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?

Wrong.

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.

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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.

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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?

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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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172 Comments

  1. Just found your article, I have been fighting with my doctor for a couple years about this. He only orders the TSH test. And that comes back normal. I have had both my thyroids removed due to large growths on them. I am taking Levothyroxine (.05mg.). I tired all the time, my hair is falling out (it is very thin now, almost bald in the crown), my skin is very dry, I am having a very very hard time losing any weight (I had a gastric bypass in 2000, and did not lose that much weight), I feel lousy all the time. I am making an appointment with my doctor and requesting the tests that you mentioned in your article. Hopefully this will get him to listen to me. Thank you for writing this article.

    1. I sure hope your doctor will run some more tests. If you have no thyroid at all it is SO important for you to be regulated well. You may also consider asking about switching from the synthetic T4-only thyroid to a natural desicated thyroid like NatureThroid or Armour (I currently take NatureThroid because the new formulation of Armour doesn’t seem to work as well for me). Anyhow, these thyroid replacements more naturally mimic your own thyroid because they also contain T3 in them along with the T4. Many people have much better results on these medications, but everyone is individual and will see different results.

      If your doctor is not willing to run these tests and/or consider different medication options I’d HIGHLY suggest you begin looking for a new doctor. Do not forget that your doctor works for YOU. I’ve written a couple of posts on this topic you may want to read.
      • 5 Questions You Need to Ask Your Doctor (here on Whole New Mom) https://wholenewmom.com/health-concerns/got-hypothyroidism-5-questions-need-ask-doctor/
      • 3 Steps to finding an Awesome Doctor to Treat Hypothyroidism (on my own site) https://www.intoxicatedonlife.com/2014/02/27/3-tips-finding-awesome-thyroid-doctor/

      Let us know how it goes! I hope you’re able to get your levels in check.

  2. Didn’t post my name as their maybe legal implications …. Thanks for the info. My daughter had a deadly botched delivery. One twin lived & is 9 months old. She has gained extreme amount of weight. She is getting blood tests on friday. Thank you for the specific information! Praying for the health of my daughter and my grandson. (We still don’t know how the extreme delivery has affected him.)

  3. Thank you for this article. I have been dealing with thyroid problems for years and yeats. My doctor keeps changing my meds and I am getting worse and worse. I am so tired, my skin is so dry I am scared ect ect. This has given me courage to try a different approch hoping I can get feeling better. I have add magnesium and feel it is helping. Again, thanks Trisha and all the others who left comments.

  4. “Optimize Vitamin D levels. {From Adrienne. I have been learning that you need to have good adrenal health before increasing vitamin D so please be careful and don’t self-prescribe.”

    Can you please give more details on needing to have good adrenal health before increasing vitamin D? I am pretty sure I have adrenal fatigue. I took some vitamin d a couple months ago, and I think it made my insomnia worse. Any input you can offer would be much appreciated.

    1. It depends on the person and their hair / mineral chemistry so this is true for me and might be for others. Thanks.

  5. I have been dealing with stupid doctors for 8 years. I have Hashimoto’s and they will not treat just wants to play the waiting game. My lab results are Thyroid Perx AB is 905 Anti Thyroglob is 4 TSH is 1.0451 FT4 is 1.10 Vit D is 30 high cholesterol enlarged thyroid is right lobe 5.4×2.2×1.3 left lobe is 5.3×2.4×1.7. I have been to all the endo’s that my insurance will cover and my pcp doesn’t know anything and wont do any testing. I have so many symptoms but no body will listen and I don’t know where to turn

    1. Gina, I’m SO sorry to hear that you’ve been dealing with these problems for so long and no help from doctors. Unfortunately, I hear stories like this all too often. I’m not a doctor, but I can say it appears from the labs you’ve listed that there is definitely something wrong.

      Tomorrow, you’ll need to come check out the post on my site Intoxicated on Life that will give you 3 steps you can follow to find a good doctor (it’s work, but it’s worth it!) and also there will be a post here on Whole New Mom about questions you can ask your doctor once you find one that will help you decide whether they’re a good one for you (no point in wasting a bunch of time on tons of appointments if they end up not being a good fit).

      Are you gluten free? If not, I’d really encourage you to ditch the gluten. It’s implicated in Hashimoto’s. You can read more about that here –> https://intoxicatedonlife.com/2014/01/31/thyroid-gluten-connection/

  6. I live in Perth WA and have been very frustrated with finding out why my weight is gaining and psoriasis is at an all time high. In addition, hot flushes, dry skin etc.
    Anyway went off to my doctor to ask for a THS, T3 and T4.
    I received results for the following (with no idea of what TPO and TG are) –
    THS – 2.26
    TPO – 12
    TG – 18
    While I asked for T3 and T4 to be tested, there was no results returned for either of these.

    Can anyone advise what the above results mean?

    I have found another doctor who apparently is very good. His name is Dr Ismail Salim and I see him in late March (earliest appointment).

    1. I am not a doc but your TPO is a little high so that would indicate hashimotos if I am not mistaken. I can’t medically advise but i have read going off iodine and I containing foods while you heal your gut, plus going off gluten, is huge.

    2. Hi Julie, just wondering if you have a contact for Dr Ismail? I cannot seem to locate his practice no matter how many phone numbers I’ve tried from googling!

    1. Sorry to hear that you’ve been newly diagnosed with hypothyroidism. Unfortunately, we’re a growing class of people! There is a lot of info out there. Try not to get overwhelmed and just take it once step at a time. I have another post coming up soon that will hopefully help you as you are talking to your doctor. 🙂

  7. This is great information, thanks for sharing!

    You ROCK for linking up this week to Tip Me Tuesday. {high fives}

    Just a heads up, Tip Junkie can help you index your blog more effectively if you upload at least 2 images, 2 steps, and blog post URL into your Tip Junkie craft room!

    Simply login and click “add a project” on your profile page to get started. {yep I’ve got your back!}

    ~ Laurie {a.k.a. the Tip Junkie}
    Link ~ https://www.tipjunkie.com/how-to-add-a-craft-room-project-on-tip-junkie

    1. Hi Laurie! Glad to see you again–I’d missed your linkup. (found you on G+ as well). I’m a little confused what you mean about the 2 images and 2 steps. I just start my own login in the craft room? I’ll go and try…hope I’ve got that right :). Take care!

  8. Thank you for writing this post. The more people who know about this, the better our hope for change in the blind, ignorant, cruel medical community. I’m one who suffered for many years with raging thyroid symptoms, at my worst being bedridden. I’ve always had optimal TSH and low in range FT3 and FT4 so I’ve always been declared normal/healthy. Once I ordered my own TPO, TgAb, TSI, and reverse T3 tests, my shockingly high test results on all of those convinced my doctor to do a thyroid ultrasound to find out that my thyroid is almost completely destroyed. My TSH remains optimal and I still can’t get thyroid treatment from a mainstream doctor because I pass their “gold-standard” test and that invalidates any other test. I have to use alternative doctors and I take T3 meds; I can’t tolerate anything with T4 in it including NTH. As the site says, stop the thyroid madness!!!

  9. Great post! Just discovered all of this about myself about a month ago. And, it really is incredible to learn how many people deal with this and how many go undiagnosed! My doctor gave me a couple books by Dr. David Brownstein. Check out his book Overcoming Thyroid Disorders! It has everything you have discussed here, but, adds his years of research on iodine deficiency – iodine & selenium being key to the conversion process T4>T3. Turns out we need more iodine than RDA because RDA doesn’t take into account the toxic halides which are in our food and clothes and mattresses etc.. The halides are similar to iodine and the body absorbs them in its place causing not only a deficiency but when prolonged plenty if other serious health problems. Putting the iodine back in can allow some people to go off thyroid medications or can optimize the use of Armour thyroid. I am so excited to be on this path myself! People in the office started commenting after 1 week how I looked like I had lost weight which surprised me and I am starting to see how my face is looking less puffy around the eyes in particular. I’ll try to remember to come back and update in my progress, but, add a link to this book too if it helps fund your blog and you find it useful. It has definitely changed my life.

    1. I appreciate your comment but would like to just add that I am not a fan of Dr. Brownstein’s use of antibiotics that tends to be a little too “free” in my opinion. Also, it is said that about 90% of those w/ hypothyroidism have Hashimoto’s and most Hashis can’t tolerate iodine, especially when they have leaky gut. I have been reading this quite a bit. Thanks! I am so glad you are doing better though and perhaps Trisha has some thoughts as well.

  10. Oh, wow! This is super helpful for me and my readers. I am a member of the infertility group of vloggers on YouTube and thyroid levels are critical for ovulation and egg quality. I am passing this info on my readers on Facebook and pinning for future reference. Thank you so much!

  11. Such good info, I was just about to get blood work done for thyroid, I will be requesting these tests! Thank you!

  12. This post may have saved my life. I was diagnosed with fibromyalgia, and resigned myself to a life of anti-depressants and feeling like death warmed up. It turns out that I have hypothyroidism (not Hashimoto’s, thank God!). I have been exercising two hours every day and living on 1500 calories a day for the last four months, I even started a blog on my experiences trying to get into shape, and I have actually GAINED weight. I had the recommended thyroid tests run, and sure enough, hypothyroid. I have had this since I was 23. Hopefully, with treatment, I will lose this 60 pounds that I have been fighting to get off of me.
    I cannot thank you enough!

    1. Wow. Thank you! I am working with a fabulous woman who specializes in thyroid if you would like to talk with her.

  13. My doctor tested for the T3, T4, etc. mentioned above and also something he called “reverse T3.” (Maybe that’s one of the antibodies you were talking about?) This “reverse T3” apparently blocks the T3 receptors. In my case, my thyroid was fine, but I had low thyroid symptoms anyway, because my body was producing too much of this, so it couldn’t USE the T3 it had, even though there was plenty.

  14. For years, my doctor would swear that I had a thyroid problem. But, the test always came back normal. I have recently been diagnosed with Hypothyroidism. I have the low vitamin D and the high cholesterol. At the end of all the testing, the final diagnoses is Insulin Resistance! This may be something that doctors need to look into for their patients.

  15. Good stuff! Thanks for putting this together. I acquired non Hashimoto thyroiditis in 2007. Have been on the path of healing and have learned so much since then. Nearly all of my “problems” are autoimmune related. Cleaning up my diet and detoxing my environment has helped greatly!

  16. You forgot one of the most important tests: reverse T3!! Especially important is the relationship between free T3 and Reverse T3. And Thyroxine Binding Globulin. That is another one you didn’t list.

    Here is where you can get a comprehensive thyroid panel for under $200. And that is WAY cheaper than you can get it at the doctor’s office unless you have amazing insurance.

    https://www.lef.org/Vitamins-Supplements/ItemLC100018/Comprehensive-Thyroid-Panel-Blood-Test.html

    That doesn’t include the Thyroxine Binding Globulin, but you can find that test at Life Extensions as well.

    Without my reverse T3 test my hypothyroidism would never have been diagnosed.

    1. Thank you for mentioning Reverse T3. I know that some people do need to have this test done to get their levels regulated, so is a good idea for those people whose T3 and T4 levels look good, but still aren’t feeling up to par.

      1. I have been trying to get my Reverse T3 checked but my insurance won’t cover it, my doc never heard of it…then she got differing opinions about it..the hospital blood taking people never heard of it. what a mess! I can’t afford the almost $200 for the above test. I guess i have to start saving money for it. I would like to know what it is. My doc always ‘forgets’ to order the Free T3 also…so annoying.
        sorry for venting!

  17. Thanks for the great post, Trisha and Adrienne! Eliminating soy products could be #4 on the list. The book, The Whole Soy Story was loaded with information about that.

    1. You’re so right… eliminating soy should also be on the list of things to do for anyone with hypothyroidism. In my opinion, really soy should be avoided by everyone. Lots of problems with soy!

  18. Hi Trisha,

    Great article. Another very bad way to ruin thyroid function is to eat a lot of soy products. I did soy products for years thinking I was being “healthy.” Little did I know that I was destroying my thyroid. I wound up with hypothyroidism and now have to take Armour thyroid for the rest of my life. After developing this condition, I did a lot of research. The soy connection totally made sense in my case. I never ate another soy product again and avoid them like the plague, reading labels religiously to keep anything remotely resembling soy out of my body.
    Just thought I’d throw that in because I feel that soy which is now almost totally genetically modified is a poison masquerading as food.

    1. Yes! Soy is in so much of our food another way to harm our thyroid. (I feel another blog post idea coming on…) 🙂

  19. ‘Good post on what tests to get! Having Hashi’s and knowing what I know now, it’s hard to believe that some doctors still totally rely on TSH only (like my mom’s family doctor–still relying on outdated tests). Actually, some doctors who are “more in the know” don’t even look at TSH; they only look at Free T3 and Free T4. It’s also important where those numbers are in the ranges. Optimal Free T3 should be in the upper third of the range, and optimal T4 should be in the upper half to upper third of the range. Also, yes, vitamin (hormone) D3 is important. I’ve learned from the Magnesium Advocacy Group on Facebook that magnesium is the conductor of this and many other hormones, enzymes, etc. So, optimal magnesium levels are important. If D3 levels are low, there is also a magnesium deficiency that needs to be addressed.

    1. Good points! It is important that people pay attention to where on the range they fall. I believe it’s very important to find a doctor who will not only look at the appropriate labs, but also one who will listen to symptoms and how you feel. Having hypothyroidism for this long, I can typically tell when my levels are off and my “optimal” level may not be your “optimal” level.

      1. Yes, I definitely agree that lab numbers do not tell the whole story and may actually be “off” from what is actually going on in the body. I’ve been dosing myself for quite some time, because I know how I feel and waiting six weeks for a lab test doesn’t work for me! It is a different journey for everyone, for sure.

    2. Great post! I have Hashi’s, too and was un-diagnosed for over 20+ years. I was first put on Levo for a year and that made me worse, because my Dr. didn’t recognize my LOW Adrenal Fatigue. Ugh!!!! I know all of this information, Trisha, but you wrote it so eloquently. Very easy to read and understand. Thanks! 🙂

      1. Thank you! I’m glad to hear that it was easy to read. That’s always my goal with my writing – make complicated issues, easy for people to understand 🙂