How To Identify Symptoms and Request Tests for Hypothyroidism

Thyroid disease affects an estimated 28,000,000 Americans. 80% of these have "hypothyroidism" or a low-functioning thyroid gland. Since the thyroid hormones, called the T-3 and T-4, regulate the metabolism of every cell of our body, when the thyroid gland produces too little of these, due to hindrance from a disease process, the body experiences "hypothyroidism" or slowed metabolism.

Thyroid disease is more common than diabetes and cancer combined, according to reputable medical sources. Americans should become more educated in regard to symptoms and diagnosis of hypothyroidism, so that they can recognize it and receive the needed treatment from a licensed physician. The steps below can help a person recognize hypothyroidism and to receive a definitive diagnosis through lab testing:

1. List your symptoms to see if they match those that are listed for hypothyroidism. When a person is experiencing bodily symptoms of an illness, they may suspect hypothyroidism if several of the symptoms match the following (commonly listed for this disorder): Feeling cold in warm temperatures, dry skin and brittle fingernails, hair that has become brittle and breaks off or falls out, thinning of the eyebrows and loss of the outer 1/3 portion of them, unexplained weight gain with no diet change, constipation, slowed heart rate and breathing, depression, physical tiredness/fatigue and feeling a fullness or tightness in the throat. If you have several or all of these symptoms, you should see your doctor and describe your symptoms in detail and also ask him to order tests for you, to diagnose or rule out the problem as being hypothyroidism, in addition to other tests he may also recommend.
2. Check your throat for visible signs of swelling in the area of the thyroid gland. Hypothyroidism many times will come with a condition know as "goiter," simply meaning a swelling of the thyroid gland. This can be true in cases of "iodine deficient hypothyroidism" (rare in the USA) and "autoimmune hypothyroidism," also called "Hashimoto's thyroiditis," the most common cause of hypothyroidism in the USA.

   As a result of hypothyroidism, the thyroid gland can become either inflamed from "thyroid autoimmunity," meaning antibodies from the immune system attacking the gland due to mistakenly recognizing it as an intruder (bacteria, allergen or virus) or from a deficient gland, swelling in attempt to find the missing iodine or hormone that has become deficient within it. In both cases, there can be visible swelling in the neck, just below the Adam's apple, in the front and on the sides of the neck. This is where the thyroid, a butterfly-shaped gland, lies beneath the skin. The lobes of the thyroid are each approximately 2 inches (5 cm) in length (sides of throat), and the isthmus (middle area) is approximately 2 inches (5 cm) in width and length and the thyroid gland weighs approximately 1 ounce. The upper projections of the right and left lobes are called the upper poles of the gland while the lower projections of the lobes are called the lower poles.

   In addition to general swelling in the thyroid gland, it can also develop "nodules" that become visible or can be felt by palpation (examining by touch). Nodules are small tumors/growths and in the case of thyroid disease, these can either be soft nodules, similar to cysts that are filled with fluid or they can be solid nodules, also called "cold nodules," which are of more concern because these types have a higher risk of containing cancerous cells (malignancy).

   Autoimmune hypothyroid patients many times have multi-nodules, meaning several within the gland but having several also reduces the chance of any of the nodules being cancerous. Single nodules, that are larger, are also more suspect and in need for being ruled out as malignant. Only 5% of nodules are found to be malignant however, precautions are always important when cancer is a possibility. Nodules found to be solid/cold, can also be biopsied via a procedure called "Fine Needle Biopsy" (FNA), which is an in-office, fairly non-invasive procedure, that more definitively rules out or confirms the presence of cancer cells.

   A person, who suspects goiter, can look in a mirror with their head slightly tilted back and watch closely by swallowing in this position and noticing whether any bulges appear in this area of the neck below the Adam's apple. It is also easier to feel the thyroid, slowly with the fingertips while the head is tilted back as well. While this method can detect most goiters and nodules, it cannot detect those that develop on the inner part of the thyroid that grows outward, into the esophagus and windpipe. These type are suspected when a patient has a problem swallowing or breathing.

3. Request that your doctor order you a full thyroid panel, blood test workup. While the symptoms and signs that have been listed above point to thyroid disease and hypothyroidism, it is important once these signs and/or symptoms are recognized to get lab blood tests. Blood testing is the single best diagnostic test for detecting diseases that exists in the field of medical lab testing.

   Thyroid testing many times comes in a grouping of tests called a "thyroid panel". These tests of thyroid function include a test of the "TSH" level, which is a pituitary hormone (also called "thyrotropin") that this brain-gland sends to the thyroid to stimulate it to produce the correct amount of thyroid hormone needed by the body. This is the reason it is called "Thyroid Stimulating Hormone" and when this hormone becomes elevated above the normal range, this means the thyroid is falling behind in producing adequate hormone to supply the body. Some doctors actually use the TSH only in testing patients for hypothyroidism or an overactive thyroid (hyperthyroidism) because of its sensitivity in detecting abnormal thyroid function earlier than any other thyroid function test. This pituitary hormone will sometimes detect hypothyroidism, even before the thyroid hormones (T-3 and T-4) do.

   A "Thyroid Panel" (group of tests) will also include a test of the thyroid hormone levels, which are the "T-4," also called the "thyroxine level," which contains four iodine molecules and the "T-3," also called the triiodothyronine level, which contains three iodine molecules within it. The T-4 is referred to in medical sources as the reserve hormone and while it helps the body with metabolism, at the tissue-level, it also converts into the more active T-3 hormone, which is several times more powerful than the T-4 hormone and more active in regulating the body's metabolism. Either one of these two hormones or a combination of the two being low, indicates hypothyroidism. If the TSH is also high, with either of these being low, this, too, indicates hypothyroidism. Even if these two thyroid hormones are in the normal range but TSH is elevated, this too can indicate hypothyroidism.

4. Request thyroid ultrasound imaging or a thyroid uptake scan. These tests are more important when goiter or nodules manifest in the thyroid. Some patients can experience these, even before thyroid hormones or TSH levels become abnormal. A "Thyroid Ultrasound" is an imaging process that uses sensitive sound waves to get a detailed image of the thyroid and of its tissue and texture. Ultrasound will also detect mild goiter that is not visible or felt by palpation and nodules that might also be present. A "Thyroid Uptake Scan" does these same things but with use of injected radioactive iodine that is absorbed by the thyroid. The radiological imaging that results also reveals how well the thyroid is functioning. An Uptake Scan can determine how well the thyroid functions to a highly accurate estimated percentage-level. While an ultrasound will not do this, it will reveal whether the thyroid has a texture that is abnormal, such as that which results from autoimmune thyroid disease (heterogeneous texture - Hashimoto's) and can also reveal any cysts or solid masses.

These four steps are valuable symptom observations and tests that are available to not only detect thyroid disease and hypothyroidism but to also reveal the severity or manifestations of the disease. Hypothyroidism that is not treated increases the risk of other health disorders in patients who have it, including heart disease and diabetes.

Once diagnosed, patients with hypothyroidism can then proceed with getting the proper treatment with the help of their licensed physician.