Health Tips
Thyroid Test (TSH) in Ja-Ela: When Tiredness, Weight Change or Hair Loss Is Worth Testing
TSH is the first thyroid test to do — LKR 1,800, no fasting, one small blood sample. Here's what a high or low result means, when Free T4 and Free T3 are added, and the three other tests worth checking when the real complaint is exhaustion.
Quick answer: TSH is the test to start with. At St. Luke's in Ja-Ela it costs LKR 1,800, needs no fasting, and takes one small blood sample. A high TSH usually points to an underactive thyroid (hypothyroidism); a low TSH to an overactive one (hyperthyroidism). Free T4 and Free T3 (LKR 1,900 each) are added when TSH comes back abnormal, to show how far the thyroid has actually shifted.
Persistent tiredness is one of the most common reasons anyone walks into a laboratory — and the thyroid is one of the most common fixable causes. It's a small gland in the front of your neck that sets the pace of your metabolism: how you burn energy, regulate temperature, and how fast almost everything runs.
When it drifts, the symptoms are vague enough to be blamed on work, age, stress or the weather for years.
Why TSH first, and not T3 or T4
This confuses a lot of people, so here's the logic in one paragraph.
TSH is made by your pituitary gland, not your thyroid. The pituitary works like a thermostat: it senses how much thyroid hormone is circulating and adjusts TSH to push the thyroid harder or ease off. If the thyroid is underperforming, the pituitary shouts louder — TSH goes up. If the thyroid is overproducing, the pituitary goes quiet — TSH goes down.
That inverse relationship is what makes TSH the most sensitive single screening test. It often moves before T4 and T3 leave their normal ranges, which is why doctors screen with TSH and add the others only when there's something to investigate.
So: high TSH → probably underactive. Low TSH → probably overactive. It feels backwards, and it catches people out every time.
Underactive vs overactive: the symptom picture
| Underactive (hypothyroidism) — TSH usually high | Overactive (hyperthyroidism) — TSH usually low | |
|---|---|---|
| Energy | Persistent tiredness, sluggishness | Restlessness, but exhausted |
| Weight | Gain, or difficulty losing | Loss despite a normal or increased appetite |
| Temperature | Feeling cold when others don't | Feeling hot, sweating more |
| Heart | Slower pulse | Fast or pounding heartbeat, palpitations |
| Mood | Low mood, mental fog, poor concentration | Anxiety, irritability, difficulty settling |
| Skin & hair | Dry skin, hair thinning or falling | Fine tremor, thin skin, hair thinning |
| Digestion | Constipation | Loose or frequent stools |
| Periods | Heavier or irregular | Lighter or absent |
| Other | Puffy face, hoarse voice, muscle aches | Bulging or gritty eyes, neck swelling |
Hair loss appears on both sides of that table, which is worth knowing — it's a thyroid signal in either direction, not just an underactive one.
The tests and what they cost
| Test | What it tells you | Price (LKR) |
|---|---|---|
| TSH | The screening test. Sensitive to thyroid problems before other tests shift | 1,800 |
| Free T4 (FT4) | The main thyroid hormone available to your tissues. Added when TSH is abnormal | 1,900 |
| Free T3 (FT3) | The active hormone. Useful particularly when hyperthyroidism is suspected | 1,900 |
A common doctor's request is TSH + FT4 together (LKR 3,700) when symptoms are strong enough that they want the fuller picture in one draw rather than calling you back. All prices are on our full price list.
These run on our Chemiluminescence Immunoassay (CLIA) analyzer — the same platform that handles Vitamin D and ferritin. More on how that works in our post on CLIA immunoassay testing in Ja-Ela.
Reading your result — carefully
A few things worth understanding before you look at your report and worry:
- Reference ranges are printed on your report for a reason. They vary between laboratories and analyser methods. Always read your number against the range on your report, not one from the internet.
- A slightly abnormal TSH with normal FT4 is a recognised pattern (subclinical thyroid disease). It does not automatically mean treatment — it usually means a repeat test after a few weeks and a conversation with your doctor.
- TSH fluctuates. It varies through the day and can be temporarily disturbed by acute illness. One borderline reading is not a diagnosis.
- Do not adjust thyroid medication yourself based on a lab report. Dose changes are a doctor's decision.
Who should consider testing
- Women over 35, and anyone with a family history of thyroid disease — thyroid conditions are considerably more common in women
- After pregnancy — postpartum thyroid problems are common and frequently mistaken for ordinary new-parent exhaustion
- Any visible neck swelling or goitre, difficulty swallowing, or a hoarse voice that persists
- Unexplained weight change in either direction
- Irregular periods, difficulty conceiving, or recurrent miscarriage
- Unexplained high cholesterol — an underactive thyroid raises LDL, and treating the thyroid can improve the lipid profile (LKR 1,500)
- Palpitations or a persistently fast pulse
- Older adults, where thyroid symptoms are easily mistaken for ageing
Preparation: two things that genuinely matter
No fasting is needed. Eat and drink normally. But two points do affect accuracy:
- Biotin supplements can distort thyroid results. Biotin (vitamin B7, found in many hair, skin and nail supplements, and in some multivitamins) can interfere with immunoassay tests and produce falsely high or falsely low readings. Tell us if you take one — the usual advice is to stop it for a couple of days before testing, but check with your doctor first.
- If you're already on levothyroxine, the common practice is to have blood drawn before the day's dose, and to be consistent about timing between tests so results are comparable. Follow your doctor's instruction.
When tiredness isn't the thyroid
This is the part that saves people money and disappointment. Exhaustion has several common causes here, and the thyroid is only one of them. If your TSH comes back normal and you still feel drained, the next three are worth discussing with your doctor:
- Anaemia — Full Blood Count (LKR 400) or Haemoglobin (LKR 400). Iron-deficiency anaemia is common, especially in women with heavy periods.
- Low iron stores without anaemia — Ferritin (LKR 2,400). Ferritin can be low, and cause real fatigue, while haemoglobin still reads normal.
- Vitamin D deficiency — Vitamin D (LKR 7,000). Surprisingly common in Sri Lanka despite the sunshine. We covered why in Vitamin D Test in Ja-Ela.
- Blood sugar — Fasting Blood Sugar (LKR 280) or HbA1c (LKR 2,100). Undiagnosed diabetes very often presents as unexplained tiredness.
Where a doctor wants several of these at once, our Joint Pain & Fatigue Profile — LKR 4,500 covers FBC, ESR, CRP, Rheumatoid Factor, TSH, Fasting Blood Sugar and a Urine Full Report in a single visit.
No fasting, so book it around your day
Because TSH needs no fasting, it's one of the simplest tests to arrange. Our home blood collection service brings a trained phlebotomist to your home or office across Ja-Ela, Kandana, Welisara, Ragama, Wattala, Batagama and Thudella, with home visits also covering Seeduwa, Katunayake and Negombo.
Call 071 123 1954 to book a time that fits around work.
Get tested near you
St. Luke's Medical Laboratory No. 67, Old Negombo Road, Ja-Ela, Western Province, 11350
- Phone: 071 123 1954
- Email: medilabstlukes@gmail.com
- Hours: Mon–Sat 07:00–19:30 · Sun 07:30–12:30
- All prices in LKR: Full price list →
Serving Ja-Ela, Wattala, Kandana, Ragama, Welisara (Walisara), Batagama and Thudella.
Frequently asked questions
How much does a TSH test cost in Ja-Ela? LKR 1,800 at St. Luke's Medical Laboratory, No. 67, Old Negombo Road, Ja-Ela. Free T4 and Free T3 are LKR 1,900 each. All prices are on our price list.
Do I need to fast for a thyroid test? No. TSH, Free T4 and Free T3 require no fasting and can be taken at any time of day. If you take a biotin supplement, tell us — it can distort the result.
What does a high TSH mean? A high TSH usually means an underactive thyroid (hypothyroidism) — your pituitary is pushing harder because the thyroid isn't producing enough. Your doctor will normally confirm with a Free T4 test before diagnosing.
What does a low TSH mean? A low TSH usually means an overactive thyroid (hyperthyroidism) — there's enough thyroid hormone circulating that the pituitary has eased off. Free T4 and Free T3 are typically added to confirm.
Should I test TSH alone or with T3 and T4? TSH alone is the standard first step and is usually sufficient for screening. Free T4 and Free T3 are added when TSH is abnormal, when symptoms are strong, or when your doctor is monitoring known thyroid disease.
Can thyroid problems cause hair loss? Yes — both underactive and overactive thyroid conditions can cause hair thinning. It's also caused by low iron, so a Ferritin test (LKR 2,400) is often worth doing alongside.
I'm always tired but my thyroid is normal. What next? Discuss anaemia (Full Blood Count, LKR 400), iron stores (Ferritin, LKR 2,400), vitamin D (LKR 7,000) and blood sugar (FBS LKR 280 or HbA1c LKR 2,100) with your doctor. Normal thyroid function rules out one cause, not all of them.
How soon after starting thyroid medication should I retest? Usually about 6–8 weeks after starting or changing a dose, because the level takes that long to stabilise. Follow the schedule your doctor gives you.
Can I have the test done at home? Yes. No fasting is needed, which makes thyroid testing ideal for home collection. We cover all seven towns we serve plus home visits to Seeduwa, Katunayake and Negombo. Call 071 123 1954.
This article is general health information, not a diagnosis or a treatment plan. Thyroid results must be interpreted by a doctor against your report's own reference ranges and your symptoms. Never start, stop or adjust thyroid medication on the basis of a lab report alone.
Related: CLIA Immunoassay Testing in Ja-Ela · Vitamin D Test in Ja-Ela · HbA1c Test in Ja-Ela
