5 Thyroid Tests to Ask Your Doctor About

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Do you feel like something might be wrong with your thyroid, but your thyroid blood work says you’re fine? If your doctor only ordered the TSH test, you might need more information to know what is really going on.

woman getting thyroid ultrasound

More and more, people are being diagnosed with thyroid issues, but some people have thyroid issues without knowing it. It’s important to know what’s wrong with you so you can know what to do.

To that end, it’s crucial to know what thyroid blood work to have your doctor order so you can get the medical care that you need.

Thyroid disease is rampant these days and since the thyroid is affected and is affected by many things, including the food you eat and your adrenal glands, it’s important to get informed about this important gland as much as possible.

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My Struggle with Thyroid Disease

I’ve struggled with hypothyroidism for years. I started noticing severe fatigue, dry skin, weight gain, and joint pain when I was just 22 years old.

I wasn’t old enough to be feeling that bad. I went to the doctor on a few occasions and described my symptoms telling her I just didn’t feel well.

She blew me off and told me I was perfectly healthy.

Long story short, I was able to begrudgingly get my doctor to run a TSH test. (This is the standard test pretty much all doctors run to test thyroid function. I didn’t have any idea what it was at that point.)

Two days later I received a call.

Low thyroid levels.  Supposedly I had hypothyroidism.
The plan? Start synthroid (that was the first problem, but more on that later).

I started my meds and waited 6 weeks.

I still felt bad.

We tweaked my meds. Waited 6 more weeks.

I still felt bad.

Round and round we went until my search for information (and a new doctor) began.

(Before we get started, I want to let you know that I am not a doctor or any sort of medical professional. All of this information I have gleaned from my own research and should not be used for any sort of diagnostic purposes. Use common sense, do your own research, and talk to your doctor before making any changes to your diet, supplements, or exercise routine.)

TSH: Just the Beginning of the Story

In this search for information, I’ve learned that the standard TSH test that most doctors rely upon for both diagnosis and treatment does not give a complete picture of what is going on with your thyroid.

You see, TSH, which stands for thyroid stimulating hormone, is actually a test of what the pituitary gland is doing.

That’s right, it isn’t even testing any of your thyroid hormones.

In theory, when your body does not have enough thyroid hormone, your pituitary gland should be releasing TSH to signal to your thyroid that you need to make more (sort of like a wake up call for your thyroid). Those with elevated TSH levels should theoretically have low thyroid levels and those with low TSH levels should have enough (or too much) thyroid.

So, what’s the problem? It seems pretty cut and dry, right?


There are many many reasons why doctors should not diagnose or treat a thyroid patient based on TSH levels.

Some people simply have a malfunctioning pituitary gland and this is why it is not producing TSH. Unfortunately, it is beyond the scope of this post to go into all of the reasons as to why TSH is not an effective marker.

You can read countless stories of hypothyroid patients who were not diagnosed for years and years because of doctors who simply tested TSH, didn’t consider other symptoms, and didn’t do further testing.

In theory, the TSH test tells a lot.

But, in reality it might not be all that you need.

woman getting thyroid ultrasound and stethoscope for thyroid blood work post

What Thyroid Blood Work Do You Need?

So, if TSH isn’t the best lab test for diagnosing and treating thyroid disorders, what is?

First, I want to confirm—in case you haven’t already guessed—there is no test that can substitute for a doctor who will listen to how you feel.

You need to be seeing a doctor who will listen to you and will place great value in your symptoms when diagnosing and treating you.

Below are the tests that might be essential for anyone who is struggling with thyroid problems or believes they may be struggling with thyroid problems.


Thyroid Blood Work Checklist

Following is a list of blood tests that you can ask your doctor to run. This list of thyroid blood tests will give your doctor and you more perspective of what exactly is going on with your body, and hopefully will put you on the road to better health.

Free T4

T4 and T3 are the two main thyroid hormones. But, T4 is the less active hormone. Your body converts much of your T4 into the more active T3 inside the cells of your body. With the T4 (and T3) test you can check both free and total levels.

You might want to ask your doctor to check your free levels. Why might this be important? Because free T4 is the T4 that is not bound to proteins in your blood. If you know that number, you will know the amount of T4 that is available to be used and converted to T3.

Free T3

This is the more active form of the thyroid hormone. If you don’t have enough of this you’re going to feel lousy. This is what should, in my opinion, be considered the gold-standard of thyroid function! Free T3 is primarily responsible for increasing your metabolism.

Anti-Thyroid Antibodies

The tests you specifically want to ask for here are TPO and TgAb. These tests will tell you if your body may be attacking your thyroid. The reason that doesn’t sound so good is because it isn’t good. If these levels are elevated, chances are you have Hashimoto’s thyroiditis. Hashimoto’s is a type of autoimmune thyroid disease, meaning your immune system is mounting an attack against your thyroid.

It is important to identify if your thyroid disorder is autoimmune in nature because if it is, there are a number of implications. One thing that’s important for individuals with autoimmune diseases is to be on a diet that is anti-inflammatory which often means at a minimum cutting out highly inflammatory foods like wheat and sugar. I know, total bummer. But nothing new from what you’ve read on this blog before?

Cholesterol Panel

Though not as important as the above tests, I believe a cholesterol panel is good to have when going in for your tests as well. Often times people who do not have optimal thyroid levels also have elevated cholesterol. Your body is not able to properly metabolize cholesterol without adequate thyroid hormone. If your levels are elevated, this is just another clue that will help you figure out what is going on.

Don’t worry too much about cholesterol levels until after you have your thyroid levels regulated. Figure out what your thyroid is doing and then check back to see what your cholesterol is doing. To get the most accurate idea of what is going on with your cholesterol be sure to request the NMR cholesterol panel.

Vitamin D

Though many people could benefit from other tests as well, the last test I believe is truly essential for anyone suspecting or treating thyroid disorders is Vitamin D. Vitamin D is a hormone that plays an important role in your immune system function.
Many individuals who struggle with hypothyroidism also have low levels of D. It is particularly important that those with autoimmune diseases have optimal D levels. If you do have low D levels, it’s important to begin to work on this right away.



What to Do About Thyroid Problems

If you have thyroid problems, after getting proper testing here are a few more suggestions for getting your health on track. Please, of course, review all of these (after the first one) with your physician prior to making any changes.

Find a good doctor

Find one who will not only complete the appropriate tests, but will also medicate you appropriately and listen to you. Some people suggest finding a doctor who is comfortable using natural desiccated thyroid hormones (as opposed to synthroid or levothyroxine).
The doctor should be determining medication based off of the above tests as well as how you feel.

Cut out gluten

You might wish to talk with your doctor about removing gluten from your diet. Gluten is highly implicated in autoimmune thyroid disease.
Some sources that that 90% of thyroid disorders are autoimmune in nature.

Optimize Vitamin D levels

It has been said that apparently you need to have good adrenal health before increasing vitamin D so please be careful and don’t self-prescribe. Vitamin D also can reduce Mg so you need to be careful about that as well.

Change Your Diet

Read this list of 5 Foods that Can Wreck Your Thyroid.
Are you eating any of those?


Testing Options

You can have tests ordered by your physician, but there are also some other options. UltaLabs is one option and Everlywell is another. You can get 12% off at Everlywell by entering the code EVERLY in the shopping cart.

{From Adrienne: This is a seriously important post.  I have been doing a lot of digging into thyroid research recently, for reasons which I will share soon.  So many people have issues with their thyroid and they don’t know where to go or what to do. If you haven’t already, please stay tuned to make sure you get this information.  It’s crucial.  You can subscribe to my site by grabbing this Essential Oils free book here.

In the meantime, I would highly recommend the following books.  I am not saying this is the advice you should follow (i.e. this isn’t medical advice), but it is very very interesting and was very helpful to me.  

I Recommend
Hashimoto's Thyroiditis: Finding and Treating the Root Cause

Hashimoto's Thyroiditis: Finding and Treating the Root Cause

I've met the author of this book, Izabella Wentz, in person and while I never agree with everyone on everything, she really is a wealth of information. This book is a great thorough resource for those wanting to gain knowledge and action points to address Hashimoto's and start on the road to feeling better.

I Recommend
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal

Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal

Your thyroid labs are normal, but you still don't feel well? This book can help.


Trisha Gilkerson is a homeschooling mom to four crazy boys. She blogs with her awesome hubby Luke at Intoxicated on Life where they talk about faith, homeschooling, and health. They’ve authored the Write Through the Bible curriculum and family Bible Studies and have recently released their first healthy living book – Weeding Out Wheat: A Simple Faith Based Guide



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  1. Thanks for this- wish I had known this before starting meds upon first diagnosis, Paleo has changed my
    life! Lost 10 years
    of my life to fatigue and illness.

    1. You are so welcome. I’m so sorry to hear about your troubles. I had chronic fatigue for 10 years too. Thank God I thought I was almost completely healed this past fall or so. I am not completely, but I’m so much better. Please do stay in touch!

  2. Hi, im competely agreed , i did lots of test all were out normal , so am i crazy i feel terrible ly bad and fatigue my nails are breaking .

        1. You are welcome. I am sorry but I don’t allow self promotion on my site so I had to remove some of your information. Thanks for reading!

  3. I’ve had hypothyroidism for years and I’ve been exhausted for years. I have a Dr. but she hasn’t been very helpful. It’s almost impossible to get a new Dr. If you have one already. I read your article and found it very interesting. I may not be able to get further testing done but I can change my diet. New recipies would be welcomed. Thanks.

    1. Thank you and welcome. You can sign up for updates here: https://wholenewmom.com/10-things-you-need-to-know-about-essential-oils-before-you-buy/ and there is a meal plan freebie on my home page: https://wholenewmom.com/

      I plan to have more recipes coming soon and just posted this one: https://wholenewmom.com/recipes/thai-green-chicken-thigh-curry/

      I also have this Healthy Living Community on FB that you are welcome to join — we’d love to have you! https://www.facebook.com/groups/171490083677560/

  4. I have seen two doctors four blood test and still no help
    One doctor said my tsh is high so I am hyper the other doctor told me I was hypo
    Waste of time
    Does anyone have a clue

    1. I am sorry that you are dealing with this. I would try to find a good functional doctor or consult the books that I shared in the post and other posts on the thyroid. Hope you can find help!! Hashimoto’s can be characterized by some hypo and some hyper swings. I’m not giving you a diagnosis but I would maybe look at that information.

  5. I was given a prescription for levothyroxine (for hypothyroidism) by an endocrinologist and told I must take it or I would go into a “thyroid storm” and be dead within 6 months. When I asked that my actual thyroid hormone levels be tested, this endocrinologist refused (in not very polite terms) and told me it was my funeral.
    It is NORMAL for your TSH to be low when you are fasting! TSH is a hormone produced by the pituitary gland which “tells” the thyroid gland whether or not to make more thyroid hormones. Thyroid hormones increase your metabolism. The interaction of the pituitary gland and the thyroid gland is part of a “feed back loop” and it functions to help ensure survival. Our bodies cannot tell the difference between fasting (voluntary, temporary starvation) and actual starvation. When you fast, it is as if the pituitary said to itself “The body is starving, we must slow down the metabolism, I will tell the thyroid gland to stop making its hormones” and so the pituitary decreases the amount of TSH it is making. Therefore. a low TSH level may be because your pituitary gland is telling your thyroid gland: “Do not make thyroid hormones”.
    The endocrinologist that told me I’d be dead within 6 months? I think he was wrong, because that happened in 2003! In the 15 years since then, whenever my TSH level has tested low I ask the doctor to test my thyroid hormones and they have always been normal. My TSH levels have NEVER been low when they were tested when I was not fasting.
    This is NOT medical advice. I am not an MD; however, I have studied human physiology – from that and my own experience I would suggest that anyone who has low TSH level that was drawn when fasting ask that their thyroid hormone levels be checked before starting any medication to treat hypothyroidism.

  6. I’m sorry, but it’s “ensure,” not “insure.” According to Associated Press style, to “ensure” that something happens is to make certain that it does, and to “insure” is to issue an insurance policy.

    1. Hi Noemi.

      No need to apologize – you helped me. I have a very busy life and I miss things sometimes. Thanks for reading!

  7. I have been telling my doc since late 1980 my meds are not working they keep saying your tsh is fine so you are fine so frustrating, that doc retired and my new one says the same thing the tsh is good, stay on your meds

  8. Hello. Would you mind sharing your sources? I’d like, ideally, to find medical journal sources for my doctor. This has been very helpful and informative for me, so thank you!

    1. Hi there. I didn’t write this post – another blogger did. Is there something in particular you want the source for?

  9. TSH blood labs off previous comment auto correct writing tee shirt sorry , i believe it can comments suggestions ? i take it daily was tested and really don’t function without it it calms me and focus — . any help please

  10. Hi my levels are T4 11.8 and TSH 6.73 I have absolutely no idea what that means .Or what they should be ,can anyone help me understand this ,i sm 65 years old and suffer with COPD too .

    1. Hi there. Sorry but I can’t medically advise. I would highly recommend the book in the post – thanks for reading and hope you can get some help.

  11. I was and I am fatigued. Traditional doctors wrote me off as OLD. I was only 62 when my oddicisy with traditional medicine began. I have modes in my thyroid and extreme fatigue. I’ve gained weight, lost hair, one eye is bulging but no Dr. cared. I finally saw a Naturopath but when my feet began burning, severe burning, she suggested I see a medical doctor! My thyroid medicine has been cut in half (natural desiccated) but my TSH is still only 0.006. It was in the Low 30’s before medication. I’m exhausted again and my feet, particularly toes, are on fire. How do I get a doctor to understand that my pituitary has never worked properly. They use it for an indicator of thyroid health.

    1. Hi Bonnie – I’m so sorry about all that you are going through- how terrible! I can’t diagnose at all. And I’m no expert on thyroid medication. I went off of the bad triggers for autoimmune – corn, soy, egg, dairy and wheat. And that helped me a lot to start on the road to feeling better. Has anyone checked you for Hashimoto’s?

  12. Ty so much I am hypothyroid and have been on generic Synthroid for many years….still have tons of the systems even though taking meds…your article has answered so many of my questions..ty so very much

  13. Very informative. Thank you. Looking forward to receiving emails. Just went for my appointment with endocrinologist. Had blood work drawn today including the tests you suggested. Will get results next week.

  14. You did not mention one other very important test…..Reverse T3. Without RT3 you do not know how well you are converting T4 to T3 and if the T3 is getting into the cells well or not when Reverse T3 is too high it blocks the cell receptors and doesn’t allow T3 to get in and you will be hypo at the cellular level no matter how good your other levels may look.