508/

#17. https://www.ncbi.nlm.nih.gov/pubmed/8262474

#18. https://www.ncbi.nlm.nih.gov/pubmed/25758370

#19. https://www.ncbi.nlm.nih.gov/pubmed/16416346

Hypothyroidism Information | Mount Sinai

Many permanent or temporary conditions can reduce thyroid hormone secretion and cause hypothyroidism. More than 90% of hypothyroidism cases occur from problems that start in the thyroid gland. In such cases, the disorder is called primary hypothyroidism. (Secondary hypothyroidism is caused by disorders of the pituitary gland. Tertiary hypothyroidism is caused by disorders of the hypothalamus.)

The two most common causes of primary hypothyroidism are:

• Hashimoto thyroiditis. This is an autoimmune condition (chronic lymphocytic thyroiditis) in which the body’s immune system attacks its own thyroid cells.
• Overtreatment of hyperthyroidism (an overactive thyroid).

Autoimmune Diseases of the Thyroid

Hashimoto thyroiditis, atrophic thyroiditis, and postpartum thyroiditis are all autoimmune diseases of the thyroid. An autoimmune disease occurs when the immune system mistakenly attacks the body’s own healthy cells. In the case of autoimmune thyroiditis, a common form of primary hypothyroid disease, the cells under attack are in the thyroid gland and include, in particular, a thyroid protein called thyroid peroxidase. The autoimmune disease process results in the destruction of thyroid cells.

Hashimoto Thyroiditis

The most common form of hypothyroidism is Hashimoto thyroiditis, a genetic disease named after the Japanese doctor who first described thyroid inflammation (swelling of the thyroid gland). Women are more likely than men to develop this disease.

Click the icon to see an image of Hashimoto disease.

An enlargement of the thyroid gland, called a goiter, is almost always present and may appear as a growth in the neck. Hashimoto thyroiditis is permanent and requires lifelong treatment. Both genetic and environmental factors appear to play a role in its development.

The other main type of autoimmune thyroid disease is Graves disease, which causes hyperthyroidism (overactive thyroid).

Click the icon to see an image of Graves disease.

Atrophic Thyroiditis

Atrophic thyroiditis is similar to Hashimoto thyroiditis, except a goiter is not present.

Riedel Thyroiditis

Riedel thyroiditis is a rare autoimmune disorder, in which scar tissue progresses in the thyroid until it produces a hard, stony mass that suggests cancer. Hypothyroidism develops as the scar tissue replaces healthy tissue. Surgery is usually required, although early stages may be treated with corticosteroids or other immunosuppressive drugs.

Autoimmune Thyroiditis Due to Pregnancy

Hypothyroidism may also occur in women who develop antibodies to their own thyroid during pregnancy, causing inflammation of the thyroid after delivery.

Subacute Thyroiditis

Subacute thyroiditis is a temporary condition that passes through 3 phases: hyperthyroidism, hypothyroidism, and a return to normal thyroid levels.

People may have symptoms of both hyperthyroidism and hypothyroidism (such as rapid heartbeat, nervousness, and weight loss, along with or followed by depression and fatigue), and they can feel extremely sick. Symptoms last about 6 to 8 weeks and then usually resolve, although each form carries some risk for becoming chronic.

The 3 forms of subacute thyroiditis follow a similar course.

Painless Postpartum Subacute Thyroiditis

Postpartum thyroiditis is an autoimmune condition that occurs in up to 10% of pregnant women and tends to develop between 4 to 12 months after delivery. In most cases, the woman develops a small, painless goiter. This condition is generally self-limiting and requires no therapy unless the hypothyroid phase is prolonged. If so, therapy may be thyroxine replacement for a few months. A beta-blocker drug may also be recommended if the hyperthyroid phase needs treatment. About 20% of women with this condition go on to develop permanent hypothyroidism.

Painless Sporadic, or Silent Thyroiditis

This painless condition is very similar to postpartum thyroiditis, except it can occur in both men and women and at any age. About 20% of people with silent thyroiditis may develop chronic hypothyroidism. Treatment considerations are the same as for postpartum subacute thyroiditis. Some medications may cause this type of thyroiditis.

Painful, or Granulomatous Thyroiditis

Subacute granulomatous thyroiditis, also called de Quervain thyroiditis, comes on suddenly with mild to severe neck pain and swelling, and often occurs several weeks after flu-like symptoms. It is thought to be caused by a viral infection and generally occurs in the summer. It is much more common in women than men and is usually a temporary condition. Treatments typically include pain relievers and, in severe cases, corticosteroids or beta-blockers.

After Treatment of Hyperthyroidism

Many people who receive radioactive iodine treatments for an overactive thyroid develop permanent hypothyroidism within a year of therapy. Radioactive iodine is a common treatment for Graves disease, which is the most common form of hyperthyroidism, an autoimmune condition resulting in excessive secretion of thyroid hormones.

After treatment for Graves disease, many people gradually develop hypothyroidism and need to take thyroid hormones for the rest of their lives. Other types of treatment for overactive thyroid glands (such as anti-thyroid drugs or surgery) may also result in hypothyroidism.

Iodine Abnormalities

Too much or too little iodine can cause hypothyroidism. If there is a deficiency of iodine, the body cannot manufacture thyroxine (T4). Millions of people around the world have hypothyroidism because of insufficient iodine in their diets. This global public health issue used to be even more widespread, but has now been almost completely resolved due to salt iodization programs. Too much iodine is a signal to inhibit the conversion process of T4 to T3. The end result in both cases is inadequate production of thyroid hormones. Some evidence suggests that excess iodine may trigger the process leading to Hashimoto thyroiditis.

Thyroid Surgery

People who have complete removal (total thyroidectomy) of the thyroid gland to treat thyroid cancer need lifetime treatment with thyroid hormone. Removing one of the two lobes of the thyroid gland (hemithyroidectomy), usually because of benign growths on the thyroid gland, rarely produces hypothyroidism. The remaining thyroid lobe will generally grow so that it can produce sufficient amounts of thyroid hormone for normal function. However, to prevent the formation of additional nodules, many doctors recommend thyroid hormone treatment.

Click the icon to see a series on thyroid surgery.

People with Graves disease who have surgery to remove most of both thyroid lobes (subtotal thyroidectomy) may develop hypothyroidism.

Drugs and Medical Treatments that Reduce Thyroid Levels

Lithium

A drug used to treat bipolar disorder, has multiple effects on thyroid hormone synthesis and secretion. Many people treated with lithium go on to develop hypothyroidism and some develop a goiter. Most people develop subclinical hypothyroidism, but a small percentage experience overt hypothyroidism.

Amiodarone (Cordarone)

Is used to treat abnormal heart rhythms, contains high levels of iodine and can induce hyper- or hypothyroidism, particularly in people with existing thyroid problems.

Other Drugs

Drugs used for treating epilepsy, such as phenytoin and carbamazepine, can reduce thyroid hormone levels. Interferons and interleukins, which are used to treat hepatitis, multiple sclerosis, and other conditions, can induce either hypothyroidism or hyperthyroidism. Some drugs used in cancer chemotherapy, such as sunitinib (Sutent) or imatinib (Gleevec), can also cause or worsen hypothyroidism.

Radiation Therapy

High-dose radiation for cancers of the head or neck and for Hodgkin disease can cause hypothyroidism up to 10 years after treatment.

Other Medical Conditions

Several medical conditions involve the thyroid and can change the normal gland tissue so that it no longer produces enough thyroid hormone. Examples include hemochromatosis, scleroderma, and amyloidosis.

Causes of Secondary and Tertiary Hypothyroidism

In rare instances, usually due to a tumor, the pituitary gland will fail to produce TSH, the hormone that stimulates the thyroid to produce its hormones. In such cases, the thyroid gland shrinks and secondary hypothyroidism occurs.

Causes of Hypothyroidism in Infants

Hypothyroidism in newborns (known as congenital hypothyroidism) occurs in one in every 3,000 to 4,000 births. It usually persists throughout life.

Permanent Congenital Hypothyroidism

In most cases of permanent congenital hypothyroidism, the thyroid gland is missing, underdeveloped, or not properly located. In other cases, hormone production is impaired or the pituitary or hypothalamus glands function abnormally. Genetic abnormalities may be a factor in congenital hypothyroidism, but in many cases the cause is unknown.

Temporary Hypothyroidism in Infants

Temporary hypothyroidism can also occur in infants. Possible causes include various immunologic, environmental, and genetic factors, including the following:

• Women who have an underactive (low) thyroid, including those who develop the problem during pregnancy, are at increased risk for delivering babies with congenital (newborn) hypothyroidism. Maternal hypothyroidism can also cause premature delivery and low birth weight.
• Some of the drugs used to treat hyperthyroidism (overactive thyroid) block the production of thyroid hormone. These same drugs can also cross the placenta and cause hypothyroidism in the infant.
• If a pregnant woman has untreated hyperthyroidism, her newborn infant may have hypothyroidism for a short period of time. This is because the excess thyroid hormone in the woman’s blood crosses the placenta and signals the fetus not to produce as much of its own thyroid hormone.
• Iodine deficiency may cause temporary hypothyroidism. (Exposure to too much iodine immediately after birth, for example from iodine-containing disinfectants or medicines, can also cause thyroid dysfunction.)
• Premature birth increases the risk of temporary hypothyroidism in the infant.

Children with temporary congenital hypothyroidism should be followed up regularly during adolescence and adulthood for possible thyroid problems. The risk for future thyroid problems is highest when girls born with this condition reach adulthood and become pregnant.

Thyroid hormones | Nikolab

By right the thyroid gland is considered one of the most important organs in the human body. The thyroid gland weighs about 20 grams. However, such a small organ is the supplier of vital energy to the body of any person.

The thyroid gland controls the activity of almost all organs and systems with the help of the iodine-containing hormones it produces.

Impossible without a sufficient amount of thyroid hormones:

• Normal metabolism.
• Growth, maturation of tissues, organs and bone apparatus.
• Energetic nutrition of cells and the whole organism.

Free triiodothyronine (FT3) is a biologically active part of triiodothyronine (thyroid hormone) not bound to blood plasma proteins, which regulates the rate of basal metabolism, tissue growth, metabolism of proteins, carbohydrates, lipids and calcium, as well as cardiovascular vascular, digestive, respiratory, reproductive and nervous systems.

Free thyroxine (FT4) – one of the two main hormones of the thyroid gland, the main function of which is the regulation of energy and plastic metabolism in the body. Free thyroxine is a biologically active part of total thyroxine, which plays an important role in metabolism.

Thyroid stimulating hormone (TSH) – the main regulator of the thyroid gland, synthesized by the pituitary gland – a small gland located on the lower surface of the brain.Its main function is to maintain a constant concentration of thyroid hormones, which regulate the processes of energy production in the body. When their levels in the blood decrease, the hypothalamus releases a hormone that stimulates the secretion of TSH by the pituitary gland.
Pituitary dysfunction can cause an increase or decrease in thyroid-stimulating hormone levels. With an increase in its concentration, thyroid hormones are released into the blood in abnormal quantities, causing hyperthyroidism. With a decrease in the concentration of thyroid-stimulating hormone, the production of thyroid hormones also decreases and symptoms of hypothyroidism develop.
The reasons for the violation of the production of thyroid-stimulating hormone can be diseases of the hypothalamus, which begins to produce increased or decreased amounts of thyroliberin – a regulator of TSH secretion by the pituitary gland. Diseases of the thyroid gland, accompanied by a violation of the secretion of thyroid hormones, can indirectly (through a feedback mechanism) affect the secretion of thyroid-stimulating hormone, causing a decrease or increase in its concentration in the blood.

Antibodies to thyroid peroxidase (ATPO) are autoantibodies to this enzyme.Until recently, these antibodies were referred to as antimicrosomal antibodies (AMA) because they bound to the microsomal fraction of thyrocytes. Modern research has determined that thyroid peroxidase is the main antigenic component of microsomes.
Determination of anti-TPO antibody concentrations is one of the most sensitive tests for the diagnosis of autoimmune thyroid diseases. Autoimmune diseases of the thyroid gland are the main factor underlying hypothyroidism and hyperthyroidism, and usually develop in genetically susceptible people.The presence of an increased titer of antibodies to TPO and an increased level of TSH allow predicting the development of hypothyroidism in the future.
The highest level of antibodies to TPO is found in patients with Hashimoto’s thyroiditis. In this disease, antibodies to TPO are detected in about 90% of cases, which confirms the autoimmune nature of the disease. These antibodies are also often found (60–80%) in Graves’ disease. There is a clear relationship between the presence of antibodies to TPO and the histological picture of thyroiditis.However, due to the significant ability of the thyroid gland to regenerate under the action of thyroid-stimulating hormone, clinical signs of hypothyroidism may appear years after the onset of chronic thyroid disease.
Determination of the titer of antibodies to TPO helps in the diagnosis of autoimmune diseases of the thyroid gland and makes it possible to differentiate between autoimmune diseases and non-autoimmune goiter or hypothyroidism. The study of antibodies to TPO (thyroid peroxidase) is usually carried out in conjunction with a study for TSH.

Antibodies to thyroglobulin – specific immunoglobulins directed against the precursor of thyroid hormones. They are a specific marker of autoimmune thyroid diseases (Graves’ disease, Hashimoto’s thyroiditis).
Thyroglobulin is a glycopeptide, a precursor of triiodothyronine (T3) and thyroxine (T4). It is produced only by the cells of the thyroid gland and accumulates in its follicles in the form of a colloid. With the secretion of hormones, a small amount of thyroglobulin enters the bloodstream.For unknown reasons, it can become an autoantigen, and in response the body produces antibodies to it, which causes inflammation of the thyroid gland. ATTG can block thyroglobulin, disrupting the normal synthesis of thyroid hormones and causing hypothyroidism, or, conversely, overstimulating the gland, causing its hyperfunction.
Antibodies to thyroglobulin simultaneously interact with components of the connective tissue of the orbit, eye muscles and the enzyme acetylcholinesterase. It is possible that an autoimmune reaction is the cause of changes in the tissues of the orbit in thyrotoxic ophthalmopathy.
ATTG is found in 40-70% of patients with chronic thyroiditis, in 70% of patients with hypothyroidism, in 40% with diffuse toxic goiter and in a small number of patients with other autoimmune pathologies, including pernicious anemia. Although the level of antibodies is slightly elevated in healthy people, especially older women.
Primarily, the ATTG test is useful in confirming a patient’s diagnosis of diffuse toxic goiter and / or hypothyroidism due to autoimmune thyroiditis.In addition, it is valuable in the differential diagnosis of Graves’ disease and toxic nodular goiter. Despite the fact that ATTG is less frequently detected in blood serum than thyroid microsomal antibodies (antibodies to peroxidase), in patients with autoimmune thyroid diseases, the results of this test are also important for confirming the diagnosis.
If a pregnant woman has an autoimmune thyroid lesion or some other autoimmune pathology, a test for one or more thyroid antibodies should be prescribed at the beginning of pregnancy and shortly before delivery to predict the risk of thyroid lesion in the newborn.

10051. Package “Thyroid hormones No. 1”:

• Free thyroxine (FT4)
• Free triiodothyronine (FT3)
• Antibodies to thyroperoxidase (ATPO)
• Thyroid stimulating hormone (TSH)

10052. Package “Thyroid hormones No. 2”:

• Free thyroxine (FT4)
• Free triiodothyronine (FT3)
• Thyroid stimulating hormone (TSH)

10053.Package “Thyroid hormones No. 3”:

• Free thyroxine (FT4)
• Antibodies to thyroperoxidase (ATPO)
• Thyroid stimulating hormone (TSH)

10054. Package “Thyroid hormones No. 4”:

• Free thyroxine (FT4)
• Thyroid stimulating hormone (TSH)

10055. Package of analyzes “Thyroid hormones No. 5”:

• Free thyroxine (T4 St.)
• Triiodothyronine free (T3 free)
• Antibodies to thyroperoxidase (ATPO)
• Thyroid stimulating hormone (TSH)
• Antibodies to thyroglobulin (ATTG)

10056. Package of analyzes “Diagnostics of neoplasms of the thyroid gland”:

• Antibodies to thyroperoxidase (Anti-TPO)
• Antibodies to thyroglobulin (Anti-TG) Thyroglobulin (TG)
• Thyroid stimulating hormone (TSH)
• Cancer-embryonic antigen (CEA)

10059.Analysis package “Diagnosis of autoimmune thyroid diseases”:

• Antibodies to thyroperoxidase (Anti-TPO)
• Antibodies to thyroglobulin (Anti-TG)
• Thyroid stimulating hormone (TSH)

90,000 Doctors have found a link between coronavirus and thyroid inflammation

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Doctors have found a link between coronavirus and thyroid inflammation

Doctors have found a link between coronavirus and thyroid inflammation – RIA News, 21.05.2020

Doctors have found a connection between coronavirus and inflammation of the thyroid gland

A new type of coronavirus SARS-CoV-2, the causative agent of the disease COVID-19, can lead to subacute thyroiditis, inflammation of the thyroid gland, follows from the article … RIA Novosti, 05.21. 2020

2020-05-21T18: 53

2020-05-21T18: 53

2020-05-21T18: 53

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MOSCOW, May 21 – RIA Novosti. A new type of coronavirus SARS-CoV-2, the causative agent of the disease COVID-19, can lead to subacute thyroiditis, an inflammation of the thyroid gland, follows from an article by Italian doctors in the Journal of Clinical Endocrinology & amp; Metabolism, which describes the first such case. Subacute thyroiditis is an inflammatory disease of the thyroid gland characterized by pain in the neck, usually preceded by an upper respiratory tract infection.It can be caused by a viral infection or a post-viral inflammatory response. “We have reported the first case of subacute thyroiditis after infection with SARS-CoV-2. We are warning doctors about additional and unreported clinical manifestations associated with COVID-19,” the article says. The authors describe a case of thyroid inflammation in an 18-year-old girl with COVID-19. She contracted a new coronavirus infection after contact with her father, she had symptoms of moderate severity – a runny nose and cough, but after a few days the girl was completely cured.Tests performed twice for COVID-19 were negative, but she developed other symptoms after a few days. In particular, the girl had a fever, pain in the neck, on examination, there was a rapid heart rate and a painful and enlarged thyroid gland. In laboratory studies, the level of thyroid hormones T4 and T3 was increased, markers of inflammation and the number of leukocytes in the blood were also increased. At the same time, during the examination a month earlier, thyroid function and imaging were normal.The girl was diagnosed with subacute thyroiditis. “Due to the chronological relationship, SARS-CoV-2 may be considered responsible for the occurrence of subacute thyroiditis,” the authors conclude. some patients also showed inflammation of the thyroid gland, but coronavirus infection has never been associated with subacute thyroiditis.

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in the world, discoveries – RIA science, health – society, coronavirus covid-19

MOSCOW, May 21 – RIA Novosti. A new type of coronavirus SARS-CoV-2, the causative agent of the disease COVID-19, can lead to subacute thyroiditis, an inflammation of the thyroid gland, follows from an article by Italian doctors in the Journal of Clinical Endocrinology & Metabolism, which describes the first such case.

Subacute thyroiditis is an inflammatory disease of the thyroid gland characterized by pain in the neck, usually preceded by an upper respiratory tract infection. It can be caused by a viral infection or post-viral inflammatory response.

21 May 2020, 11:36 The spread of coronavirus In China, how to protect against the second wave of coronavirus

“, – the article says.

The authors describe a case of an inflammation of the thyroid gland in an 18-year-old girl who had recovered from COVID-19. She contracted a new coronavirus infection after contact with her father, she had symptoms of moderate severity – a runny nose and cough, but after a few days the girl was completely cured. Tests conducted twice for COVID-19 showed negative results.

However, after a few days she developed other symptoms. In particular, the girl had a fever, pain in the neck, on examination, there was a rapid heart rate and a painful and enlarged thyroid gland.In laboratory studies, the level of thyroid hormones T4 and T3 was increased, markers of inflammation and the number of leukocytes in the blood were also increased. At the same time, during the examination a month earlier, thyroid function and imaging were normal. The girl was diagnosed with subacute thyroiditis.

May 21, 2020, 4:35 pm Spread of coronavirus Scientists talked about the effect of coronavirus on brain neurons

It is noted that during the outbreak of the SARS-CoV coronavirus in 2002-2003, autopsy also revealed inflammation of the thyroid gland in some patients, however, coronavirus infection has never been associated with subacute thyroiditis.

April 23, 2020, 10:43 am The spread of coronavirus You can’t take it with your bare hands: what the new coronavirus is afraid of

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Thyroid stimulating hormone (Thyrotropin, TSH)

Material for research: Serum or plasma

Physiological conditions leading to a change in the level of TSH in the blood

In healthy newborns, a sharp rise in the level of TSH in the blood is noted at birth, and by the end of the 1st week of life it reaches the level of adults.In women, the concentration of TSH in the blood is about 20% higher than in men. With age, the concentration of TSH increases slightly. For TSH, a diurnal rhythm is characteristic: the highest values ​​of TSH in the blood reach by 2-4 a.m., in the morning hours, the highest level in the blood is determined at 6 a.m., the minimum TSH values ​​are noted at 17-18 p.m. In middle-aged women and old men, the maximum peak serum TSH ( thyrotropin ) occurs in December.

Diseases and conditions in which changes in the level of TSH in the blood are possible

Bulimia, heat stress, starvation, premorbid state, smoking, surgical interventions cause a decrease in thyroid-stimulating hormone in serum; smoking cessation, electroconvulsive therapy, exercise on a bicycle ergometer, exposure to lead, pregnancy (III trimester), preeclampsia, some surgical interventions (cholecystectomy), hemodialysis – augmentation.

Medicines affecting the level of TSH in the blood

Decrease in TSH ( thyrotropin ) is facilitated by the intake of the following drugs: amiodarone (hyperthyroid patients), anabolic steroids, apomorphine, aspirin, bombesin, clofibrate, corticosteroids, cytostatics, dinazole, dobutamine, dopamine, dopexanexamine, phenol-dicotrophic acid -hormone, hydrocortisone, interferon-2, iodoamide and other X-ray contrast agents, iosamycin, levothyroxine, lisuride, metergoline, nifedipine, octreotide, peribedil, pimozide, pyridoxine, somatostatin, thyroxine, periorphinpronycin, trolene.

An increase in TSH ( thyrotropin ) is facilitated by the intake of such drugs as: aminoglutethimide, amiodarone (in euthyrioid and hypothyroid patients), atenolol, benserazide, calcitonin, chlorpromazine, clomiphene, domperidone, erythrosine, sulphurizinic acid, iron, fobaridone iodides, glycerin with iodine, iopanoic acid, ipodeate, lithium, lovastatin, methimazole, metoclopramide, metoprolol, monoiodotyrosine, morphine, phenytoin, parazosin, prednisone, propranolol, rifampin, tyrotropinrilizing hormone

Diagnosis of hypothyroidism: is TSH really so informative?

Until now, many doctors consider thyroid-stimulating hormone (TSH) the most sensitive marker of the thyroid gland, which often leads them to the erroneous conclusion that there is no thyroid gland pathology in cases where they receive normal TSH test results, attributing the observed symptoms to other diseases.

Meanwhile, the pituitary gland – anatomically and physiologically unique formation – in response to stress and inflammation reacts differently from other tissues and organs. For example, inflammation causes a local increase in the concentration of triiodothyronine (T3) in the pituitary gland, which, through the mechanism of negative feedback, causes a decrease in TSH, while in cells and peripheral tissues the conversion of thyroxine (T4) to T3 is suppressed and the content of reverse T3 increases … Thus, during physiological or emotional stress, during depression or inflammation, the pituitary and peripheral T3 do not correlate with each other, and TSH turns out to be an unreliable marker of thyroid status, as well as T4, the concentration of which in serum, regardless of the level of T3 in the tissues. may increase, decrease or remain unchanged.

The accumulated knowledge about the functional characteristics of the thyroid gland at the cellular level suggests that for a reliable assessment of its status, it is necessary to take into account the level of reverse T3 and the ratio T3 / reverse T3 . For patients in whom the level of reverse T3 is higher than the average, and the ratio T3 / reverse T3 is less than 2, replacement therapy should be considered.

To obtain a comprehensive assessment of the properties and features of the thyroid gland, it is necessary, in combination with a clinical assessment, to conduct a comprehensive analysis for TSH , free forms of T3 and T4, reverse T3, antibodies to thyroglobulin (AT-TG) and thyroid peroxidase (AT -TPO), sex hormone binding globulin (SHBG) . By limiting the assessment of TSH alone, it is possible to misdiagnose and mis-treat a large number of hypothyroid patients.

Kent Holtorf, M.D., David Brownstein, M.D., Denis Wilson, M.D., Michael Freidman, N.D., and Mary Shomon. How Accurate is TSH Testing?

Thyroid – Your Doctor

The thyroid gland and its hormones , together with the nervous and immune systems, takes part in the coordination and regulation of the work of all human organs (heart, brain, kidneys, etc.).etc.). In a coordinated “orchestra” of signals, nerve impulses and biological substances, thyroid hormones play the role of the “main violin”. The reason for the special importance of thyroid hormones for the body is that they are needed by all tissues and every cell. Simply put, existence is impossible without them.

The problem of imbalance of thyroid hormones has been known for many centuries. Ancient Roman doctors were the first to notice the increase in its size during adolescence and pregnancy.BC in China already knew how to prevent the appearance of goiter – an enlargement of the gland, by the use of seaweed. A rounded and swollen neck in the Renaissance was a sign of female attractiveness, which was emphasized in their paintings by Rembrandt, Durer, Van Dyck. A nervous and excitable disposition, as a result of an excess of thyroid hormones, was in vogue in the 17th century in Spain. Calm and graceful slowness was appreciated by the aristocrats of Switzerland, but they did not suspect that the reason for this was a deficiency of iodine , which is necessary for the thyroid gland.

The structure of the thyroid gland

The thyroid gland is located on the front of the neck, just below the Adam’s apple. For the first time, the ancient Roman physician Galen described the gland as a separate organ, and it received its name much later in the 17th century. The name of the gland comes from the Greek words “thyreos” – shield and “idos” – view, i.e. an organ that looks like a shield. The international name for this organ of endocrine secretion is the thyroid gland. In shape, the thyroid gland resembles a butterfly or a horseshoe; there are three main parts in it – two lateral lobes and an isthmus.Every third has another unstable lobule – pyramidal.

The size of the gland can vary significantly even in the same person, depending on the activity of its functioning. Gender, age, climate, medication intake and, of course, the nature of the diet largely affect the size and amount of hormones in the gland. Due to the tight connection with the larynx, its position can change, it rises and falls when swallowing, shifts to the side when the head is turned in different directions, which can be seen with the naked eye

The structure of the thyroid gland is rather complex.Under a microscope, it is noticeable that it consists of many vesicles – follicles. At the edges of the follicles there are cells – thyrocytes, and inside the follicle there is a thick watery liquid – a colloid. Thyrocytes synthesize hormones, and they accumulate in the colloid for immediate entry into the bloodstream if necessary.

In the walls of the follicles between the cells, as well as between the follicles themselves, there are larger, light parafolicular cells (C-cells) that produce the hormone calcitonin , which is involved in the regulation of calcium metabolism and phosphorus .It inhibits the excretion of calcium from bones and reduces the calcium content in the blood.

Action of thyroid hormones

Unlike most hormones that act only on certain target cells (for example, for estradiol these are the genitals), thyroid hormones are necessary for normal functioning of all tissues, without exception. Penetrating into the cell, the hormone is sent to the nucleus, where it binds to certain areas on the chromosomes, stimulates a complex of reactions, which leads to the activation of oxidation and reduction processes.

The effect of thyroid hormones on the body:

– increased heat generation

– activation of protein synthesis required to build new cells

– the correct growth and development of the central nervous system, especially the brain (especially important for children)

– strengthening the processes of reabsorption in the intestine, the formation of glucose from proteins and fats, increasing the level of glucose in the blood

– stimulation of the breakdown of fats in fat depots, which leads to weight loss

– anabolic effect – body growth, maturation, bone differentiation

– formation of erythrocytes

– normal development of the genitals and the release of sex hormones .

How many hormones should there be?

Hormones should be enough to ensure the normal functioning of the body. Tests can be used to accurately determine the level of thyroid hormones. Among the laboratory methods for the analysis of thyroid hormones is the analysis by ELISA (enzyme-linked immunosorbent assay).

The amount of thyroid hormones depends on:

– the intensity of signals coming from the brain and regulating the work and the level of thyroid hormones

– the number of working cells in the gland itself

– the presence of a sufficient amount of iodine, which is necessary for the synthesis of hormones.

When conducting tests for thyroid hormones, not only their quantity is assessed, but also antibody indicators. In case of disturbances in the immune response system, antibodies begin to form not only on foreign organisms, but also on “native” tissues. Some of these antibodies interfere with the functioning of the thyroid gland and the action of thyroid hormones. The most common are antibodies to TSH receptor (TSH receptor Ab), antibodies to thyroglobulin (ATTG) and antibodies to thyroperoxidase (anti-ATPO).

Antibodies to TSH receptors are similar in structure to TSH and their attachment to receptors on the thyroid gland leads to the active release of T3 and T4. Antibodies to thyroglobulin appear in Hashimoto’s autoimmune thyroiditis and pregnancy. Monitoring their level in the blood indicates the activity of inflammation. Anti-ATPO – antibodies to thyroperoxidase (AMC, antibodies to the microsomal fraction ) lead to the destruction of the gland and the flow of hormones into the blood.

A condition in which there are enough thyroid hormones for the body is called euthyroidism.

Not enough thyroid hormones

Reduced function of the thyroid gland – hypothyroidism , occurs with a deficiency in iodine intake or intake of substances that disrupt the formation of hormones. Less common causes of hypothyroidism are certain medications (such as cordarone), removal of the gland as a result of tumors, or a deficiency in TSH secretion. Hypothyroidism in childhood leads to stunted growth, disproportionate growth, mental retardation, cretinism.Hypothyroidism in adults is called myxedema.

Manifestations of thyroid hormone deficiency:

– weight gain that is not reduced by diet and exercise

– general weakness, constant fatigue, fatigue

– constantly depressed mood

– menstrual irregularities, infertility

– low body temperature (35.6-36.3 ° C)

– dry, swollen skin, itching, dandruff that does not disappear when using medicated shampoos, nail changes

– persistent constipation

– persistent swelling of the legs, feet, puffiness of the face

– low blood pressure, low heart rate

– inability to warm up even in a warm room

– pain in muscles and joints

– memory impairment and reaction speed

One of the forms of hypothyroidism – endemic goiter , which develops with insufficient intake of iodine.This situation is typical for areas where its low level in water and soil Radioactive iodine can irradiate the gland from the inside and be incorporated into thyroid hormones, which leads to active tumor growth. Carrying out iodine prophylaxis helps to prevent the ingress of radiation iodine into the thyroid gland by replacing it with a stable isotope.

Excess thyroid hormones

With hyperthyroidism – increased work of the thyroid gland, increased synthesis and secretion of T3 and T4, there is an increase in the size of the gland, exophthalmos (bulging eyes).

Symptoms of an elevated thyroid hormone level:

– weight loss with increased appetite

– general weakness, fatigue

– permanent excitement

– menstrual irregularities, infertility

– increased body temperature, sometimes at certain hours (36.9-37.5 ° C)

– dry and loose skin

– rapid heart rate and high blood pressure

– feelings of heat

– memory impairment and reaction speed

Hyperthyroidism is observed in such diseases of the thyroid gland: Basedow-Graves disease ( diffuse toxic goiter ), Plummer’s disease (nodular toxic goiter), de Quervain’s viral thyroiditis , Hashimoto’s autoimmune thyroiditis .More rare reasons for an increase in the amount of thyroid hormones are excessive consumption of thyroid hormone preparations for treatment (thyroxin, eutirox) or for the purpose of losing weight, with ovarian and pituitary tumors, overdose of iodine preparations.

What to do?

In order to determine the quality of the thyroid gland, it is necessary to pass tests for hormones and antibodies, as well as to do an ultrasound study. The most important hormones in the thyroid gland are the assessment of the levels of free T4 and TSH.Ultrasound will show the structure of the gland, its size and volume, and will reveal nodes, cysts.

To prevent thyroid diseases, it is necessary to ensure the intake of a sufficient amount of iodine and tyrosine with food. Iodine is found in iodized salt and sunflower oil, kelp seaweed, fish (herring, flounder, cod, halibut, tuna, salmon), crabs, shrimp, squid and other seafood, feijoa. Sources of tyrosine are milk, peas, eggs, peanuts, beans.