In addition to recognizing subtle clinical signs of hypothyroidism—fatigue, decreased energy, and other non-specific findings—what are the guideline-consistent benchmarks for laboratory evaluation of a person suspected of having hypothyroidism?
So when we talk about diagnosis of hypothyroidism, uh we should not expect major clinical signs or symptoms because diagnosis, from a biochemical point of view, say so straightforward that uh most of the patients will have minor symptoms or even on the regular checkups, physicians will just add TSH and free T. Four on their regular checkups. And and then we'll start looking at those patients that have slightly elevated TSH. So how do we make the diagnosis of hypothyroidism? First, we asked for Syrian levels of TSH and serum levels of uh T. For best, Free T. four is the ideal. So you're gonna have elevated serum levels of TSH combined with decreased levels of free T. Form. So a lot of people will think, well, why we're not asking for T. Three levels? What happens is that the thyroid system, which is the thyroid gland and pituitary gland and the hypothalamus they bend over backwards to keep the three normal in the circulation so that hypothyroidism patients will always will only exhibit decreased levels of T. Three way into the syndrome. I mean, after really T four is really low and TSH is really lie is high is when 73 levels will decrease. So from a diagnostic point of view, it has no role Whatsoever asking for 73 levels for hypothyroidism. So we will see a slight decrease in free T four and an elevation of TSH and that closes the diagnosis of hypothyroidism. Now there's a lot of questions and controversy about how high the TSH should be. So we know that more or less, the normal range for serum TSH is between 0.45 4.5 micro units were ml And uh we, In terms of guidelines and these are guidelines in Europe and the United States, in Latin America and Asia, they all talk about 10 as being the threshold for the diagnosis of hypothyroidism. So if an individual patient has a TSH that's higher than 10, even if the TSH, even if the T four levels, the free T four levels are within the normal range, or with, you know, the lower limit of normal range, those patients should be treated. They will benefit from treatment with leave of Iraq's. So if you have a patient with the TSH is higher than 10, that sort of closes the diagnosis of hypothyroidism uh at that level of TSH, you will frequently see a low free T 40 a free T four or a free T four that towards the low end of the normal range.
