Together with TSH, you need to determine the amount of hormones of the thyroid gland itself during a blood test. But what indicators to choose, because there are FREE and TOTAL thyroid hormones - T3 and T4? Some doctors suggest determining free T3 and T4, others - general, and still others - only TSH. How right?
The thyroid gland produces free hormones - thyroxine (or T4) and triiodothyronine (or T3). These chemicals enter the bloodstream along with thyroglobulin (therefore, a certain amount of thyroglobulin is always detected in the blood). Hormones are released from this protein of the gland and become FREE, i.e. able to exert their specific influence.
But, a very large number of free hormones T3 and T4 immediately binds to plasma proteins. Nearly 99% of thyroid hormones become BOUND. The compounds of proteins with hormones are STOCK (depot or warehouse). Only a small part of the hormones remains unconnected with the blood plasma proteins - FREE. They are an ACTIVE part of the hormones of the gland existing in the body.
Free T3 and T4 are active hormones.
Bound T3 and T4 are not active hormones.
But the BOUND hormone fractions are able to become FREE. This event occurs by detaching hormones from proteins in the blood.
Some types of protein molecules hold hormones stronger, others - weaker. Therefore, when needed, blood proteins "release" the hormones of the gland held by them and they become FREE.
Most laboratories do not identify RELATED types of thyroid hormones. But then they analyze the TOTAL fractions. TOTAL includes BOUND and FREE. But since there are more BOUND hormones in TOTAL, it is TOTAL hormones T3 and T4 that tell us about the amount of hormones in the body.
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C O R R E C T Blood test
ALWAYS, together with TSH, T3 and T4 FREE hormones should be determined. Only in addition to these three indicators is it fashionable to evaluate T4total and T3total.
Mandatory minimum: TSH, T3sv and T4sv.
Optimum minimum: TSH, T3fr., T4fr. and T4total.
The maximum hormonal set: TSH, T3fr., T4fr., T4total, T3total.
For the first time or after a long period of time, it is additionally appropriate to determine antibodies AT-TPO and AT-TG. With hyperthyroidism AT-rTTG.
Endocrinologists, as a rule, do not have a substantiated opinion of their own and rely on the recommendations of professors and thyroid associations. In addition, the fate of their patients is usually completely indifferent to strangers-doctors. Unfortunately it is so.
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