Thyroid Test: Symptoms and a TSH, FT4 and FT3 Result Interpreter

Tiredness that will not pass, weight that comes from nowhere, cold hands, hair loss, palpitations or insomnia: all of it can, but need not, come from the thyroid. This test has two parts. In the first you tick symptoms and see whether the pattern looks like an underactive or an overactive gland. In the second you enter TSH, FT4, FT3 and anti-TPO from your report and get an interpretation by the same logic an endocrinologist reads a report with. Neither part makes a diagnosis; both tell you whether it is time for a test, an examination and an ultrasound.

Thyroid symptom test

How the thyroid produces symptoms

The thyroid secretes the hormones T4 and T3, which set the metabolic rate of every cell in the body. When there is too little of them (hypothyroidism), everything slows down: pulse, digestion, calorie burning, skin and hair renewal, mood and memory. When there is too much (hyperthyroidism), everything speeds up: the heart races, the hands tremble, the kilograms melt despite the appetite, sleep disappears. That is why the symptoms are so varied and why people attribute them for years to stress, age or "that kind of metabolism".

The most common cause of an underactive gland in Serbia is Hashimoto's thyroiditis, an autoimmune inflammation in which antibodies (anti-TPO) gradually damage the gland; it mostly affects women and is often found only when TSH rises. An overactive gland is most often caused by Graves' disease or an autonomous nodule. Read more about the symptoms in thyroid gland: symptoms.

Thyroid hormone report interpreter

The first and most important number on the report is TSH, the pituitary hormone that "orders" the gland how hard to work. When the gland falters, TSH rises; when it overdoes it, TSH falls. TSH is therefore inversely proportional to the gland's activity, which confuses many people: a high TSH means an underactive gland. FT4 and FT3 are the free, active hormones of the gland itself and tell whether the disorder is already real or still subclinical. Anti-TPO antibodies reveal an autoimmune cause.

What the TSH and FT4 combination means

TSH	FT4	Most common interpretation
normal	normal	healthy function; the symptoms probably have another origin
high	normal	subclinical hypothyroidism; repeat in 6 to 12 weeks, anti-TPO
high	low	hypothyroidism; hormone replacement, endocrinologist
low	normal	subclinical hyperthyroidism; repeat, FT3, endocrinologist
low	high	hyperthyroidism; endocrinologist in the coming days
low or normal	low	rare: pituitary disorder or severe general illness

When to see a doctor and what is done

If the symptom test gave a clear pattern or any value on the report is out of range, an endocrinology examination follows. At the Miren Medic polyclinic it includes a consultation, an examination of the neck and, when needed, a thyroid ultrasound in the same place, without a referral, in the same appointment. The ultrasound shows the size of the gland, signs of autoimmune inflammation and nodules, which are common and mostly harmless but are followed up. Do not wait for a repeat test if you have:

• a resting pulse above 100 with trembling, sweating and weight loss
• TSH above 10 mIU/L, or any raised TSH in pregnancy or when planning one
• a growing swelling in the neck, difficulty swallowing or hoarseness that persists
• thyroid hormone treatment with new symptoms: the dose may need changing

If you are already on treatment, TSH is checked 6 to 8 weeks after every dose change and then usually once a year. Our article on Hashimoto's thyroiditis explains what anti-TPO antibodies mean and how an autoimmune disease is followed.

How blood is taken for thyroid hormones

• In the morning, ideally by 10 a.m., because TSH has a daily rhythm and is lower in the afternoon.
• Fasting is not required, but it is for a panel with lipids and glucose.
• If you take levothyroxine, take the tablet only after the blood draw; pause biotin (in hair and nail supplements) 2 days before, because it falsely changes the result.
• After a cold or infection wait 4 to 6 weeks: illness temporarily shifts TSH.
• In pregnancy tell the laboratory the week of pregnancy, because reference ranges depend on the trimester.

Examination prices

Service	Price
Endocrinology consultation (Dr Nemanja Nenezić)	12.000 RSD
Endocrinology consultation + thyroid ultrasound (Dr Nemanja Nenezić)	14.000 RSD
Endocrinologist consultation (Dr Zorana Đuran)	7.000 RSD
Endocrinology consultation + thyroid ultrasound (Dr Zorana Đuran)	12.000 RSD
Thyroid ultrasound (Dr Uroš Miladinović)	6.000 RSD

Frequently asked questions

What are the first symptoms of a thyroid problem?

With an underactive gland they are tiredness, sleepiness, weight gain, feeling cold, dry skin and hair loss; with an overactive gland weight loss, palpitations, nervousness, insomnia and trembling hands. In women cycle disturbances are also common. The symptoms develop slowly, which is why they are easily attributed to something else.

What is a normal TSH value?

Indicatively 0.4 to 4.0 mIU/L in adults outside pregnancy. Many endocrinologists follow values above 2.5 more closely when there are symptoms or anti-TPO antibodies, and in pregnancy lower values are targeted. Your laboratory's range is the one that counts.

What does a high TSH with a normal FT4 mean?

That is subclinical hypothyroidism: the gland still keeps the hormones up, but the pituitary has to "push" it. The test is repeated in 6 to 12 weeks with anti-TPO. Whether treatment is started depends on how high TSH is, antibodies, symptoms and pregnancy plans.

Can the thyroid be checked without a referral?

Yes. At the Miren Medic polyclinic the TSH, FT4, FT3 and anti-TPO tests, the endocrinology examination and the thyroid ultrasound are done without a referral, and the examination with ultrasound can be done in the same appointment.

Is this test enough for a diagnosis?

No. The symptom test shows whether the pattern looks like a disorder, and the report interpreter applies general logic to your numbers. The diagnosis is made by an endocrinologist from the examination, the complete report and the ultrasound, because the same numbers are read differently in a pregnant woman, an older person or someone taking medicines.