Help diagnosing hyperthyroidism

[ILR2019]

Hi all,

Can anyone advise what tests are needed to diagnose hyperthyroidism please. I assume low TSH and high T3 & T4, but are there any other blood tests? Are TPO &TG antibodies still relevant with hyper?

(Asking for my sister who I suspect has hyper. Have advised her to order a test via Medichecks, but I obviously need to know which one is most relevant, hence my question about which tests)

[Lora7again]

Yes your TSH will be either very low or suppressed mine was 0.002 when I was diagnosed with Graves' disease .... she will also have high antibodies and low vitamin D.

[SlowDragon Administrator]

Early stage Hashimoto's can present as similar symptoms and hyperthyroid type blood test results

Early in Hashimoto's, many people have several months of hyperthyroid type symptoms, weightloss etc as thyroid is attacked and excess thyroid hormones are released

Important to test TPO and TG thyroid antibodies for possible Hashimoto's (or Graves)

TSI or TRab antibodies tested for Graves' disease

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) or Graves' disease

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Private testing for suspected Graves - TSI or TRab antibodies

medichecks.com/thyroid-func...

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

[greygoose]

Thing is, hyper can either be Grave's, or the 'hyper' phase of Hashi's.

For Hashi's, she needs TPO and Tg antibodies.

For Grave's, TSI or TRAB.

But, you won't find them in the same bundle. So, she would have to do the TSH/FT4/FT3/TPOab/TgAB bundle, and the TSI (I think that's the only one Medichecks do) separately.

The TSH would be suppressed, yes, whether it were Grave's or Hashi's, so that doesn't mean very much. But, if it were the 'hyper' phase of Hashi's, the FT4 would be about 30 - 40 and the FT3 about 12-ish. With Grave's they would probably be a lot higher than that. But, it's the antibodies that are the most important in her case.

[ILR2019 in reply to greygoose]

Thank you so much for your help!

[greygoose in reply to ILR2019]

You're welcome.