Other Thyroid Lab Patterns Which May Result In Hypothyroid Symptoms
Are your lab tests slightly different than what we discussed here?
Ive included a list of various other lab tests below and how they may present in terms of your symptoms:
- High TSH, normal T4, normal T3 = This is the pattern weve been discussing in this post and will usually present with hypothyroid symptoms.
- High TSH, normal T4, low T3 = This pattern may be an indication that you are having issues with thyroid conversion and most often presents with hypothyroid symptoms.
- Normal TSH, low T4, low T3 = This pattern is usually what is seen in those with chronic illness and in those who are taking multiple medications. If you have this pattern you will most likely be symptomatic.
- Normal TSH, normal T4, low T3 = This pattern may be consistent with low T3 syndrome or euthyroid sick syndrome and may present with hypothyroid symptoms but not always.
- Normal TSH, normal T4, normal T3, positive thyroid antibodies = This is a classic presentation for early Hashimotos, and most patients with this pattern will be symptomatic. If you are symptomatic this is a valid reason to consider a trial of thyroid medication even though your lab tests are normal.
- Normal TSH, normal T4, normal T3, high reverse T3 = This pattern is most often seen immediately after calorie restriction or after dieting and weight loss. This pattern usually indicates an adaptive response from your body and one that shows your metabolism will be slowing over the next few months .
High Tsh: Causes Symptoms And How It Affects T3 And T4
High level of TSH usually indicates that you have an underactive thyroid and that it doesnt produce enough thyroid hormones. Thyroid-stimulating hormone directly affects how much T3 and T4 hormones the thyroid secretes. If there is not enough T3 and T4 in the blood, your pituitary gland will increase levels of TSH as a result. Elevated TSH levels usually cause symptoms of hypothyroidism like fatigue, constipation, joint pain, a puffy face, or heavy menstrual bleeding .
The reasons for levels of TSH being higher than the normal range can include dysfunction of your thyroid, an autoimmune disease, or a side effect of some medications. Sometimes pregnancy can cause T3 and T4 to increase which will affect levels of TSH. If you are showing signs of an underactive thyroid and your TSH levels are too high, doctors will usually arrange for blood tests to check for levels of free T3 and T4.
To treat symptoms of high TSH, doctors usually prescribe thyroxine to lower TSH levels and treat hypothyroidism. Blood tests are then regularly taken to monitor levels of TSH and regulate thyroid therapy.
In this article, you will find out about the important role thyroid hormones play in your general health. I will also examine what medical literature says about how high TSH levels affect the thyroid hormones T3 and T4 . This will help you to spot the signs and symptoms of an underactive thyroid.
What Is Thyroid Medication
Thyroid Hormone TreatmentLevothyroxine is the standard of care in thyroid hormone replacement therapy and treatment of hypothyroidism. Levothyroxine 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 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 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.
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Too Much Thyroid Hormone Medicine
Some people who take thyroid hormone medicine for hypothyroidism may take too much. If you take thyroid hormone medicine, see your doctor at least once a year to have your thyroid hormone levels checked. You may need to adjust your dose if your doctor finds your thyroid hormone level is too high.
Some other medicines may also interact with thyroid hormone medicine and raise hormone levels. If you take thyroid hormone medicine, ask your doctor about interactions when starting new medicines.
How Is Resistance To Thyroid Hormone Diagnosed
The first step is to do a simple blood test called a thyroid function test. This usually shows high levels of thyroid hormones along with a normal or slightly high level of thyroid stimulating hormone. This abnormal test is also seen in those patients with thyroid hormone resistance and no symptoms. This pattern of results can also be seen in several other situations. These include incorrect laboratory measurement of thyroid hormones due to interfering antibodies or abnormal thyroid hormone binding proteins in the blood or a pituitary condition called a TSH-secreting pituitary adenoma.
The laboratory will check the test results carefully to exclude interference with measurement or a problem with circulating binding proteins. A TSH-secreting pituitary adenoma can be excluded by doing a blood test called alpha subunit and a magnetic resonance imagining scan of the brain. A test called a thyrotropin-releasing hormone test is also usually carried out to differentiate resistance to thyroid hormone from TSH-secreting pituitary adenoma. This is done in hospital but only takes a morning. It involves taking an initial blood sample followed by an injection of thyrotropin-releasing hormone, then further blood tests over an hour. Blood will also be taken to look for abnormalities of the thyroid hormone beta receptor by genetic testing. Family members may also be asked to have thyrotropin-releasing hormone checked.
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Why Your Thyroid Hormone Levels May Be Fluctuating
Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.
If you have thyroid disease, you may experience some fluctuations in your thyroid hormone levels from time to time. These fluctuations can occur as your thyroid disease progresses.
But other factors, such as hormonal changes and medication variations, or significant weight gain or loss, can alter your thyroid hormone levels as well in some cases progression of a thyroid condition may be responsible. These hormonal fluctuations can produce a variety of symptoms.
This article explains what things might contribute to thyroid hormone fluctuations and what you can do about it.
Verywell / Brianna Gilmartin
What Is Postpartum Thyroiditis
Postpartum thyroiditis, or inflammation of the thyroid after giving birth, affects 10% of women.3 It often goes undiagnosed because symptoms are much like the baby blues that may follow delivery. Women with postpartum thyroiditis may feel very tired and moody.
Postpartum thyroiditis typically happens in two phases, though not everyone with the condition goes through both phases:4
- The first phase starts 1 to 4 months after giving birth and typically last 1 to 2 months. In this phase, you may have signs and symptoms of hyperthyroidism because the damaged thyroid leaks thyroid hormones out into the bloodstream.
- The second phase starts about 4 to 8 months after delivery and lasts 6 to 12 months. In this phase, you may have signs and symptoms of hypothyroidism because the thyroid has lost most of its hormones or because the immune attack is over and the thyroid may recover later.
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What Are Thyroid Hormones
Thyroid hormones are secreted by the thyroid gland secretes. Three thyroid hormones exist, but T4 and T3 are the most prominent.
Heres what each thyroid hormone does within the body:
- T4 is the primary hormone produced by the thyroid gland. Also known as tetraiodothyronine, T4 is inactive. Its primary function is to become active T3.
- T3 is the active form of T4. It regulates your metabolism and other vital functions. 20% of it is made in the thyroid, while most T3 is produced in other organs from T4.
- Calcitonin is the less prominent hormone that your thyroid gland produces. It helps regulate calcium and phosphate levels in your blood, both of which contribute to healthy bones.
Thyroid Disease And Insulin
Thyroid disease can also interfere with the production of insulin. Insulin makes it possible for cells to use glucose for energy. This lowers blood sugar.
Because hyperthyroidism increases metabolism, insulin is eliminated from the body faster than usual. This can lead to high blood sugar and an increased risk of type 2 diabetes. People with diabetes who need insulin shots may also find themselves needing higher doses.
On the flip side, hypothyroidism decreases metabolism. When this happens, insulin can linger, causing blood sugar to drop . For people on diabetes medications, the drop can sometimes be extreme, leading to dizziness, disorientation, and unconsciousness.
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Cysts Or Nodules In The Thyroid Gland
Nodules or cysts in the thyroid gland can affect its function and cause too little T4 and T3 to be produced. This has the effect of increased secretion of TSH which can cause levels to increase above 4.0 mIU/L.
The journal Medical Clinics of North America reports that testing for high levels of TSH is essential in monitoring thyroid nodules. Blood serum tests for TSH are usually combined with ultrasound scans to check for cancerous cells in the thyroid. Doctors say that constant monitoring is essential because low T4 in the blood along with normal or high TSH can increase the risk that nodules become malignant.16
How Long Does It Take To Treat Hyperthyroidism
The amount of time it takes to treat hyperthyroidism can change depending on what caused it. If your healthcare provider treats your condition with antithyroid medications your hormone levels should drop to a healthy level in about six to 12 weeks.
Your healthcare provider may decide to give you high doses of iodine drops , which would normalize thyroid levels in seven to 10 days. However, this is a short-term solution, and you’ll most likely need a more permanent solution like surgery. Though you may need to wait to be scheduled for thyroid surgery , this is a very effective and definitive way to treat hyperthyroidism. Its considered a permanent solution for hyperthyroidism.
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No One Size Fits All Approach
For most people with hypothyroidism, taking some form of thyroid hormone replacement will make thyroid function tests return to the normal range andproduce general improvement in symptoms.
But this simple approach does not hold true for everybody. Sometimes the correct dosage is a bit difficult to pinpoint and therefore you may need an exam and blood tests more frequently. Also, some people dont do well on some thyroid medications but will feel better with other options, such as .
Its important to find an endocrinologist who is willing to listen to you and to spend the time you need to explore different dosages and to consider other types of medications .
Remember, thyroid tests have a wide normal range. You want to work with a doctor who helps make you feel better, not just make your labs better.
How Is Resistance To Thyroid Hormone Treated
Many people with resistance to thyroid hormones have abnormal blood tests but no symptoms. They do not require any treatment. Children will need extra assessment to check they are growing and developing normally.
Patients who have symptoms of hypothyroidism are treated with levothyroxine tablets a synthetic version of thyroxine given to replace the sub-optimal level of thyroid hormone. Once the levothyroxine is absorbed in the bloodstream, it is converted to triiodothyronine, which is the active hormone that the tissues and cells require. Combination treatment with levothyroxine and triiodothyronine is not recommended because there is no clear evidence in research studies that it is more beneficial than levothyroxine alone. The treatment needs to be monitored with regular blood tests.
Drugs to slow the heart rate may be prescribed for patients who have a fast heart beat because of the high levels of thyroid hormones.
Sometimes a drug called TRIAC, which mimics the action of thyroid hormone in specific tissues , can be used to treat patients with resistance to thyroid hormone.
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Normal T3 And T4 Levels
What are normal T3 and T4 levels when your thyroid is functioning properly?
Dr. Jayita Poduval who specializes in neck and throat disorders says that normal free T3 levels are 125 250 ng/dL in children and 80 200 ng/dL in adults.21
The reference range for free T4 is 0.7 1 ng/dL in adults and 0.8 2 ng/dL in children and adolescents.22
What Are The Longer
Rarely, the very high levels of thyroid hormones can cause growth and related problems in an unborn child and this requires careful monitoring. Women who have resistance to thyroid hormones should speak to their specialist before becoming pregnant.
Resistance to thyroid hormone comes with an increased likelihood of thinning of the bones so monitoring of bone density is carried out in adult patients.
There is no evidence that any specific dietary modification can help in resistance to thyroid hormone.
Are there patient support groups for people with resistance to thyroid hormone?
British Thyroid Foundation may be able to provide advice and support to patients and their families dealing with resistance to thyroid hormone.
Last reviewed: Mar 2018
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Is It Possible To Have A High Tsh And Normal T3 & T4
In some cases, the serum T3 and T4 levels can be relatively preserved despite elevation in TSH levels.
Some people assume this is a reactive response but you must realize that serum concentrations of thyroid hormone do not necessarily reflect tissue levels of thyroid hormone.
Whats important is not the serum concentration but the amount of thyroid hormone that enters the cells and activates genetic transcription.
TSH reflects the tissue concentration of the pituitary gland, but it does not reflect the concentration of say your liver.
You can learn more about using the SHBG for this purpose in this guide.
Just realize for now that in order to get a complete picture of thyroid function in the body, you should evaluate TSH in the presence of other thyroid lab studies such as free T3, total T3, free T4, sex hormone-binding globulin, and of course thyroid antibodies.
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Hyperthyroidism Signs And Symptoms
- Fine, brittle hair
- Changes in your menstrual cycle
If youâre an older adult, youâre more likely to have subtle symptoms like a faster heart rate or being more sensitive to warm temperatures. Or you could just feel more tired after everyday activities.
Certain medicines can mask the signs of hyperthyroidism. If you take beta-blockers to treat high blood pressure or another condition, you might not know you have it. Be sure your doctor knows about all the medications you take.
When you first get hyperthyroidism, you may feel energetic. This is because your metabolism is sped up. But over time, this increase in your metabolism can break your body down and cause you to feel tired.
Usually, hyperthyroidism develops slowly. If youâre young when you get it, the symptoms might come on suddenly.
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If You Suspect That A Medication Is Causing Your High Tsh
If you suspect that a medication is contributing to your high TSH and low thyroid function, I encourage you to do two things.
- Watch my video that explains medications that alter thyroid levels leading to symptoms of being Thyroid overmedicated
- Have a serious conversation with your endocrinologist or your prescribing doctor regarding these drugs and the effects they are having on your thyroid levels.
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What Are Other Lab Tests Used To Assess Thyroid Function
The most common way to check for autoimmune thyroiditis is to test for the presence of thyroperoxidase antibodies . Like TgAB, your immune system also creates TPO antibodies to attack your thyroid gland.
Thyroid peroxidase is a key enzyme involved in the production of thyroid hormone. Specifically, the TPO enzyme facilitates the chemical reaction where iodine bonds to the thyroglobulin protein. This critical step helps to create thyroxine .
When your immune system sends out antibodies to disrupt this chemical reaction, it prevents thyroid hormones from being made. Over time, it can lead to chronic inflammation and eventual hypothyroidism and organ failure.
The American Thyroid Association recommends your doctor test for either TPO antibodies or TgAB in patients with hypothyroidism because autoimmune disease is most often the culprit.
However, the ATA specifies that the TPO antibody test is more sensitive and specific than the TgAB test for autoimmune thyroid disease like Hashimoto’s thyroiditis.
Thyroid-stimulating hormone is the primary marker your doctor will look at to assess your thyroid function. TSH is a hormone released by the pituitary gland that tells your thyroid how much thyroid hormone to make. When thyroid hormone levels are low, the pituitary releases more TSH to signal the thyroid to produce more hormones. Alternatively, when thyroid hormone levels are high, TSH levels fall.
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