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Subclinical hypothyroidism, a milder form of hypothyroidism characterized by normal thyroxine levels and an elevated TSH level, is thought to occur in 4.3–8.5% of people in the United States. [8] Subclinical hypothyroidism has been associated with an increased risk of atrial fibrillation (AF) and is the most frequent thyroid abnormality in ...
Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. [1] TFTs may be requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy.
The therapeutic target range TSH level for patients on treatment ranges between 0.3 and 3.0 μIU/mL. [18] For hypothyroid patients on thyroxine, measurement of TSH alone is generally considered sufficient. An increase in TSH above the normal range indicates under-replacement or poor compliance with therapy.
TSH levels are determined by a classic negative feedback system in which high levels of T3 and T4 suppress the production of TSH, and low levels of T3 and T4 increase the production of TSH. TSH levels are thus often used by doctors as a screening test, where the first approach is to determine whether TSH is elevated, suppressed, or normal. [25]
T 3 is preferred, because in hypothyroidism T 3 levels may be normal. [84] The ratio of bound to unbound thyroid hormones is known as the thyroid hormone binding ratio (THBR). [ 85 ] It is also possible to measure directly the main carriers of the thyroid hormones, thyroglobulin and throxine-binding globulin. [ 86 ]
When treatment is first initiated, TSH levels may be monitored as often as a frequency of every 6–8 weeks. [71] Each time the dose is adjusted, TSH levels may be measured at that frequency until the correct dose is determined. [71] Once titrated to a proper dose, TSH levels will be monitored yearly. [71]
Affected patients may have normal, low, or slightly elevated TSH depending on the spectrum and phase of illness. Total T4 and T3 levels may be altered by binding protein abnormalities, and medications. Reverse T3 levels are generally increased, while FT3 is decreased. FT4 levels may have a transient increase, before becoming subnormal during ...
Levothyroxine is also used to treat subclinical hypothyroidism, which is defined by an elevated TSH level and a normal-range free T 4 level without symptoms. [14] Such people may be asymptomatic [ 14 ] and whether they should be treated is controversial. [ 13 ]
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