Why standard thyroid tests miss the mark

It’s estimated that one woman in five aged 60 and older has some form of thyroid disease. Twenty percent of people over 75 (again, mostly women), have hypothyroidism, or low levels of thyroid hormones.

It’s a condition that is often misdiagnosed because the symptoms mimic those of so many other conditions.

For example, the confusion that comes with low thyroid function is often mistaken for dementia.

Given the right testing, a case of hypothyroidism is hard to miss. The problem is that the “standard” test for thyroid malfunction can actually hide the problem.

Once you understand how thyroid hormones work and the different types of thyroid testing available, you can be your own advocate, and help your doctor select the test that will uncover your thyroid problems.

How thyroid hormones work and what can go wrong

The thyroid is a small gland that lives just behind your larynx, or “voice box.”

It regulates energy production and metabolism throughout the body, including the heart, brain, skin and bowels. It also regulates body temperature.

So, when your thyroid is off, a lot of things are off.

T3 and T4, your main thyroid hormones, control your metabolism, growth, sexual development and mood.

Thyroid stimulating hormone (TSH), on the other hand, is made in the pituitary gland, located at the base of the brain. Its job is to tell the thyroid when to make more T3 and T4.

How do you know when something’s wrong?

As mentioned earlier, hypothyroidism is easily mistaken for other conditions.

Symptoms include excessive fatigue, hair loss, depression and anxiety, unexplained weight gain, mental fogginess, constipation and sleep problems.

And even when your doctor does order a thyroid test, there’s a good chance it will come back looking like everything is fine.

The most common thyroid test, and why it doesn’t work

Most doctors will order a test of your TSH levels if they suspect a thyroid issue.

But testing for TSH alone can make it look like everything is fine with your thyroid when it isn’t.

There are two possible reasons for this.

One is that high stress and high cortisol levels may be suppressing your pituitary gland. It can’t “hear” the message that more thyroid hormone is needed, so it’s not producing much TSH, and those levels look normal when they ought to be quite high.

And because of the way the test was built, experts have suggested that the standard TSH range could be missing as many as 75 percent of people with low thyroid.

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Even when blood levels of thyroid hormone are normal, if the level of thyroid-stimulating hormone is low (a condition known as subclinical hyperthyroidism), serious problems can result.

In a Swiss study, the 2.219 of 70,298 men and women who had subclinical hypothyroidism were at significantly higher risk for fractures, particularly hip fractures.

What kind of testing should you ask for?

If you have any of the troublesome symptoms of low thyroid that were mentioned here, and particularly if you’re a woman over 60, talk to your doctor about being tested for thyroid function.

That means more than a TSH test, which only tells you how well the pituitary is “talking” to the thyroid, rather than measuring the actual levels of thyroid hormone and thyroid activity in your body.

There are blood tests available that give a more complete picture of how well the thyroid is producing T4, how well that T4 is being converted to T3 (which does the “heavy” work) and whether there are anti-thyroid antibodies present.

If your doctor isn’t familiar with these tests, don’t hesitate to find one who is.

One thing you might consider doing is an at-home self-test. Dr. Michael Cutler recommends his patients check their basal body temperatures, just after awakening but before getting out of bed. If this is low (e.g. below 98.2 F oral or 97.3 F axillary) and you have three or more of the signs/symptoms listed below, then you most likely have low thyroid function…

• Sensitivity to cold; cold hands and feet often
• Feeling tired in the daytime when sitting or at rest
• Unwanted weight gain; morning puffy face/swollen eyelids; water retention
• Constipation, abdominal bloating or colitis symptoms
• High blood cholesterol; high blood pressure
• Memory/concentration impairment; easily confused
• Depressed mood or anxiety upon waking or often during the waking hours
• Dry or slow-growing hair or nails/excessive hair loss; acne, eczema, psoriasis
• Stiff or painful joints; rheumatoid or osteoarthritis; carpal tunnel syndrome
• Hoarse voice, slowed speech
• Endometriosis, infertility, menstrual disorders, or abnormal uterine bleeding
• Frequent colds, sore throats, earaches, or other infections

Sources:

1. Why your doctor is wrong about thyroid testing — Women’s Health Network
2. Thyroid testing for hypothyroidism — Women’s Health Network
3. The Subtle Signs of a Thyroid Disorder — The New York Times
4. What is a thyroid antibodies test? — Medline Plus
5. What Your Hypothyroidism Test Results Mean — Everyday Health
6. Subclinical Thyroid Dysfunction and Fracture Risk: A Meta-Analysis — JAMA