Thyroid tests

[cheerigirl]

Can you please tell me what the best tests are for determining thyroid health?  It seems there is a disparity between what many thyroid patients think and what many endocrinologists think.


My doc has ordered a TSH w/ Reflex to T4, but I can't find much info on this test and whether it is adequate in determining if the symptoms are thyroid related.

It seems that most patients feel that TSH, Free T3 and Free T4 are needed for a correct diagnosis.  Why don't doctors agree?  And why are doctors hesitant to do these tests?

I'm trying to find the balance between people w/ symptoms wanting help and feeling the need for these tests and the reason doctors feel they are unnecessary.  It has been suggested that many doctors are not well-educated on thyroid and thyroid testing so the treatment is averted, but I am curious if this is the case or if patients are just trying to make a thyroid problem explain their symptoms.

Looking for both sides on this.  While I would like a fix to my symptoms, I do not want to pin my hope on an unlikely cause.  I would however like to find a cause for the symptoms and not just treat the symptoms.

Thank you for your time.

[Mark Lupo, M.D.]

If the thyroid is truly normal, then other etiologies must be explored.  Endocrine causes would include insulin resistance most commonly, but also Cushing's Syndrome (rare) and a few other rarities.  Anemia, liver/kidney problems, rheumatologic & neruologic disorders, lack of exercise, depression, sleep-apnea, sleep disorders, medication side-effect, stress --- all these are potential causes.

[Mark Lupo, M.D.]

A TSH w/T4 (reflex means, the T4 is tested if the TSH is abnormal) is adequate to screen for thyroid problems.  A complete panel would be TSH, FT4, FT3.  But in 99% of cases, to detect a thyroid problem in a person not on any thyroid meds, TSH w reflex T4 will pick up the problem.

[cheerigirl]

Thank you for the explanation, it makes sense to me now.

I did get my test back and the TSH was 0.9 and my previous TSH results were 1.83 and 1.96 so all fall within the normal range.

May I ask, if you have a patient presenting with all these symptoms (fatigue, weight gain, depression, cold intolerance, hair loss, constipation, and several more) and their thyroid was normal, what would be your advice to them?  What else should be checked to help resolve these symptoms?

I'd really like to resolve some of these symptoms, but don't know how to.

Thank you for you time and any advice you can offer.