Thyroid Status Examination - OSCE Guide | Geeky Medics (2022)

Thyroid status examination frequently appears in OSCEs and you’ll be expected to pick up the relevant clinical signs using your examination skills. This thyroid status examination OSCE guide provides a clear step-by-step approach to assessing thyroid status, with an included video demonstration.

Download the thyroid status examination PDF OSCE checklist, or use our interactive OSCE checklist. You might also be interested in our neck lump examination guide.

Thyroid hormone (T3)

Thyroid hormone (T3) plays an essential role in the normal functioning of cells and therefore excessive or low levels can cause a broad range of symptoms and clinical signs which can be identified on clinical assessment. High levels of circulating T3 significantly increases metabolism resulting in weight loss and potentiates the effects of catecholamines such as adrenaline resulting in excessive sympathetic output (e.g. tachycardia, tremor, anxiety). Low levels of circulating T3 have the opposite effect, causing weight gain, low mood, constipation, poor memory and hyporeflexia.

Gather equipment

  • Stethoscope
  • Glass of water
  • Tendon hammer
  • Piece of paper

Introduction

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient’s name and date of birth.

Briefly explain what the examination will involve using patient-friendly language.

Gain consent to proceed with the examination.

Ask the patient to sit on a chair for the assessment.

Adequately expose the patient’s neckand upper sternum.

Ask the patient if they have any pain before proceeding with the clinical examination.

You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.

General inspection

Clinical signs

Inspect the patient, looking for clinical signs suggestive of underlying pathology:

  • Weight: weight loss is typically associated with hyperthyroidism (increased metabolism), whilst weight gain is associated with hypothyroidism (decreased metabolism).
  • Behaviour:anxiety and hyperactivity are associated with hyperthyroidism (due to sympathetic overactivity). Hypothyroidism is more likely to be associated with low mood.
  • Clothing:may be inappropriate for the current temperature. Patients with hyperthyroidism suffer from heat intolerance whilst patients with hypothyroidism experience cold intolerance.
  • Hoarse voice: caused by compression of the larynx due to thyroid gland enlargement (e.g. thyroid malignancy).

Objects and equipment

Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status:

  • Mobility aids: patients with hyperthyroidism can develop proximal myopathy.
  • Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. levothyroxine).
  • General inspection

Hands

Inspection

Inspect the patient’s hands for peripheral stigmata of thyroid-related pathology:

  • Thyroid acropachy: similar in appearance to finger clubbing but caused by periosteal phalangeal bone overgrowth secondary to Graves’ disease.
  • Onycholysis: painless detachment of the nail from the nail bed associated with hyperthyroidism.
  • Palmar erythema: reddening of the palms associated with hyperthyroidism, chronic liver disease and pregnancy.

Peripheral tremor

Peripheral tremor is a feature of hyperthyroidism reflecting sympathetic nervous system overactivity.

To assess for evidence of a subtle peripheral tremor:

1.Ask the patient to stretch their arms out in front of them.

2.Place a piece of paper across the back of the patient’s hands.

3. Observe for evidence of a peripheral tremor (the paper will quiver).

  • Inspect the hands

    (Video) Thyroid Status Examination - OSCE Guide

Radial pulse

Palpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.

Once you have located the radial pulse, assess the rate and rhythm.

You can calculate the heart rate in a number of ways, including measuring for 60 seconds, measuring for 30 seconds and multiplying by 2 or measuring for 15 seconds and multiplying by 4.

For irregular rhythms, you should measure the pulse for a full 60 seconds to improve accuracy.

Abnormal heart rates and rhythms
  • In healthy adults, the pulse should be between 60-100 bpm.
  • A pulse <60 bpm is known as bradycardia and has a wide range of aetiologies (e.g. healthy athletic individuals, hypothyroidism, atrioventricular block, medications, sick sinus syndrome).
  • A pulse of >100 bpm is known as tachycardia and also has a wide range of aetiologies (e.g. hyperthyroidism, anxiety, supraventricular tachycardia, hypovolaemia).
  • An irregular rhythm is most commonly caused by atrial fibrillation which can be associated with hyperthyroidism.

Face

General inspection

Inspect the patient’s face for clinical signs suggestive of thyroid pathology:

  • Dry skin:associated with hypothyroidism.
  • Excessive sweating:associated with hyperthyroidism.
  • Eyebrow loss: the absence of the outer third of the eyebrows is associated with hypothyroidism (although this is a rare sign).
  • Inspect the face

Eyes

Inspect the eyes for evidence of eye pathology associated with thyrotoxicosis (e.g. Graves’ disease) including lid retraction, eye inflammation, exophthalmos (also known as proptosis), eye movement abnormalities and lid lag.

Lid retraction

To identify lid retraction inspect the eyes from the front and note if sclera is visible between the upper lid margin and the corneal limbus (this indicative of lid retraction).

Upper eyelid retraction is the most common ocular sign of Graves’ disease however it can be present in other thyrotoxic states (e.g. toxic multinodular goitre). Eyelid retraction is thought to occur due to sympathetic hyperactivity causing excessive contraction of the superior tarsal and levator palpebrae superioris muscles.

Exophthalmos

To identify exophthalmos, inspect the eye from the front, the side and from above.

Exophthalmos is bulging of the eye anteriorly out of the orbit. Bilateral exophthalmos develops in Graves’ disease, due to oedema and lymphocytic infiltration of orbital fat, connective tissue and extraocular muscles.

Eye inflammation

Inspect for evidence of inflammation affecting the eyes.

Due to lid retraction and exophthalmos, the eye is more prone to dryness and the development of conjunctival oedema (chemosis), conjunctivitis and in severe cases corneal ulceration.

  • Inspect the eyes for exophthalmos

Eye movements

Assess for evidence of ophthalmoplegia (e.g. restricted eye movement, diplopia) and pain during eye movement caused by Graves’ disease (lymphocytic infiltration of orbital fat, connective tissue and extraocular muscles):

1. Ask the patient to keep their head still and follow your finger with their eyes.

2. Move your finger through the various axes of eye movement (“H” shape).

3. Observe for restriction of eye movements and ask the patient to report any double vision or pain.

(Video) Thyroid Status Examination - OSCE Guide

  • Assess eye movement

Lid lag

Lid lag refers to a delay in the descent of the upper eyelid in relation to the eyeball when looking downward. Lid lag is most commonly associated with Graves’ disease although it can be present in other thyrotoxic states (e.g. toxic multinodular goitre). Lid lag is thought to occur secondary to a combination of lid retraction and exophthalmos.

To assess for evidence of lid lag:

1. Hold your finger superiorly and ask the patient to follow it with their eyes, whilst keeping their head still.

2. Move your finger in a downwards direction whilst observing the patient’s upper eyelids as the patient’s eyes follow your finger. If lid lag is present, the upper eyelids will be observed lagging behind the eyes’ downward movement, with the sclera being visible between the upper lid margin and the corneal limbus.

  • Assess for lid lag

Thyroid inspection

General inspection

Inspect the midline of the neck from the front and the sides noting any masses (e.g. goitre) or scars (e.g. previous thyroidectomy). The normal thyroid gland should not be visible.

Further inspection of a mass

If a mass is identified during the initial inspection, perform some further assessments to try and narrow the differential diagnosis.

Swallowing

Ask the patient to swallow some water and observe the movement of the mass:

  • Thyroid gland masses (e.g. a goitre) and thyroglossal cysts typically move upwards with swallowing.
  • Lymph nodes will typically move very little with swallowing.
  • An invasive thyroid malignancy may not move with swallowing if tethered to surrounding tissue.

Tongue protrusion

Ask the patient to protrude their tongue:

  • Thyroglossal cysts will move upwards noticeably during tongue protrusion.
  • Thyroid gland masses and lymph nodes will not move during tongue protrusion.
  • Inspect the neck

Thyroid palpation

Palpate each of the thyroid’s lobes and the isthmus:

1. Stand behind the patient and ask them to tilt their chin slightly downwards to relax the muscles of the neck to aid palpation of the thyroid gland.

2. Place the three middle fingers of each hand along the midline of the neck below the chin.

3. Locate the upper edge of the thyroid cartilage (“Adam’s apple”) with your fingers.

4. Move your fingers inferiorly until you reach the cricoid cartilage. The first two rings of the trachea are located below the cricoid cartilage and the thyroid isthmus overlies this area.

5. Palpate the thyroid isthmus using the pads of your fingers.

6. Palpate each lobe of the thyroid in turn by moving your fingers out laterally from the isthmus.

7. Ask the patient to swallow some water, whilst you feel for the symmetrical elevation of the thyroid lobes (asymmetrical elevation may suggest a unilateral thyroid mass).

8. Ask the patient to protrude their tongue (if a mass represents a thyroglossal cyst, you will feel it rise during tongue protrusion).

(Video) Thyroid examination in surgery-Osce Guide/Thyroid Status Examination/NLE/PMDC/FCPS MD IMM

Characteristics of the thyroid gland

When palpating the thyroid gland, assess the following characteristics:

  • Size: note if the thyroid gland feels enlarged.
  • Symmetry: assess for any evidence of asymmetry between the thyroid lobes (unilateral enlargement may be caused by a thyroid nodule or malignancy).
  • Consistency: assess the consistency of the thyroid gland tissue, noting any irregularities (e.g. a widespread irregular consistency would be suggestive of a multinodular goitre).
  • Masses: note if there are any distinct palpable masses within the thyroid gland’s tissue (e.g. solitary thyroid nodule or thyroid malignancy).
  • Palpable thrill: assess for evidence of a palpable thrill caused by increased vascularity of the thyroid gland due to hyperthyroidism (suggestive of Graves’ disease).

Characteristics of a thyroid mass

If a thyroid mass is noted assess its position, shape, consistency and mobility (i.e. is it tethered to underlying tissue).

  • Palpate the thyroid cartilage

Thyroglossal cyst

Thyroglossal cysts are the most common congenital abnormality of the neck and arise as a result of the persistence of the thyroglossal duct. The thyroglossal duct is the tract by which the thyroid gland descends during embryological development to its final position in the front of the neck. The tongue is attached to the thyroglossal duct, which is why thyroglossal cysts rise during tongue protrusion.

Types of goitre

There are several different subtypes of goitre which include:

  • Diffuse goitre: the whole thyroid gland is enlarged due to hyperplasia of the thyroid tissue.
  • Uninodular goitre: the presence of a single thyroid nodule which may be active (toxic) autonomously producing thyroid hormones (causing hyperthyroidism) or inactive.
  • Multinodular goitre: the presence of multiple thyroid nodules which may be active or inactive. Active multinodular goitres are often referred to as a toxic multinodular goitre.

Lymph node palpation

Assess for local lymphadenopathy which may indicate the metastatic spread of primary thyroid malignancy.

1.Position the patient sitting upright and examine from behind if possible.Ask the patient to tilt their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes. You should also ask them to relax their hands in their lap.

2. Stand behind the patient and use both hands to start palpating the neck.

3. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes. By using both hands (one for each side) you can note any asymmetry in size, consistency and mobility of lymph nodes.

4. Start in the submental area and progress through the various lymph node chains. Any order of examination can be used, but a systematic approach will ensure no areas are missed:

  • Submental
  • Submandibular
  • Pre-auricular
  • Post-auricular
  • Superficial cervical
  • Deep cervical
  • Posterior cervical
  • Supraclavicular

Take caution when examining the anterior cervical chain that you do not compromise cerebral blood flow (due to carotid artery compression). It may be best to examine one side at a time here.

A common mistake is a “piano-playing” or “spider’s legs” technique with the fingertips over the skin rather than correctly using the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue.

  • Palpate local lymph nodes

Trachea

Inspect for evidence of tracheal deviation, which may be caused by a large goitre.

  • Assess for tracheal deviation

Percussion of the sternum

Percuss the sternum moving downwards from the sternal notch to assess for retrosternal dullness.

Retrosternal dullness may indicate a large thyroid mass extending posteroinferiorly to the manubrium.

  • Assess for retrosternal dullness

(Video) Neck Lump Examination - OSCE Guide (New Version)

Auscultation of the thyroid gland

Auscultate each lobe of the thyroid gland for a bruit using the bell of the stethoscope.

A bruit indicates increased vascularity, which typically occurs in Graves’ disease.

  • Auscultate each thyroid lobe

Further tests

Reflexes

Reflexes are assessed to screen for hyporeflexia, which is associated with hypothyroidism. The most commonly tested reflexes are the biceps reflex or the knee jerk reflex (you only need to assess one).

Biceps reflex

1.With the patient’s arm relaxed, locate the biceps brachii tendon which is typically found at the medial aspect of the antecubital fossa.

2.Place the thumb of your non-dominant hand over the tendon and then tap your thumb with the tendon hammer.

3.Observe for a contraction of the biceps muscle and associated flexion of the elbow.

Pretibial myxoedema

Pretibial myxoedema is a form ofdiffusemucinosisin which there is an accumulation of excess glycosaminoglycans in thedermisandsubcutis of the skin. It usually presents itself as a waxy, discoloured induration of the skin on theanterior aspect of the lower legs (pre-tibial region). Pretibibial myxoedema is a rare complication of Graves’ disease.

Proximal myopathy

Proximal myopathy is a potential complication of both multinodular goitre and Graves’ disease. Patients develop wasting of their proximal musculature causing difficulties in tasks such as standing from a sitting position.

To screen for proximal myopathy ask the patient to stand from a sitting position with their arms crossed (to minimise their ability to mask proximal muscle weakness). Make sure to stand close to the patient to prevent them from falling. An inability to stand up would suggest proximal muscle weakness.

  • Assess for hyporeflexia

To complete the examination…

Explain to the patient that the examination is now finished.

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

Summarise your findings.

Example summary

“Today I examined Mr Smith, a 32-year-old male. On general inspection, the patient appeared hyperactive at rest, with a peripheral tremor. There were no objects or medical equipment around the bed of relevance.”

“The patient was tachycardic at 105 bpm with a regular pulse. Inspection of the neck was unremarkable but palpation revealed a mass in the thyroid region that contained multiple nodules. The mass moved upwards on swallowing but was stationary during tongue protrusion. There was no palpable lymphadenopathy but retrosternal dullness was present to the level of the manubrium. Auscultation of the thyroid gland did not reveal any bruits, reflexes were normal and there was no evidence of pretibial myxoedema or proximal myopathy.”

“In summary, these findings are consistent with a toxic multinodular goitre.”

“For completeness, I would like to perform the following further assessments and investigations.”

(Video) Examination of the Thyroid - Clinical Examination

Further assessments and investigations

  • Thyroid function tests: these include TSH, T3 and T4.
  • ECG: should be performed if an irregular pulse was noted to rule out atrial fibrillation.
  • Further imaging: an ultrasound scan of the neck to further assess any thyroid lumps.

Reviewer

Mr Peter Truran

Consultant surgeon

References

  1. Herbert L. Fred, MD and Hendrik A. van Dijk. Adapted by Geeky Medics. Thyroid acropachy and pretibial myxoedema. Licence: CC BY.
  2. CopperKettle. Adapted by Geeky Medics. Onycholysis. Licence: CC BY-SA.
  3. Jonathan Trobe, M.D. University of Michigan Kellogg Eye Center. Adapted by Geeky Medics. Graves’ disease. Licence: CC BY.
  4. Drahreg01. Adapted by Geeky Medics. Goitre. Licence: CC BY-SA.
  5. Bp20151130. Adapted by Geeky Medics. Thyroglossal cyst. Licence: CC BY-SA.

FAQs

What is a normal TFT result? ›

Normal test range for an adult: 0.40 - 4.50 mIU/mL (milli-international units per liter of blood).

How do you check thyroid status? ›

The best way to initially test thyroid function is to measure the TSH level in a blood sample. Changes in TSH can serve as an “early warning system” – often occurring before the actual level of thyroid hormones in the body becomes too high or too low.

How do you interpret T3 T4 TSH results? ›

Comparing High/Low TSH and T3/T4 Levels

High TSH + normal T4 = you may have a higher risk of developing an underactive thyroid. Low TSH + high T4 = overactive thyroid. High TSH + low T4 = underactive thyroid. Low TSH + low T4 = low thyroid function due to another problem, such as pituitary gland dysfunction.

How can I get my thyroid history? ›

What is the normal range of T3 T4 and TSH? ›

The normal range of T4 is suggested to be 77–155 nmol/l, T3 to be 1.2–2.8 nmol/L and TSH to be 0.3–4 mU/l [3]. The levels of hormones above or below the normal range indicate hyperthyroidism or hypothyroidism.

What is the difference between TFT and TSH? ›

A Thyroid function test (TFT) commonly refers to the quantitation of thyroid stimulating hormone (TSH) and circulating thyroid hormones in serum to assess the ability of the thyroid gland to produce and regulate thyroid hormone production.

What are the 5 thyroid tests? ›

Blood tests for your thyroid include:
  • TSH - measures thyroid-stimulating hormone. It is the most accurate measure of thyroid activity.
  • T3 and T4 - measure different thyroid hormones.
  • TSI - measures thyroid-stimulating immunoglobulin.
  • Antithyroid antibody test - measures antibodies (markers in the blood).
6 Jul 2016

What are the 3 thyroid tests? ›

Commonly ordered thyroid blood tests include:
  • T4 test: This is done to measure the blood level of the hormone T4 (thyroxine). ...
  • TSH test: A thyroid stimulating hormone (TSH) test can help tell how well the thyroid is working. ...
  • T3 total test: The T3 total test measures the other major thyroid hormone in the blood.

What is normal thyroid level? ›

These levels are influenced by many factors that affect protein levels in the body, including medications, sex hormones, and liver disease. A normal Total T4 level in adults ranges from 5.0 to 12.0μg/dL. A normal Total T3 level in adults ranges from 80-220 ng/dL.

Which is more important T4 or TSH? ›

Across many clinical studies it seems clear that the physiologic effects of low or high thyroid function correlate much more strongly to free T4 and free T3 levels than to TSH levels. In fact, correcting for changes in T4 and T3 levels there appeared to be no correlation between TSH level and body function.

What if TSH is high but T3 and T4 are normal? ›

When the thyroid gland becomes inefficient such as in early hypothyroidism, the TSH becomes elevated even though the T4 and T3 may still be within the "normal" range.

Can you have normal TSH and T4 but low T3? ›

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. Patients with this pattern present with hypothyroid symptoms, normal TSH and T4, and low T3.

Can a thyroid test be wrong? ›

Outside factors may affect the results of your thyroid blood test. This can include whether or not you ate before your test, what time of day you take the test, and things like stress, diet, and sleep. Some medications and supplements may also affect your results. This may be because they change your thyroid function.

Can you have a thyroid problem with normal blood work? ›

Yes, it is possible to have hypothyroidism and normal TSH levels in the blood. Most people with hypothyroidism have high TSH because their thyroid gland is not releasing enough hormones.

How can I test my thyroid at home? ›

How to test your Thyroid at home - YouTube

Is T3 more important than T4? ›

Bound T4 attaches to proteins that prevent it from entering these tissues. More than 99% of T4 is bound. Because T4 is converted into another thyroid hormone called T3 (triiodothyronine), free T4 is the more important hormone to measure.

What are optimal T3 and T4 levels? ›

A normal T3 level might be somewhere between 100 to 200 nanograms per deciliter (ng/dL), while a normal T4 level falls between 5.0 to 12.0 micrograms per deciliter (μg/dL). Free T4, which tests for the amount of T4 that is available in the body, should range between 0.8 to 1.8 nanograms per deciliter (ng/dL).

What is the difference between T3 and T4 and TSH? ›

TSH then triggers your thyroid to produce T4 and T3. Of the total amount of hormones that TSH triggers your thyroid to release, about 80% is T4 and 20% is T3. Your thyroid also needs adequate amounts of iodine, a substance you get from the food you eat, to create T4 and T3.

Is T3 and T4 high in hypothyroidism? ›

If your results show high total T3 levels or high free T3 levels, it may mean you have hyperthyroidism. Low T3 levels may mean you have hypothyroidism, a condition in which your body doesn't make enough thyroid hormone. T3 test results are often compared with T4 and TSH test results to help diagnose thyroid disease.

Can your TSH levels be normal and still have hypothyroidism? ›

Normal TSH values may not rule out patients that are hypothyroid. It is possible that a large number of hypothyroid individuals are missed using TSH as a screening tool, which is a problem for the patient, who remains hypothyroid, and to the healthcare system as a whole.

Is levothyroxine a T3 or T4? ›

Levothyroxine is the name of all synthetic forms of the thyroid hormone T4. This manufactured hormone mimics the natural hormone produced by your thyroid and is prescribed as the primary treatment for hypothyroidism, or an underactive thyroid.

What are the two types of thyroid? ›

The two main types of thyroid disease are hypothyroidism and hyperthyroidism. Both conditions can be caused by other diseases that impact the way the thyroid gland works. Conditions that can cause hypothyroidism include: Thyroiditis: This condition is an inflammation (swelling) of the thyroid gland.

What is full thyroid test? ›

The tests included in a thyroid panel measure the level of thyroid hormones in the blood. A thyroid panel usually includes tests for: TSH (thyroid-stimulating hormone) Free T4 (thyroxine) Free T3 or total T3 (triiodothyronine)

What is a dangerously high TSH level? ›

A TSH over 10 mIU/L has been linked to an increased risk of coronary heart disease and heart failure, which is why you'll probably want to seek treatment if your TSH is close to (but still under) that upper limit.

Which thyroid test is best? ›

Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism.

Can I drink water before thyroid test? ›

Can I drink water before Thyroid Test? "Yes, you can have water before a Thyroid Test."

What if your T4 is high? ›

In general, T4 results that are higher than normal may be a sign of: Hyperthyroidism, which may be caused by Graves disease or another medical condition that causes your thyroid to make too much T4. Thyroiditis (thyroid inflammation) Toxic goiter (an enlarged thyroid with areas that make extra thyroid hormone)

What is a dangerously low TSH level? ›

A low TSH level—below 0.4 mU/L—indicates an overactive thyroid, also known as hyperthyroidism. This means your body is producing an excess amount of thyroid hormone.

What is a good thyroid level for a woman? ›

Optimal TSH hormone levels are 0.5-5.0 mIU/L, according to the mainstream medical community. We recommend 0.5-2.5 mIU/L, though — especially for pregnant women. Pregnancy tends to reduce TSH hormone levels. You may dip below 0.5 mIU/L but remain euthyroid (which means your thyroid is healthy).

Can I lower my TSH naturally? ›

Exercise helps increase the thyroid hormones T4 and T3 and decreases TSH as shown in this study. But there are also some supplements and herbs you can take to help boost your energy levels, like vitamin B12, iron, Ashwagandha, and ginseng.

What should TFT levels be? ›

Reference range: TSH: 0.27 - 4.2 mU/L, Free T4 12 - 22 pmol/L, Free T3: 3.1 - 6.8 pmol/L. See document below for Reference Ranges in Children (ages 0-18 years). If replaced with T4 ideally TSH should be in the reference range unless suppression is required e.g. Thyroid cancer.

What is a normal TSH level? ›

An imbalance in TSH provides information about your thyroid and its ability to produce and secrete thyroid hormones. It's often the most sensitive indicator that a thyroid problem is present. The normal range of TSH levels in adults is between 0.4 to 4.0 mIU/L (milli-international units per liter).

What is normal FT4 level? ›

Normal Results

A typical normal range is 0.9 to 2.3 nanograms per deciliter (ng/dL), or 12 to 30 picomoles per liter (pmol/L). Normal value ranges may vary slightly among different laboratories. Some laboratories use different measurements or may test different specimens.

What is low T3 syndrome? ›

Low T3 syndrome, also known as euthyroid sick syndrome or non-thyroidal illness syndrome, is a condition where T3 and/or T4 levels are lower than normal, but the thyroid gland is functioning properly [1]. The most common lab results in those with low T3 syndrome are [1]: Low T3 (total and free) High rT3.

What time of day are thyroid levels highest? ›

[1] A large laboratory data-based study by Ehrenkranz et al. showed that there is a significant circadian variation in the TSH levels with peak levels occurring between midnight and 8 am and nadir levels between 10 am–3 pm and 9–11pm.

Can TSH levels change quickly? ›

Thyroid values like TSH are measured in blood tests. Because a single test can be misleading, a second test is usually done 2 or 3 months later. In both tests, the blood is taken at the same time of day because TSH levels can fluctuate over the course of 24 hours.

Can you have normal TSH and T4 but low T3? ›

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. Patients with this pattern present with hypothyroid symptoms, normal TSH and T4, and low T3.

What is a dangerously high TSH level? ›

A TSH over 10 mIU/L has been linked to an increased risk of coronary heart disease and heart failure, which is why you'll probably want to seek treatment if your TSH is close to (but still under) that upper limit.

Can I lower my TSH naturally? ›

Exercise helps increase the thyroid hormones T4 and T3 and decreases TSH as shown in this study. But there are also some supplements and herbs you can take to help boost your energy levels, like vitamin B12, iron, Ashwagandha, and ginseng.

What is a dangerously low TSH level? ›

A low TSH level—below 0.4 mU/L—indicates an overactive thyroid, also known as hyperthyroidism. This means your body is producing an excess amount of thyroid hormone.

What if my T3 and T4 are normal but TSH is high? ›

When the thyroid gland becomes inefficient such as in early hypothyroidism, the TSH becomes elevated even though the T4 and T3 may still be within the "normal" range.

What happens if only T4 is high? ›

In general, T4 results that are higher than normal may be a sign of: Hyperthyroidism, which may be caused by Graves disease or another medical condition that causes your thyroid to make too much T4. Thyroiditis (thyroid inflammation) Toxic goiter (an enlarged thyroid with areas that make extra thyroid hormone)

Which is better FT3 or FT4? ›

FT3 is a good brother of FT4, they together play the role of thyroid hormones. According to FT3 and FT4 results which are high or low, you can directly determine the hyperthyroidism or hypothyroidism. The biggest feature of TSH is the opposite of FT3 and FT4, which the higher the FT3 / FT4, the lower the TSH.

Can low thyroid make you dizzy? ›

The release of insufficient thyroid hormone (hypothyroidism) may result in low blood pressure and a slowed heart rate, causing dizziness, weakness, lethargy, and chills.

Can low T3 cause weight gain? ›

According to Kitahara, if someone has low thyroid function, their TSH is high, and the thyroid hormones known as T3 and T4 are low—and weight gain often occurs.

Can low T3 affect heart? ›

Low T3 contributes to heart failure, specifically, Left Ventricular dysfunction. Both systolic and diastolic dysfunction may occur at rest and during exercise.

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