Is it possible to be hypothyroid with normal tsh

Effect of levothyroxine therapy. Arch Intern Med. Thyroxine replacement therapy and circulating lipid concentrations. The use and misuse of thyroid hormone. Endocr Rev. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. Ross DS. Hyperthyroidism, thyroid hormone therapy, and bone. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

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Feb 15, Issue. Subclinical Hypothyroidism: Deciding When to Treat. Treatment Final Comment References. TABLE 2 Causes of Hypothyroidism Chronic autoimmune thyroiditis Treated Graves' disease Radioactive iodine therapy Subtotal thyroidectomy Antithyroid drugs Head and neck surgery Radiation therapy to the head, neck or chest area Iodine deficiency Medications: lithium, iodine, amiodarone Cordarone Secondary hypothyroidism hypopituitarism Idiopathic Congenital.

Should We Treat Subclinical Hypothyroidism? Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value!

To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Family history of thyroid disease. Personal history of thyroid disease. Therefore, this activity can be measured by having an individual swallow a small amount of iodine, which is radioactive.

The radioactivity allows the doctor to track where the iodine goes. By measuring the amount of radioactivity that is taken up by the thyroid gland radioactive iodine uptake, RAIU , doctors may determine whether the gland is functioning normally.

A very high RAIU is seen in individuals whose thyroid gland is overactive hyperthyroidism , while a low RAIU is seen when the thyroid gland is underactive hypothyroidism. In addition to the radioactive iodine uptake, a thyroid scan may be obtained, which shows a picture of the thyroid gland and reveals what parts of the thyroid have taken up the iodine see Thyroid Nodules brochure. There are many medications that can affect thyroid function testing. Some common examples include:.

For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www. Thyroid Function Tests. TESTS Blood tests to measure these hormones are readily available and widely used, but not all are useful in all situations. Some common examples include: Estrogens , such as in birth control pills, or in pregnancy, cause high levels of total T4 and T3. This is because estrogens increase the level of the binding proteins.

In these situations, it is better to ask both for TSH and free T4 for thyroid evaluation, which will typically be in the normal range.

Biotin , a commonly taken over-the-counter supplement, can cause the measurement of several thyroid function tests to appear abnormal, when they are in fact normal in the blood.

What it means in regard to an indication to treat, or who to treat, is clearly something else. I hope we encourage more clinical studies in which we evaluate, in the normal double-blinded manner, fatigue levels, mortality and morbidity, behavioral and mood changes, and other QOL considerations. T-3 is being given by many physicians now with the belief, based on their clinical experiences, that it is helpful.

We need to have an open expression of views so we can have access to the data available from those treating their patients. Such situations can drive physicians who follow practices that might lie outside of, or straddle, clinical orthodoxy underground. It isolates and may be unfair to them. It certainly impedes resolution of such issues in the normal scientific manner. I wholly disagree. My TSH was under 10 but I was very symptomatic.

My doctor was skeptical, but my numbers got worse and I was put on a thyroxine trial after months and months of suffering. I could have been spared what I went through. I have been on 75mcg for about 11 years and have never tested hyperthyroid. So no over- medication there, doc. Your arguments are totally wrong and out of the arc. They develop other conditions, requiring statins, diabetes meds, blood-pressure meds or vasodilators, water tablets, anti-inflammatories for joint and muscle pain, migraine meds, IBS meds and anti- depressants.

Regarding only testing TSH. Question: if you extrapolate how many people have thyroid disease in the world and calculate the number of people not captured by the TSH test, I wonder how many people would remain sick in your claimed.

What do you do for those individuals? That being said, there is plenty of research to demonstrate that TSH is not a perfect test as it tests a pituitary hormone, is not a direct measure and relies on the idea of a perfect HPT axis. Many people diagnosed with a thyroid condition are surprised that such a small gland can have such a profound impact on overall health and well-being. But the thyroid gland plays an enormous role in human health.

Throughout life, this busy gland is constantly producing hormones that influence metabolism. When disease causes your thyroid gland to slack off and underproduce thyroid hormone, or overwork and produce too much of it, you'll know something isn't right.

Thyroid Disease: Understanding hypothyroidism and hyperthyroidism will help you recognize the symptoms and find the right treatment before you experience the long-term effects of this common condition. Thanks for visiting. Don't miss your FREE gift.

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Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss Stay on top of latest health news from Harvard Medical School. However, these malfunctions are not revealed by a standard thyroid panel. Some are handed prescriptions for thyroid hormone replacement. This one-size-fits-all approach to managing hypothyroidism ignores the multitude of factors that influence thyroid function and may even worsen symptoms in some patients.

At best, it does our patients a disservice, and at worst it could be considered sheer negligence. This pattern is caused by high cortisol. Cortisol, in turn, is elevated in response to active infection; 1 blood sugar dysregulation, hypoglycemia, insulin resistance, or chronic stress; 2 or pregnancy.

In other words, there is nothing wrong with the thyroid gland itself; the problem lies with the pituitary gland. The key to correcting this pattern is to resolve the underlying causes of pituitary dysfunction by treating infection, balancing blood sugar , improving insulin sensitivity, and helping patients find ways to reduce their stress levels.

Patients with this pattern will present with hypothyroid symptoms, TSH below the functional range 1. T4 is the inactive form of thyroid hormone. It comprises 90 percent of thyroid hormone produced by the thyroid gland and must be converted to T3 before the body can utilize it.

When T4 is not converted into T3 in adequate amounts, symptoms of hypothyroidism result. This pattern of thyroid dysfunction characterized by under-conversion of T4 to T3 has many potential causes, including inflammation, elevated cortisol, nutrient deficiencies, and intestinal dysbiosis. Twenty percent of thyroid hormone activation is initiated in the gastrointestinal tract by gut microbes , which produce deiodinase enzymes that convert T4 into T3.

Disruption of the normal gut microbiota may reduce levels of beneficial bacteria that perform this crucial conversion, resulting in a decreased amount of T3 and symptoms of hypothyroidism. T4 to T3 conversion occurs in cell membranes.