Hypothyroidism is evaluated and diagnosed by a physician, your primary care doctor or an endocrinologist. Many factors, signs, and symptoms are taken into consideration when hypothyroidism is diagnosed.
How is hypothyroidism diagnosed?
A diagnosis is reached after a thorough review of the patient’s symptoms, family and medical history, risk factors, physical examination, and effectively, a blood test. There are many types of blood tests, which the most authoritative one is known as the TSH test (thyroid-stimulating hormone). However, in some cases, healthcare professionals may refer patients to receive a total T4 or T4, free T4 index, or even thyroxine to aid in the diagnosis.
Why Hypothyroidism is not Diagnosed on Symptoms Alone
Lots of the signs of hypothyroidism are fairly frequent complaints found in people with a normally functioning thyroid gland, so it can be tough to decipher if the symptoms are linked to the thyroid gland. Among the best ways to find out whether your symptoms might be related to a thyroid condition is to consider how long you have been experiencing them. For example, have you felt cold when others were warm? Did you just begin to notice decreased energy? It might be associated with a thyroid issue if you are beginning to notice new signs and symptoms. But only a specialized healthcare professional (eg, endocrinologist) can diagnose a thyroid issue.
Medical and Family History
It is important to give your doctor as many details as you can about your own personal medical history, in addition to family history (eg, mom had eczema). Make sure you talk about:
- Your overall state of health, particularly any changes you’ve noticed on your general well-being.
- Your family’s health history, especially if a near relative was diagnosed with hypothyroidism (or any other thyroid-related issues).
- Whether you’ve ever had thyroid surgery, or radiation into your own neck to deal with cancer.
- Any medications you could be taking that could cause hypothyroidism (eg, amiodarone, lithiumion, interferon alpha, interlukin-2, or even earlier chemotherapy).
Your doctor will perform a thorough examination and look for physical signs of hypothyroidism, such as:
- Proof of dry skin
- Swelling around the eyes and legs
- Slower reflexes
- Slower heartbeat
Hypothyroidism can be diagnosed using different blood tests such as:
A thyroid-stimulating hormone or TSH is a blood test that measures the amount of T4 (thyroxine) that the thyroid gland has been indicated to create. In case you have an abnormally significant degree of TSH, it might indicate you have hypothyroidism.
T4 (thyroxine) Evaluation
The thyroid gland produces T4 (thyroxine). The T4 along with the free T4 index are blood tests which, in conjunction with a TSH test, can let your doctor know your thyroid is functioning.
The adrenal gland tells the thyroid how much thyroxine to produce through signaling by TSH. There are cells from the pituitary gland that determine what your body’s “set point” is. Your collection point is that the normal array of TSH as determined by your thyroid gland that your body needs.
As blood flows throughout the pituitary gland, the very same cells detect if there are sufficient T4 levels in the body. The pituitary sends the amount of TSH into the thyroid to maintain levels in the standard range in case your T4 amount is sufficient. If your level is too low, the pituitary sends TSH outside telling the thyroid to make more T4. In case your T4 level is too high, the pituitary sends TSH that is less out, then 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 array (there may be slight variation depending on the laboratory), and people that have a normally functioning thyroid gland usually fall within this range.
- If TSH measures > 4.0 mU/L, a second evaluation (T4) is done to verify the results. TSH p4.0/mU/L using a very low T4 level indicates hypothyroidism.
- If your TSH is > 4.0 mU/L along with your T4 level is normal, this may prompt your physician to test your serum anti-thyroid peroxidase (anti-TPO) antibodies. When these antibodies are found, it may signal an autoimmune thyroid disease, which is a risk factor for developing hypothyroidism. In case you have those anti-bodies, your doctor will perform and TSH test at least once each year.
An easy way to remember how the thyroid works is to think about supply and demand. The TSH rises as the T4 level drops. The TSH drops as the T4 level rises. But not everyone with hypothyroidism has elevated levels of TSH. If the pituitary is not working properly, perhaps it does not send out regular TSH levels. But if the quantity of TSH is off, the thyroid will not make the perfect quantity of T4. This is rare and is called secondary or central hypothyroidism.
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By Dr. Alex Jimenez
Additional Topics: Wellness
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