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Thyroid dysfunction: Frequently asked questions among patients

(Patient question) If I haven’t had goitre or thyroid surgery in the past, why would I develop hypothyroidism?

The most common cause of hypothyroidism around the world is still iodine deficiency. However, in iodine-sufficient populations, thyroiditis is the most common cause of hypothyroidism. This is due to progressive destruction of thyroid follicular cells by antibodies directed towards specific parts of the cells that produce thyroid hormones. This condition often develops very insidiously over years and may not produce any manifestations until the person becomes overtly hypothyroid.

(Patient question) What is the best way to find out if I am hypothyroid?

Diagnosis of hypothyroidism requires documentation of low levels of thyroid hormones (i.e. T4 and T3). However, the diagnosis is refined by also measuring levels of thyroid stimulating hormone (TSH), which is produced in the brain and acts on the thyroid gland to stimulate T4 and T3 production. If TSH is high, then thyroid gland hormone secretion is the primary defect. However, if TSH is low, then the defective supply of this hormone from the brain (pituitary gland) is the cause of the hypothyroidism.

(Patient question) Do I need a special test, such as thyroid ultrasound or biopsy, to know if I am hypothyroid?

A blood test to check levels of the thyroid hormones T3 and T4 and the level of a further hormone (thyroid stimulating hormone, TSH) is sufficient to diagnose hypothyroidism. There is no need to do any other test if only to diagnose hypothyroidism. However, these other tests, thyroid ultrasound or a biopsy, are used to detect the presence of thyroid abnormalities that may have led to the hypothyroidism. Thus, a physician may request them after documenting that a person has biochemically confirmed hypothyroidism so that the probable cause can be investigated.