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Diagnosis Of Hypothyroidism
By peace | March 19, 2007
A diagnosis of hypothyroidism can be suspected in patients with fatigue, cold intolerance, constipation, and dry, flaky skin. A blood test is needed to confirm the diagnosis.
After you have discussed your symptoms with your doctor and hypothyroidism is suspected, a TSH (thyroid stimulating hormone) test, and possibly others, may be ordered.
When a physician receives a laboratory report, the report slip will state normal ranges for TSH and possibly for other specific hormones. The TSH measurement is of fundamental importance since it reflects the sufficiency of the brain’s supply of thyroid hormone.
A normal range TSH indicates that the hypothalamus senses a normal amount of thyroid hormone and is stimulating the thyroid to continue making and releasing thyroid hormone at the same rate. An elevated TSH level signals the central nervous system’s insufficiency of thyroid hormone, while a reduced TSH level indicates that the central nervous system senses increased amounts of thyroid hormone.
There are many blood tests used to diagnose and monitor patients with thyroid conditions. No single lab test is considered 100% accurate in determining thyroid disease, but a combination of two or more tests may help to determine if there is a problem with the thyroid gland or the pituitary gland. The Thyroid Stimulating Hormone (TSH) and Free Thyroxine Index (FT4I) are the two blood tests most commonly used to diagnose patients with hypothyroidism and to monitor their progress while using a thyroid medication.
In the typical person with an under-active thyroid gland, the blood level of T4 (the main thyroid hormone) will be low, while the TSH level will be high. This means that the thyroid is not making enough hormone and the pituitary recognizes it and is responding appropriately by making more Thyroid Stimulating Hormone (TSH) in an attempt to force more hormone production out of the thyroid. In the more rare case of hypothyroidism due to pituitary failure, the thyroid hormone T4 will be low, but the TSH level will also be low. The thyroid is behaving “appropriately” under these conditions because it can only make hormone in response to TSH signals from the pituitary. Since the pituitary is not making enough TSH, then the thyroid will never make enough T4. The real question in this situation is what is wrong with the pituitary? But in the typical and most common form of hypothyroidism, the main thyroid hormone T4 is low, and the TSH level is high.
Although the majority of individuals with hypothyroidism will be easy to diagnose with these simple blood tests, many millions will have this disease in mild to moderate forms which are more difficult to diagnose. The solution for these people is more complex and this is due to several factors. First we must realize that not all patients with hypothyroidism are the same. There are many degrees of this disease from very severe to very mild. Additionally, and very importantly, we cannot always predict just how bad (or good) an individual patient will feel just by examining his/her thyroid hormone levels. In other words, some patients with very “mild” deviations in their thyroid laboratory test results will feel just fine while others will be quite symptomatic. The degree of thyroid hormone abnormalities often, but NOT ALWAYS will correlate with the degree of symptoms. It is important for both you and your physician to keep this in mind since the goal is not necessarily to make the lab tests go into the normal range, but to make you feel better as well! We must also keep in mind that even the “normal” thyroid hormone levels in the blood have a fairly large range, so even if a patient is in the “normal” range, it may not be the normal level for them.
For the majority of patients with hypothyroidism, taking some form of thyroid hormone replacement (synthetic or natural, pill or liquid, etc) will make the “thyroid function tests” return to the normal range, AND, this is accompanied by a general improvement in symptoms making the patient feel better. This does not happen to all individuals, however, and for these patients it is very important to find an endocrinologist who will listen and be sympathetic.
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