Diagnosis and Treatment of Hypothyroidism

Diagnosis and Treatment of Hypothyroidism

Thyroid function test

If you have normal levels of TSH, your test score will be from 0.4 to 2.5. A score between 0 and 0.4 is hyperthyroidism. Between 2.5 and 4 means you are at risk for hypothyroidism, and should be retested within a year. Above 4 means you have a mild case. 

How is hypothyroidism diagnosed? After checking that you have the symptoms of hypothyroidism, the doctor will ask you to do a:  

The test looks at levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in the blood. A high TSH level indicates that the thyroid gland is failing because it reflects a low level of T4. The opposite situation, in which the TSH level is low, usually indicates that the person has an overactive thyroid which causes hyperthyroidism. 

To accurately determine this disease, a T4 test is also done. T4 circulates in the blood in two forms:

T4 bound to proteins and free T4, which enters the tissues to do its function. The free T4 level is used to determine how the thyroid is functioning. Individuals who have hypothyroidism will have a low level of T4. 

Blood tests are also sometimes used for other measurements, such as checking the level of a hormone called triiodothyronine (T3). However, this isn't routine, because T3 levels can often remain normal, even if you have a significantly underactive thyroid.

Radioactive Iodine Uptake
Because T4 contains iodine, the thyroid gland must get iodine from the blood for the gland to produce the required amount of T4. Therefore to perform this test, individuals are asked to swallow a liquid or capsule containing radioactive iodine. After 4 to 6 hours and again 24 hours later the amount of radioactivity in the thyroid gland is measured. This is done using a device called a gamma probe where it is moved back and forth over the area of your neck where the thyroid gland is located.

The radioactivity allows the iodine molecules to be tracked. By measuring the amount of radioactivity that is taken up by the thyroid gland, it can then be determined whether the gland is functioning normally. A low radioactivity is seen in individuals with hypothyroidism. 

(Graves' disease is due to an overactive thyroid gland. As seen from the picture, there is higher radioactivity in the thyroid gland, which shows increased uptake of the radioactive iodine. The opposite is true for those with hypothyroidism)

After diagnosis of hypothyroidism, what comes next?

Treatment, of course. Currently there are no cures for hypothyroidism, but there are treatments to replace the levels of T4 in the body. Most hypothyroid patients take a drug called levthyroxine daily. They will have regular blood tests until the correct dose of levothyroxine is reached. A low dose of levothyroxine is first started on the patient, which may increased depending on their body response. Once the suitable dose is found, blood test is done about once a year to monitor the hormone levels.

References:

http://www.nhs.uk/Conditions/Thyroid-under-active/Pages/Treatment.aspx

http://www.thyroid.org/thyroid-function-tests/

http://www.hormone.org/diseases-and-conditions/thyroid/hypothyroidism

www.oprah.com

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