How to Test for Hypothyroidism

Medically reviewed by Ricardo Correa, MD

Last Updated: June 7, 2022 References

Studies show that hypothyroidism occurs when your thyroid does not produce enough hormones, which upsets the balance of chemical reactions in your body.^{[1]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source} The thyroid is an important endocrine gland that controls the body’s metabolism and is located in the front part of the neck just below your Adam’s apple. Experts agree that this condition, which is prevalent in women over 40, is hard to diagnose without a medical test, but it can usually be discovered relatively quickly via a blood test or a synthetic hormone injection.^{[2]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source} Although hypothyroidism is prevalent in older women, it can also affect pregnant women, postpartum females, those experiencing menopause, newborn babies, people with autoimmune diseases, people receiving radioactive iodine or therapy, and people who have had radiation in the neck or upper chest.

Part 1

Part 1 of 3:

Determining Who Should Get Tested

1
Get tested if you see symptoms. Symptoms develop slowly over a number of years. Many of the symptoms can also be associated with many other types of conditions, but any combination of fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, muscle stiffness or weakness, thinning hair, depression, and/or impaired memory will mostly likely lead you to hypothyroidism.
- If left untreated, hypothyroidism can become a serious problem. Physically, it could lead to a goiter and mentally lead to depression.
- Myxedema, or advanced hypothyroidism, is rare but can become life-threatening. Low blood pressure, decreased breathing, lowered body temperature, unresponsiveness, and a coma are signs and symptoms of the advanced stage that could ultimately lead to death.
2
Test newborn babies. Because of the risk of intellectual disability in infants, get your newborn tested while still in the hospital. An early diagnosis, within the first month of life, will make it easy for your baby to reverse any effects of hypothyroidism. A simple blood test can detect the condition and then, once the proper medication is prescribed, your doctor will monitor the thyroid hormone levels with regularly scheduled blood tests. ^{[3]
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- Newborns who suffer from hypothyroidism will exhibit jaundice, frequent choking, a large, protruding tongue, and a puffy face.
- If the condition progresses, your infant may have trouble feeding, constipation, poor muscle tone, or be excessively sleepy.
- If untreated, hypothyroidism could lead to severe physical and mental underdevelopment.
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3
Examine pregnant women. If you are pregnant or thinking about becoming pregnant then you should test your thyroid. Thyroid disease is common in women of childbearing age. Therefore, this condition could dramatically impact both mother and baby during the course of pregnancy.
- All pregnant women with an enlarged thyroid (goiter), family history of hypothyroidism, or high blood levels of thyroid antibodies should get tested.
- Ask your doctor for selenium supplementation if you have high antibody levels at the time of preconception.
- Women taking thyroid hormone replacement prior to pregnancy need to monitor their levels, especially during the first trimester. Doses might increase as the pregnancy progresses.
- After delivery (postpartum hypothyroidism), women may experience depression, memory and concentration issues, or thyroid enlargement.
4
Watch for signs in children and teens. Children and teens will experience the same signs and symptoms as adults, but since they are still growing and have very active thyroid glands, they may also suffer poor growth resulting in shorter stature, delayed development of their teeth, slowed mental development, or a longer time period to enter puberty. ^{[4]
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- Children with hypothyroidism need to see a doctor regularly because, as they grow, the dosage of medication will change. Severe consequences may occur if the dosage is incorrect.
5
Screen patients with conditions or exposures associated with high risk of developing hypothyroidism. People with conditions such as Down syndrome or Turner syndrome or those taking certain medications (amiodarone, lithium, thalidomide, interferon, sunitinib, and rifampicin) or treatments (radiation therapy to neck, radioiodine treatment, subtotal thyroidectomy), should be screened yearly for hypothyroidism.^{[5]
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Research source}^{[6]
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Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec;22(12):1200-35}
- Screening those who are not at risk and show no symptoms provides little benefit and is not encouraged.^{[7]
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  American College of Physicians guidelines on screening for thyroid disease. Ann Intern Med 1999 Feb 2;130(3):246} Women who are over 50 and have one or more symptoms, however, should be screened.^{[8]
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  American College of Physicians guidelines on screening for thyroid disease. Ann Intern Med 1999 Feb 2;130(3):246}

Part 2

Part 2 of 3:

Getting Tested

1
Examine yourself at home. If you are exhibiting a combination of the symptoms associated with hypothyroidism, you might want to take some preliminary measures to determine if you have the condition. A noninvasive way of determining if you have hypothyroidism is to check your basal body temperature (BBT is your lowest body temperature in a 24 hour period) at home. ^{[9]
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National Institute of Diabetes and Digestive and Kidney Diseases
Health information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health
Go to source}
- To get an accurate reading, you must take your temperature when you first wake up in the morning, before you even sit up in bed. Keep it under your arm for ten minutes.
- Perform this for four consecutive days and write it down. Your normal temperature should be between 97.8 and 98.2°F (36.6 and 36.8°C). If your temperature is below 97.8°F *(36.6°C), your thyroid could be underperforming. Check with your doctor of thyroid supplements.
- Remember, hypothyroidism cannot be confirmed as a condition with home testing alone. Only an official blood test conducted by your doctor can confirm any type of diagnosis. Even if home testing does not reveal hypothyroidism, you should remain wary since it is extremely difficult to detect and oftentimes takes several years to fully develop.
2
Screen your family and medical history. Since many of the symptoms of hypothyroidism are common complaints found in people that do not have a problem with their thyroid, an intense, detail-oriented medical history is conducted by your doctor. Make sure you remember how long your symptoms have been bothering you. ^{[10]
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- Doctors will pay particular attention to whether you mother or a close relative was ever diagnosed with hypothyroidism. Try to find this information before going to see your doctor.
- Cancer survivors, especially those who received radiation around the neck, or neck surgery, will be closely scrutinized.^{[11]
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- Another important red flag is medication that could cause hypothyroidism, such as amiodarone, lithium, interferon alpha, or interleukin-2.^{[12]
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3
Get a physical exam. A physical exam will take place after screening your family and medical history to check for symptoms. Your doctor will be checking for evidence of dry skin, swelling around the eyes and legs, slow reflexes, and a slow heart rate. ^{[13]
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4
Take blood tests. If the results from your history and physical exams lead your doctor to suspect you have hypothyroidism or subclinical hypothyroidism, you will have blood tests to confirm the diagnosis. There are two main blood tests to confirm a diagnosis of hypothyroidism: Thyroid-stimulating hormone (TSH) test and the Thyroxine (T4) measurement. ^{[14]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}
- If the tests come back atypical, anti-thyroid antibody tests may determine whether you have the autoimmune disease Hashimoto's thyroiditis, in which the body's defense system attacks the thyroid gland.
- Ultrasound is only used in rare cases to evaluate a thyroid gland that appears abnormal. Instead, a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the hypothalamus or pituitary gland may be done to look for any changes in these areas of the brain.

Part 3

Part 3 of 3:

Testing Positive

1
Take drugs. Standard treatment for hypothyroidism is an oral medication that restores your hormone levels to their proper levels. You will need to take the thyroid hormone levothyroxine on a daily basis to reverse the signs and symptoms of hypothyroidism. After starting treatment, you will have regular visits with your doctor to make sure you have the right dose of medicine. ^{[15]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}
- In most cases, your symptoms will begin to abate and you will gain some energy back two to six weeks after beginning treatment.
- Another benefit to this drug treatment is the lowering of cholesterol, which may reduce weight gained during the pregnancy.
- Infants and children with hypothyroidism should always be treated.
2
Continue treatment. Taking levothyroxine is often for life, but the dosage size could become less over time. For older adults, the reverse happens. It is common that hypothyroidism gets worse with age requiring higher dosages because the thyroid slows down naturally. ^{[16]
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Trustworthy Source
National Institute of Diabetes and Digestive and Kidney Diseases
Health information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health
Go to source}
- Taking medicine everyday for the rest of your life is no easy chore and as physical symptoms disappear, you might be tempted to stop taking your medication. In this case, the symptoms will reappear and you will have to start all over again.
- The thyroid often returns to normal if the cause of your hypothyroidism was a result of a serious illness or infection.
- You may briefly stop taking your medication to see if your thyroid is functioning normally. If the thyroid can produce enough hormones by itself, treatment can end.
- Continue checkups annually while on medication.
3
Think about the future. Be careful about which foods you eat and whether to take supplement or not with your medication. It is important that you continue to take your thyroid medication properly. If you are confused as to why you are taking it or the possible side effects, contact your doctor. ^{[17]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source}
- Avoid taking iron and calcium supplements with your medication because they reduce the amount of thyroid hormone absorbed by the body. Calcium supplements, however, can be taken prior to or after four hours of taking medication.
- Foods such as walnuts, soybean flour, and cottonseed meal should also be avoided because they could interact with your medication and, therefore, reduce its overall effectiveness.
- If you take birth control pills or other hormone medication, talk to your doctor about adjusting the dose of your medicine.
- Many health food stores carry “natural” ingredient thyroid hormone supplements. These products are unregulated by the Food and Drug Administration. Therefore, be wary of the quality and effectiveness of these products. Some do have active ingredients that work, but can still be dangerous to certain people. Consult your doctor if you are interested in these supplements.

Expert Q&A

Question

What's the difference between hypothyroidism and hyperthyroidism?

Damaris Vega, MD
Board Certified Endocrinologist
Dr. Damaris Vega is a board certified Endocrinologist. She graduated Magna Cum Laude from the Pontifical Catholic University of Puerto Rico with a BS in General Science and subsequently earned an MD from the Ponce School of Medicine, Ponce, PR. During medical school, Dr. Vega served as president of the Alpha Omega Alpha Medical Honor Society and was selected as her school's representative for the American Association of Medical Colleges. She then completed a residency in Internal Medicine and a fellowship in Endocrinology, Diabetes, Mineral, and Metabolism at The University of Texas Southwestern Medical School. Dr. Vega has been recognized for excellent patient care multiple times by the National Committee for Quality Assurance and received the Patients' Choice Award in 2008, 2009, and 2015. She is a fellow of the American College of Clinical Endocrinologists and is an active member of the American Association of Clinical Endocrinologists, the American Diabetes Association, and the Endocrine Society. Dr. Vega is also the founder and CEO of Houston Endocrinology Center as well as a principal investigator for multiple clinical trials at Juno Research, LLC.

Damaris Vega, MD

Board Certified Endocrinologist

Expert Answer

Hypothyroidism occurs when your thyroid doesn't produce enough hormones, and hyperthyroidism occurs when your thyroid produces too much hormone.
Question

What are early warning signs of thyroid problems?

Damaris Vega, MD
Board Certified Endocrinologist
Dr. Damaris Vega is a board certified Endocrinologist. She graduated Magna Cum Laude from the Pontifical Catholic University of Puerto Rico with a BS in General Science and subsequently earned an MD from the Ponce School of Medicine, Ponce, PR. During medical school, Dr. Vega served as president of the Alpha Omega Alpha Medical Honor Society and was selected as her school's representative for the American Association of Medical Colleges. She then completed a residency in Internal Medicine and a fellowship in Endocrinology, Diabetes, Mineral, and Metabolism at The University of Texas Southwestern Medical School. Dr. Vega has been recognized for excellent patient care multiple times by the National Committee for Quality Assurance and received the Patients' Choice Award in 2008, 2009, and 2015. She is a fellow of the American College of Clinical Endocrinologists and is an active member of the American Association of Clinical Endocrinologists, the American Diabetes Association, and the Endocrine Society. Dr. Vega is also the founder and CEO of Houston Endocrinology Center as well as a principal investigator for multiple clinical trials at Juno Research, LLC.

Damaris Vega, MD

Board Certified Endocrinologist

Expert Answer

The signs change depending on if you have hypothyroidism or hyperthyroidism. When you have hypothyroidism you may experience fatigue, weight gain, hair loss, depression, high blood pressure, and dry skin. If it is hyperthyroidism, you may experience heart palpitations, anxiety, tremors, problems sleeping, weight loss, and hair loss or skin changes.
Question

I have a lump at the front of my neck at the bottom that I am told is fine. How would I go about having it removed? I believe it is a benign cyst.

Lisa Bryant, ND
Licensed Naturopathic Physician
Dr. Lisa Bryant is Licensed Naturopathic Physician and natural medicine expert based in Portland, Oregon. She earned a Doctorate of Naturopathic Medicine from the National College of Natural Medicine in Portland, Oregon and completed her residency in Naturopathic Family Medicine there in 2014.

Lisa Bryant, ND

Licensed Naturopathic Physician

Expert Answer

If it's a cyst, you can schedule with a dermatologist. If it's a nodule on your thyroid, you will most likely need to consult with an endocrinologist.

Warnings

If you are not sure if you have an underactive thyroid, do not hesitate to discuss this with your doctor. A blood test can help your doctor make a diagnosis. Failure to treat hypothyroidism can have devastating, even long-term or fatal, consequences that may get you later in life.

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