4 Simple Steps to Determine If You Are Hyperthyroid

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Under the care of your family doctor or a doctor who specializes in treating thyroid diseases (called an endocrinologist), here are four steps you will undergo to determine whether or not you have hyperthyroidism. 

Identify Your Risk Factors

You will want to identify and track your risk factors for hyperthyroidism or Graves' disease, the autoimmune condition that causes hyperthyroidism. These risk factors include:

  • Gender (women are more at risk)
  • Family or personal history of thyroid problems such as nodules, goiter, hypothyroidism, and thyroid cancer
  • Previous thyroid surgery
  • Personal or family history of any autoimmune disease.

Identify Your Symptoms and Related Conditions

Note any common symptoms of hyperthyroidism you are experiencing, including neck enlargement, weight loss, anxiety, insomnia, fatigue, hair loss, heart palpitations, rapid heartbeat, sweating, feeling overheated, high blood pressure, diarrhea, weakness, and eye/vision changes.

In addition, identify any related conditions that are more common when you are hyperthyroid. These may include atrial fibrillation, recurrent pregnancy loss, panic disorder, and anxiety disorder. 

It's important to understand that hyperthyroidism can be overlooked or easily misdiagnosed. In some cases, the common hyperthyroidism symptoms like panic attacks, anxiety, difficulty sleeping, loss of appetite, weight loss, and rapid heart rate are assumed to be mental health issues like anxiety disorder, panic disorder, and depression, or attributed to issues such as aging, hormones, and stress.

See a Doctor for A Full Evaluation and Tests

Meet with your doctor for an in-depth clinical thyroid examination and various blood tests.

These tests should include a TSH (thyroid stimulating hormone) blood test, along with T4 and T3 tests. Your doctor may also test thyroid antibody levels to identify antibodies that help diagnose autoimmune Graves' disease.

In some cases, imaging tests, such as ultrasound, MRI, CT scans, x-rays, or radioactive iodine uptake (RAI-U), will be performed to make a thorough and accurate diagnosis. 

Review and Understand Your Test Results

You need to review your test results with your doctor and understand the results. 

TSH Results

The normal range for the TSH test is approximately 0.5 to 5.0 milli-international units per liter (mIU/L). All people with primary hyperthyroidism have a low TSH; however, the TSH level alone cannot determine the degree of hyperthyroidism. This is why your doctor will also check your T4 and T3 levels.

High Free T4 and T3 Results

A diagnosis of primary hyperthyroidism is consistent with a low TSH, and a high free T4 and/or T3 blood test.

However, if your TSH is normal or elevated, and your free T4 and T3 are high, you will need an MRI of your pituitary gland to evaluate for a condition called central hyperthyroidism. 

High T3 and Normal Free T4 Results

If your TSH is low and your T3 is high (but your free T4 is normal), it's likely that your diagnosis is Graves' disease or a thyroid nodule that is producing too much hormone. An imaging test, called a radioactive iodine uptake scan, can differentiate between these two diagnoses.

Normal T3 and High Free T4 Results

If your TSH is low, your free T4 is high, but your T3 is normal, you may be experiencing hyperthyroidism from taking too much exogenous T4 (levothyroxine). Another possible diagnosis is an amiodarone-induced thyroid problem.

Lastly, this lab combination is seen in people with hyperthyroidism who have a concurrent nonthyroidal disease (for example, a severe infection) that is decreasing the conversion of T4 to T3.

Normal Free T4 and T3 Results

If your TSH is low, but your T3 and T4 levels are normal, you may have subclinical hyperthyroidism. This can also be seen in pregnancy.

Antibody Results

If your test results come back normal, but you have many of the symptoms or risk factors for thyroid disease, make sure you ask for an antibodies test for Graves' disease.

Imaging Tests

Imaging tests can identify goiter—more common in hyperthyroidism—as well as nodules that may be causing hyperthyroidism. In addition, RAI-U tests can provide evidence that your overactive thyroid may be triggered by the autoimmune condition known as Graves' disease.

A Word From Verywell

It's important that if you have risk factors for hyperthyroidism and/or suggestive signs or symptoms of hyperthyroidism that you undergo a comprehensive evaluation and testing with a doctor, which includes a hands-on examination of your thyroid, as well as detailed blood and imaging tests.

If all your test results come back normal, but you have symptoms or risk factors for thyroid disease, consider seeking out a second opinion. Some people also choose to see a reputable holistic, integrative, or complementary physician for further interpretation and diagnosis.


Bahn, R., Burch, H, Cooper, D, et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists."Endocrine Practice. Vol 17 No. 3 May/June 2011.

Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

Ross DS. (2017). Diagnosis of hyperthyroidism. Cooper DS, ed. UpToDate. Waltham, MA: UpToDate Inc.