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Hashimoto's thyroiditis
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==== TSH levels test ==== Elevated [[Thyroid-stimulating hormone]] (TSH) levels may indicate [[hypothyroidism]] (underpeforming thyroid).<ref name="Niddk2021"/> Hypothyroidism is a common symptom and potential indication of Hashimoto's disease.<ref name="Ramos-Levi2023" /> As blood levels of thyroid hormones fall due to hypothyroidism, the anterior [[Pituitary gland|pituitary]] gland increases production of TSH, which stimulates increased production of thyroid hormones in the thyroid.<ref name=":6" /> The elevation is usually a marked increase over the normal range.<ref name="Singh2020"/> TSH is the preferred initial test of thyroid function as it has a higher [[Sensitivity and specificity|sensitivity]] to changes in thyroid status than free T<sub>4</sub>.<ref>{{Cite book | author = Royal College of Pathologists of Australasia | chapter = Thyroid stimulating hormone | chapter-url = https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/T/Thyroid-stimulating-hormone | title = Royal College of Pathologists of Australasia Manual }}</ref> Biotin can cause this test to read "falsely low".<ref name=":6" /> Time of day can affect the results of this test; TSH peaks early in the morning and slumps in the late afternoon to early evening,<ref>{{cite journal | vauthors = Ikegami K, Refetoff S, Van Cauter E, Yoshimura T | title = Interconnection between circadian clocks and thyroid function | journal = Nature Reviews. Endocrinology | volume = 15 | issue = 10 | pages = 590β600 | date = October 2019 | pmid = 31406343 | pmc = 7288350 | doi = 10.1038/s41574-019-0237-z }}</ref> with "a variation in TSH by a mean of between 0.95 m[[International unit|IU]]/mL to 2.0 mIU/mL".<ref>{{cite journal | vauthors = Sheehan MT | title = Biochemical Testing of the Thyroid: TSH is the Best and, Oftentimes, Only Test Needed - A Review for Primary Care | journal = Clinical Medicine & Research | volume = 14 | issue = 2 | pages = 83β92 | date = June 2016 | pmid = 27231117 | pmc = 5321289 | doi = 10.3121/cmr.2016.1309 }}</ref> Hypothyroidism is diagnosed more often in samples taken soon after waking.<ref>{{cite journal | vauthors = Sviridonova MA, Fadeyev VV, Sych YP, Melnichenko GA | title = Clinical significance of TSH circadian variability in patients with hypothyroidism | journal = Endocrine Research | volume = 38 | issue = 1 | pages = 24β31 | date = 2013-05-01 | pmid = 22857384 | doi = 10.3109/07435800.2012.710696 }}</ref>
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