Hypothyroidism and Irregular Periods | Everyday Health

If your periods aren’t like they used to be, you and your doctor might need to do some sleuthing. Irregular periods can be caused by a number of factors, from habits such as extreme exercise to a variety of medical conditions, including hypothyroidism.

Hypothyroidism, a condition in which your thyroid gland doesn’t produce enough hormones, affects about 4.6 percent of Americans 12 and older, and women are more likely to develop it than men, according to the National Institutes of Health.

Thyroid hormones play multiple roles in your body, such as regulating your energy levels and your internal temperature. When you don’t make enough thyroid hormones, many of your bodily functions slow down, and you can experience constipation, fatigue, depression, dry skin, thinning hair, intolerance to cold, muscle cramps, joint pain, and unexplained weight gain, says Rachel McConnell, MD, an assistant professor of obstetrics and gynecology at Columbia University Medical Center in New York.

Hypothyroidism can also affect your periods by setting off a cascade of hormonal changes that affect your reproductive system.

Here’s what happens: When your thyroid hormone levels decrease, your brain’s hypothalamus starts producing extra thyrotropin releasing hormone (TRH), and your pituitary gland releases extra thyroid stimulating hormone (TSH) and prolactin, another hormone.

High prolactin levels then suppress production of gonadotropin-releasing hormone (GnRH) in your hypothalamus. This is a problem, because you need GnRH to produce follicle-stimulating hormone and luteinizing hormone in your pituitary gland. These hormones are important for normal ovarian function, and when hypothyroidism leads to a decrease in their levels, menstrual irregularities may occur, says Dr. McConnell.

Hypothyroidism Can Make Periods Heavy, Absent, or Irregular

Hypothyroidism can put the brakes on ovulation — a phenomenon known as anovulation — resulting in heavy periods. “In some women with uncontrolled hypothyroidism, this anovulation can lead to disordered growth and shedding of the uterine lining, causing unpredictable bouts of heavy bleeding from the uterus,” says Jessica Spencer, MD, an associate professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. “This can be monthly in some women and far apart in others.”

Changes in prolactin levels can lead to thinning of the uterine lining and changes in how the pituitary gland controls the ovaries; both can result in periods stopping completely, says Dr. Spencer.

Hypothyroidism can also change coagulation factors, increasing the risk of heavy bleeding.

Women of reproductive age with hypothyroidism may experience heavy periods, absent periods, or irregular periods, says McConnell, and the symptoms of menstrual irregularities will depend on the severity of the hypothyroidism.

“Menstrual irregularities tend to be more common in women with severe hypothyroidism compared to mild hypothyroidism,” says McConnell.

When to Talk to Your Doctor About Your Periods

If your periods are out of whack, you need to find the cause so you can treat it.

Left untreated, hypothyroidism can lead to other complications, such as anemia, low body temperature, and heart disease.

There could also be something else going on altogether.

“Hypothyroidism is only one potential cause of menstrual irregularities,” says McConnell. “There are many causes of menstrual irregularities, such as polycystic ovary syndrome (PCOS), uterine fibroids, infections, and uterine cancer.”

If you have menstrual irregularities, you should seek medical attention if your flow is heavy for more than 24 hours, your periods are more frequent than 21 days, or your periods stopped for more than three months (and you are not pregnant), says McConnell.

Your medical provider can perform blood tests to check your levels of various hormones. In hypothyroidism, your TSH level will be elevated and your free thyroid hormone levels will be low.

In some cases, your doctor might recommend a pelvic ultrasound to check for uterine fibroids, polyps, and ovarian cysts, says Spencer. “Depending on the examination and history, further testing may also be warranted to assess for PCOS, another common cause of irregular cycles,” says Spencer. “An endometrial biopsy is sometimes recommended as well to assess for precancerous tissue inside the uterus; this is especially important in women who are obese or have diabetes or hypertension.”

If you already know you have hypothyroidism and have noticed a change in your cycle, see your doctor to make sure your TSH is in the normal range with treatment, says Spencer. If your period does not normalize and your TSH is in the normal range, you should make an appointment with your ob-gyn so they can evaluate you for other causes, she says.

How Hypothyroidism’s Effect on Periods Can Impact Fertility 

Hypothyroidism could disrupt your plans to get pregnant. To conceive, you need to ovulate and have a good endometrial lining of the uterus for an embryo to implant.

“Women with hypothyroidism may develop a short luteal phase, which is the time between ovulation and the start of your period,” says McConnell. “If a woman has a short luteal phase, implantation of an embryo may not occur.” You might also have abnormal ovulation or none at all.

Changes in periods do not always mean reduced fertility but should be evaluated by a physician if they persist, says Spencer.

“Untreated hypothyroidism may also increase a woman’s risk of miscarriage, so it’s important to have your thyroid checked if you are struggling to conceive or have a history of miscarriages,” Spencer says.

The Benefits of Catching Hypothyroidism Early

There’s an early stage of hypothyroidism called subclinical hypothyroidism, where a blood test for TSH is slightly elevated but the thyroid gland is still producing enough thyroid hormones, says McConnell.

“In our fertility clinic, the most common presentation is subclinical hypothyroidism,” says McConnell.

Subclinical hypothyroidism doesn’t usually disturb periods, but it can still lead to some irregular bleeding and complications in pregnancy, says Spencer. “Eventually, without treatment, subclinical hypothyroidism may lead to overt hypothyroidism, causing more menstrual abnormalities and medical problems,” she says.

Hypothyroidism Treatment Can Help Your Periods Too

The standard treatment for hypothyroidism is the prescription medication levothyroxine, a synthetic version of the thyroid hormones your body is lacking.

“If hypothyroidism is the cause of menstrual irregularities, treatment with thyroid hormone replacement using levothyroxine [restores] normal thyroid levels, and in turn, the interactions between thyroid hormone and reproductive function will return,” says McConnell.

If you have hypothyroidism, your doctor will check your TSH levels regularly and work with you to ensure you are taking the right amount of medication. “Finding the right replacement dose can take time in some women, and the requirements for thyroid hormone can change with diet, age, pregnancy, and weight gain,” says Spencer.

Reach out to your doctor if you have any new or concerning symptoms.

What Is Graves’ Disease? Symptoms, Causes, Diagnosis, and Treatment

The three treatment options for Graves’ disease are medicine, radioiodine therapy, and thyroid surgery, according to the NIDDK. (1) Your doctor will help you decide which treatment is best for you based on your age, whether you are pregnant, or whether you have other medical conditions.

Radioiodine Therapy

Radioiodine therapy is the most common treatment for Graves’ disease in the United States, and it entails taking radioactive iodine-131 (I-131) orally as a capsule or liquid. I-131 slowly destroys the cells of the thyroid gland that produce thyroid hormone. In some cases, you may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range, but it’s not likely.

Most people who have radioactive iodine treatment later develop hypothyroidism, because the thyroid hormone–producing cells have been destroyed. However, hypothyroidism is easier to treat (it can be controlled with medication) and causes fewer long-term health problems than hyperthyroidism.

Medication Options

Medications to treat Graves’ disease include:

Beta blockers Beta blockers don’t stop your thyroid from producing thyroid hormone, but they can quickly improve symptoms until other treatments begin working.

Antithyroid medicines Antithyroid medicines cause your thyroid to make less thyroid hormone. They usually don’t cure Graves’ disease, but in some cases, the effects last for a long time, even after you are no longer taking the medication. Methimazole is the most commonly prescribed antithyroid medicine. However, during the first three months of pregnancy, propylthiouracil is more commonly prescribed, because in rare cases, methimazole may harm the fetus (propylthiouracil may also affect the fetus in rare cases).

Antithyroid medicines can cause the following side effects:

• Allergic reactions, including rashes and itching
• A decrease in the number of white blood cells in your body, which can lower resistance to infection
• Rarely, liver failure

Thyroid Surgery

Surgery to remove the thyroid gland is another treatment for Graves’ disease, but it is used less frequently than radioiodine therapy and medication. It may be used to treat people with large goiters, or pregnant women who are allergic to or have side effects from antithyroid medicines.

If you have thyroid surgery, you will develop hypothyroidism and need to take thyroid hormone medicine every day for the rest of your life.

Alternative and Complementary Therapies

Certain lifestyle changes can also help improve Graves’ disease symptoms and boost general health, such as eating well and exercising, according to the Mayo Clinic. (2) Weight gain may occur when hyperthyroidism is successfully treated, because the thyroid controls the metabolism, so eating healthfully and exercising are important. Graves’ disease can also cause brittle bones, and weight-bearing exercises can help maintain bone density.

Stress may trigger Graves’ disease or make it worse, so stress-relieving practices can help, such as listening to music, taking a warm bath, or walking.

Understanding thyroid tests – InformedHealth.

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The thyroid gland is a vitally important endocrine (hormone) gland that is mainly involved in the body’s energy metabolism. It is located at the front of the neck, below the voice box, and is butterfly-shaped. The thyroid gland produces the thyroid hormones triiodothyronine (T3) and thyroxine (T4), among other things.

These thyroid hormones have various functions: They are responsible for the metabolism, growth and development of the body. The production of the thyroid hormones is regulated by the pituitary gland. The pituitary gland makes a hormone called TSH (thyroid-stimulating hormone). TSH not only stimulates the production of thyroid hormones – it also influences the size of the thyroid gland.

The production of TSH, in turn, is inhibited by thyroid hormones. The system can be compared to a thermostat, which makes sure that the room is kept at a certain temperature. So the concentration of thyroid hormones in the blood is usually fairly constant.

There are different tests and examinations to check whether the thyroid gland is functioning normally and whether its surface, shape and size are normal.

Palpation of the thyroid gland

In this examination, the doctor feels the neck with his or her hands, paying attention to what the thyroid gland feels like and whether it is enlarged.

What do the results tell us?

An enlarged thyroid – also called a goiter – can be a sign of an iodine deficiency that hasn’t yet affected the function of the thyroid. But it could also be a sign of an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism), where too many or too few hormones are made respectively.

Nodules that can be felt from the outside may also be a sign of a thyroid problem. But sometimes people have an enlarged thyroid gland or nodules without it affecting the function of their thyroid gland.

So this palpation examination can only tell us whether there might be a thyroid problem. Further tests and examinations are needed in order to be sure.

Blood tests

The thyroid gland constantly releases a certain amount of hormones into the blood. So a blood test can be used to determine the amounts of hormones produced by the thyroid gland. The blood test measures the levels of TSH and the thyroid hormones triiodothyronine (T3) and thyroxine (T4). A change in the TSH level can be an early sign of a thyroid problem. For this reason, it is common to only measure the TSH level at first.

If the TSH level in the blood is higher or lower than normal, the levels of the thyroid hormones T4 and T3 are also measured. Most thyroid hormones are bound to certain proteins in the blood. Only unbound “free” thyroid hormones are active and have an effect, though. So only the free thyroid hormones are measured (FT3 and FT4 – where “F” stands for “free”).

When trying to find out what is causing a thyroid problem, a blood test is done to look for thyroid antibodies. These antibodies are made if the immune system attacks the body’s own thyroid tissue by mistake. They may also block the effect of thyroid hormones.

Another hormone produced by the thyroid gland is called calcitonin. The level of calcitonin in the blood is usually only measured if there is reason to believe that someone has a certain type of thyroid cancer which increases the amount of calcitonin.

What do the results tell us?

If the levels of T3 and T4 in the blood are too high or too low, there is an imbalance between the amount of thyroid hormones needed by the body and the amount of thyroid hormones available. The levels of the following substances can help find out what is causing the imbalance:

• Thyroid-stimulating hormone (TSH): High TSH levels are a sign of an underactive thyroid (hypothyroidism). The pituitary gland produces more TSH in order to stimulate the thyroid gland to produce thyroid hormones. Very low TSH levels in the blood may be a sign of an overactive thyroid (hyperthyroidism). The pituitary gland then produces less TSH, in order to stop “telling” the thyroid gland to make more hormones.

• Free triiodothyronine (FT3) and free thyroxine (FT4): High levels of free thyroid hormones in the blood may be a sign of an overactive thyroid, and low levels could be a sign of an underactive thyroid.

• Thyroid antibodies: The concentration of thyroid antibodies in the blood is higher in certain disorders where the body’s immune system attacks the thyroid gland. These include Hashimoto’s disease and Graves’ disease. Low levels of thyroid antibodies may be a sign of various diseases, such as an inflammation of the thyroid gland (thyroiditis), type 1 diabetes or rheumatoid arthritis.

• Calcitonin: Calcitonin levels are usually higher in a certain type of thyroid cancer. But high levels of calcitonin can also be a sign of other diseases, such as kidney failure. Calcitonin levels play an important role in calcium and bone metabolism too.

The concentration of TSH and thyroid hormones in the blood can also be influenced by the long-term use of certain medications. These medications include:

• Acetylsalicylic acid (ASA, the drug in medicines like Aspirin)

• Steroids

• St John’s wort

• Certain diuretic medications containing furosemide

• Thyroid medications

Because of this, it’s important to let your doctor know about any medications you are taking before having a blood test.

Thyroid ultrasound

In a thyroid ultrasound (sonography), sound waves are sent to the thyroid gland. Depending on the type of tissue they bounce off there, the sound waves are then sent back with different intensities or not at all. To do the examination, a small amount of gel is put on the “head” (transducer) of the ultrasound device, which is then moved over the neck. The sound waves that bounce off the thyroid tissue are measured by the transducer and turned into a spatial image that is shown on a screen.

What do the results tell us?

The ultrasound image shows whether the thyroid gland is enlarged. Changes in the tissue – like cysts or age-related changes in its structure – can also be seen. An enlarged thyroid gland could be a sign that it is underactive or overactive.

To know for sure whether the thyroid gland really is making too many hormones or not enough, a blood test has to be done too. If nodules (lumps) are discovered in the ultrasound examination, other examinations may be done to find out more about them. These include a thyroid scan or – in some cases – magnetic resonance imaging (MRI).

Thyroid scan

A thyroid scan (or thyroid scintigraphy) is an imaging technique used to see how active the thyroid gland is (the amount of hormones it is producing). Before doing the scan, a slightly radioactive substance is injected into an arm vein. This substance travels around the body in the bloodstream, but most of it is absorbed by the thyroid gland. More active areas of the thyroid gland absorb more of the substance, and less active areas absorb less. The thyroid scan image shows how much of the radioactive substance has been absorbed in different areas of the thyroid gland. This image is called a scintigram.

It may be necessary to stop taking certain drugs, such as thyroid medications, before having a thyroid scan. Because of this, it’s important to let your doctor know about any medication you are taking.

Thyroid scans can have adverse effects: In rare cases, the needle might damage blood vessels or nerves, or the skin at the site of injection may become inflamed. Allergic reactions, particularly to the injected substance, are possible.

People are exposed to a small amount of radiation during the scan. Only very small amounts of radioactive substances are used, though, and they are broken down in the body within a few days.

What do the results tell us?

Thyroid scans allow us to look at how active the thyroid tissue is: The more active it is, the more blood goes through it and the more of the injected substance builds up in it. Active areas of the thyroid gland can be clearly seen on the thyroid scan image.

Depending on how much of the injected substance builds up, “cold” nodules and “hot” nodules can be identified:

Cold nodules have less of the radioactive substance in them because the metabolism in their tissue is slower (less active). In most cases, cold nodules are caused by harmless changes in the tissue. In very rare cases, though, they are caused by a thyroid tumor.

Hot nodules have more of the radioactive substance in them – their metabolism is faster (more active) and their tissue produces more hormones. If hot nodules grow bigger than a certain size, they may lead to an overactive thyroid.

Fine needle aspiration

In fine needle aspiration, a very fine, hollow needle is inserted into the thyroid gland to remove samples of tissue or fluid. It’s usually not necessary to numb the area with an anesthetic because it’s not more unpleasant than having a normal blood sample taken from an arm. To be able to see the procedure better, doctors often use an ultrasound machine too.

In rare cases, the place where the needle was inserted may become bruised or inflamed. If you take medication that stops blood from clotting (anticoagulants), it’s important to talk to your doctor about whether you should stop taking it before the procedure.

What do the results tell us?

Fine needle aspiration can provide further information about whether the changes in thyroid tissue are benign (non-cancerous) or malignant (cancerous). The tissue samples that are taken are sent to a laboratory, where the cells are examined. Fine needle aspiration can be used to remove fluid from fluid-filled cysts too. Removing and examining thyroid tissue in this way also allows doctors to see whether the tissue is inflamed.

Sources

• Andreae S. Lexikon der Krankheiten und Untersuchungen. Stuttgart: Thieme; 2008.

• Bruhn HD, Fölsch UR, Schäfer H. LaborMedizin – Indikationen, Methodik und Laborwerte – Pathophysiologie und Klinik. Stuttgart: Schattauer-Verlag. 2008.

• Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison’s Principles of internal medicine. New York: McGraw-Hill Companies. 18th ed; 2011.

• Pschyrembel W. Klinisches Wörterbuch. Berlin: De Gruyter; 2014.

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Order a TSH Test – Get Tested at an AZ Lab

My Lab ReQuest is a service that allows you to order your own lab tests to assess your health, check for diseases, or monitor chronic conditions. No doctor’s order or insurance is required to order testing. Place an order online or download and complete an order form to bring to your lab visit. Visit any of our 75+ locations across Arizona to complete your test!

Why order your own Thyroid Screen (TSH, High Sensitivity) with My Lab ReQuest?

Since the passage of the law in 2015 that allows for consumers in Arizona to order their own lab tests, thousands of patients have used our My Lab ReQuest service to take charge of their health and make more informed healthcare decisions. Our Thyroid Screen (TSH, High Sensitivity) is one of four screenings we offer for you to check and monitor your thyroid health.

Patients choose Sonora Quest Laboratories to meet their lab testing needs for a wide range of reasons, including:

Award-Winning Quality

As the nation’s largest integrated laboratory system, Sonora Quest Laboratories delivers award-winning quality services every day to more than 23,000 patients across Arizona. We are the #1 bioscience company in Arizona, according to Ranking Arizona, and we are also the only healthcare company to even win the Arizona Governor’s Award for Quality. Most importantly, we are accredited by the College of American Pathologists (CAP), the organization whose accreditation ensures the highest standard of care for laboratory patients.

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Schedule an appointment or walk in to any of our 75+ Patient Service Centers located across Arizona! We have over 45 locations in Metro Phoenix, 14 locations in Tucson and Southern Arizona, and various other locations across Northern and Western Arizona. Moreover, several of our locations are conveniently located inside of Safeway markets so that you can plan your screening around your trip to your neighborhood grocery store.

Learn More about Thyroid Disease

What is thyroid disease?

The thyroid is a small gland located near the bottom of your neck. The thyroid gland is responsible for producing hormones that support many of your bodily functions. However, the gland may become overactive or underactive, resulting in too much or too little of the thyroid hormone being produced. Thyroid disease is a condition in which too much or too little of the hormone is being produced in the body.

Thyroid disease can affect both men and women, but women are much more likely to develop thyroid disease. Women are five times more likely than men to have thyroid problems and one in eight women will experience thyroid problems in her lifetime. Additionally, thyroid disease can also result in infertility and can cause health problems for pregnant women and their babies.

What are the risk factors for thyroid disease?

The following risk factors, according to the Mayo Clinic, increase your risk for hypothyroidism and hyperthyroidism:

Hypothyroidism:

• Women
• Adults over the age of 60
• People with a family history to thyroid disease
• People with an autoimmune disease
• People that have been treated with radioactive iodine or any-thyroid medications
• Have received radiation to neck or upper chest
• Have had thyroid surgery
• Have been pregnant or delivered a baby within the past six months

Hyperthyroidism: 

• Women
• Family history, particularly of Graves’ disease
• Personal history of certain chronic illnesses such as type 1 diabetes

What are the symptoms of thyroid disease?

The symptoms of hypothyroidism are:

• Fatigue
• Frequent, heavy menstrual periods
• Forgetfulness
• Weight gain
• Dry, coarse skin and hair
• Hoarse voice
• Intolerance to cold

The symptoms of hyperthyroidism are:

• Irritability/nervousness
• Muscle weakness/tremors
• Infrequent, scant menstrual period
• Weight loss
• Sleep disturbances
• Enlarged thyroid gland
• Vision problem so eye irritation
• Heat sensitivity

Who should get tested for thyroid disease?

If you have symptoms of thyroid disease and have had a thyroid problem in the past, have had surgery or radiotherapy, or have a condition such as goiter, you may want to talk to your doctor about getting tested for thyroid disease.

At this time, the USPSTF has concluded that there is insufficient evidence to assess the benefits or harms of thyroid screenings, so it does not recommend testing for non-pregnant, asymptomatic adults. Patients that are not pregnant and are asymptomatic are encouraged to evaluate both the potential benefits and harms of such testing.

How is thyroid disease diagnosed?

Thyroid-stimulating hormone is a hormone produced by the anterior pituitary gland that helps to maintain stable levels of thyroid hormones in the blood. A Thyroid Screen (TSH, High Sensitivity) test can detect problems affecting the thyroid gland by measuring the amount of TSH in the blood. If TSH levels are too high or low, a person may have an overactive or underactive thyroid, conditions that can both lead to thyroid disease. In addition to a thyroid screen, a T4 test or T3 test may also be ordered to help in the diagnosis of thyroid disease.

Results

If the results from a TSH screening are high, it may indicate an underactive thyroid and the presence of hypothyroidism. If the results from the screening are low, then it may indicate an overactive thyroid and the presence of hyperthyroidism.

Once your results are available, you may share these results with your medical provider for assistance with interpretation and for guidance as to additional testing and/or to develop a treatment plan based on your results. If monitoring your current thyroid condition, your medical provider can also use your test results to assess the success of your current treatment plan.

What is the treatment for thyroid disease?

Once thyroid disease has been diagnosed, you and your doctor can develop a proper treatment plan. Treatment will depend on whether you have been diagnosed with hypothyroidism or hyperthyroidism. Hypothyroidism is typically treated with the synthetic thyroid hormone levothyroxine. Hyperthyroidism has several common treatments, ranging from radioactive iodine, anti-thyroid medications, beta-blockers, and sometimes surgery.

*It is solely your responsibility to promptly discuss all laboratory test results with a physician. Neither Sonora Quest Laboratories nor its Medical Director will provide interpretation, counseling, consulting, or care recommendations on the basis of any laboratory results provided to you. 

Thyroid stimulating hormone (TSH) – Lab Tests Online AU

How is it used?

Thyroid stimualting hormone (TSH) testing is used to:

• screen newborns for an underactive thyroid gland
• diagnose a thyroid disorder in a person with
• monitor thyroid replacement therapy in people with
• as part of the investigation of female infertility problems
• help to evaluate pituitary function (occasionally)

When is it requested?

Your doctor requests this test if you show symptoms of a thyroid disorder. For example, symptoms of include heat intolerance, weight loss, rapid heartbeat, nervousness, sweating and increased frequency of stools.

Common symptoms of include fatigue, weakness, weight gain, muscle aches, constipation, slow heart rate and cold intolerance.

The blood test is often requested with other thyroid hormone tests and after a physical examination of your thyroid. TSH screening is routinely performed in newborns. There are currently no recommendations for routine screening of adults in Australia.

What does the test result mean?

A high TSH result often means an underactive thyroid gland caused by failure of the gland (). Very rarely, a high TSH result can indicate a problem with the pituitary gland, such as a , in what is known as secondary hyperthyroidism. A high TSH value can also occur in people with underactive thyroid glands who have been receiving too little thyroid hormone medication.

A low TSH result can indicate an overactive thyroid gland () or damage to the pituitary gland that prevents it from producing TSH. A low TSH result can also occur in people with an underactive thyroid gland who are receiving too much thyroid hormone medication.

An abnormal TSH usually indicates a deficiency or an excess of thyroid hormones available to the body but it does not indicate the reason why. An abnormal TSH result is usually followed by additional testing of free thyroxine (FT4) and/or free tri-iodothyronine (FT3) to investigate the cause. The combination of a TSH test and tests for the thyroid hormones T3 and T4 is known as a thyroid function test (TFT).

The following table summarises patterns of thyroid function test results and their most common causes.

Is there anything else I should know?

Thyroid-hormone replacement therapy and some drugs may interfere with thyroid function test results, so tell your doctor about any drugs you are taking.

When your doctor adjusts your dose of thyroid hormone, it is important that you wait at least one to two months before checking your TSH again, so that your new dose can have its full effect.

Extreme stress and acute illness may also affect TSH test results. In this event, TSH should be rechecked a few weeks after the illness has resolved. 

Results for TSH may be low during the first trimester of pregnancy. This is because one of the hormones of pregnancy (HCG) has a TSH-like effect so the pituitary is not required to produce as much TSH. TSH results in pregnancy should be interpreted in relation to reference intervals specific for pregnancy.

What is a TSH test and what do your results mean?

The thyroid-stimulating hormone (TSH) test evaluates thyroid function and thyroid hormone levels. It’s produced by the pituitary gland, which tells your thyroid, located in the lower front of your neck, to make and release hormones that control our body temperature, metabolism, and keep our brains, hearts, and other organs working properly.  

The American Thyroid Association (ATA) recommends that adults begin TSH testing at the age of 35 and repeat tests every five years if results are in the normal range. Your doctor may also order a TSH test if you’re experiencing symptoms of an underactive or overactive thyroid. Symptoms of hypothyroidism (an underactive thyroid) can include fatigue, brain fog, extremely dry skin, hair loss, and feeling cold. Symptoms of hyperthyroidism (an overactive thyroid) can include sweating, a fast heart rate, muscle weakness, anxiety, and irritability. In either case, you—or your healthcare provider—might find that your thyroid is enlarged, which is called a goiter, or thyroid nodules, which are small lumps on the thyroid gland.

What does the TSH test involve? 

The TSH blood test is often administered as part of a panel of blood tests in conjunction with an annual health exam. The test determines how well your thyroid is working by measuring the amount of thyroid-stimulating hormone in your blood. It’s a non-fasting blood test, meaning you don’t have to do anything special to prepare. 

Physicians should take a TSH blood sample for thyroid patients every four to eight weeks after their initial diagnosis. The ATA recommends TSH testing every six to 12 months while you’re on a stable medication dose and more often if your dose has changed. 

What should your TSH level be?

Most laboratories classify normal TSH levels as between 0.4 and 4.5 milliunits per liter (mU/L), according to the American Thyroid Association (ATA). A normal TSH level in most cases, usually indicates that you don’t have a thyroid problem.

The ATA reports that nearly 20 million Americans have some form of thyroid disease. Yet more than 60% of those with a thyroid disorder are unaware of their medical condition. 

What does it mean when your TSH is low?

In most cases, TSH levels lower than 0.4 mU/L indicate hyperthyroidism, also known as overactive thyroid, meaning, your body produces too much thyroid hormone. Graves’ disease is an autoimmune disorder that sometimes causes hyperthyroidism.

What happens when your TSH is high?

Generally, TSH levels higher than 4.5 mU/L indicate hypothyroidism, or an underactive thyroid, meaning your body isn’t making enough thyroid hormone. Hashimoto’s thyroiditis is an autoimmune disorder that sometimes causes hypothyroidism.

Can you still have a problem if your TSH is normal?

“The TSH test is a highly sensitive indicator of your overall thyroid health,” says Brittany Henderson, MD, a board-certified endocrinologist at Charleston Thyroid Center in Mount Pleasant, South Carolina. “Interpretation can be difficult because there is a wide range of ‘normal’ on the TSH scale.”

Medications and supplements you’re currently taking can affect the results of your TSH test. One example is biotin, which can falsely show low TSH levels.

What’s considered normal is influenced by several factors:

Research has shown that levels of TSH tend to increase with age, decrease with pregnancy, and vary by ethnicity.  

Age

One study found that 97.5% of patients up to the age of 55 years had TSH values less than 4.0 mU/L. Above that age the upper value for the 97.5th percentile gradually rose, reaching about 4.75 mU/L between 75 and 85 years and 5.0 mU/L in patients between 85 and 90. The study went on to say that slightly high TSH levels in older adults don’t necessarily require treatment.

TSH levels can also vary for children and the range can change according to age. It’s recommended that parents check with a pediatric endocrinologist to determine their child’s optimal TSH range.

Pregnancy

In pregnant women in their first trimester, the American Thyroid Association recommends TSH levels are maintained based on the status of thyroid autoimmunity. Usually, TSH is maintained between 0.2-<2.5 mU/L or the upper limit of TSH ie, 4.5 mU/L based on autoimmunity. TSH is recommended to be maintained between 0.3-3 mU/L in the remaining trimesters.

Ethnicity

Dr. Henderson, who co-authored the book, What You Must Know About Hashimoto’s Disease, notes that TSH results can also vary according to ethnicity. “TSH levels are traditionally higher in the white population, lower in the black population, and somewhere in the middle for the Hispanic population,” she explains.

She says patients might have TSH results in the ‘normal’ range, while still experiencing active symptoms (such as weight loss or gain, hair loss, fatigue, anxiety and more). TSH levels indicate if your thyroid has a problem, but they don’t indicate what’s causing the problem. To find that out, your healthcare provider may order additional tests.

When you might need additional tests

In these cases, doctors may choose to order a comprehensive panel of thyroid function tests to measure thyroxine such as Free T4, Total T4, Total T3, and thyroid antibodies, in addition to the TSH. A critical part of obtaining the best possible TSH test results and thyroid treatment involves ensuring you’re receiving the right diagnostic tests.  

T4 test

A Free T4 is a non-fasting blood test that measures levels of T4, a thyroid hormone. A normal level of Free T4 ranges between 0.8 to 1.5 micrograms per deciliter (ng/dL). It can vary depending on the laboratory assay used. Total T4 is not normally done except in pregnancy when it is more accurate than Free T4 test. A normal Total T4 range is 5-12 ug/dl. Low levels of T4 are seen with hypothyroidism, while high levels are seen with hyperthyroidism. 

T3 test

A Total T3 non-fasting blood test is sometimes recommended as a way of diagnosing hyperthyroidism and determining the severity of the disease. Normal Total T3 results are measured as ranging from 100 to 200 nanograms per deciliter (ng/dl). Free T3 test is not recommended due to its laboratory assay inconsistency. Reverse T3 has a limited role in diagnosing thyroid problems and is routinely not recommended. 

When do you need treatment? 

“Many hypothyroid patients feel at their best when they’re on medication and their thyroid levels are in the ‘optimal’ TSH range of 0. 5-2.00 (with a lab scale of 0.45-4.5),” Dr. Henderson says. “Since lab assays and ranges vary, the optimized levels for a patient’s specific lab can also vary.” For elderly patients, the TSH target is in the 4.0 – 6.0 range. 

Most doctors commonly treat their hypothyroid patients with a daily dose of levothyroxine (levothyroxine coupons | what is levothyroxine?), a man-made version of the T4 thyroid hormone made by the body, some doctors recommend using both T4 and T3 as the treatment option.  

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RELATED: 5 things that can mess with your thyroid medication

“With thyroid medication, the dosing has to be just right,” Dr. Henderson says. “Too much or too little of the medication can lead to side effects that affect a patient’s health.”

In patients who are diagnosed as hyperthyroid, treatment can include antithyroid medications such as methimazole, that works to control the overactive thyroid. Some patients are given radioactive iodine, which is given in pill form to gradually and safely shrink the thyroid.

If you are experiencing signs of an under- or overactive thyroid, seek professional medical advice from your doctor or a specialist in endocrinology about these tests and treatments.

Tests for Thyroid Cancer

Thyroid cancer may be diagnosed after a person goes to a doctor because of symptoms, or it might be found during a routine physical exam or other tests. If there is a reason to suspect you might have thyroid cancer, your doctor will use one or more tests to confirm the diagnosis. If cancer is found, other tests might be done to find out more about the cancer.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have thyroid cancer, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had thyroid cancer (especially medullary thyroid cancer) or tumors called pheochromocytomas, it is important to tell your doctor, as you might be at high risk for this disease.

Your doctor will examine you to get more information about possible signs of thyroid cancer and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck.

Imaging tests

Imaging tests may be done for a number of reasons:

• To help find suspicious areas that might be cancer
• To learn how far cancer may have spread
• To help determine if treatment is working

People who have or may have thyroid cancer will get one or more of these tests.

Ultrasound

Ultrasound uses sound waves to create images of parts of your body. You are not exposed to radiation during this test.

This test can help determine if a thyroid nodule is solid or filled with fluid. (Solid nodules are more likely to be cancerous.) It can also be used to check the number and size of thyroid nodules as well as help determine if any nearby lymph nodes are enlarged because the thyroid cancer has spread.

For thyroid nodules that are too small to feel, this test can be used to guide a biopsy needle into the nodule to get a sample. Even when a nodule is large enough to feel, most doctors prefer to use ultrasound to guide the needle.

Radioiodine scan

Radioiodine scans can be used to help determine if someone with a lump in the neck might have thyroid cancer. They are also often used in people who have already been diagnosed with differentiated (papillary, follicular, or Hürthle cell) thyroid cancer to help show if it has spread. Because medullary thyroid cancer cells do not absorb iodine, radioiodine scans are not used for this cancer.

For this test, a small amount of radioactive iodine (called I-131) is swallowed (usually as a pill) or injected into a vein. Over time, the iodine is absorbed by the thyroid gland (or thyroid cells anywhere in the body). A special camera is used several hours later to see where the radioactivity is.

For a thyroid scan, the camera is placed in front of your neck to measure the amount of radiation in the gland. Abnormal areas of the thyroid that have less radioactivity than the surrounding tissue are called cold nodules, and areas that take up more radiation are called hot nodules. Hot nodules usually are not cancerous, but cold nodules can be benign or cancerous. Because both benign and cancerous nodules can appear cold, this test by itself can’t diagnose thyroid cancer.

After surgery for thyroid cancer, whole-body radioiodine scans are useful to look for possible spread throughout the body. These scans become even more sensitive if the entire thyroid gland has been removed by surgery because more of the radioactive iodine is picked up by any remaining thyroid cancer cells.

Radioiodine scans work best if patients have high blood levels of thyroid-stimulating hormone (TSH, or thyrotropin). For people whose thyroid has been removed, TSH levels can be increased by stopping thyroid hormone pills for a few weeks before the test. This leads to low thyroid hormone levels (hypothyroidism) and causes the pituitary gland to release more TSH, which in turn stimulates any thyroid cancer cells to take up the radioactive iodine. A downside of this is that it can cause the symptoms of hypothyroidism, including tiredness, depression, weight gain, sleepiness, constipation, muscle aches, and reduced concentration. One way to raise TSH levels without withholding thyroid hormone is to give an injectable form of thyrotropin (Thyrogen) before the scan.

Because any iodine already in the body can affect this test, people are usually told to avoid foods or medicines that contain iodine for a few days before the scan.

Radioactive iodine can also be used to treat differentiated thyroid cancer, but it is given in much higher doses. This type of treatment is described in Radioactive iodine (radioiodine) therapy.

Chest x-ray

If you have been diagnosed with thyroid cancer (especially follicular thyroid cancer), a plain x-ray of your chest may be done to see if cancer has spread to your lungs.

Computed tomography (CT) scan

The CT scan is an x-ray test that makes detailed cross-sectional images of your body. It can help determine the location and size of thyroid cancers and whether they have spread to nearby areas, although ultrasound is usually the test of choice. A CT scan can also be used to look for spread into distant organs such as the lungs.

One problem using CT scans is that the CT contrast dye contains iodine, which interferes with radioiodine scans. For this reason, many doctors prefer MRI scans for differentiated thyroid cancer.

Magnetic resonance imaging (MRI) scan

MRI scans use magnets instead of radiation to create detailed cross-sectional images of your body. MRI can be used to look for cancer in the thyroid, or cancer that has spread to nearby or distant parts of the body. But ultrasound is usually the first choice for looking at the thyroid. MRI can provide very detailed images of soft tissues such as the thyroid gland. MRI scans are also very helpful in looking at the brain and spinal cord.

Positron emission tomography (PET) scan

A PET scan can be very useful if your thyroid cancer is one that doesn’t take up radioactive iodine. In this situation, the PET scan may be able to tell whether the cancer has spread.

Biopsy

The actual diagnosis of thyroid cancer is made with a biopsy, in which cells from the suspicious area are removed and looked at in the lab.

If your doctor thinks a biopsy is needed, the simplest way to find out if a thyroid lump or nodule is cancerous is with a fine needle aspiration (FNA) of the thyroid nodule. This type of biopsy can sometimes be done in your doctor’s office or clinic.

Before the biopsy, local anesthesia (numbing medicine) may be injected into the skin over the nodule, but in most cases an anesthetic is not needed. Your doctor will place a thin, hollow needle directly into the nodule to aspirate (take out) some cells and a few drops of fluid into a syringe. The doctor usually repeats this 2 or 3 more times, taking samples from several areas of the nodule. The biopsy samples are then sent to a lab, where they are looked at to see if the cells look cancerous or benign.

Bleeding at the biopsy site is very rare except in people with bleeding disorders. Be sure to tell your doctor if you have problems with bleeding or are taking medicines that could affect bleeding, such as aspirin or blood thinners.

This test is generally done on all thyroid nodules that are big enough to be felt. This means that they are larger than about 1 centimeter (about 1/2 inch) across. Doctors often use ultrasound to see the thyroid during the biopsy, which helps make sure they are getting samples from the right areas. This is especially helpful for smaller nodules. FNA biopsies can also be used to get samples of swollen lymph nodes in the neck to see if they contain cancer.

Sometimes an FNA biopsy will need to be repeated because the samples didn’t contain enough cells. Most FNA biopsies will show that the thyroid nodule is benign. Rarely, the biopsy may come back as benign even though cancer is present. Cancer is clearly diagnosed in only about 1 of every 20 FNA biopsies.

Sometimes the test results first come back as “suspicious” or “of undetermined significance” if FNA findings don’t show for sure if the nodule is either benign or malignant. If this happens, the doctor may order lab tests on the sample (see below).

If the diagnosis is not clear after an FNA biopsy, you might need a more involved biopsy to get a better sample, particularly if the doctor has reason to think the nodule may be cancer. This might include a core biopsy using a larger needle, a surgical “open” biopsy to remove the nodule, or a lobectomy (removal of half of the thyroid gland). Surgical biopsies and lobectomies are done in an operating room while you are under general anesthesia (in a deep sleep). A lobectomy can also be the main treatment for some early cancers, although for many cancers the rest of the thyroid will need to be removed as well (during an operation called a completion thyroidectomy).

Lab tests of biopsy (or other) samples

In some cases, doctors might use molecular tests to look for specific gene changes in the cancer cells. This might be done for different reasons:

• If FNA biopsy results aren’t clear, the doctor might order lab tests on the samples to see if there are changes in the BRAF or RET/PTC genes. Finding one of these changes makes thyroid cancer much more likely.
• For some types of thyroid cancer, molecular tests might be done to see if the cancer cells have changes in certain genes (such as the BRAF, RET/PTC, or NTRK genes), which could mean that certain targeted drugs might be helpful in treating the cancer.

These tests can be done on tissue taken during a biopsy or surgery for thyroid cancer. If the biopsy sample is too small and all the molecular tests can’t be done, the testing may also be done on blood that is taken from a vein, just like a regular blood draw.

Blood tests

Blood tests are not used to find thyroid cancer. But they can help show if your thyroid is working normally, which may help the doctor decide what other tests may be needed. They can also be used to monitor certain cancers.

Thyroid-stimulating hormone (TSH)

Tests of blood levels of thyroid-stimulating hormone (TSH or thyrotropin) may be used to check the overall activity of your thyroid gland. Levels of TSH, which is made by the pituitary gland, may be high if the thyroid is not making enough hormones. This information can be used to help choose which imaging tests (such as ultrasound or radioiodine scans) to use to look at a thyroid nodule. The TSH level is usually normal in thyroid cancer.

T3 and T4 (thyroid hormones)

These are the main hormones made by the thyroid gland. Levels of these hormones may also be measured to get a sense of thyroid gland function. The T3 and T4 levels are usually normal in thyroid cancer.

Thyroglobulin

Thyroglobulin is a protein made by the thyroid gland. Measuring the thyroglobulin level in the blood can’t be used to diagnose thyroid cancer, but it can be helpful after treatment. A common way to treat thyroid cancer is to remove most of the thyroid by surgery and then use radioactive iodine to destroy any remaining thyroid cells. These treatments should lead to a very low level of thyroglobulin in the blood within several weeks. If it is not low, this might mean that there are still thyroid cancer cells in the body. If the level rises again after being low, it is a sign that the cancer could be coming back.

Calcitonin

Calcitonin is a hormone that helps control how the body uses calcium. It is made by C cells in the thyroid, the cells that can develop into medullary thyroid cancer (MTC). If MTC is suspected or if you have a family history of the disease, blood tests of calcitonin levels can help look for MTC. This test is also used to look for the possible recurrence of MTC after treatment. Because calcitonin can affect blood calcium levels, these may be checked as well.

Carcinoembryonic antigen (CEA)

People with MTC often have high blood levels of a protein called carcinoembryonic antigen (CEA). Tests for CEA can help monitor this cancer.

Other blood tests

You might have other blood tests as well. For example, if you are scheduled for surgery, tests will be done to check your blood cell counts, to look for bleeding disorders, and to check your liver and kidney function.

Medullary thyroid carcinoma (MTC) can be caused by a genetic syndrome that also causes a tumor called pheochromocytoma. Pheochromocytomas can cause problems during surgery if the patient is under anesthesia (in a deep sleep). This is why patients with MTC who will have surgery are often tested to see if they have a pheochromocytoma as well. This can mean blood tests for epinephrine (adrenaline) and a related hormone called norepinephrine, and/or urine tests for their breakdown products (called metanephrines).

Vocal cord exam (laryngoscopy)

Thyroid tumors can sometimes affect the vocal cords. If you are going to have surgery to treat thyroid cancer, a procedure called a laryngoscopy will probably be done first to see if the vocal cords are moving normally. For this exam, the doctor looks down the throat at the larynx (voice box) with special mirrors or with a laryngoscope, a thin tube with a light and a lens on the end for viewing.

Ito Clinic

Survey

For the diagnosis of Basedow’s disease, a study of symptoms, a blood test, and in some cases a radioisotope examination is carried out. In addition, an ultrasound scan is performed to exclude concomitant diseases. High thyroid hormone levels put stress on the heart, so a chest x-ray and ECG may be done.

(1) Blood test

There is an increase in the level of thyroid hormones (FT3 、 FT4, a low level of thyroid stimulating hormone (TSH), a high level of antibodies to TSH receptors).

(2) Radiosotope survey

If the TRAb value in the blood test is normal or slightly increased, it is necessary to establish a diagnosis using this examination. Since radioactive iodine and technetium have the ability to be captured by the thyroid gland, the level of their accumulation increases with the excessive production of hormones, which occurs with Graves’ disease.

(3) Ultrasound examination

The size of the thyroid gland and the presence of lumps are checked.

(4) ECG, chest X-ray

Check for arrhythmias and heart failure, which can occur in a state of hyperthyroidism.

Explanatory Notes on Radioisotope Survey

• For examinations using radioactive iodine, it is necessary to refrain from eating foods rich in iodine for 7 days before the appointed examination date.
• Since radioactive substances are used, this examination is not prescribed during pregnancy. For nursing mothers, the survey uses isotope nuclei with a short half-life * (123I), but breastfeeding must be stopped for 3 days, including the day of the survey.
  More detailed explanations are provided during the survey.
  ※ Half-life: the time by which the amount of radioactive substances in the body will be reduced by 2 times

How do you know if your thyroid is working properly?

How you can find out if your thyroid gland is working properly, says Una Gailisha, endocrinologist, head of the Outpatient Department of the Endocrinology Center, Clinical University Hospital. Paula Stradinya.

WATCH YOURSELF

Have you had any recent symptoms that could indicate an underactive thyroid gland or hypothyroidism?

• EXTREMELY FATIGUE, SLEEPY, which you may be attributing to a lot of work, lack of sleep, or other reasons. Young mothers often experience constant drowsiness, so it is very difficult for yourself to understand whether everything is in order in such a situation. If the feeling of fatigue persists and drowsiness persists, see your family doctor.These symptoms can occur for several reasons, but if they are related to thyroid problems, a routine blood test will show.
• REDUCED HEART BEAT, which can be overlooked.
• WEIGHT GAIN, slower metabolism, constipation, which you may explain by eating too much or moving too little lately.
• DRY SKIN, FRAGILE HAIR, which many complain about in the spring, but for women in the postpartum period this is the norm.
• CHILD, slow speech, sluggishness, memory impairment, which is often attributed to emotional and physical fatigue.
• INCREASED CHOLESTEROL LEVEL, which may not be noticed, since it does not manifest itself for a long time.

Much less common, but there are also thyroid disorders when it works too hard and produces too much thyroid hormones. This condition is called hyperthyroidism. In this case, heart palpitations are observed, intestinal activity is too active, weight loss, sleep disturbance, nervousness, tearfulness, mood swings, a feeling of heat, sweating, trembling in the hands.

Thyroid disorders are more common in women, usually after age 40, most often after age 60.

DO TESTS

If your doctor advises you, be sure to do tests that will show the level of thyroid hormone in the blood. In some situations, thyroid antibodies are also detected when an autoimmune disorder is suspected. If tests show antibodies, but hormone levels are normal, treatment is usually not started, but regular tests are needed henceforth.Since in such a situation the level of TSH (thyroid-stimulating hormone of the pituitary gland) must be checked at least once every six months, it is recommended to evaluate changes in test results over a longer period of time. maniveselibasdati.lv offers the opportunity to conveniently monitor the changes in your test results. If you need treatment, the ability to compare test results will be especially important.

FOLLOW YOUR ANALYSIS

If the tests show that the thyroid gland is not secreting enough of an important thyroid hormone – thyroxine (the thyroid gland produces two hormones in total), the endocrinologist will assess the situation and you may need to drink the artificially synthesized hormone levothyroxine able to replace the missing thyroxine.No other treatment is required. Monitoring by a doctor will be necessary – at first more often, then once a year.

If unpleasant sensations occur when using the natural hormone substitute levothyroxine, this is usually associated with an incorrect dose of the drug. This happens if something has changed in the body or, for any reason, the drug has been changed. In such a situation, consult your doctor immediately. Important: if you do not take the natural substitute for the thyroxine hormone levothyroxine in hypothyroidism, serious consequences can occur.

If the thyroid gland is working too actively, treatment is necessary, which usually helps very quickly. Within a few weeks or months, the thyroid hormones in the blood stabilize, but the medication should be taken longer under the supervision of a doctor (usually a year or two). This is necessary so that the disease does not recur.

What do the tests say? – Medical and Diagnostic Center Neuron (Taganrog)

Glucose and carbohydrate metabolites
Glucose (gluc, bgl)	3.33-6.10 mmol / L	The main indicator of carbohydrate metabolism.Increased glucose levels are observed in diabetes mellitus, endocrine disorders, chronic liver and kidney diseases, pancreatitis, cerebral hemorrhage, myocardial infarction. The glucose content rises after strong emotions, stress and smoking, with improper diet. A low glucose level may indicate a tumor of the pancreas, liver, adrenal gland, stomach, hypothyroidism, as well as poisoning with arsenic, alcohol
Fructosamine	205-285 μmol / l	Fructosamine shows the average blood glucose level 2-3 weeks before measurement. It is an effective method for diagnosing diabetes mellitus and monitoring the effectiveness of treatment
Glycated hemoglobin (HbA1c)	3.5-7.0 μmol / g	An increase in the level of glycated hemoglobin occurs with an excess of glucose in the blood, which occurs in diabetes mellitus, a decrease – with hypoglycemia, hemolytic anemia, bleeding and blood transfusion
Lactic acid (lactate)	0.55-1.7 mmol / L	Lactic and pyruvic acids are indicators of carbohydrate metabolism, reflecting the degree of muscle oxygen saturation.The analysis is prescribed to assess impaired blood circulation and tissue oxygen supply (tissue hypoxia), with resuscitation measures to assess acidosis, with heart failure, diabetes mellitus
Pyruvic acid (pyruvate, PVC)	0.05-0.114 mmol / L
Proteins and amino acids
total protein	65-85 g / l	Total protein is the total concentration of albumin and globulins in the blood serum. The indicator is used to diagnose diseases of the liver, kidneys, oncological diseases, malnutrition and extensive burns
Albumin	35-50 g / l	Basic blood protein. The albumin content is used to diagnose liver and kidney diseases, rheumatic and oncological diseases
C-reactive protein (CRP)	Up to 8 mg / l	An increase in CRP in the blood is observed in rheumatic diseases, gastrointestinal diseases, cancer, myocardial infarction, tuberculosis, meningitis, postoperative complications
Myoglobin men women	19–92 μg / L 12–76 μg / L	Protein found in the heart and skeletal muscles.An increased level of myoglobin is observed with myocardial infarction, renal failure, as well as injuries, burns, convulsions. The growth of myoglobin is possible with muscle overexertion. Decreased myoglobin indicates polymyositis, rheumatoid arthritis, myasthenia gravis
Transferrin	2–4 g / l	Plasma protein, the main iron carrier. An increased level of transferrin is a symptom of iron deficiency, a decreased level indicates a chronic inflammatory process, liver cirrhosis, malignant tumors
Rheumatoid factor	Up to 10 U / ml	Proteins, autoantibodies to class G immunoglobulins.An increase in rheumatoid factor is a sign of such diseases as rheumatoid arthritis, liver cirrhosis, malignant neoplasms, tuberculosis, syphilis, rubella, measles, influenza, etc. However, an increase in rheumatoid factor alone is not a sufficient basis for a diagnosis.
Protein fractions: albumin α1-globulins α2-globulins β-globulins γ-globulins	56–76% 2–7% 4–12% 3–12% 8–18%	Protein fractions – the ratio of various protein groups in the total blood protein.The reason for the increase in the concentration of α-globulins is inflammatory processes. An increase in the concentration of β-globulins is observed in iron deficiency anemia, lipid metabolism disorders, estrogen intake, and pregnancy. The content of γ-globulins increases in acute inflammation, chronic hepatitis and liver cirrhosis, tuberculosis, bronchial asthma, ischemic heart disease. A decrease is noted with long-term chronic infections, treatment with cytostatics, radiation, lack of protein in food
Low molecular weight nitrogenous substances
Uric acid (URAC) men women	0.24-0.50 mmol / L 0.16-0.40 mmol / L	Uric acid removes excess nitrogen from the body.Elevated uric acid levels, or hyperuricemia, are the main symptom of gout. Hyperuricemia is observed in some oncohematological diseases, acute infections, diseases of the kidneys, liver and biliary tract, diabetes mellitus, chronic eczema, etc. The level of uric acid in the blood rises after exercise, alcohol intake, prolonged fasting, a diet rich in fats and carbohydrates. A decrease in the level of uric acid is characteristic of some congenital abnormalities. Possibly with a diet poor in nucleic acids
Urea	Up to 8.3 mmol / L	Main protein breakdown product.An increased level of urea in the blood is observed in acute or chronic diseases of the kidneys, as well as in heart failure, bleeding, tumors, thyrotoxicosis, decreased – in disorders of the liver, digestive system
Creatinine (Cr) Men Women	0.044-0.100 mmol / L 0.044-0.088 mmol / L	Elevated blood creatinine is characteristic of renal failure, muscle damage, hyperthyroidism
Pigments
Total bilirubin (Bil)	8.5-20.5 mmol / L	Yellow-red pigment in bile, a breakdown product of hemoglobin and some other blood components.An increase in the level of bilirubin in the blood is most often a symptom of certain liver diseases
Direct bilirubin (linked) (DBil)	0. 9-4.3 mmol / L
Lipids
Triglycerides (TG)	0.55-1.65 mmol / L	Blood fats. Elevated triglyceride levels in obesity, decompensated diabetes mellitus, hypothyroidism, kidney disease
Total cholesterol (cholesterol, cholesterol, hol)	3-6 mmol / L	The most important indicator of lipid metabolism.Elevated cholesterol levels contribute to the development of vascular atherosclerosis and related diseases of the cardiovascular system (coronary artery disease, myocardial infarction)
High-density lipoprotein cholesterol (HDL) men women	0.7-1.73 mmol / L 0.86-2.28 mmol / L	The so-called good cholesterol. A decrease in its level below normal is a risk factor for the development of vascular atherosclerosis, coronary heart disease, myocardial infarction
Low-density lipoprotein cholesterol (LDL, LDL) men women	2. 25-4.82 mmol / L 1.92-4.51 mmol / L	The so-called bad cholesterol.It is LDL that accumulates on the walls of blood vessels, forming plaques. The risk of developing atherosclerosis and associated diseases is more closely associated with LDL than with total cholesterol
Apolipoprotein A1 men women	0.95-1.86 g / l 1.01-2.23 g / l	Used for risk assessment, diagnosis, prognosis of atherosclerosis and associated diseases of the cardiovascular system (coronary artery disease, myocardial infarction)
Apolipoprotein B men women	0.7-1.2 g / l 0.65-1.05 g / l
Lipoprotein (a) (Lp (a))	20-30 mg / dL
Enzymes
Aspartate aminotransferase (AST, ASAT) men women	Up to 41 U / L Up to 31 U / L	As a rule, the activity of two aminotransferases, ALT and AST, is determined simultaneously. They are used to diagnose diseases of the myocardium, liver and muscular disorders. Increased activity of enzymes in the blood indicates myocardial infarction, angina pectoris, acute hepatitis, cirrhosis, liver cancer, trauma. Low levels are possible with severe liver damage and vitamin B6 deficiency
Alanine aminotransferase (ALT, ALT) men women	Up to 41 U / L Up to 31 U / L
Alpha-amylase (α-amylase)	28-100 U / L	Enzyme of the pancreas and salivary glands.With the help of this analysis, diseases of the pancreas, salivary glands are diagnosed, the causes of abdominal pain are determined. Enzyme activity is increased in diseases of the pancreas (pancreatitis, cyst, tumor) and biliary tract, parotitis, acute peritonitis, diabetes mellitus, renal failure
Amylase pancreatic	Up to 50 U / l	Pancreatic enzyme. Above normal activity is observed in diseases of the pancreas, gastric ulcer, renal failure
Gamma-glutamyltransferase (GGT, gamma-HT): men women	Up to 49 U / l; Up to 32 U / l	Contained in the liver, kidneys, pancreas. Increased GGT activity indicates diseases of the liver, pancreas, kidneys, gallstones, hyperthyroidism
Creatine kinase (CK) men women	Up to 190 U / L Up to 167 U / L	Contained in the muscles, including the heart – KK-MB, and the brain. Above normal activity is a sign of diseases of the cardiovascular and central nervous system, as well as some malignant tumors
Creatine kinase MB (KK-MB)	Up to 24 U / L
Lipase	Up to 190 U / ml	An enzyme that breaks down triglycerides.An increase in lipase activity is observed in many diseases: diseases and tumors of the pancreas, gallbladder, intestinal obstruction, peritonitis, heart attack, fat metabolism disorders, renal failure , etc.
Sorbitol dehydrogenase (SDH)	Up to 1.3 U / l
Alkaline phosphatase (ALP) men women	270 U / L 240 U / L	Most of all alkaline phosphatase is found in bone tissue, intestinal mucosa. Its increased level may indicate tumors of the bone tissue, biliary tract, liver diseases, myeloma, lymphogranulomatosis
Cholinesterase	5300-12900 U / L	An enzyme produced in the liver and found in nerve tissues and skeletal muscles. A low level of cholinesterase can be a sign of cirrhosis and other liver diseases, cancer, myocardial infarction, its increased level is observed in arterial hypertension, nephrosis, diabetes mellitus, obesity, tetanus, mental illness
Vitamins and minerals
Ascorbic acid (C) in the blood	40-114 μmol / L
Thiamine (B1) in blood plasma	30-45 nmol / L
Riboflavin (B2) in blood serum	13.65-40.95 nmol / L
Pyridoxine (B6) in the blood	590 nmol / L
Nicotinic acid (PP) in the blood	2. 92 μmol / l
Retinol (A) in the blood	0.552-2.45 μmol / L
Tocopherol (E) in the blood	0.96-1.2 μg / dL
Cobalamin (B12) in the blood	0.07-0.2 nmol / L
Serum folic acid	3-17 ng / ml
Iron men women	11.64-30.43 μmol / L 8.95-30.43 μmol / L
Calcium	2.15-2.50 mmol / L
Potassium	3.5-5.5 mmol / L
Sodium	136-145 mmol / L
Manganese	0.65-1.05 mmol / L
Chlorine	98-107 mmol / L
Phosphorus	0.87-1.45 mmol / L

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