What are the normal ranges for thyroid hormone levels. How do TSH, T4, and T3 tests help diagnose thyroid disorders. What factors can affect thyroid hormone test results.

The Importance of Thyroid Hormones in Body Function

Thyroid hormones play a crucial role in regulating various bodily functions. Produced by the butterfly-shaped thyroid gland located in the front of the neck, these hormones are essential for maintaining proper metabolism, energy levels, and overall health. Understanding normal thyroid hormone levels is vital for diagnosing and treating thyroid disorders effectively.

What are the main thyroid hormones?

The two primary thyroid hormones are:

• Thyroxine (T4): The main form of thyroid hormone, accounting for about 95% of thyroid hormones in the blood
• Triiodothyronine (T3): The active form of thyroid hormone, converted from T4 in various tissues throughout the body

These hormones work together to regulate numerous bodily functions, including heart rate, body temperature, and energy production.

The Thyroid-Pituitary Axis: A Delicate Balance

The production and release of thyroid hormones are controlled by a complex feedback system involving the pituitary gland. This system, known as the thyroid-pituitary axis, helps maintain proper thyroid hormone levels in the body.

How does the pituitary gland regulate thyroid function?

The pituitary gland produces Thyroid Stimulating Hormone (TSH), which acts as a messenger to the thyroid gland. When thyroid hormone levels in the blood are low, the pituitary releases more TSH to stimulate the thyroid gland to produce more hormones. Conversely, when thyroid hormone levels are high, the pituitary reduces TSH production, effectively acting as a thermostat for thyroid function.

Understanding Thyroid Function Tests

To assess thyroid function and diagnose potential disorders, healthcare providers rely on several blood tests. These tests measure the levels of different thyroid hormones and related substances in the bloodstream.

What are the most common thyroid function tests?

The three primary thyroid function tests are:

1. TSH Test
2. T4 Test
3. T3 Test

Each of these tests provides valuable information about thyroid function and can help diagnose various thyroid disorders.

The TSH Test: A Crucial Indicator of Thyroid Function

The Thyroid Stimulating Hormone (TSH) test is often considered the most sensitive and reliable initial screening tool for thyroid function.

Why is the TSH test important?

The TSH test serves as an early warning system for thyroid dysfunction. Changes in TSH levels often occur before noticeable changes in T4 or T3 levels, making it an excellent first-line test for thyroid disorders.

How are TSH results interpreted?

TSH results are interpreted as follows:

• High TSH: May indicate an underactive thyroid (hypothyroidism)
• Low TSH: May suggest an overactive thyroid (hyperthyroidism)
• Normal TSH: Generally indicates proper thyroid function

It’s important to note that TSH levels can sometimes be affected by conditions other than thyroid disorders, such as pituitary gland abnormalities.

The T4 Test: Measuring Thyroxine Levels

The T4 test measures the levels of thyroxine in the blood. There are two main types of T4 tests: Total T4 and Free T4.

What’s the difference between Total T4 and Free T4?

Total T4 measures both the protein-bound and free thyroxine in the blood, while Free T4 measures only the unbound hormone. Free T4 is often considered a more accurate reflection of thyroid function, as it represents the hormone available for use by the body’s tissues.

Can medications affect T4 test results?

Yes, several factors can influence T4 test results, including:

• Medications (e.g., oral contraceptives, steroids)
• Pregnancy
• Liver disease
• Certain viral infections

These factors can affect thyroid hormone binding proteins, potentially leading to misleading Total T4 results. In such cases, Free T4 tests may provide a more accurate assessment of thyroid function.

The T3 Test: Assessing Triiodothyronine Levels

T3 tests measure the levels of triiodothyronine in the blood. Like T4 tests, there are Total T3 and Free T3 tests available.

When are T3 tests most useful?

T3 tests are particularly valuable in:

• Diagnosing hyperthyroidism
• Determining the severity of hyperthyroidism
• Identifying specific thyroid disorders, such as Graves’ disease

In some thyroid conditions, the ratio of T3 to T4 in the blood can provide important diagnostic information.

Interpreting Thyroid Function Test Results

Interpreting thyroid function test results requires careful consideration of various factors and often involves looking at multiple test results together.

How do healthcare providers interpret thyroid test results?

Healthcare providers consider several factors when interpreting thyroid test results:

• The specific values of TSH, T4, and T3
• The relationship between different test results
• The patient’s symptoms and medical history
• Other factors that may affect test results (e.g., medications, pregnancy)

It’s important to note that “normal” ranges can vary slightly between laboratories and may be adjusted for factors like age and pregnancy.

Factors Affecting Thyroid Hormone Levels

Various factors can influence thyroid hormone levels, potentially affecting test results and complicating diagnosis.

What external factors can affect thyroid hormone levels?

Several factors can impact thyroid hormone levels, including:

• Medications (e.g., amiodarone, lithium)
• Iodine intake
• Stress
• Certain medical conditions (e.g., pituitary disorders)
• Pregnancy

Healthcare providers must consider these factors when interpreting thyroid function test results to ensure accurate diagnosis and appropriate treatment.

Thyroid Disorders: Beyond Normal Hormone Levels

When thyroid hormone levels fall outside the normal range, it may indicate a thyroid disorder. The most common thyroid disorders are hypothyroidism and hyperthyroidism.

How are thyroid disorders diagnosed?

Diagnosing thyroid disorders typically involves:

1. Evaluating symptoms
2. Performing a physical examination
3. Conducting thyroid function tests
4. Sometimes, additional tests like thyroid antibody tests or imaging studies

The combination of these factors helps healthcare providers determine the presence and type of thyroid disorder.

What are the treatment options for thyroid disorders?

Treatment for thyroid disorders depends on the specific condition and its severity. Common treatments include:

• Medication to replace or suppress thyroid hormones
• Radioactive iodine therapy
• Surgery (in some cases)

The goal of treatment is to restore normal thyroid function and alleviate symptoms associated with thyroid disorders.

The Importance of Regular Thyroid Function Monitoring

For individuals with thyroid disorders or those at risk of developing them, regular monitoring of thyroid function is crucial.

How often should thyroid function be tested?

The frequency of thyroid function testing depends on several factors:

• The presence of an existing thyroid disorder
• The stability of thyroid hormone levels
• The type and dosage of thyroid medication (if applicable)
• Individual risk factors for thyroid disorders

Healthcare providers typically recommend a personalized testing schedule based on these factors.

Thyroid Health: Prevention and Lifestyle Factors

While some thyroid disorders are not preventable, certain lifestyle factors can support overall thyroid health.

How can individuals support thyroid health?

To promote thyroid health, consider the following:

• Maintain a balanced diet rich in iodine, selenium, and zinc
• Manage stress through relaxation techniques and regular exercise
• Avoid exposure to environmental toxins when possible
• Stay informed about family history of thyroid disorders
• Discuss any concerns or symptoms with a healthcare provider

By understanding normal thyroid hormone levels and the factors that influence them, individuals can take an active role in maintaining their thyroid health and overall well-being.

Advances in Thyroid Function Testing and Treatment

The field of thyroid health is continuously evolving, with new developments in testing methods and treatment approaches.

What are some recent advances in thyroid function testing?

Recent advancements in thyroid function testing include:

• More sensitive TSH assays for detecting subtle thyroid dysfunction
• Improved techniques for measuring free thyroid hormones
• Development of thyroid antibody tests for diagnosing autoimmune thyroid disorders
• Use of genetic testing to identify inherited thyroid conditions

These advances are helping healthcare providers make more accurate diagnoses and tailor treatment plans to individual patients.

How are treatment approaches for thyroid disorders evolving?

Treatment for thyroid disorders is becoming more personalized, with approaches such as:

• Combination therapy using both T4 and T3 for some hypothyroid patients
• Targeted therapies for thyroid cancer based on genetic markers
• Improved techniques for minimally invasive thyroid surgery
• Exploration of new drug therapies for autoimmune thyroid disorders

These advancements aim to improve treatment outcomes and quality of life for individuals with thyroid disorders.

The Role of Thyroid Health in Overall Wellness

Thyroid health plays a significant role in overall wellness, affecting numerous bodily functions and systems.

How does thyroid function impact other aspects of health?

Thyroid hormones influence various aspects of health, including:

• Metabolism and weight management
• Cardiovascular health
• Bone density and strength
• Cognitive function and mood
• Reproductive health and fertility
• Skin, hair, and nail health

Maintaining optimal thyroid function is crucial for overall health and well-being.

Can thyroid disorders affect mental health?

Yes, thyroid disorders can have significant impacts on mental health. Both hypothyroidism and hyperthyroidism can cause or exacerbate:

• Depression
• Anxiety
• Mood swings
• Cognitive difficulties

Proper diagnosis and treatment of thyroid disorders can often lead to improvements in mental health symptoms.

Thyroid Health Across the Lifespan

Thyroid function and the prevalence of thyroid disorders can vary across different life stages.

How does thyroid health change with age?

Thyroid health considerations change throughout life:

• Infancy and childhood: Proper thyroid function is crucial for growth and development
• Adolescence: Hormonal changes can sometimes affect thyroid function
• Adulthood: Risk of thyroid disorders increases, especially in women
• Pregnancy: Thyroid function changes to support fetal development
• Older adulthood: Increased risk of thyroid disorders, particularly hypothyroidism

Regular monitoring and awareness of thyroid health become increasingly important as individuals age.

What are the special considerations for thyroid health during pregnancy?

Thyroid health is particularly important during pregnancy due to its impact on fetal development. Key considerations include:

• Increased iodine requirements
• Changes in thyroid hormone levels and binding proteins
• Potential need for thyroid medication adjustments
• Screening for thyroid disorders in early pregnancy

Close monitoring of thyroid function during pregnancy is essential for the health of both mother and baby.

The Future of Thyroid Health Management

As our understanding of thyroid function and disorders continues to grow, the future of thyroid health management looks promising.

What emerging technologies might impact thyroid care?

Several emerging technologies and approaches may shape the future of thyroid care:

• Artificial intelligence for interpreting thyroid imaging and test results
• Wearable devices for continuous monitoring of thyroid hormone levels
• Gene therapy for treating inherited thyroid disorders
• Personalized medicine approaches based on genetic and molecular profiles
• Advanced imaging techniques for early detection of thyroid nodules and cancer

These innovations have the potential to improve diagnosis, treatment, and management of thyroid disorders.

How might patient involvement in thyroid care evolve?

The future of thyroid care is likely to involve greater patient engagement and empowerment:

• Increased use of telemedicine for thyroid monitoring and management
• Patient-friendly apps for tracking symptoms and medication adherence
• Improved patient education resources and support networks
• Greater involvement in shared decision-making regarding treatment options

This shift towards patient-centered care aims to improve outcomes and quality of life for individuals with thyroid disorders.

As our knowledge of thyroid health continues to expand, individuals and healthcare providers alike can look forward to more effective, personalized approaches to maintaining optimal thyroid function and overall well-being. By staying informed about normal thyroid hormone levels, understanding the importance of regular monitoring, and embracing advances in thyroid care, we can work towards a future where thyroid disorders are more easily prevented, diagnosed, and managed.

Normal Thyroid Hormone Levels: What are Normal Thyroid Hormone Levels? Normal Thyroid Hormone Level Symptoms, Treatment, Diagnosis

Affiliated: TSH Test | T4 Test | T3 Test

What is thyroid hormone?

Thyroid hormone is made by the thyroid gland, a butterfly-shaped endocrine gland normally located in the lower front of the neck. Thyroid hormone is released into the blood where it is carried to all the tissues in the body. It helps the body use energy, stay warm and keeps the brain, heart, muscles, and other organs working as they should.

Thyroid hormone exists in two main forms: thyroxine (T4) and triiodothyronine (T3). T4 is the primary form of thyroid hormone circulating in the blood (about 95%). To exert its effects, T4 is converted to T3 by the removal of an iodine atom; this occurs mainly in the liver and in certain tissues where T3 acts, such as in the brain. T3 normally accounts for about 5% of thyroid hormone circulating in the blood.

Most thyroid hormone in the blood is bound by protein, while only a small fraction is “free” to enter tissues and have a biologic effect. Thyroid tests may measure total (protein bound and free) or free hormone levels.

Production of thyroid hormone by the thyroid gland is controlled by the pituitary, another endocrine gland in the brain. The pituitary releases Thyroid Stimulating Hormone (abbreviated TSH) into the blood to stimulate the thyroid to make more thyroid hormone. The amount of TSH that the pituitary sends into the bloodstream depends on the amount of thyroid hormone in the body. Like a thermostat, if the pituitary sense low thyroid hormone, then it produces more TSH to tell the thyroid gland to produce more. Once the T4 in the bloodstream goes above a certain level, the pituitary’s production of TSH is shut off. In this way, the pituitary senses and controls thyroid gland production of thyroid hormone. Endocrinologists use a combination of thyroid hormone and TSH testing to understand thyroid hormone levels in the body.

What is a TSH test?

Thyroid tests
Blood tests to measure thyroid hormones are readily available and widely used. Not all thyroid tests are useful in all situations.

TSH Test
The best way to initially test thyroid function is to measure the TSH (Thyroid Stimulating Hormone) level in a blood sample. Changes in TSH can serve as an “early warning system” – often occurring before the actual level of thyroid hormones in the body becomes too high or too low.

A high TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism). On the other hand, a low TSH level usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism). Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid (central hypothyroidism). In most healthy individuals, a normal TSH value means that the thyroid is functioning properly.

What is a T4 test?

T4 Tests
A Total T4 test measures the bound and free thyroxine (T4) hormone in the blood. A Free T4 measures what is not bound and able to freely enter and affect the body tissues.

What does it mean if T4 levels are abnormal?
Importantly, Total T4 levels are affected by medications and medical conditions that change thyroid hormone binding proteins. Estrogen, oral contraceptive pills, pregnancy, liver disease, and hepatitis C virus infection are common causes of increased thyroid hormone binding proteins and will result in a high Total T4. Testosterone or androgens and anabolic steroids are common causes of decreased thyroid hormone binding proteins and will result in a low Total T4.

In some circumstances, like pregnancy, a person may have normal thyroid function but Total T4 levels outside of the normal reference range. Tests measuring free T4 – either a free T4 (FT4) or free T4 index (FTI) – may more accurately reflect how the thyroid gland is functioning in these circumstances. An endocrinologist can determine when thyroid disease is present in the context of abnormal thyroid binding proteins.

What is a T3 test?

T3 Tests
T3 tests measure triiodothyronine (T3) levels in the blood. A Total T3 test measures the bound and free fractions of triiodothyronine. Hyperthyroid patients typically have an elevated Total T3 level. T3 tests can be used to support a diagnosis of hyperthyroidism and can determine the severity hyperthyroidism.

In some thyroid diseases, the proportions of T3 and T4 in the blood change and can provide diagnostic information. A pattern of increased T3 vs T4 is characteristic of Graves’ disease. On the other hand, medications like steroids and amiodarone, and severe illness can decrease the amount of thyroid hormone the body converts from T4 to T3 (active form) resulting in a lower proportion of T3.

T3 levels fall late in the course of hypothyroidism and therefore are not routinely used to evaluate patients with underactive or surgically absent thyroid glands.

Measurement of Free T3 is possible, but is often not reliable and therefore may not be helpful.

What is a normal thyroid (hormone) level?

Tests often used to assess thyroid hormone status include TSH and FT4 tests. The normal value for a laboratory test is determined by measuring the hormone in a large population of healthy individuals and finding the normal reference range. Normal ranges for thyroid tests may vary slightly among different laboratories, and typical ranges for common tests are given below.

TSH normal values are 0.5 to 5.0 mIU/L. Pregnancy, a history of thyroid cancer, history of pituitary gland disease, and older age are some situations when TSH is optimally maintained in different range as guided by an endocrinologist.

FT4 normal values are 0.7 to 1.9ng/dL. Individuals taking medications that modify thyroid hormone metabolism and those with a history of thyroid cancer or pituitary disease may be optimally managed with a different normal FT4 range.

Total T4 and Total T3 levels measure bound and free thyroid hormone in the blood. These levels are influenced by many factors that affect protein levels in the body, including medications, sex hormones, and liver disease.
A normal Total T4 level in adults ranges from 5.0 to 12.0μg/dL.
A normal Total T3 level in adults ranges from 80-220 ng/dL.

Free T3 assays are often unreliable and not routinely used to assess thyroid function.

What does it mean if my thyroid levels are abnormal?

Patterns of thyroid tests associated with thyroid disease

Primary Hypothyroidism
A high TSH and low thyroid hormone level (e.g. low FT4) can indicate primary hypothyroidism. Primary hypothyroidism occurs when the thyroid gland makes too little thyroid hormone. Symptoms of hypothyroidism can include feeling cold, constipation, weight gain, slowed thinking, and decreased energy.
Causes of primary hypothyroidism include:

• Autoimmune thyroid disease, including Hashimoto’s thyroiditis
• Thyroid gland dysfunction due to a medication (e.g. amiodarone, tyrosine kinase inhibitors, or cancer immunotherapy)
• Removal of all or part of the thyroid gland
• Radiation injury to the thyroid (e.g. external beam radiation, radioactive iodine ablation treatment)
• Excess treatment with anti-thyroid medications (e.g. methimazole, propylthiouracil)

Early or mild hypothyroidism may present as a persistently elevated TSH and a normal FT4 hormone level. This pattern is called subclinical hypothyroidism and your doctor may recommend treatment. Over time, untreated subclinical hypothyroidism can contribute to heart disease.

It is important to remember that normal TSH levels in older individuals (ages 70 and above) are higher than the normal ranges for younger individuals.

Primary Hyperthyroidism
A low TSH and a high thyroid hormone level (e.g. high FT4) can indicate primary hyperthyroidism. Primary hyperthyroidism occurs when the thyroid gland makes or releases too much thyroid hormone. Symptoms of hyperthyroidism can include tremors, palpitations, restlessness, feeling too warm, frequent bowel movements, disrupted sleep, and unintentional weight loss.
Causes of primary hyperthyroidism include:

• Graves’ disease
• Toxic or autonomously functioning thyroid nodule
• Multinodular goiter
• Thyroid inflammation (called thyroiditis) early in the course of disease
• Thyroid gland dysfunction due to a medication (e.g. amiodarone or cancer immunotherapy)
• Excess thyroid hormone therapy

Early or mild hyperthyroidism may present as a persistently low TSH and a normal FT4 hormone level. This pattern is called subclinical hyperthyroidism and your doctor may recommend treatment. Over time, untreated subclinical hyperthyroidism can worsen osteoporosis and contribute to abnormal heart rhythms.

Thyroiditis
Thyroid inflammation, also called thyroiditis, causes injury to the thyroid gland and release of thyroid hormone. Individuals with thyroiditis usually have a brief period of hyperthyroidism (low TSH and high FT4 or Total T4) followed by development of hypothyroidism (high TSH and low FT4 or Total T4) or resolution.

Some forms of thyroiditis are transient, like post-partum thyroiditis or thyroiditis following an infection, and often resolve on their own without need for medication.

Other forms of thyroiditis, like thyroiditis resulting from cancer immunotherapy, interferon alpha, or tyrosine kinase inhibitors, usually result in permanent hypothyroidism and require long term treatment with thyroid hormone replacement.

Your endocrinologist will monitor your thyroid tests during thyroiditis and can help determine if you need short and long term medications to balance your thyroid function and control any symptoms.

Central Hypothyroidism
A low TSH and a low FT4 may indicate pituitary disease. Detection of central hypothyroidism should prompt your doctor to check for problems in other pituitary hormones, an underlying cause, and you may need imaging tests to look at the pituitary gland.

Central hypothyroidism is treated with thyroid hormone replacement. Importantly, adequacy of thyroid replacement in central hyperthyroidism is assessed with FT4 and Total T4 tests not TSH as in primary hyperthyroidism, and deficiency in stress hormone cortisol should be assessed before starting thyroid treatment to prevent an adrenal crisis. 

Causes of central hypothyroidism include pituitary gland disease, such as a pituitary mass or tumor, history of pituitary surgery or radiation, pituitary inflammation (called hypophysitis) resulting from autoimmune disease or cancer immunotherapy, and infiltrative diseases.

Rare causes of abnormal thyroid function
Thyroid hormone resistance
Iodine induced hyperthyroidism
TSH-secreting tumor (TSH-oma)
Germ cell tumors
Trophoblastic disease
Infiltrative diseases, such as systemic scleroderma, hemochromatosis, or amyloidosis

When abnormal thyroid function tests are not due to thyroid disease

While blood tests to measure thyroid hormones and thyroid stimulating hormone (TSH) are widely available, it is important to remember that no all tests are useful in all circumstances and many factors including medications, supplements, and non-thyroid medical conditions can affect thyroid test results. An endocrinologist can help you make sense of thyroid test results when there is a discrepancy between your results and how you feel. A good first step is often to repeat the test and ensure there are no medications that might interfere with the test results. Below are some common reasons for mismatch between thyroid tests and thyroid disease.

Non-thyroidal illness
Significant illness, such as an infection, cancer, heart failure, or kidney disease, or recent recovery from an illness can cause changes transient changes in the TSH. Fasting or starvation can also cause a low TSH. An endocrinologist can help to interpret changes in thyroid function tests in these circumstances to distinguish non-thyroid illness from true thyroid dysfunction.

Test interference
Biotin, a common supplement for hair and nail growth, interferes with many thyroid function tests and can lead to inaccurate results. Endocrinologists recommend stopping biotin supplements for 3 days before having a blood test for thyroid function.

Individuals who have exposure to mice, like laboratory researchers and veterinarians, may develop antibodies against mouse proteins in their blood. These antibodies cross react with reagents in multiple thyroid function tests and cause unpredictable results. A specialized assay can accurately measure thyroid hormone levels and TSH in this circumstance.

I don’t feel well, but my thyroid tests are normal

Thyroid blood tests are generally accurate and reliable. If your thyroid tests are normal, your symptoms may not be related to thyroid disease and you may want to seek additional evaluation with your primary care physician.

How is hypothyroidism treated?

What is thyroid medication?

Thyroid Hormone Treatment
Levothyroxine is the standard of care in thyroid hormone replacement therapy and treatment of hypothyroidism. Levothyroxine (also called LT4) is equivalent to the T4 form of naturally occurring thyroid hormone and is available in generic and brand name forms.

How do I take levothyroxine?
To optimize absorption of your thyroid medication, it should be taken with water at a regular time each day. Multiple medications and supplements decrease absorption of thyroid hormone and should be taken 3-4 hours apart, including calcium and iron supplements, proton pump inhibitors, soy, and multivitamins with minerals. Because of the way levothyroxine is metabolized by the body, your doctor may ask you to take an extra pill or skip a pill on some days of the week. This helps us to fine tune your medication dose for your body and should be guided by an endocrinologist.

For patients with celiac disease (autoimmune disease against gluten) or gluten sensitivity, a gluten free formulation of levothyroxine is available.

Some individuals may have genetic variant that affects how the body converts T4 to T3 and these individuals may benefit from the addition of a small dose of triiodothyronine.

Liothyronine is replacement T3 (triiodothyronine) thyroid hormone. This medication has a short half-life and is taken twice per day or in combination with levothyroxine. Liothyronine alone is not used for treatment of hypothyroidism long term.

Other formulations of thyroid hormone replacement include natural or desiccated thyroid hormone extracts from animal sources. Natural or desiccated thyroid extract preparations have greater variability in the dose of thyroid hormone between batches and imbalanced ratios if T4 vs T3. Natural or animal sources of thyroid hormone typically contain 75% T4 and 25% T3, compared to the normal human balance of 95% T4 and 5% T3. Treatment with a correct balance of T4 and T3 is important to replicate normal thyroid function and prevent adverse effects of excess T3, including osteoporosis, heart problems, and mood and sleep disturbance. An endocrinologist can evaluate symptoms and thyroid tests to help balance thyroid hormone medications.

How do I know if my thyroid dose is correct?

Monitoring thyroid levels on medication
Correct dosing of thyroid hormone is usually assessed using the same tests for diagnosis of thyroid disease, including TSH and FT4. Thyroid tests are typically checked every 4-6 weeks initially and then every 6 to 12 months once stable. In special circumstances, such as pregnancy, a history of thyroid cancer, central hypothyroidism, amiodarone therapy, or use of combination T4 and T3 thyroid hormone replacement, your endocrinologist may check different thyroid tests. Additionally, your endocrinologist will evaluate for symptoms of hyperthyroidism and hypothyroidism and peform a physicial exam.

Women who are pregnant and women who may become pregnant should only be treated with levothyroxine (T4). Only T4 efficiently crosses the placenta to provide thyroid hormone to the developing fetus. Thyroid hormone is critical in early pregnancy for brain development. Normal ranges for thyroid tests in pregnancy are different and change by trimester. Women with thyroid disease in pregnancy or who are considering pregnancy should be under the care of an endocrinologist to guide therapy.

Individuals with a history of thyroid cancer, even if only a portion of the thyroid was removed, also have different target ranges for TSH and FT4 tests. Thyroid hormone replacement in these individuals is closely tied to ongoing thyroid cancer surveillance, monitoring of thyroid cancer tumor markers, and dynamic assessment of recurrence risk. These patients are optimally managed by a multidisciplinary team including an endocrinologist and endocrine surgeon.

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Thyroid-Stimulating Hormone (TSH): TSH Levels Test

A TSH test is done to find out if your thyroid gland is working the way it should. It can tell you if it’s overactive (hyperthyroidism) or underactive (hypothyroidism). The test can also detect a thyroid disorder before you have any symptoms. If untreated, a thyroid disorder can cause health problems.

TSH stands for “thyroid stimulating hormone” and the test measures how much of this hormone is in your blood. TSH is produced by the pituitary gland in your brain. This gland tells your thyroid to make and release the thyroid hormones into your blood.

The Test

The TSH test involves simply drawing some blood from your body. The blood will then be analyzed in a lab. This test can be performed at any time during the day. No preparation is needed (such as overnight fasting). You shouldn’t feel any pain beyond a small prick from the needle in your arm. You may have some slight bruising.

In general, there is no need to stop taking your medicine(s) before having your TSH level checked. However, it is important to let the doctor know what medications you are taking as some drugs can affect thyroid function. For example, thyroid function must be monitored if you are taking lithium. While taking lithium, there is a high chance that your thyroid might stop functioning correctly. It’s recommended that you have a TSH level test before starting this medicine. If your levels are normal, then you can have your levels checked every 6 to 12 months, as recommended by your doctor. If your thyroid function becomes abnormal, you should be treated.

High Levels of TSH

TSH levels typically fall between 0.4 and 4.0 milliunits per liter (mU/L), according to the American Thyroid Association. Ranges between laboratories will vary with the upper limit generally being between 4 to 5. If your level is higher than this, chances are you have an underactive thyroid.

In general, T3 and T4 levels increase in pregnancy and TSH levels decrease.

Low Levels of TSH

It’s also possible that the test reading comes back showing lower than normal levels of TSH and an overactive thyroid. This could be caused by:

• Graves’ disease (your body’s immune system attacks the thyroid)
• Too much iodine in your body
• Too much thyroid hormone medication
• Too much of a natural supplement that contains the thyroid hormone

If you’re on medications like steroids, dopamine, or opioid painkillers (like morphine), you could get a lower-than-normal reading. Taking biotin (B vitamin supplements) also can falsely give lower TSH levels.

The TSH test usually isn’t the only one used to diagnose thyroid disorders. Other tests, like the free T3, the free T4, the reverse T3, and the anti-TPO antibody, are often used too when determining whether you need thyroid treatment or not.

Treatment

Treatment for an underactive thyroid usually involves taking a synthetic thyroid hormone by pill daily. This medication will get your hormone levels back to normal, and you may begin to feel less tired and lose weight.

To make sure you’re getting the right dosage of medication, your doctor will check your TSH levels after 2 or 3 months. Once they are sure you are on the correct dosage, they will continue to check your TSH level each year to see whether it is normal.

If your thyroid is overactive, there are several options:

• Radioactive iodine to slow down your thyroid
• Anti-thyroid medications to prevent it from overproducing hormones
• Beta blockers to reduce a rapid heart rate caused by high thyroid levels
• Surgery to remove the thyroid (this is less common)

Your doctor may also regularly check your TSH levels if you have an overactive thyroid.

Understanding Thyroid Function Tests and Normal Ranges

Blood tests for thyroid function—TSH, total T4, free T3, TSI, and others—are an important part of diagnosing and treating thyroid disorders. While some conclusions can be drawn from a single test, a combination of test results are usually needed to establish the full nature of your thyroid health. By comparing the values of thyroid tests, a doctor can determine whether a person has hypothyroidism (low thyroid function), hyperthyroidism (overactive thyroid), or an autoimmune thyroid disease such as Graves’ disease or Hashimoto’s thyroiditis.

How to Work With Your Thyroid Medical Team

Figuring out what the various names and numbers mean can be complicated, but taking the time to learn them can help you better manage your disease.

Types of Tests

The purpose of thyroid testing is to measure the so-called “markers” of thyroid health. These are substances not only produced by the thyroid gland but other organs that regulate thyroid function. For example, the pituitary gland produces a hormone known as thyroid stimulating hormone (TSH), which regulates how much of the hormones triiodothyronine (T3) and thyroxine (T4) are produced by the thyroid gland. The interrelationship of these and other values can tell you a lot about how well or poorly your thyroid gland is functioning.

Thyroid function tests typically look at six key substances in the blood, including hormones, proteins, and immune cells known as antibodies.

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Thyroid Stimulating Hormone (TSH)

Thyroid stimulating hormone (TSH) is the pituitary hormone that acts as a messenger to the thyroid gland. If the pituitary gland detects that there is too little thyroid hormone in the blood, it will produce more TSH, prompting the thyroid gland to produce more thyroid hormone. When the pituitary detects too much thyroid hormone, it slows the production of TSH, signaling the thyroid gland to do the same.

Thyroxine (T4)

Thyroxine (T4) functions as a “storage” hormone. On its own, it is unable to produce energy or deliver oxygen to cells but must undergo a process known as monodeiodination in which it loses an atom of iodine to become triiodothyronine (T3). The T4 test measures two key values:

• Total T4 is the total amount of thyroxine circulating in the blood. The includes T4 that has bonded with protein (interfering with its ability to enter certain tissue) and T4 that has not bonded to protein. 
• Free T4 is the type not bonded to protein and is considered the active form of thyroxine.

Triiodothyronine (T3)

Triiodothyronine (T3) is the active thyroid hormone created from the conversion of thyroxine into triiodothyronine. Three different tests measure various aspects of T3:

• Total T3 is the total amount of triiodothyronine circulating in the blood, both bound and unbound by protein.
• Free T3 is not bound to protein and considered the active form of triiodothyronine.
• Reverse T3 is the inactive “mirror image” of T3 that attaches to thyroid receptors but is unable to activate them.

Thyroglobulin (Tg)

Thyroglobulin (Tg) is a protein produced by the thyroid gland. It is mostly used a tumor marker to help guide thyroid cancer treatment. The aim of cancer treatment is the eradication of all cancer cells. The elevation of Tg is a sign that cancer cells are still present following thyroid removal surgery (thyroidectomy) or radioactive ablation (RAI) therapy.

By comparing baseline values with subsequent results, the Tg test can tell doctors whether the cancer treatment is working, how durable remission is, and whether there are signs of cancer recurrence.

Thyroid Antibodies

There are some thyroid disorders caused by an autoimmune disease. Autoimmune diseases occur when the immune system mistakenly targets and attacks normal cells. It does so by secreting defensive antibodies that are “matched” to receptors (antigens) on the targeted cell.

There are three common antibodies associated with autoimmune thyroid disease: 

• Thyroid peroxidase antibodies (TPOAb) are detected in 95 percent of people with Hashimoto’s and around 70 percent of those with Graves’ disease. Elevated TPOAb is also seen, albeit less commonly, in women with postpartum thyroiditis.
• Thyroid stimulating hormone receptor antibodies (TRAb) are seen in 90 percent of Graves’ disease cases, but only 10 percent of Hashimoto’s cases.
• Thyroglobulin antibodies (TgAb) are produced by your body in response to the presence of thyroglobulin. They are detected in 80 percent of people with Hashimoto’s and between 50 percent to 70 percent of those with Graves’ disease. Moreover, one in four people with thyroid cancer will have elevated TgAb.

Thyroid Binding Proteins

Testing the level of proteins in the blood that binds to T3 and T4 can help doctors characterize the nature of a thyroid problem or explore conditions in which thyroid symptoms develop in people with normally functioning glands. Among the three common measures:

• Thyroid binding globulin (TBG) measures the level of protein, known as globulin, that carries thyroid hormones in the blood. It can be measured either with electrophoresis (which uses an electrical field to measure particles) or a radioimmunoassay (which uses radioactive isotopes to measure particles).
• T3 resin uptake (T3RU) calculates the percentage of TBG in a sample of blood.
• Free thyroxine index (FTI) is an older method of calculation in which the total T4 is multiplied by the T3RU to characterize whether a person is hypothyroid or hyperthyroid

Test Reference Ranges

The results of any blood test will be listed alongside a reference range. The reference range is simply the expected range of values within a population.

Generally speaking, anything between the high and low ends of the reference range can be considered normal. Anything near the upper or lower limit may be considered borderline, while anything outside of the upper and lower limits would be considered abnormal.

In the middle of the reference range is a “sweet spot,” called the optimal reference range, in which thyroid function is considered ideal. 

Interpretation of Results

The interpretation of the test results can vary based on the individual and comparative values. The one test that arguably provides the most insight is the TSH. When used in combination with free T3 and free T4, the TSH can also suggest the cause of an abnormality. 

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TSH Interpretations

TSH values outside of the optimal reference range are suggestive of a thyroid disorder. Values at or near the upper or lower range may suggest a subclinical disorder (or one in which there are no observable symptoms).

According to guidelines issued by the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA), a TSH value:

• Between 4.7 and 10 mU/L is considered subclinical hypothyroidism.
• Over 10 mU/L is overt (symptomatic) hypothyroidism.
• Between 0.1 and 0.5 mU/L is considered subclinical hyperthyroidism.
• Less than 0.1 mU/L is overt hyperthyroidism.

T3 and T4 Interpretations

By comparing TSH with T4 values, your doctor may be able to better characterize the nature of a thyroid disorder. For example:

• A normal TSH and normal T4 indicates a normally functioning thyroid gland.
• A low TSH and high T4 generally indicates hyperthyroidism.
• A high TSH and low T4 indicates primary hypothyroidism (due to a thyroid disease).
• A low TSH and low T4 suggest secondary hypothyroidism (due to a disease of the pituitary gland or hypothalamus of the brain).

For diagnostic purposes, a low T3 value accompanied by a high TSH value is considered evidence of hypothyroidism. By contrast, a low TSH value accompanied by a high T3 value is considered evidence of hyperthyroidism.

Other Interpretations

The other thyroid tests may be included as part of a standard panel or ordered when needed. Some have specific aims; others are used for screening purposes or to differentiate between possible causes.

• RT3 tests can help identify dysregulation disorders, such as euthyroid sick syndrome (ESS), in which hormone levels are abnormal, but the thyroid gland does not appear dysfunctional.
• Tg tests, in addition to detecting cancer recurrence, can help predict the long-term outcome of treatment. According to research published in the journal Thyroid, only 4 percent of people with a thyroglobulin level under 1 will experience recurrence after five years.
• TPOAb tests can help confirm Hashimoto’s disease if your TSH is elevated but your T4 is low.
• TRAb tests, in addition to diagnosing Graves’ disease, may help confirm a diagnosis of toxic multinodular goiter. The test is also commonly performed during the last three months of pregnancy to evaluate the baby’s risk of being born with hyperthyroidism or Graves’ disease.
• TgAb tests, in addition to supporting an autoimmune diagnosis, can help clarify post-cancer treatment results. This is because TgAB can interfere with Tg readings in as many as 15 percent of people with detectable TgAb. If Tg readings are low but TgABb levels are elevated, further evaluation may be needed to avoid misdiagnosis.
• TBG tests can help determine whether the lack of the binding protein is the cause of the thyroid disorder or simply a characteristic. TBG deficiency can sometimes occur as a result of an inherited disorder, in which the thyroid gland is functioning normally but lab tests appear abnormal.
• T3RU tests are another method of assessing TBG deficiency with higher T3RU values corresponding to lower TBG levels (and vice versa).
• FTI tests are a reliable means of assessing thyroid function in the presence of a TBG deficiency. However, they are less commonly used today given the accuracy of newer free T3 and free T4 tests.

Controversies

There is not always consensus as to what thyroid test results mean, particularly between conventional endocrinologists and integrative medical practitioners. By and large, integrative specialists contend that the diagnostic measures endorsed by the AACE and ATA fall short in diagnosing thyroid disorders, especially in people with subclinical disease.

Even with regards to TSH testing, most integrative doctors will tell you that a TSH under 10.0 mU/L—classified as subclinical hypothyroidism—should be treated and that doing so may prevent the development of overt hypothyroidism. AACE/ATA guidelines suggest a more watch-and-wait approach.

Integrative physicians also believe that the true measure of a person’s thyroid health is the number of active hormones circulating in the blood (free T4 and free T3) and not TSH. They argue that TSH is an inexact value given that it can lie within the normal range with Hashimoto’s disease and that free T3 offers a “real-time” snapshot of thyroid function. For these practitioners, a low free T3 is considered justification for thyroid hormone replacement therapy.

By contrast, many conventional doctors will not test T3 given that there is no direct association between T3 levels and the risk of overt hypothyroidism. Moreover, the T3 replacement drug Cytomel (liothyronine) is not even endorsed for the treatment of hypothyroidism due to the risk of reactive hyperthyroidism, minimizing the value of T3 in directing thyroid treatment.

The same argument has extended to RT3 testing for which integrative practitioners believe an elevated RT3 or an imbalance in the RT3/T3 ratio is a clear sign of hypothyroidism. Research shows that there is little credible evidence that either of these claims is inherently true. 

Nor is there evidence that elevated TPOAb warrants preemptive treatment to prevent overt hypothyroidism in people suspected of having Hashimoto’s, as some might suggest.

A Word From Verywell

While there may a lack of consensus as to the interpretation of thyroid test results, most experienced endocrinologists will adhere to the principles of the AACE/ATA guidelines and use clinical judgment to individualize treatment based on your test results, symptoms, medical history, and current health.

Medical opinions can sometimes vary. The responsibility, therefore, falls on you to understand what the test results mean, to ask questions, and to find an endocrinologist willing to work with you as a full partner. If you aren’t comfortable with what you are being told, do not hesitate to seek a seek a second opinion from a qualified medical professional.

It is also important to remember that reference ranges and units of measurement used can vary from lab to lab. To ensure consistency in your test results, try to use the same lab for every test.

How Doctors Diagnose Hypothyroidism – Diagnosis of an underactive thyroid function is made based on a combination of thyroid blood test results, symptoms, and several other factors.

Hypothyroidism is evaluated and diagnosed by a physician, usually an endocrinologist or your primary care doctor. Symptoms, signs, and more critically, blood tests—are taken into consideration when evaluating the possibility of an underactive thyroid gland—all of which help identify the cause and severity of the disease.

A diagnosis is reached after a thorough review of the patient’s personal medical and family histories, any risk factors, findings on physical examination, in addition to the results of thyroid function levels. There are several types of hormones checked in a blood test to assess your thyroid status—the most definitive one is the TSH (thyroid-stimulating hormone). Often, physicians may decide to check the free thyroxine, or T4, free T4 index, or total T4 to aid in the diagnosis.

Your doctor may check your thyroid status for an underactive thyroid by reviewing thyroid hormone levels. Photo: 123rf

Why Hypothyroidism is not Diagnosed on Symptoms Alone

Many of the symptoms of hypothyroidism are fairly common complaints found in people with a normally functioning thyroid gland, so it can be hard to decipher if the symptoms are related to the thyroid. One of the best ways to figure out if your symptoms could be related to a thyroid condition is to consider how long you have been experiencing them. 

For example, have you always felt cold when others were warm? Did you just start to notice decreased energy? If you are starting to notice new signs and symptoms, it could be related to a thyroid issue. However, only a physician (eg, endocrinologist) can diagnose a thyroid problem.

What to Consider in Your Personal and Family Medical Histories

It’s important to give your physician as many details as possible about your personal medical history, as well as family history (eg, mother had hypothyroidism). Be sure to discuss:

• Your general state of health—particularly any changes you have noticed in your general overall health.
• Your family’s health history—especially if a close relative has been diagnosed with hypothyroidism (or any other thyroid-related issues).
• Whether you’ve ever had thyroid surgery, or radiation to your neck to treat cancer.
• Any medicines you may be taking that could cause hypothyroidism (eg, amiodarone, lithium, interferon alpha, interleukin-2, or prior chemotherapy).

Physical Examination—Looking for Signs of Hypothyroidism
Your physician will perform a thorough examination and look for physical signs of hypothyroidism, including:

• Evidence of dry skin
• Swelling around the eyes and legs
• Slower reflexes
• Slower heart rate

Blood Tests: Hypothyroidism can be detected by different blood tests.

• TSH Test.  A thyroid-stimulating hormone or TSH is a blood test that measures the amount of T4 (thyroxine) that the thyroid is being signaled to make. If you have an abnormally high level of TSH, it could mean you have hypothyroidism.
• T4 (thyroxine) Test. The thyroid gland produces T4 (thyroxine). The free T4 and the free T4 index are blood tests that, in combination with a TSH test, can let your physician know how your thyroid is functioning. 

[[wysiwyg_imageupload::]]The pituitary gland tells the thyroid how much thyroxine to produce through signaling by TSH. There are cells in the pituitary gland that decide what your body’s “set point” is. Your set point is the normal range of TSH your body needs, as determined by your pituitary gland.

As blood flows through the pituitary gland, these same cells detect if there are adequate T4 levels in the body. If your T4 level is adequate, the pituitary sends the appropriate amount of TSH to the thyroid to maintain T4 levels in the normal range. If your T4 level is too low, the pituitary sends more TSH out telling the thyroid to make more T4. If your T4 level is too high, the pituitary sends less TSH out, telling the thyroid to make less T4.

Normal and Abnormal TSH Ranges

• 0.4 mU/L to 4.0 mU/L is considered the reference range (there may be a slight variation depending on the laboratory), and people who have a normally functioning thyroid gland usually fall within this range.
• If TSH measures > 4.0 mU/L, a second test (T4) is performed to verify the results. TSH > 4.0/mU/L with a low T4 level indicates hypothyroidism.
• If your TSH is > 4.0 mU/L and your T4 level is normal, this may prompt your physician to test your serum anti-thyroid peroxidase (anti-TPO) antibodies. When these antibodies are present, it may indicate an autoimmune thyroid disorder, which is a risk factor for developing hypothyroidism.  If you have these antibodies, your doctor will most likely perform and TSH test at least once per year.

An easy way to remember how the thyroid works–think about supply and demand. As the T4 level falls, the TSH rises. As the T4 level rises, the TSH falls. However, not everyone with hypothyroidism has elevated levels of TSH. 

If your pituitary gland is not working properly, it may not send out normal TSH amounts—and if this is the case—the thyroid may be healthy. However, if the amount of TSH is off, the thyroid won’t make the right amount of T4. This is rare and is known as secondary or central hypothyroidism.

Updated on: 01/22/19

What is Thyroid Hormone Replacement Therapy?

At Home Thyroid Test – Easy to Use and Understand

What are thyroid hormones?

The thyroid is a small gland that sits at the front of your neck. It’s responsible for controlling many of the body’s key activities – such as metabolism. It does this by releasing specific hormones into the bloodstream.

A hormone is small chemical messenger that allows different parts of your body to “talk” with each other. The thyroid makes two kinds of hormones: thyroxine (or T4) and triiodothyronine (or T3). These hormones circulate in your blood, allowing the thyroid gland to regulate many of the body’s important functions, such as:

• Metabolism – Thyroid hormones tell the body when to burn fat, which gives you more energy. Thyroid hormones can also trigger the production of glucose – a sugar formed from carbohydrates – to provide your body with more energy.
• Heart rate – Thyroid hormones can affect your resting heart rate (the number of times your heart beats in a minute when you’re at rest).
• Internal body temperature – Thyroid hormones are involved in regulating your body’s internal temperature – so the thyroid gland acts a bit like a thermostat that helps make sure your body doesn’t get too cool or too hot.

What’s more, thyroid hormones can contribute to more wakefulness and alertness because of how they affect the nervous system.

In short, your body requires the right balance of thyroid hormone levels in order to effectively carry out many of its functions.

Thyroid-Stimulating Hormone (TSH)

While the thyroid gland helps regulate many processes in the body, another gland (the pituitary) is in charge of controlling the thyroid’s activity. The pituitary gland does this by releasing a hormone of its own – thyroid-stimulating hormone, or TSH – into the bloodstream, which carries TSH to the thyroid gland.

TSH tells the thyroid to pump out more thyroid hormones. So when your body needs more thyroid hormones, the pituitary gland will increase the amount of TSH in your blood. Thus, if a thyroid test shows you have a high level of TSH, this can mean that your thyroid is underactive: it’s not making enough hormones. It can also mean that more TSH is required to keep thyroid hormone levels normal, which may indicate an evolving problem with the thyroid gland itself.

What’s included in a full thyroid panel?

A full thyroid panel usually checks thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) levels. In some cases, a blood test for thyroid function will also check your blood’s level of TPO antibodies. If you have abnormal thyroid hormone levels, high levels of TPO antibodies can point to an autoimmune thyroid disease as a possible reason for those abnormal levels.

How does a blood test for hypothyroidism work?

How to test for hypothyroidism?

It’s important to note that there is no hypothyroidism test that can check thyroid hormones and—based only on those test results—conclusively determine if someone has hypothyroidism. That’s because both thyroid hormone testing and a physician’s evaluation of symptoms and medical history is required for a diagnosis.

A blood test for hypothyroidism is based on your levels of thyroid-stimulating hormone (TSH) and the thyroid hormones T3 and T4. Because TSH signals the thyroid gland to produce more thyroid hormones, unusually high levels of TSH can mean that your thyroid isn’t making enough hormones.

A thyroid lab test might also measure T3 and T4 to reveal just how low your thyroid hormone levels are, which can help your healthcare provider decide on a treatment strategy.

How does a blood test for hyperthyroidism work?

A TSH test for hyperthyroidism evaluates your levels of thyroid-stimulating hormone (TSH), and the thyroid hormones T3 and T4 may also be evaluated. Because TSH signals the thyroid gland to produce more thyroid hormones, unusually low levels of TSH can mean that your thyroid is making too many hormones. T3 and T4 measurements can also reveal just how high your thyroid hormone levels are, which can help your healthcare provider decide on a treatment strategy.

What are thyroid nodules?

Thyroid nodules are small bumps that can form inside the thyroid gland. Approximately 90% of thyroid nodules are non-cancerous; however, in some cases, these nodules may suggest the presence of thyroid cancer. Also, thyroid nodules can sometimes alter thyroid hormone levels, resulting in either hypothyroidism or hyperthyroidism.

Women are about 4 times more likely than men to have thyroid nodules. And older age, a history of thyroid radiation, and iron deficiency are all linked with a greater likelihood of having thyroid nodules.

What do normal, high, and low levels mean?

The thyroid stimulating hormone (TSH) test measures the amount of TSH in the blood. The results convey how well the thyroid is functioning.

Doctors can use TSH test results to diagnose thyroid disorders, such as hypothyroidism and hyperthyroidism.

The pituitary gland produces TSH, which is a hormone that stimulates the thyroid gland.

The thyroid is a butterfly-shaped gland in the throat. It produces hormones that help regulate many bodily functions, such as metabolism, heart rate, and body temperature.

In this article, we describe the TSH test and results. We also discuss what high and low TSH levels indicate and available treatments.

Share on PinterestA TSH test can help a doctor diagnose hypothyroidism and hyperthyroidism.

The normal range depends on a person’s age and whether they are pregnant.

The ranges tend to increase as a person gets older. Research has not shown a consistent difference in TSH levels between males and females.

However, according to the American Thyroid Association, doctors generally consider levels to be within a normal range if they are between 0.4 and 4.0 milliunits per liter (mU/l).

The table below provides estimates of TSH levels that are normal, low (indicating hyperthyroidism) and high (indicating hypothyroidism):

Most labs use these reference values.

However, there is some debate about these ranges — the author of a 2016 review has found that normal levels are more likely to fall between 0.5 and 2.5 milli-international units (mIU) per milliliter.

Females are more likely to experience thyroid dysfunction than males. The Office on Women’s Health report that 1 in 8 females experience thyroid problems at some point. This includes hyperthyroidism and hypothyroidism.

The risk of thyroid problems increases during pregnancy and around menopause.

Research has not shown a consistent difference in TSH levels between males and females.

A 2002 study reports higher TSH levels in females than in males, but a 2013 study reports that males have higher median TSH levels. It appears that any such difference is small, varies with age, and is unlikely to be clinically relevant.

In some people, thyroid conditions are linked with sexual dysfunction. This may affect more males than females. According to a 2019 study, 59–63% of males who have hypothyroidism also experience sexual dysfunction, compared with 22–46% of females with hypothyroidism.

Blood TSH levels tend to increase as a person gets older.

According to the authors of one study, the percentage of people with TSH levels between 0.4 and 2.49 mIU/l fell from 88.8% among people aged 20–29 years to 61.5% in people 80 or older.

Pregnancy hormones naturally increase the levels of certain thyroid hormones in the blood. This is essential for the development of the fetal brain and nervous system.

At the same time, the levels of TSH in the blood decrease. As a result, doctors use lower reference ranges for pregnant women. The lower TSH range is decreased by around 0.1 to 0.2 mU/l and the upper limit is decreased by around 0.5 to 1.0 mU/l.

Levels of TSH in the blood increase gradually during the second and third trimesters, but they remain lower than normal levels in women who are not pregnant.

Doctors carefully monitor TSH levels throughout pregnancy. Having unusually high or low levels can affect the risk of miscarriage and cause pregnancy-related complications, such as:

TSH levels are highest at birth and gradually decrease as a child gets older.

The following table shows TSH levels for children by age, according to a study from 2012 based on data from 512 healthy children:

High TSH levels indicate hypothyroidism. People develop hypothyroidism when their thyroid produces low levels of hormones.

When the thyroid gland does not produce enough hormones, the pituitary gland produces more TSH to compensate.

Symptoms of hypothyroidism include:

• fatigue
• weight gain
• swelling of the face and neck
• increased sensitivity to cold temperatures
• dry skin
• thinning hair
• a slow heart rate
• irregular or heavy menstrual periods
• fertility problems
• depression
• constipation

Low TSH levels indicate hyperthyroidism. This is also known as an overactive thyroid.

If the thyroid gland is secreting levels of hormones that are too high, the pituitary gland produces less TSH.

Symptoms of hyperthyroidism include:

• an irregular or rapid heartbeat
• muscle weakness
• nervousness or irritability
• difficulty sleeping
• frequent bowel movements or diarrhea
• weight loss
• changes in mood

The TSH test involves a healthcare professional drawing blood from a vein in the inner arm. They then send the blood sample to a laboratory for testing.

Usually, people do not need to prepare for a TSH test. However, if the doctor is testing the blood for more than one issue, a person may need to fast or prepare in another way. The doctor will provide this information beforehand.

If a person has abnormally high or low TSH levels, the doctor needs to run at least one other diagnostic test to identify the underlying cause. These tests look at levels of specific thyroid hormones and antibodies.

Doctors can treat hypothyroidism with medications, such as levothyroxine, that replace the missing thyroid hormones.

A person should take this medication once a day, or as prescribed by their doctor. The doctor will monitor how well the treatment is working by running additional blood tests every few months.

According to the Food and Drug Administration (FDA), people should take levothyroxine once a day: in the morning and on an empty stomach, at least half an hour before eating.

They recommend that a person tells their doctor if they eat soybean flour, walnuts, dietary fiber, or cottonseed meal, as these can affect how the body processes levothyroxine.

Share on PinterestA doctor may prescribe medication to help a person manage the symptoms of hyperthyroidism.

Treatments for hyperthyroidism focus on reducing thyroid hormone levels to prevent long term health complications.

A person may need to take beta-blockers and antithyroid medications.

Another effective treatment is radioiodine therapy. This involves taking a capsule or liquid that contains radioactive iodine-131, which destroys cells that produce thyroid hormones. However, people who take radioiodine therapy may develop hypothyroidism in the future.

Surgical removal of the thyroid gland can treat severe hyperthyroidism. Doctors often reserve this for people who cannot take first-line medications, such as during pregnancy.

People who experience extreme swelling of the neck may also benefit from thyroid surgery.

A TSH test measures the amount of the hormone in the blood. Doctors can use the results to diagnose thyroid conditions, such as hypothyroidism and hyperthyroidism.

Normal TSH ranges can vary widely, depending on a person’s age, sex, and body weight. Reference ranges remain controversial, but for most people, the normal range falls between 0.4 and 4.0 mU/l.

Having an overactive or underactive thyroid can cause health issues that interfere with daily life. During pregnancy, unusually high or low TSH levels can lead to complications.

A doctor can provide more information about the TSH test and interpreting the results.

What are T3, T4, and TSH?

With Cory Rice DO

Healthy TSH levels are usually an indicator that the whole system is working as it should.

Thyroid disorders are complicated, fickle, and highly individual — meaning thyroid issues are going to look very different for each person. In any case, it’s important to have a basic understanding of how the thyroid gland works and the hormones it produces. This understanding can help you advocate for yourself and ask the right questions when you visit your healthcare provider. It can also clue you into some of those mysterious symptoms you may be experiencing. 

An introduction to the thyroid gland

First things first: The thyroid gland is part and parcel of the endocrine system, which is a collection of glands that produce all-important hormones responsible for metabolism, growth, sexual function, sleep, and your mood. 

The gland, which is tiny and butterfly-shaped, is found at the bottom front of your neck. It makes the two main thyroid hormones, triiodothyronine (T3) and thyroxine (T4) — both of which have a major hand in your energy levels, internal temperature, hair, skin, weight, and more. For this reason, T3 and T4 are definitely not to be taken for granted — and you probably know this already if you’ve experienced any of the frustrating symptoms of a thyroid disorder. 

According to Dr. Cory Rice, DO, an internal medicine physician and certified practitioner with BioTE Medical, “When thyroid hormone levels are off, several issues can arise. You can have an overactive thyroid gland where too much thyroid hormone is produced (Hyperthyroidism). An example of this is Grave’s disease. You can also have an underactive thyroid gland in which too little thyroid hormone is produced (Hypothyroidism). An example of this is Hashimoto’s thyroiditis.”

Understanding the two main thyroid hormones: T3 & T4

The thyroid gland takes its direction from both the hypothalamus (which is in your brain) and the pituitary gland, a pea-sized gland at the base of your skull. In a complex dance, the hypothalamus releases something called thyrotropin-releasing hormone, which then triggers the pituitary gland to produce something called the thyroid stimulating hormone (TSH). The TSH is then what helps your thyroid gland release T4 and T3. Without TSH, the system would fail.

Thyroxine (T4) is responsible for your metabolism, mood, and body temperature, among other things. T3, too, is made in the thyroid gland, and it can also be made in other tissues within the body by converting T4 (in a process called deiodination) into T3. This hormone is at the center of your digestive and metabolic function, and it also oversees bone health. 

So, if your T3 and T4 levels are too low, the pituitary gland will release more TSH. If they’re too high, the gland will release less TSH — but this give and take system only works if everything is functioning properly.

When you have too much T3 or T4, you might experience:

• Anxiety
• Feelings of irritation
• Hyperactivity
• Hair loss
• Skipped periods
• Tremors and shaking
• Sweating 

When you specifically have too much T3, you might experience thyrotoxicosis, a condition that comes from an overactive thyroid gland, or hyperthyroidism.

It’s also important to note that hormone levels are very complex. For example, an elevated free T4 —along with a low TSH — could indicate hyperthyroidism. 

When you have too little T3 or T4, you might experience:

• Weight gain
• Memory issues
• Lethargy
• Fatigue
• Constipation
• Brain fog
• Dry skin

Understanding thyroid stimulating hormone (TSH)

As mentioned above, the thyroid stimulating hormone (aka thyrotropin or thyrotrophin) is produced by the pituitary gland. It works sort of like the master of the hormones, and rules the production of T3 and T4 from its control center.

If you have too much TSH, it might mean that your thyroid gland isn’t making enough T3 or T4. Remember, the TSH is supposed to stimulate the thyroid gland — but if the gland isn’t responding, then you’ll have too much TSH in your system.

If your TSH levels are too low, it may mean that your thyroid gland is making too much thyroid hormone. This excessive thyroid production could actually suppress the TSH.

A word of warning for pregnant women: It’s incredibly important that your hormones are balanced in pregnancy, as thyroid stimulating hormone plays a role in the development of a healthy fetus.

Testing your thyroid levels

According to the American Thyroid Association, there isn’t one test for every situation; in fact, there are several kinds of thyroid tests. But if you are concerned about thyroid issues, or if your hormones are imbalanced, your doctor may provide an initial TSH level blood test. This is because the TSH level can serve as a tip-off to other, more specific issues.

What’s a normal TSH level? “Most lab companies have a wide reference as it relates to TSH levels (0.4-4.0 mIU/L),” Dr. Rice says. So, if your results are somewhere between 0.4-4.0, you’d be in the “normal” range. However, there is research that suggests that the reference range for TSH should be narrowed to 0.4 to 2.5, says Dr. Rice, which means that the “normal range” could be even smaller than some healthcare providers might think.

Generally, healthy TSH levels are an indicator the whole system is working well, but that’s an oversimplification at best. A normal T3 level might be somewhere between 100 to 200 nanograms per deciliter (ng/dL), while a normal T4 level falls between 5.0 to 12.0 micrograms per deciliter (μg/dL). Free T4, which tests for the amount of T4 that is available in the body, should range between 0.8 to 1.8 nanograms per deciliter (ng/dL).

However, it’s important to note that different labs and doctors may have a varying “normal range.” There also isn’t one single laboratory test that can tell you exactly what might be going wrong, or that is totally accurate in diagnosis, which is why you may need a few different tests. Furthermore, you may need a thyroid ultrasound or biopsy to determine the exact cause of your symptoms or hormone level imbalance. There are several different thyroid disorders — all with their own root causes. Your endocrinologist or thyroid specialist will know what to test for, as there are many different tests per your specific condition and levels.

Questions to ask your endocrinologist:

• What tests do I need to check my thyroid levels?
• What are the normal ranges for each hormone?
• Are my T3, T4, and TSH levels normal?
• Are my symptoms indicative of a thyroid disorder?
• How can we correct any issues with the levels through medication or lifestyle changes?
• Are there any side effects to the medications?
• How long does it take before the medicine starts to work? 

Supporting a healthy thyroid

Now that you have a basic overview of thyroid function, you may be wondering if there are ways to support your thyroid health — in addition to medication. This is important because sometimes it can take a while before medication can correct hormone imbalance. In this case, the next best thing you can do is adjust your lifestyle habits.

Managing stress: Because there is a relationship between your adrenal health and your thyroid health, it’s wise to get a hold on your stress levels. When you are chronically stressed, adrenal fatigue — an overtaxing of the adrenal system — may kick in, triggering your body to release hormones as a way of coping. This chronic stress can worsen thyroid issues, leading to imbalanced hormone levels. Chronically stressed? You might notice slowed metabolism and weight gain — and stress may even further lower your levels of T3 and T4. It can also affect the conversion of T4 into T3.

For this reason, it’s key to find a regular stress management ritual. This might be a daily yoga, meditation, or journaling break in which you disconnect from all distractions and stressors and simply focus on your breath and your emotional well-being. Regular nature walks — also referred to as earthing or forest bathing — have been proven to provide stress reduction on a physiological level as well. 

Eating well: There isn’t one single “thyroid diet,” but there are foods that can help support our overall health. Focus on eating nutritious, colorful, whole foods. These should include fruits, veggies, fatty fish, beans, whole grains, and lean proteins. Stock up on healthy fats, such as avocados and olive oil. Reach for rich-in-fiber foods such as carrots, lentils, and bananas.

Avoid foods that are nonnutritious or full of empty calories; these will only further any feelings of fatigue or lethargy caused by thyroid issues. Skip and reduce processed foods (anything in a bag or box), candies, sodas, and junk foods. When it comes to supplementation, beware of products that contain hidden T3, which can increase your levels. Be sure to speak with your doctor before taking any supplements.

Movement is important: Exercise is critical — but it’s important to clear any exercise with your doctor. This is because hyperthyroid patients (who already have a revved-up metabolism) may experience heart issues if they excessively exercise. On the flipside, patients with hypothyroidism may want to wait until their medication has controlled their thryoid levels before kicking off a new workout routine.

That said, exercise is important — especially for hypothyroid patients, whose metabolisms have slowed down. One study published in the Archives of Medicine and Health Science, found that hypothyroid patients “should do regular physical exercise along with thyroxine replacement to improve thyroid function.” Look into lower-impact workouts, such as daily walking, hiking, swimming, or strength training.

In the end, you should work closely with your doctor to monitor your thyroid hormone levels. It may take some time and medication adjustment to find what works for you — but it’s important that you do.

Updated on: 05/18/20

Endocrinology | Clinic of Dr. Myasnikov

NODULAR GOITER – the formation of nodes in the thyroid gland, the node can be one then the goiter is called single-node, or there can be many nodes, such a goiter is called multinodular.

Nodal education or simply “ node” is a collective concept. And this concept includes both absolutely benign formations that do not pose any oncological danger, and tumors. Tumors, in turn, can be benign, and, much less often, malignant.

Most often, small nodes in the thyroid gland do not manifest themselves in any way, and the person does not know that he has a node. A nodule can be discovered by chance during an ultrasound examination, or when a nodule in the thyroid gland becomes large and changes the shape of the neck, and also begins to press on other organs located on the neck.

Despite the fact that most of the nodes are not a tumor and do not require any treatment, but only observation, when a node is found in the thyroid gland, especially when its size exceeds 1 cm, it is necessary to determine the nature of this node and assess the oncological risks.For this purpose, a puncture biopsy of the node (or simply a puncture) is performed. Today, the puncture of the node is always performed under the control of an ultrasound machine, it is a procedure that is practically painless, safe and takes only a few minutes. However, the results of a puncture biopsy will largely depend on whether a person needs any treatment or whether it is enough to simply observe the node, performing a control ultrasound examination once a year. If surgery is nevertheless necessary, it is imperative that it be performed in a specialized surgical department or by a surgeon who specializes in thyroid diseases.In some cases, instead of an operation, minimally invasive treatment can be carried out – a special method, the effectiveness of which is close to the surgical one, but at the same time the destruction of the node is achieved by injections, which avoids the operation.

Nodular goiter can occur against the background of normal thyroid function, when the production of thyroid hormones is not impaired. In this case, the nodes do not have a direct effect on the entire body. However, in some cases, one or more nodes can produce a large amount of thyroid hormones, a person develops thyrotoxicosis, which leads to a significant metabolic disorder in the body.

DIFFUSE TOXIC GOITER (Graves ‘disease, Graves’ disease)

– an autoimmune disease in which the human body produces antibodies that stimulate the thyroid gland, as a result of which too many hormones are produced, the excess of which causes poisoning of the whole body. With diffuse toxic goiter, thyrotoxicosis develops, which is manifested by rapid heartbeat, sleep disturbances, weight loss, frequent mood swings, irritability, and memory loss.In some cases, the disease is accompanied by the development of exophthalmos (bulging eyes), which, if untimely or improperly treated, can lead to visual impairment.

Treatment of diffuse toxic goiter usually begins with the appointment of drugs – thyreostatics, which block the production of thyroid hormones. Treatment of diffuse toxic goiter is long enough and the patient during treatment must necessarily be under the supervision of an endocrinologist. Unfortunately, the treatment of diffuse toxic goiter with drugs is not always effective, then an operation is necessary, which is best performed by an endocrinologist surgeon, who represents all the subtleties of this pathology.

CHRONIC AUTOIMMUNE THYROIDITIS (Hashimoto’s thyroiditis)

– an autoimmune disease in which there is a gradual destruction of thyroid tissue and its replacement with connective tissue. Chronic autoimmune thyroiditis, the pathology is quite common, women are prone to chronic autoimmune thyroiditis much more often than men. At different stages, chronic autoimmune thyroiditis can manifest itself in different ways, sometimes at the onset of the disease, thyrotoxicosis is noted, usually not severe, which over time, usually quite long, is replaced, on the contrary, by insufficient production of hormones, this condition is called hypothyroidism.There are forms of chronic thyroiditis, in which the thyroid gland reaches a very large size, begins to exert compression on the surrounding organs, in these cases surgical treatment is required, but more often chronic autoimmune thyroiditis requires regular monitoring and control of the level of hormones, and in case of violation of hormone production, prescribing drugs …

THYROID CANCER

– Approximately 5% of people with thyroid nodules have thyroid cancer.Therefore, it is so important to timely perform a puncture biopsy of the node in the presence of a node. Despite an increase in cancer incidence in all countries over the past decade, most forms of thyroid cancer respond well to treatment and are not fatal. If cancer is suspected, the first stage is surgical treatment, then, after surgical treatment, depending on the form of cancer and the stage of the disease, additional treatment may be prescribed, if necessary.

THYROID AND PREGNANCY

The normal functioning of the thyroid gland during pregnancy is an important factor in the formation of a healthy fetus and the birth of a healthy baby. During pregnancy, the need for thyroid hormones increases significantly, this is due to the fact that the fetus’s needs for thyroid hormones are satisfied by the hormones of the expectant mother. The work of the thyroid gland changes with the onset of pregnancy, it is important to control the level of thyroid hormones at least once a trimester.To control the level of thyroid hormone production, the level of thyroid stimulating hormone (TSH) is determined. Pregnant women are more at risk of developing autoimmune thyroiditis. With the development of autoimmune thyroiditis during pregnancy, more frequent determination of the TSH level is necessary and, if necessary, replacement therapy with thyroid hormone drugs.

THYROID GLAND, IODINE EXCHANGE IN THE HUMAN BODY AND IODIZED SALT

Iodine is one of the most important world elements, without iodine normal functioning of the body is impossible.The daily human need for iodine is 150 mcg, and in fact all the iodine entering the body is captured by the thyroid gland and included in the composition of hormones. It should be noted that the daily requirement for iodine increases during pregnancy.

There is, however, one problem: in many geographic areas on our planet, iodine is significantly lacking in food. Such areas are called iodine-deficient areas. In iodine-deficient areas, the incidence of goiter is very high.A goiter that develops in iodine-deficient areas is called an endemic goiter. In addition to goiter, the population of endemic areas is susceptible to other diseases resulting from hypothyroidism (insufficient amount of thyroid hormone), in endemic areas there is a high rate of birth of children with mental retardation.

Fortunately, in the first quarter of the twentieth century, mankind figured out how to cope with this problem. In order to prevent iodine deficiency, iodine was added to the product most used by humans – salt.Thus, iodized salt appeared. Eating iodized salt in food, a person receives a sufficient amount of iodine. Today, when iodizing salt according to GOST R 51575-2000, 20 to 60 g of potassium iodate per 1 ton are added to it.

Salt iodization – should be recognized as one of the greatest inventions of mankind. The use of iodized salt in food is the key to preventing many diseases.

OPERATIONS FOR DISEASES OF THE THYROID

Today, the most frequent surgical intervention for diseases of the thyroid gland is its complete surgical removal, such an operation is called thyroidectomy.In some cases, if the disease is localized in only one lobe, and the second lobe is healthy, it is possible to remove only one lobe – hemithyroid ketomy. The operation should be preceded by a thorough examination in order to minimize the risks of anesthesia and possible complications. The vast majority of operations are performed under general anesthesia.

The operation is performed from an incision in the neck, depending on the disease and the size of the thyroid gland, the length of the incision is usually from 3 to 8 cm.At the end of the operation, a cosmetic suture is applied to the skin and in most patients the place where the incision was made becomes invisible after 2-3 years after surgery.In some cases, unfortunately, it is far from always possible to remove the thyroid gland by video endoscopic method, in this case, small incisions about 1 cm long are performed in the armpit and breast area, this type of surgery is aimed at achieving an even better cosmetic effect.

HOW TO LIVE AFTER THYREODECTOMY

Given the widespread prevalence of thyroid gland diseases, millions of people live in the world who have undergone thyroidectomy and these people work, give birth to children, play sports and live absolutely full life.The only necessary condition is a daily single dose of the medicine: the hormone – thyroxine. The selection of the required dose of thyroxine after the operation is carried out by an endocrinologist and is not a super difficult task. However, it is important not to forget to take the prescribed dose of the medication and to monitor the level of thyroid-stimulating hormone at least annually.

DISEASES OF THE PERIPHYTHOLOGY (PERTHYTHOID) GLANDS.

Parathyroid glands are the smallest endocrine glands in the human body.The normal size of the parathyroid gland does not exceed a few millimeters.

In the last decade, doctors of various specialties have shown increased attention to the work of the parathyroid (parathyroid) glands, and this is no coincidence, because they are responsible for the exchange of calcium and phosphorus in the body.

The parathyroid glands were discovered by the Swedish physician Ivar Sandeström (1852-1889) and first described in 1880. However, it took more than 90 years for scientists to study the action of parathyroid hormone – a hormone that is produced by the parathyroid glands.

Today it is known that very often such diseases as osteoporosis, urolithiasis, various skin lesions, some diseases of the gastrointestinal tract, diseases of the heart and blood vessels are directly related to the malfunction of the parathyroid glands and impaired (excessive or insufficient) production of parathyroid hormone.

Today, the pathology of the parathyroid glands ranks third among all endocrine diseases, second only to diabetes and thyroid diseases.

The following diseases of the parathyroid glands are distinguished:

Hyperparathyroidism – excessive production of parathyroid hormone by enlarged or tumor-like altered parathyroid glands.

Distinguish between :

Primary hyperparathyroidism

Tumor of the parathyroid gland, leading to uncontrolled production of parathyroid hormone. This disease always requires surgical treatment; it is necessary to remove the parathyroid gland affected by the tumor.

Secondary hyperparathyroidism

A disease in which the production of parathyroid hormone is also increased, but there is an obvious reason that led to the disruption of the work of the parathyroid glands. Often this reason is a reduced intake of calcium into the body, as well as hypovitaminosis (lack in the body) of vitamin D.

A careful analysis of the cause of the disease allows you to choose the right treatment if necessary, prescribe a course of drugs that will avoid surgical intervention, but if the operation cannot be avoided , in the postoperative period, competent observation of the patient is necessary, aimed at preventing the recurrence of the disease.

A separate place should be given to secondary and tertiary hyperparathyroidism which develops in chronic kidney disease. Patients requiring an “artificial kidney” and undergoing programmed hemodialysis very often suffer from hyperparathyroidism. Therefore, for many years we have been cooperating with hemodialysis centers in Moscow and other cities of Russia, providing assistance to this severe category of patients.

Surgical treatment of hyperparathyroidism is preceded by examination of the patient.The main purpose of the examination is to determine the possible risks of surgical intervention, as well as to identify the exact localization of the altered parathyroid gland, the success of the operation will largely depend on this. In order to determine localization, the following techniques are often used: ultrasound, scintigraphy, multispiral computed tomography.

The operation is performed under anesthesia (the patient sleeps during the operation), the anesthesia and the operation are preceded by a thorough examination of the patient in order to minimize the possible risks of the operation and anesthesia.The usual length of a skin incision on the neck is 4-5 cm, but in some cases it is possible to perform an operation from a mini-incision only 1.5-2.5 cm long. In all cases, operations end with a cosmetic suture, which gives a very good cosmetic result.

Thyroid Diseases / Diseases / Clinic EXPERT

General understanding of the thyroid gland and its function

The thyroid gland (thyroid gland) is an endocrine organ located on the anterior surface of the neck.The gland is separated from the skin only by thin fascia (“plates” of connective tissue), therefore it is located almost under the skin. Due to its location, it is well accessible to palpation (palpation during examination), and with a significant increase it is clearly visible “by eye”, deforming the contour of the neck. The thyroid gland normally consists of two lobes connected by an isthmus. This structure resembles a butterfly.

The main task of the thyroid gland is the production of specific substances – thyroid hormones. This process takes place with the obligatory participation of iodine.The thyroid gland is the only gland that captures iodine from the bloodstream and is capable of synthesizing hormones only with an adequate supply of it.

Thyroid hormones affect the entire body. If you describe in one phrase the action of “thyroid” hormones – they regulate metabolism. With a normal content of thyroid hormones in the blood, all processes in the body proceed in a physiological rhythm. The mechanism of hormone production in adults does not depend on gender and age.

Causes

There is definitely a hereditary predisposition to thyroid diseases.It has long been noted that such diseases are more often suffered in the same family. Usually, patients already at the first visit report that the closest blood relatives had problems with the thyroid gland. Women are more susceptible to thyroid diseases (10 times more often than men).

There is a connection between the onset of thyroid disease and:

• stress transferred
• infection
• intense exposure to the sun
• unfavorable environmental conditions

Against the background of a genetic predisposition, provoking external factors trigger a pathological mechanism, which results in thyroid disease glands.

Diseases of the thyroid gland

All diseases of the thyroid gland occur either with impaired production of thyroid hormones, or without them.

In turn, thyroid dysfunction occurs in the direction of

• decrease – hypofunction, hypothyroidism
• increase – hyperfunction, hyperthyroidism.

Hypothyroidism

Primary hypothyroidism can be caused by:

• autoimmune thyroiditis
• removal of thyroid gland during surgery (postoperative hypothyroidism)
• destruction of thyroid gland under the influence of radioactive substances (post-radiation 90 hypothyroidism)
  

  000 , belonging to the category of autoimmune, when its own immune system produces antibodies that affect the work of the thyroid gland.

  Typical for AIT are antibodies to thyroperoxidase (at to TPO) – more specific for the disease and antibodies to thyroglobulin (at to TG). With immune aggression, these antibodies develop a gradual decrease in the work of the thyroid gland, i.e. hypothyroidism occurs – one of the natural manifestations of AIT.

  The pathological process occurring in the thyroid gland can change not only the function, but also its structure. Ultrasound of the thyroid gland determines the changes specific to AIT.Since AIT leads to hypothyroidism, the treatment of the disease is reduced to the appointment of the thyroid hormone (thyroxine) to compensate for the deficiency of hormones in the body.

  Treatment is prescribed only when the thyroid function is reduced. If the patient only has an increased level of antibodies in the blood, but the thyroid function is normal, no treatment is prescribed. Thyroid function is retained for annual monitoring and more frequent monitoring in women during pregnancy. It is also believed that the presence of an autoimmune disease of one organ can be combined with other autoimmune diseases (of other organs).Therefore, the detection of AIT often entails examination of other endocrine glands.

  To establish the diagnosis of “Autoimmune thyroiditis”, it is necessary to identify at least two of the three indicators (decreased thyroid function (hypothyroidism), the presence of antibodies to the thyroid gland, a specific picture of the thyroid structure during ultrasound).

  If only one parameter is present, then the diagnosis is put “in question” and is taken under control.

  Postoperative and post-radiation hypothyroidism (AIT)

  As a result of partial or complete removal / destruction of the thyroid gland (surgery or treatment with radioactive iodine), the body finds itself in conditions of thyroid hormone deficiency.The disease is detected immediately after treatment (with complete removal of the thyroid gland) or after a short time (with incomplete removal of the organ or after radioiodine therapy). The only treatment is to replenish thyroid hormones by taking thyroxine.

  Causes of secondary hypothyroidism

  A rare reason for a decrease in the thyroid gland is the pathology of the organs regulating its function (pituitary gland and hypothalamus). This means that it is not the thyroid gland itself that is affected, but the “bosses” above it. The cause of the pathology of the pituitary gland and hypothalamus can be tumors, trauma, cysts in this area.Very rarely, the pituitary gland can produce the “inactive” hormone TSH, which is unable to stimulate the thyroid gland to produce hormones.

  Hyperthyroidism

  Diseases with increased thyroid function

  Diffuse toxic goiter (Graves disease, Graves disease, Graves disease)

  This is an autoimmune thyroid disease, when the immune system produces specific antibodies that stimulate thyroid stimulation ( TSH receptor). The production of hormones in the thyroid gland becomes pathologically increased, clinically manifested by thyrotoxicosis (the reaction of various tissues of the body to a large amount of thyroid hormones in the thyroid gland), and in the laboratory – by an increased concentration of T3 and T4 in the blood and a reduced TSH index.Often, DTZ is combined with autoimmune endocrine ophthalmopathy (specific eye damage). These two diseases have common autoimmune roots, so it is not uncommon to combine them. There are three treatment options for this disease:

  • conservative therapy (with tablets) for 1-1.5 years
  • surgery to remove the thyroid gland
  • treatment with radioactive iodine (radioiodine therapy).

  The success of the pill therapy is the least persistent (the disease can relapse in 30-70% of cases).

  More often Graves’ disease occurs in young patients, more often in women.

  Nodular (and multinodular) toxic goiter (UTZ, MUTZ)

  The disease is the same as nodular non-toxic goiter: for an unknown reason, nodules form in the structure of the thyroid gland, but they (nodes) are pathologically active and capable of producing a high amount of thyroid hormones with the development of the clinical picture of thyrotoxicosis. Often the disease is accompanied by an abnormal heart rhythm.In addition to routinely determining the level of thyroid hormones (they will be like in Graves’ disease), the disease is also confirmed by thyroid scintigraphy to determine the autonomy of the node. Treatment – surgery or radioiodine therapy after drug preparation of the patient.

  Diseases proceeding without dysfunction of the thyroid gland:

  Nodular (and multinodular) non-toxic goiter (UNZ, MNZ)

  Disease of unspecified etiology (causes), when nodules form in the thyroid tissue.In most cases, the nodes are small (from 1 cm to 2.5-3 cm), are benign in their cellular composition, do not impair thyroid function and do not require any treatment. Observation is carried out, an annual dynamic examination is performed.

  Diffuse non-toxic goiter (DNZ)

  This term describes a diffuse enlargement of the thyroid gland in size with unchanged organ function, the absence of laboratory and ultrasound data for an autoimmune process. Most often, an increase in thyroid gland is associated with iodine deficiency.When this fact is eliminated, the size of the thyroid gland returns to normal.

  Malignant diseases

  This is a separate group of thyroid cancer. Distinguish between papillary cancer, follicular cancer, medullary cancer, anaplastic thyroid cancer. They differ in their cellular composition, each has features of diagnosis, treatment and observation. The most common variants of thyroid cancer (papillary and follicular) are successfully treated, respectively, patients have a good chance of cure and a prognosis for life.More aggressive cancer – medullary and anaplastic – has its own diagnostic and therapeutic characteristics, gives a worse prognosis for treatment and survival. Patients with thyroid cancer are monitored by an oncologist and an endocrinologist, who draw up an individual treatment and follow-up plan.

  Symptoms of thyroid diseases

  The most typical manifestations of thyroid diseases:

  • General and muscle weakness 90 140 90 139 uncontrolled weight loss with increased appetite or, conversely, poorly controlled weight gain 90 140 90 139 memory impairment, attention, apathy, depression
  • nervousness, anger, increased emotionality, tearfulness, decreased performance
  • low productivity, lack of “strength to work”
  • common edema (face, arms, legs, anterior abdominal wall, tongue)
  • stool disorder (constipation or diarrhea )
  • heart rhythm disturbance (especially in elderly patients)
  • anemia, difficult to treat
  • constant feeling of internal tremors, restlessness, hand tremors (up to changes in handwriting and inability to perform small movements)
  • changes in the eyes (bulging, change in view lada, swelling of the eyelids, lacrimation, especially from bright light)
  • Finally, the patient may complain of an increase in the front surface of the neck in size, deformation of the contour of the neck.

  Symptoms of thyroid disease are not always specific. It is not at all necessary that all these symptoms are observed at the same time. If you have at least one of the listed symptoms, you need to check your thyroid function. The endocrinologist will also pay attention to these complaints when talking and examining the patient.

  Diagnostics

  Since the influence of thyroid hormones on the body is very significant and diverse, its diseases will undoubtedly affect the functions of all organs, therefore timely diagnosis is important.

  The survey is simple and very affordable.

  The first step is an appointment with an endocrinologist, which includes a conversation and examination. As a rule, when questioning the patient, you can identify some disturbing symptoms that make you think about a violation of the thyroid gland. These symptoms are mostly nonspecific and can be observed in many patients, and sometimes healthy people under stress and fatigue.

  The second step, if there is a reasonable suspicion of a violation of the function or structure of the thyroid gland, is to refer the patient to a blood test to determine the content of thyroid hormones.

  • in the blood determine the level of T4, T3 (thyroid hormones) and TSH (pituitary hormone) 90 140
  • often the study is supplemented by the determination of the level of various antibodies to the thyroid gland in the blood 90 140

  With a decrease in the work of the thyroid gland itself, the hormones T4 (to a greater extent) and T3 is reduced, and the “boss hormone” (TSH) is increased. On the contrary, with increased production of thyroid hormones, the level of T4 and T3 is increased, but TSH is reduced.

  The third step in diagnosis is to visualize the thyroid gland.

  The simplest, most accessible and informative method is ultrasound examination of the thyroid gland, in which the size and structure of the organ tissue is determined.

  At the same time, one study does not replace another study. Examination, laboratory and instrumental examinations are three key points in the diagnosis of thyroid diseases.

  Doctors of the EXPERT Clinic have compiled a list of all necessary examinations required for a basic examination of the thyroid gland.

  There are also more specialized studies that are needed only in some cases:

  Thyroid scintigraphy is a method used when there is a suspicion of actively functioning nodules in the thyroid gland.It can also be used for differential diagnosis in conditions of thyrotoxicosis to confirm / exclude destructive thyroiditis.

  Other instrumental examination methods (MRI, CT, PET) are used much less frequently in routine clinical practice. Good reasons are needed to carry out these survey methods additionally.

  Of particular importance is the assessment of the functional state of the thyroid gland in a pregnant woman due to the fact that the development of the child – especially his nervous system – depends on the level of thyroxine (the main form of thyroid hormones) in the expectant mother.

  Treatment of thyroid disorders

  Treatment depends on the specific pathology and thyroid dysfunction.

  Treatment of all forms of hypothyroidism is the same – the appointment of the drug thyroxine. The treatment is well tolerated and completely compensates for the deficiency of hormones in the body.

  Treatment of hyperthyroidism is more complex. A number of drugs are required: some reduce the excessive work of the thyroid gland, others normalize the work of the heart and intestines. Often, participation in the treatment is required not only of an endocrinologist, but also of other specialists (cardiologist, gastroenterologist).

  In the absence of thyroid dysfunctions, they are most often limited to monitoring the pathology.

  Forecast

  Any thyroid disease can be treated. Most often, it is possible to achieve a good response to drug (pill) therapy with a decent chance of a complete cure. Treatment of some diseases of the thyroid gland allows them to be transferred into long-term remission (the disease does not manifest itself actively, does not progress and does not violate the patient’s quality of life, and, accordingly, does not require constant treatment).Thyroid diseases occurring with persistent hypothyroidism can also be successfully compensated for with medication, when you have to constantly (all your life) take pills to replenish the lost thyroid function. In this case, the treatment is absolutely safe, since when prescribed for the purpose of treating thyroid hormone drugs, there are no side effects from the treatment.

  If the disease cannot be compensated (or cured) with tablet drugs (this mainly concerns pathologies occurring with thyrotoxicosis; with large sizes of the thyroid gland and nodes in it; thyroid cancer), then surgery on the thyroid gland allows in the overwhelming majority of cases to solve disease problem.

  Competent and timely treatment of thyroid diseases will prevent complications of the disease from other systems in the body: cardiovascular, digestive, bone, etc.

  Lack of treatment for a long time will cause changes in vital organs over time. They can be irreversible – even when starting therapy!

  Prevention and recommendations

  There is no prevention of thyroid diseases as such.Therefore, a high degree of importance is acquired by periodic preventive examination (examination by an endocrinologist, ultrasound of the thyroid gland, blood tests), especially for risk groups (they include in the presence of heredity factors, unfavorable ecology of the place of residence, occupational harm, frequent stress).

  Leading a healthy lifestyle, a protective attitude towards one’s nervous system, physiological consumption of products containing iodine, etc. will act as the best prevention of the pathology of this endocrine organ.

  Frequently asked questions

  Close relatives diagnosed with thyroid disease, is there a risk of getting sick?

  Thyroid diseases are not “contagious”, but there is a genetic predisposition to thyroid disease. Often (but not at all 100%), in one family, several people have thyroid disease. The pathology of the thyroid gland does not have to be the same for everyone; it can be completely different variants of thyroid diseases.

  The only serious thyroid disease – medullary cancer – must be specified in all the closest blood relatives of the patient with this pathology, i.e.because there are genetic variants of the disease that affect relatives with 100% probability.

  Nothing worries, but laboratory examination revealed very high levels of antibodies to thyroid gland in the blood, what next?

  About 15-20% of healthy people have antibodies (ABs) in the blood to various structures of the thyroid gland (as a rule, these are antibodies to TPO and TG, less often to the TSH receptor). If the function of the thyroid gland is not impaired, then the fact of the presence of antibodies will not have clinical significance, let us call it an “individual feature”Of course, the mere fact of the presence of antibodies will not be treated, whatever their level is recorded in the blood. In case of thyroid dysfunction or with an increase in thyroid size, the determination of the presence of antibodies (mainly antibodies to TPO) will report the cause of abnormalities in the gland. The combination of impaired thyroid function and a high titer of antibodies to the thyroid gland makes it possible to diagnose thyroid autoimmune damage. The presence of antibodies to the thyroid gland will dictate the need for a more frequent assessment of thyroid function in conditions of taking drugs with a large (non-physiological) amount of iodine and lithium preparations, as well as during pregnancy, since there may be peculiarities in the functioning of the thyroid gland against this background.Note that the presence of antibodies in the blood itself has no effect on well-being. In most cases, the patient is more afraid of the “number” of antibodies in the laboratory form, sometimes hundreds of times higher than the upper limit of the norm. There is no need to treat the “level of antibodies in the blood”.

  What can be done to reduce the risk of illness?

  We are not able to influence the genetic predisposition to the disease. It was given to us from birth. The starting point in the implementation of a pathological hereditary predisposition may be stress, severe infectious diseases, taking certain medications, etc.Therefore, the implementation of general recommendations for a healthy lifestyle will to some extent prevent the manifestation of the disease.

  To exclude thyroid dysfunction, which test should be taken?

  The first (and sometimes the only) test to be performed if thyroid dysfunction is suspected is thyroid stimulating hormone (TSH). If this indicator is normal, then not a single disorder in the patient’s well-being can be associated with the thyroid gland. In fairness, it must be said that there are very rare diseases of the endocrine system, in which TSH remains normal, but there is a violation of hormone production.Determining the indications for expanding the examination is the prerogative of the endocrinologist who examines the patient. Sometimes the patients themselves ask the doctor to issue a referral for the study of “all thyroid hormones”, explaining such a desire by the “dislike” for taking blood for analysis, but this is not always justified. A detailed conversation, an explanation of when an in-depth examination of thyroid function may be required, will help the patient not to waste “unnecessary”, but also not to miss the “necessary”.

  A blood test for thyroid hormones is performed in the first half of the day, on an empty stomach.In women, regardless of the day of the menstrual cycle.

  Changes in TSH level were detected for the first time, should they be treated immediately?

  Most often, a very moderate (up to 10 Med / l) increase in the TSH level is detected with normal T4 values. This situation first requires re-monitoring after 2-3 months. If the increase is persistent, i.e. there was no independent normalization of the level of hormones, then individually with the patient, with a thorough assessment of concomitant pathology, the endocrinologist decides whether to prescribe treatment.It is possible that the situation will simply be “taken on a pencil.” The only category of our patients for whom an increase in TSH levels does not require additional rechecking is pregnant women. In this case, thyroxine therapy is prescribed immediately, because “No time” to recheck in a few months.

  Diagnosed with autoimmune thyroiditis, what should I do?

  When such a diagnosis is established and substitution therapy with thyroxine drugs is prescribed, the dose of the drug is selected under the control of the TSH level.At the onset of the disease, the decrease in the function of one’s own thyroid gland may not be total, i.e. to compensate for the lack of thyroxine, a small dose of the hormone is required. Over the course of the disease, all new thyroid cells are captured by the pathological process and to replenish the lost, a corresponding increase in the thyroxine dose is required, which eventually reaches the individual daily requirement. Patients often draw “their” conclusions from this fact: “Taking the drug has stopped the work of my thyroid gland, now I will be“ dependent on hormones ”.This narrow-minded view is absolutely not true. Not taking the drug, but the thyroid gland itself gradually decreased and finally stopped its work. This is a completely natural course of autoimmune thyroiditis, when the need for thyroxine increases over time.

  How often should thyroid function be monitored?

  There are more common and less common thyroid diseases.

  In case of autoimmune thyroiditis and a selected dose of thyroxine, it is sufficient to control the TSH level once a year.An exception is pregnancy, when control is carried out once a month. The need for correction of therapy is discussed with the doctor after receiving the results.

  Thyroid hormone control is much more frequent in Graves’ disease. At first monthly, and with a good response to treatment, then once every 2 months. A doctor’s examination is mandatory, because correction of therapy is possible.

  In case of a nodular goiter with a confirmed benign structure of a node in the thyroid gland, thyroid hormones are monitored once a year.

  Other, more rare diseases require an individual plan-dynamic examination and observation by an endocrinologist.

  What parameters, besides thyroid hormones, should be monitored?

  In some thyroid diseases, periodic monitoring requires thyroid ultrasound. To a greater extent, this concerns the nodular non-toxic goiter, when the dimensions of the nodules in the thyroid gland are assessed in dynamics. Also, dynamic thyroid ultrasound is performed with a diffuse increase in the thyroid gland, when it is necessary to assess the dynamics of thyroid size with or without treatment.Ultrasound of the bed of the removed thyroid gland and lymph nodes is necessary after radical treatment of thyroid cancer.

  As a rule, there is no need for dynamic performance of ultrasound of the thyroid gland when observing a patient with autoimmune thyroiditis.

  Other special methods of dynamic examination (scintigraphy, computed tomography, MRI of the neck) are rarely prescribed, only if there are special indications for that.

  The material was prepared using data from the “Clinical guidelines of the Russian Association of Endocrinologists for the diagnosis and treatment of autoimmune thyroiditis in adults”; “Clinical recommendations of the Russian Association of Endocrinologists for the diagnosis and treatment of nodular goiter”

  Treatment histories

  Nodular goiter

  Patient V., 45 years. I turned to the EXPERT Clinic with the data of an ultrasound of the thyroid gland. There were no complaints about the state of health. I went to be examined “for the company” with a friend. The patient’s family has no relatives suffering from thyroid pathology. The first ultrasound revealed multiple very small changes in the gland tissue 3-6 mm in diameter, described by the ultrasound specialist as “multiple nodes”. The patient performed a blood test for thyroid hormones, there were no abnormalities in the laboratory examination data.The patient was offered dynamic observation (ultrasound control) every six months, which the patient did. She came to the appointment with five ultrasound reports, in which there were no changes in the size of the lesions in the thyroid gland. However, dynamic examination was recommended by the ultrasound specialist.

  Important! The “nodes” in the thyroid gland revealed in this patient, which do not have negative dynamics, do not require any treatment and monitoring in dynamics at all. These are accidental findings that have no clinical significance.

  Patient I., 32 years old. She did not complain about her health. Sent to an endocrinologist after a dispensary examination, during which the therapist suspected a node in the thyroid gland. Examination of the nodular goiter was confirmed – a 12 mm node in diameter with indistinct contours and increased blood flow inside. The hormonal function of the gland was not disturbed. A biopsy of the node was performed, which revealed a suspicion of thyroid cancer. The patient was operated on (the gland and partly the lymph nodes in the neck were removed).Subsequent histological examination confirmed the diagnosis of cancer, additionally revealed metastases to the lymph nodes. The patient required further treatment – radioiodine therapy. Currently, the patient is receiving treatment and is under the dynamic control of an endocrinologist and oncologist. There are no data on the progression and return of the disease after 2 years.

  Subsequently (after 3 years), after making sure that the disease has not returned, the patient plans to become pregnant.

  Important! Timely diagnosis and treatment allow the patient to be adequately treated, giving him a good chance of recovery.

  Hypothyroidism

  Patient M., 20 years old. Over the course of 3 years, it gradually and steadily gains weight. He notes swelling on the face, hands, legs, and abdomen. During all this time, persistent constipation is troubling. The skin became pale, with a yellowish tinge. The patient is studying at the institute in the third year. I began to study worse, tk. attention and ability to remember worsened, it became difficult to assimilate a large amount of information, although earlier learning was easy. I tried to study more.All the described complaints – in particular, weight change, swelling and constipation – were associated with the fact that she leads a predominantly sedentary lifestyle. I tried to use “different diets” for weight loss. They did not bring a significant effect. To normalize the stool, I used laxatives, enemas. I went to the student clinic. The examination revealed a reduced level of hemoglobin. Prescribed iron supplements, vitamin preparations, but there was no significant effect of the treatment.

  Turned to the EXPERT Clinic.The examination revealed hypothyroidism against the background of autoimmune thyroiditis. The patient was prescribed treatment, all symptoms of the disease disappeared within 3 months.

  Important! Hypothyroidism in adults, which most often occurs against the background of an autoimmune thyroid gland, is a common disease. It is easy to diagnose and easy to treat. The main thing is to diagnose in time and choose the right treatment. The patient’s quality of life will depend on this.

  Diffuse toxic goiter

  Patient N., 32 years. I went to the EXPERT Clinic with complaints of tearfulness, instability of mood, increased irritability. She became conflicted in relation to household members and work colleagues. I was worried about increased sweating, trembling hands – both during nervous stress and at rest. I began to notice frequent loose stools; weight loss. All these changes occurred in 3-4 months. The patient herself indicated that her state of health was disturbed soon after a traumatic situation in the family.

  With the above complaints, the patient turned to the therapist of the polyclinic, where a diagnosis of “disorder of the autonomic nervous system” and “irritable bowel syndrome” was established.

  Turned to a gastroenterologist, then to a neurologist at the EXPERT Clinic. On examination, a possible pathology of the thyroid gland was immediately suspected. The examination revealed for the first time and confirmed hyperthyroidism (Graves’ disease).

  On the background of timely treatment, the patient’s state of health completely returned to normal. Gastroenterological and neurological treatment was not even required. The patient is currently continuing treatment and feels well. It is under the supervision of an endocrinologist (curator) who is correcting the treatment.The patient is satisfied with the supervision, the opportunity to consult and receive advice in case of any alarming changes in the state of health, has full information about the treatment and prognosis of her disease.

  Important! Timely diagnosis of thyroid disease allows prescribing treatment in the shortest possible time, without waiting for a pronounced effect on other systems of the body.

  Thyroid hormones

  • T3 general
  • T4 general
  • T3 free
  • T4 free
  • TSH (thyrotropic)
  • Antibodies to thyroglobulin (AT-TG)
  • Antibodies to thyroperoxidase (AT-TPO)

  The thyroid gland and its hormones , together with the nervous and immune systems, takes part in the regulation of the work of all human organs (heart, brain, kidneys, etc.).etc.). Unlike most hormones that act only on certain cells of individual organs (for example, for estradiol, these are the genitals), thyroid hormones are necessary for normal functioning of all tissues and all organs, without exception. Penetrating into the cell, the hormone is sent to the nucleus, where, by binding to certain areas on the chromosomes, it activates a complex of reactions responsible for the processes of oxidation and reduction. Thyroid hormones are the main regulators of energy expenditure in the body, and maintaining their concentration at the required level is extremely important for the normal functioning of all organs and systems.For the synthesis of thyroid hormones, two essential components are required – iodine and the amino acid tyrosine. Without iodine, the synthesis of hormones completely stops, so it is extremely important to ensure that you get enough iodine from your diet. Tyrosine also enters the body with food, it is the basis of not only thyroid hormones, but also adrenaline, melanin, dopamine.

  T3 and T4 . The main two hormones that the thyroid gland produces are triiodothyronine and tetraiodothyronine (thyroxine).Triiodothyronine contains 3 iodine molecules, and thyroxine contains 4 molecules. These hormones are abbreviated as T3 and T4, respectively. In the cells and tissues of our body, T4 is gradually converted into T3, which is the main biologically active hormone that directly affects metabolism. However, thyroxine (T4) makes up about 90% of the total hormones secreted by the thyroid gland.

  Free T3 and T4 . Thyroid hormones, before entering the blood, must be associated with transport proteins, globulins (in order not to be “washed out” by the kidneys), but to get into the cell and into the tissues, they must be freed from this “transport”.So in the blood, T3 and T4 are found either in free or bound form. The level of free hormones is less than 0.1% of their total amount, but it is the free fraction of hormones that is the most biologically active, and it is they that provide all the effects of thyroid hormones.

  Analysis of the level of the main hormones T3, T4 and their free variants is the first and most important step in determining the quality of the thyroid gland in case of any suspicion of thyroid disease.

  Thyroid stimulating hormone (TSH) – the main regulator of thyroid function.It is produced by the pituitary gland, a small gland located on the lower surface of the brain. TSH controls the production of thyroid hormones (thyroxine and triiodothyronine), which in turn regulate energy production in the body. The feedback mechanism allows you to maintain a stable level of these hormones – when their content in the blood decreases, the hypothalamus determines this fact and gives a signal to the pituitary gland to synthesize TSH. An increase in TSH concentration, in turn, stimulates the production of thyroid hormones by the thyroid gland.The reverse process is similar. Dysfunction of the pituitary gland can cause an uncontrollable increase or decrease in the level of thyroid-stimulating hormone, thereby provoking the thyroid gland to produce abnormal amounts of thyroxine and triiodothyronine. An increase in their concentration becomes the cause of hyperthyroidism, and a decrease, respectively, of hypothyroidism. Diseases of the hypothalamus, a regulator of TSH secretion by the pituitary gland, can also cause disruptions in this system. In addition, diseases of the thyroid gland, accompanied by a violation of the production of thyroid hormones, can indirectly (through a feedback mechanism) affect the synthesis of thyroid-stimulating hormone, causing a decrease or increase in its concentration.

  Antibodies to thyroglobulin (AT-TG) and to thyroperoxidase (AT-TPO) In general, antibodies are proteins synthesized by cells of the immune system. Their main function is to identify and destroy foreign objects (bacteria, viruses, etc.). However, it happens that as a result of a malfunction, the body begins to produce antibodies against its own healthy tissues. In the thyroid gland, most often, the enzyme thyroperoxidase (TPO) and the basis for the synthesis of hormones, thyroglobulin (TG), become the objects for the production of antibodies.

  Thyroglobulin is a preparation for thyroid hormones, from which thyroid cells “make” the hormones T3 and T4. First, the cells produce thyroglobulin (thus creating reserves of iodine), which is “stored for the future” in special containers – follicles. Then, as necessary, T3 and T4 are synthesized from thyroglobulin.

  Thyroid peroxidase is a thyroid enzyme involved in the formation of the active form of iodine and thus plays a key role in the production of thyroid hormones.

  The damaging effect of antibodies can lead to disruption of the normal production of thyroid hormones and negatively affect the regulation of its function, which ultimately causes chronic pathologies associated with hypo- or hyperthyroidism. Nevertheless, it is important to emphasize that antibodies to TPO and TG are not a key link in the pathogenesis of autoimmune diseases of the thyroid gland and begin to be produced in response to thyroid damage. Therefore, attempts to reduce the level of antibodies are devoid of any practical sense.

  Tests AT-TG and AT-TPO are used to confirm or exclude the autoimmune nature of a particular thyroid disease (enlargement of the thyroid gland without impairing its function, primary hypo- or hyperthyroidism, ophthalmopathy, etc.), since this allows you to prescribe the most effective therapy. Tests are also prescribed to children born to mothers with endocrine pathology to identify risk groups for developing thyroid diseases. Quantitative analysis of blood serum for AT-TPO is the most sensitive method for diagnosing autoimmune diseases of the thyroid gland.AT-TG analysis is valuable in differential diagnosis.

  Prices for research can be found in the “Pricelist” section of the clinical laboratory. Blood for research is taken daily (except Sunday) from 7 am to 11 am. Strictly on an empty stomach.

  Read also about Adrenal hormones and Sex hormones

  90,000 What you need to know about common thyroid diseases

  The thyroid gland helps regulate human metabolism by producing hormones.Problems can arise if the thyroid gland overproduces hormones, when it is known as hyperthyroidism, or does not produce enough hormones, which are called hypothyroidism. These problems can also lead to the growth of the thyroid gland, a problem called goiter. Researchers estimate that about 3 million people in Ukraine have an undiagnosed thyroid condition. This article examines the different types of thyroid diseases, what causes them, what their symptoms are, and how specialists at the Molecule Clinic diagnose and treat them.

  Hypothyroidism

  Hypothyroidism is when a person’s thyroid gland does not produce enough thyroid hormones. According to top endocrinologists, this is a more common thyroid problem than hyperthyroidism. A lack of thyroid hormones can slow down a person’s metabolism. Hypothyroidism is especially common in women.

  Reasons for the development of hypothyroidism:

  • surgical removal of part or all of the thyroid gland;
  • radioactive iodine treatment for hyperthyroidism;
  • radiation therapy for head and neck cancer;
  • Certain medications such as lithium for bipolar disorder and sulfonylureas for diabetes;
  • Injured or missing thyroid gland, often present from birth;
  • too much or too little iodine in the diet;
  • Turner Syndrome, a chromosomal disorder occurring in women;
  • damage to the pituitary gland.

  The most common cause of hypothyroidism is Hashimoto’s thyroiditis, which is an autoimmune disease. It is sometimes called Hashimoto’s disease. The exact cause of Hashimoto’s is unclear, but heredity may play a role, and having a close family member with the condition may increase a person’s risk. Having another autoimmune disorder, such as rheumatoid arthritis, type 1 diabetes, or lupus, also increases your risk of Hashimoto’s. The development of the disease can be very slow, lasting over several months or even years.

  Symptoms of hypothyroidism

  Symptoms of hypothyroidism can vary, but may include:

  • feeling cold;
  • rapid body fatigue;
  • dry skin;
  • forgetfulness;
  • depression;
  • constipation.

  A person may also develop a goiter or an enlarged thyroid gland. This is because the gland is trying to compensate for the lack of hormones.

  Diagnostics

  After discussing symptoms and history, your doctor may recommend a blood test for hypothyroidism.

  This test looks for high levels of a thyroid stimulating hormone in a person’s blood. The body releases TSH to signal the release of hormones.

  When the body senses low levels of thyroid hormones, it releases more TSH, so a high level usually indicates hypothyroidism.

  In addition, your doctor may test you for low levels of a thyroid hormone known as thyroxine.

  Hyperthyroidism

  Hyperthyroidism is when a person has too many thyroid hormones in the body, which speeds up metabolic processes.

  Someone with hyperthyroidism may initially have more energy, but their body will break down faster, which can cause various problems, especially fatigue.

  Symptoms of the disease

  • Common symptoms of hyperthyroidism may include:
  • changeable increase in energy;
  • fatigue from overeating;
  • rapid pulse;
  • “jolts” in the hands;
  • anxiety;
  • sleep problems;
  • nervousness;
  • irritability;
  • fine and brittle hair;
  • muscle weakness;
  • Frequent bowel movements;
  • unintentional weight loss;
  • light menstrual flow.

  A person with Graves’ disease may also experience eye inflammation. This pushes the eyes forward and they appear bulging.

  However, only 5 percent of people with Graves’ disease have severe and persistent visual impairment.

  Over-stimulation of the thyroid gland often enlarges it, which is called a goiter.

  Treatment of hyperthyroidism

  A doctor may recommend beta-blockers for short-term treatment of hyperthyroidism.Beta blockers stop some of the effects of thyroid hormone and quickly reduce some symptoms, such as a fast heart rate and tremors.

  He can also more effective permanent treatment:

  Antithyroid drugs: they prevent the thyroid gland from producing as many thyroid hormones.

  Iodized tablets: thyroid cells absorb iodine. This treatment destroys them and the overproduction of the gland hormone stops.

  Surgery: is done by a surgeon who removes part or all of the thyroid gland.

  If a person takes radioactive iodine or undergoes surgery, their thyroid can no longer produce enough hormones and they may develop hypothyroidism. Then they will need thyroid hormone replacement therapy.

  Thyroid nodules

  During the examination, the doctor will be able to feel the nodes of the thyroid gland.Thyroid nodules are lumps in the area of ​​the human “thyroid” itself. They can appear alone or in groups and are very common among the Ukrainian population. About 50 percent of people over the age of 60 have lumps in the form of thyroid nodules. However, the vast majority of them are harmless.

  It is not clear why humans develop thyroid nodules. Thyroid nodules usually do not cause symptoms of malignant lumps, although there is a possibility that they can cause hyperthyroidism by becoming overactive.The doctor will be able to feel the thyroid nodules in the person’s neck during the examination. If they find nodules, they can check for hyperthyroidism or hypothyroidism.

  There is a small risk of thyroid cancers. To check this, your doctor may do an ultrasound or biopsy with a fine needle. If there are any signs of cancer or a possible risk of developing cancer in the future, your doctor will recommend removing the nodules. Depending on the type of cells found in the biopsy and the risk of cancer, the doctor may remove part or all of the gland.

  There are many different diseases of the thyroid gland, but doctors usually divide them into two groups: those that make the thyroid gland overactive and those that make it weakened. Although symptoms may be nonspecific, diagnosing a thyroid disorder is usually straightforward. If a person is concerned that they may have a thyroid disorder, they should talk to a doctor at Molecule Cancer Clinic about testing.

  Thyroid function – hand over at the Unified Medical Center in St. Petersburg

  A blood test for thyroid hormones is an important diagnostic method for assessing the level of thyroid-stimulating and thyroid hormones prescribed by doctors of various specialties.Since the thyroid gland is responsible for the functioning of the organs of all the endocrine system, failures in its work lead to the appearance of very serious disturbances in the activity of the body.

  Where can I get tested for thyroid hormones in St. Petersburg?

  Specialists of the Unified Medical Center are ready to conduct an analysis for thyroid hormones at affordable prices. Having our own laboratory allows patients to receive ready-made results in the shortest possible time. According to the identified indicators, specialists can prescribe a referral to a specialized doctor for further diagnostics and treatment.Affordable prices for tests for thyroid hormones will allow all patients to donate blood for examination.

  When do I need to get tested for thyroid hormones?

  It is recommended to take an analysis for thyroid hormones in cases where the patient has symptoms such as:

  • Palpitations, frequent dizziness.
  • Irregularities in the menstrual cycle in women.
  • Feeling of constant tiredness and weakness.
  • Unexplained weight gain or loss.
  • Upset stomach.
  • Hair loss.
  • Muscle pain.

  Most often, a doctor directs a patient to undergo diagnostics, who needs to have a base for further assessing the activity of the thyroid gland and identifying the level of certain hormones.

  What indicators are determined by the analysis of the thyroid gland for hormones?

  • Antibodies to TSH receptors – autoantibodies against TSH receptors.Used to identify diseases characterized by thyrotoxicosis syndrome.
  • Antibodies to thyroglobulin (AT-TG) – antibodies to thyroglobulin. Important in the diagnosis of autoimmune diseases.
  • Antibodies to thyroid peroxidase (AT-TPO) are antibodies to an enzyme secreted by thyroid cells involved in the formation of T4 and T3. Important in the diagnosis of autoimmune diseases.
  • Thyroglobulin (TG) is a prohormone that is a marker for the timely diagnosis and treatment of thyroid tumors 90 140

  • Thyroid stimulating hormone (TSH) – produced in the pituitary gland and is responsible for the thyroid gland.
  • Thyroxine (T4) is a thyroid tissue producer responsible for certain types of metabolism and involved in protein metabolism.
  • Free thyroxine (T4w.) Is a biologically active part of total thyroxine, involved in metabolism.
  • Triiodothyronine (T3) is a hormone secreted by thyroid cells that is responsible for the body’s redox processes and some types of metabolism.
  • Free triiodothyronine (T3w.) Is a biologically active part of triiodothyronine, which regulates the rate of tissue growth, metabolism of lipids, proteins, calcium and carbohydrates.

  Take a blood test TSH (thyroid stimulating hormone) in the laboratory Medical tests, prices in the laboratory KDL

  TSH – thyroid stimulating hormone. A pituitary hormone that regulates the function of the thyroid gland. It is used to screen and diagnose various thyroid dysfunctions: hypothyroidism (decreased function) and hyperthyroidism (increased function).

  The synthesis and secretion of TSH is stimulated by thyroliberin, a hypothalamic peptide that is produced when the level of thyroid hormones in the bloodstream is low. Elevated levels of T3 and T4 suppress TSH secretion in a classic negative feedback loop.

  When is a TSH test usually prescribed?

  Most often, this study is prescribed when there is a symptom of an altered thyroid function (hyper- or hypothyroidism), when changes in the thyroid gland are detected by ultrasound, to monitor treatment when taking hormonal drugs.

  An analysis for TSH in women must be prescribed during pregnancy.

  What exactly is determined in the analysis process?

  Thyroid stimulating hormone consists of two subunits: alpha and beta. The alpha unit of the hormone is similar to the analogous subunits of LH, FSH and hCG. The beta unit of TSH is significantly different. The test system used detects the presence of the hormone TSH in the blood by the method of chemiluminescent immunoassay on microparticles.

  What do the test results mean?

  Decreased TSH levels are most commonly seen in hyperthyroidism.Graves’ disease (diffuse toxic goiter) is the most common cause of hyperthyroidism. It is a chronic autoimmune disorder that results in overproduction of thyroid hormones. As a result, patients may experience symptoms associated with hyperthyroidism, such as palpitations, weight loss, nervousness, hand tremors, redness and irritation of the eyes, and difficulty falling asleep. In response to high levels of T3 and T4, the pituitary gland produces less TSH, which leads to low levels in the blood.

  If there is a decrease in the level of thyroid hormones in the thyroid gland (hypothyroidism), the person may experience symptoms such as weight gain, dry skin, regular constipation, fatigue, and poor cold tolerance. Hashimoto’s thyroiditis is the most common cause of hypothyroidism. It is a chronic autoimmune condition in which the immune system attacks the cells of the thyroid gland, causing inflammation, causing the thyroid to not produce enough hormones. According to the principle of feedback, the pituitary gland begins to produce more TSH, which is manifested by its increased level in the blood.

  In rare cases, a change in the level of TSH in the blood is associated with dysfunction of the pituitary gland or hypothalamus.

  Typical test execution time

  Typically a TSH test result can be obtained within 1-2 days

  Do I need special preparation for the analysis?

  No special training required. More details about the terms of delivery can be found in the “Preparation” section. When monitoring treatment, the TSH test should be taken under similar conditions: at the same time of day.

  Taking care of your thyroid

  The thyroid gland is one of the organs of the endocrine system that provides control and regulation of various processes in the body with the help of special substances (hormones). Normally, this is a small (up to 50 g) organ located on both sides of the larynx, just below its thyroid cartilage. Actually, it was precisely from this cartilage that it got its name, and in its shape the gland itself resembles not a shield, but a butterfly that spread its wings.

  Even with minor disorders of the thyroid gland, a significant deterioration in health is observed.It affects almost all metabolic processes in the body and “produces” several of the most important hormones – calciotonin, triiodothyronine and thyroxine, which have a direct effect on the work of the digestive and cardiovascular systems, allow you to control mental and mental activity, regulate protein, fat and carbohydrate metabolism , controls the level of calcium in the body. Usually, in diseases of the thyroid gland, we are talking about insufficient or, conversely, excessive synthesis of hormones, often such phenomena are accompanied by its increase.Diseases of the thyroid gland can occur against the background of unchanged, decreased (hypothyroidism) or increased (hyperthyroidism, thyrotoxicosis) endocrine function. Iodine deficiency found in certain areas can lead to the development of endemic goiter and even cretinism. Not a single organ remains without the influence of thyroid hormones, any violation in its work immediately affects the general condition of a person.

  For the synthesis of T3 and T4, iodine is needed in a certain form. A person should receive 150-200 μg of iodine per day with food and water in the form of various compounds that our digestive system can assimilate.If there is not enough iodine in the water and soil of any region, if too little of it enters the body with food, the normal functioning of the gland is disrupted, it simply has nothing to synthesize the necessary substances from. Iodine deficiency can also be observed in cases where the iodine itself is sufficient, but there is not enough trace elements (primarily selenium) and vitamins necessary for its normal assimilation.

  But an excess of iodine is also harmful, arising in t.ch. and because of the uncontrolled intake of iodine-containing drugs. In addition, other environmental factors, such as radiation levels and the presence of toxic substances in food, water and air, can affect the functioning of the thyroid gland.Affected by heredity, and the possibility of the development of autoimmune processes, and some surgical operations. One of the serious and severe consequences of the Chernobyl accident for the Republic of Belarus is the increase in the incidence of the thyroid gland. In about 50-60% of cases, the pathology of the thyroid gland is heredity. More often, of course, it is not the disease itself that is inherited, but a predisposition to it. Under the influence of certain environmental factors, the disease may eventually make itself felt, or it may never manifest itself.

  In general, the appearance of specific symptoms of thyroid disease will depend on what hormones and in what quantity are produced by the gland. Trying to determine the thyroid gland dysfunctions in oneself only by the state of health is practically useless. Well, only a specialist should establish an accurate diagnosis and only after a full examination

  • blood test for hormone levels;
  • ultrasound examination of the thyroid gland;
  • puncture biopsy, if necessary and according to indications;
  • scintigraphy.

  Of course, ideally, each person should undergo preventive examinations once a year with general and specialized specialists. But there are a number of signs that will certainly alert and force you to visit a doctor for a full examination.

  Violation of the psycho-emotional background.

  We are talking about the appearance of irritability, despondency, fatigue for no apparent reason, it is the level of synthesized thyroid hormones that affects a person’s mood – if it is too low, then a bad mood, despondency and depression will be clearly noticeable, but an increased level of hormones leads to anxiety and irritability.

  Weight fluctuations.

  Rapid weight loss or too fast weight gain is the most characteristic sign of the development of thyroid diseases. For example, if a person progresses hypothyroidism, then his weight will steadily increase, but with hyperthyroidism, it will rapidly decrease. Moreover, this condition cannot be corrected even with strict diets.

  Hair loss, changes in the structure of nails and skin.

  If a person develops hyperthyroidism, then he will certainly complain about skin pigmentation and thickening of the skin in the area of ​​the feet and legs.And in the case of hypothyroidism, brittle nails, dryness and peeling of the skin.

  Fever or chills are also a sign of thyroid gland diseases, because when hormone synthesis is disturbed, the body’s thermoregulation is also disturbed – if the level of hormones is too high, then there will be a constant feeling of heat and increased sweating, but with a low level of thyroid hormones – a feeling of freezing and chills. If hypothyroidism progresses, then the body temperature will be slightly reduced and in the normal state, such a manifestation does not represent anything terrible.But if, against the background of a stably lowered body temperature, an infection joins, then you can skip its first signs, which leads to a more severe course of the infection and the development of complications. In hyperthyroidism, the body temperature, on the other hand, is slightly elevated.

  Disorders in the work of the digestive system.

  Usually, with problems in the thyroid gland, all organs of the gastrointestinal tract suffer, for example, chronic constipation or frequent diarrhea, bile stasis and insufficient intestinal motility may develop.In addition, diseases of the thyroid gland can provoke the appearance of stones in the gallbladder and bile ducts.

  Menstrual irregularities.

  This symptom is present when the level of synthesized hormones is too high, and when the level is low. As a rule, hypothyroidism leads to scanty and rare periods, but hyperthyroidism is characterized by too frequent menstrual bleeding, a shortened menstrual cycle. Many women diagnosed with thyroid disease suffer from infertility or miscarriage.

  Problems in the work of the cardiovascular system.

  If hypothyroidism progresses, there will be shortness of breath even with little physical exertion, slow heartbeat, lowering blood pressure. With the development of hyperthyroidism, on the contrary, there will be a rapid heartbeat, a regular increase in blood pressure, noticeable pulsation, a feeling of strong pressure on the chest.

  Eye symptoms.

  It means the appearance of bulging eyes, photophobia, lacrimation and rare blinking, decreased visual acuity and a feeling of bursting of the eyeball – these symptoms appear with severe hyperfunction of the thyroid gland. But never pain syndrome appears in the eyes – this is a sign of completely different pathologies.

  Headaches and dizziness.

  With an imbalance of hormones that the thyroid gland synthesizes, fluctuations in blood pressure and vegetative-vascular disorders often occur for no apparent reason.

  Swelling of the face.

  In hypothyroidism, a person experiences disturbances in the work of the heart, and this, in turn, leads to disturbances in metabolic processes and insufficient blood flow – this is the cause of edema.It is noteworthy that, specifically, with violations of the thyroid gland, facial edema appears only at night, and after the patient wakes up, they disappear by themselves.

  Swelling of the neck.

  If the thyroid gland increases in size, nodes grow on it, or tumor processes progress, then the patient will have a change in the timbre of his voice, a cough will appear, and problems with swallowing even soft foods and liquids arise. If, against the background of these symptoms, a clear swelling of the neck appears, then this indicates the development of any pathology of the thyroid gland – it is necessary to consult a doctor urgently.

  Joint pain, increased fragility of bones. Periodically appearing pain in the joints and the lack of diagnosis of any disease of the musculoskeletal system should alert the person – most likely, the thyroid gland produces too little calcitonin. It is the disturbances in calcium metabolism that lead to changes in the structure of bone tissue – hence the pain in the joints of an unexplained etiology.

  Numbness, tingling and muscle pain. Similar health problems arise against the background of hyperfunction of the thyroid gland – protein metabolism is disrupted, which leads to pain in muscle tissues, and an imbalance of hormones provokes a disruption in the process of conducting nerve impulses – hence numbness and tingling.

  It should be understood that if at least one of the listed signs of thyroid dysfunction appears, you should immediately seek medical help. Modern medicine successfully treats thyroid pathology, but only if an appeal to a specialist was timely.

  Many people have heard that for the prevention of thyroid diseases it is necessary to eat more “iodine” products. We are advised to consume more sea fish, seaweed salads, not to ignore walnuts, persimmons, feijoa, kiwi, black chokeberry.It is recommended to purchase and use instead of regular iodized salt. Is it always necessary? In areas where there is not enough iodine in drinking water, it is a must, although people with already identified disorders of the thyroid gland should still consult a doctor. For healthy people, a slightly increased intake of iodine usually does not threaten anything. The main thing is to observe the measure and not to use medications without consulting a doctor and without undergoing an examination: such “prevention” can seriously harm health.

  In addition, one should not forget that the prevention of thyroid diseases is by no means limited to the use of iodine alone. Normal sleep and rest, timely treatment of chronic infections (special attention should be paid to prevent acute respiratory infections), a healthy lifestyle, a balanced diet with a sufficient amount of trace elements and vitamins – all this will benefit not only the thyroid gland, but also the whole body.

  Our life is connected with constant stress.Stress, weakness, insomnia and fatigue are familiar symptoms, right? Did you know that such symptoms can be the cause of a rather serious illness? So how can you understand whether this is a simple overwork and you just need to rest, or the work of such a vital organ as the thyroid gland is disrupted in the body?

  This requires early diagnosis of this pathology.