TSH Test | Overview Of Thyroid Stimulating Hormone To Test Your Thyroid

Posted by Tyler Britton and Dette Avalon ANP on Apr 14, 2017 10:57:02 AM

What is TSHWhat is TSH (Thyroid Stimulating Hormone)?

Thyroid Stimulating Hormone (TSH) is produced by your pituitary gland and is the throttle for your thyroid. Your thyroid regulates every single cell in your body with thyroid hormones: thyroxine 4 (T4) and triiodothyronine (T3).

When your body needs to produce more thyroid hormone, your pituitary steps on the gas pedal by producing more TSH, which in turn tells your thyroid to produce more hormone. When your body needs less thyroid hormone, your pituitary produces less TSH, which signals the thyroid to slow down hormone production.

It’s important to know what your TSH level is because it indicates what your thyroid is doing (or not doing). For example:

  • If TSH levels are HIGH, it indicates that thyroid production may be LOW
  • If TSH levels are LOW, it indicates that thyroid production may be HIGH
  • Abnormal TSH levels are an indicator of thyroid disease

We care about TSH because of its close relationship with our thyroids.

What a TSH Test Is Used For

TSH tests have been the most common test screening for thyroid function for over a decade [1]. is used to test the amount of Thyroid Stimulating Hormone that our pituitary gland is producing. Indirectly, we use a TSH tests as an indicator of:

  • What your thyroid is doing
  • How much thyroid hormone is floating around in your body (TSH decreases when T4 rises, and vice versa)

As a general rule:

  • High TSH tells us that your pituitary is pressing on the gas pedal, but your body isn’t producing enough T3 and T4
  • Low TSH tells us that your thyroid is producing too much T3 and T4

High TSH is a symptom of hypothyroidism. Low TSH is a symptom of hyperthyroidism. Usually, these tests are done in response to symptoms that you are experiencing, though functional medicine practitioners often highly recommend TSH testing at the onset of pregnancy because thyroid problems.

TSH tests are generally considered as a core part of any thyroid health assessment. For more information about thyroid health assessments, see our Dr. Amy Myers Thyroid Testing page.

How to Test TSH

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Testing your TSH levels is as simple as getting a blood draw. Also, contrary to what many sites report, even the largest medical sites such as webmd, research shows us that time of day and fasting are relevant to your TSH test, and the best times to establish your upper TSH level may be in the morning on an empty stomach.  

TIME OF DAY: TSH tests DO fluctuate with the time of day TSH levels peak in the middle of the night, and so getting tested in the morning will be helpful to see what your TSH upper limit is [2].

FASTING: You will also commonly see online that you don’t need to fast prior to a TSH test. However, research shows, such as this 2014 study, that TSH levels decline significantly after meals in comparison with fasting levels [3].  

OTHER FACTORS: It’s important to note that if you have received radioactive materials or had X-rays that used iodine dye in the 4-6 weeks preceding your test, your results may not be correct.

THYROID MEDICATION: There are mixed opinions about whether or not you should take thyroid medication before your TSH test. Consult your medical practitioner to see what they recommend and why they recommend it.

TSH Test Results: Normal TSH Levels? (There’s a Better Question)

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The first questions you care about when you receive your TSH test results is, “Is this normal?” Unfortunately, there’s no consensus on exactly what normal TSH levels are in terms of the upper limit. However:

  • .45 – 5.5 mIU/L | Historically this has been the accepted range of TSH [4, 5, 6]
  • .45 – 4.5 mIU/L | In 2008 the Endocrine Society and American Medical Association adopted this range [4, 5, 6]
  • < 3.0 mIU/L | The American Association of Clinical Endocrinologist now recommends this as an upper limit [6]
  • < 2.5 mIU/L | National Academy of Clinical Biochemistry suggests this as an upper limit for TSH levels [7], as 95% of normal individuals have TSH levels below 2.5 [8]

However, a much better question to ask is what is “Are my TSH levels functional?” “Functional” TSH level addresses whether or not your thyroid is working optimally. It’s sort of like the difference between getting a C- and an A-. C- isn’t failing grade, but do you want it?

Many functional medicine providers suggest that an optimal range for functional TSH levels is 1.0 – ~2.0 mIU/L. This is because:

  • Studies have found that TSH above 2.0 may be associated with cardiovascular risk factors [9], as well as other serious health risks such as dysglycemia (above 2.1 mIU/L) [10] and non-alcoholic fatty liver disease (NAFLD) [11],
  • TSH between 1.0 and 2.0 has been associated with the lowest incidence of abnormal thyroid function [12]

Remember, TSH levels fluctuate throughout the day and over time depending any number of factors (stress level, infection, etc.). If your TSH levels are high, you may consider retesting later to hone in on an accurate diagnoses.

References

[1] LifeExtension. Disease Prevention and Treatment: 5th Addition. 2013. 1256.

[2] Sviridonova MA, Fadeyev VV, Sych YP, Melnichenko GA. Clinical significance of TSH circadian variability in patients with hypothyroidism. Endocr Res. 2012 Aug 2.

[3] Rakesh Nair, Shriraam Mahadevan, R. S. Muralidharan, and S. Madhavan. Does fasting or postprandial state affect thyroid function testing? Indian J Endocrinol Metab. 2014 Sep-Oct; 18(5): 705–707.

[4] Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc. 2009;84(1):65-71.

[5] Guan H, Shan Z, Teng X, et al. Influence of iodine on the reference interval of TSH and the optimal interval of TSH: results of a follow-up study in areas with different iodine intakes. Clin Endocrinol (Oxf). 2008 Jul;69(1):136-41.

[6] American Association of Clinical Endocrinologists. Subclinical thyroid disease.

[7] Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003 Jan;13(1):3-126.

[8] Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab. 2005 Sep;90(9):5483-8.

[9] Benvenga S, Ruggeri RM, Russo A, Lapa D, Campenni A, Trimarchi F. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001 Aug;86(8):3579-94.

[10] Boggio A, Muzio F, Fiscella M, Sommariva D, Branchi A. Is thyroid-stimulating hormone within the normal reference range a risk factor for atherosclerosis in women? Intern Emerg Med. 2011 Dec 28. 

[11] 6. Chung GE, Kim D, Kim W, et al. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol. 2012;57(1):150-156.

[12] Teng W, Shan Z, Teng X, Guan H, Li Y, Teng D, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med. 2006 Jun 29;354(26):2783-93.

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