Read on to learn more about thyroid blood tests.
The thyroid gland is located in the lower part of the neck, below Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus).
The thyroid itself is regulated by another gland that is located in the brain, called the pituitary which is regulated in part by the thyroid (via a "feedback" effect of thyroid hormone on the pituitary gland) and by another gland called the hypothalamus.
The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If a disruption occurs at any of these levels, a defect in thyroid hormone production may result in a deficiency of thyroid hormone (hypothyroidism).
The thyroid gland uses iodine (mostly available from the diet in foods such as seafood, bread, and salt) to produce thyroid hormones that are essential for normal body metabolism.
The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3), which account for 99.9% and 0.1% of thyroid hormones present in the blood respectively. However, the hormone with the most biological activity is T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted into T3 - the active hormone that affects the metabolism of cells.
The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary gland in an attempt to stimulate more thyroid hormone production.
In contrast, when there is an excessive amount of circulating thyroid hormone, TSH levels fall as the pituitary attempts to decrease the production of thyroid hormone. In persons with hypothyroidism (thyroid hormone production is below normal), there is a continuously decreased level of circulating thyroid hormones.
In persons with hyperthyroidism (thyroid hormone production is above normal), there is a continuously elevated level of circulating thyroid hormones.
A diagnosis of hypothyroidism can be suspected in patients with fatigue, cold intolerance, constipation, and dry, flaky skin. A blood test is needed to confirm the diagnosis.
Blood testing is now commonly available to determine the adequacy of the levels of thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or underactive.
When hypothyroidism is present, the blood levels of thyroid hormones can be measured directly and are usually decreased. However, in early hypothyroidism, the level of thyroid hormones (T3 and T4) may be normal. Therefore, the main tool for the detection of hyperthyroidism is the measurement of the TSH, the thyroid stimulating hormone. However, there is one exception.
If the decrease in thyroid hormone is actually due to a defect of the pituitary or hypothalamus, then the levels of TSH are abnormally low. This kind of thyroid disease is known as "secondary" or "tertiary" hypothyroidism and a special test – TRH test can help distinguish if the disease is caused by a defect in the pituitary or the hypothalamus. This test requires an injection of the TRH hormone and is performed by an endocrinologist (hormone specialist).
Further testing might be used to isolate an underlying cause. These tests might include more blood testing for thyroid antibodies, nuclear medicine thyroid scanning, ultrasound of the thyroid gland, or others.
