5 Thyroid Tests Every Thyroid Patient Needs
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Wondering what thyroid tests you need?
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.
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.
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.
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 and see if you should eliminate some of those from your diet.
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.
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.
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.
I have been taking synthetic thyroid hormone for almost 20 years. My TSH levels went from 4.85 when I started to between 1.5 and 1.75 after starting Synthroid. Lately most of the symptoms have returned as my TSH has started to climb 2.39 to 2.75 and today 3.5. My doctor does not ever adjust my dosage even though my symptoms worsen. My weight is up, fatigue, very low energy, cholesterol is way up, blood pressure in slightly up. what should I do?
I’m sorry but I can’t medically advise. There are so many things that could be going on. I found for me that adrenal and toxin and liver work helped. Here’s more info: https://wholenewmom.com/health-concerns/thyroid-disease-hashimotos-blood-test/
Sometimes food allergies but I would personally try to get a good physician who will listen to you.
This post might be of interest as well – the first good practitioner that I worked w/ wrote it: https://wholenewmom.com/health-concerns/thyroid-disease-hypothyroid-what-causes-hypothyroidism/
Fatigued and feeling generally unwell. Thyroid panel seems to be within range. Thyroid antibodies have decreased probably because I have been gluten free for a year. Would thyroid meds help? Ndt?
Sorry but I cant medically diagnose. 🙁
I’ve only read 1/2 of your blog but I’ve read enough to know that the same thing happened to me after I had my 3rd child 27 years ago. I went to just about every endo in the area back then and came to the conclusion that most of them were quacks. One of them concluded because I had a goiter that I needed to have surgery and remove 2/3’s of my thyroid. Had it and within a few years the goiter grew back.. They said that I didn’t need meds because my thyroid was still putting out thyroid hormone. I quit going to any of them. I feel sure that most endocrinologist haven’t a clue how to diagnose thyroid disease. They are way to complacent using the the current thyroid test.
I’ve been on Levothoroxine (sp?) for 5 years. Each year by Dr. orders the TSH. Past two years I have been within normal levels. I have a new doctor and she wants me to have TSH and the T4 labs. I private pay so am hesitant to have both if not completely necessary. What do you think?
I’m sorry but I don’t know enough about thyroid labs. I need to do more reading on it. I personally think getting labs done every year is a good idea.
You need more than just TSH and T4. A good Dr should be testing TSH, Free T4, Free T3, Reverse T3 and all antibodies. Free T3 and Reverse T3 are two of the most important tests in mine and many others opinion. FT4, FT3 and RT3 are the only true way to know if you are converting T4 to T3 well or not and if the T3 is getting into your cells well or not.
Would advice on this page be equally applicable to men? You introduce some pretty purposeful avenues of inquiry, and I assume it’s for both sexes, but don’t want to be presumptuous. Seems like great information.
I would think it’s the same but please ask your practitioner.
I just learned my 13 year old daughter has hypothyroidism. I have known for over a year something was not right, mother’s medical intuition, and finally they tested her T4, TSH, and all the other panels. The levels were very high and very low respectively. I was surprised the doctor did not recommend any dietary changes. We are going back to gluten free and completely organic. I just recently learned it isn’t just the wheat/gluten, it is the fact that the farmers spray the wheat with Roundup prior to harvesting so that the plant dies and releases the wheat seeds more easily. This chemical has already been proven to wreck havoc on our hormones and adrenals! I have always thought it was amazing that none of us had a reaction when we were in Rome and ate like the Romans, pasta, bread, etc, and lost weight. Our food system is a mess and our bodies are suffering.
Hi there. I think it’s a mix b/c toxins, wheat changing, and our microbiomes changing. Just my hunch. You really were able to eat in Rome but not here? I’m looking at something to possibly help.
I am 53 years old, and completely frustrated. In the last 3 years I brought to my doctors attention but never pushed it that my hair is falling out, not in clumps but it is everywhere! My fatigue level is really high, and I have gained 30# over the past 3-4 years. I am an avid runner, do strength training and eat right. Yet, I cant control the weight. I had a complete hysterectomy when I was 29 and use a HRT patch. I went in for my yearly physical and I told her I have been experiencing hot flashes more and more. My comment to her was ” something is wrong. I dont feel right. I am tired, my hair is falling out, I am having hot flashes and my weight keeps going up”. Her reply was “well as we age things happen”. I decided to try and schedule an appointment with an Endo doctor. Which they called my doctor as a referral was needed. Back in to her I go to try to explain everything…again! She ran a panel and this is what my numbers are T3 total is 133. TSH 2.16. She said nothing is wrong. My Vitamin D level is 24.4 and that is the only thing she focused on. Said I might see a specialist for hormones. So I did. She put me on testim to see if it would help the hot flashes. She explained one of the side benefits of taking it would be weight loss. Wrong- 5 weeks and 9.5# increase I am completely frustrated. I want to cry. I have no idea where to go for help.
I am so sorry you are dealing with this. Can you find a more natural minded doctor like a functional medicine practitioner? Hope you can find someone to help.
Dealing with Hashimito’s for over a decade. Yes, Vit D needs to be supplemented for most of us. My endo had me taking 2000 units a day. Colds were rare. Then I read somewhere that you needed K2 with it for it to assimilate properly. I found “Michael’s D3K2” online (Various sites incl Amazon) and began taking 5000 daily as I live in the often sunless Pacific Northwest. Endo doesn’t like the K2 part but my chiropractor (much more studied re: supplementation) says the K2 is what fixed up the calcific tendonitis in my shoulders! I haven’t had a cold in years! My endo did agree to let me try a 2 mo trial of NatureThroid last year. He was plwased and a bit surprised by the good results and I still take it. Though still battling with many symptoms (fatigue, weight, ankle edema) I do feel better than on synthetics. One thing to be aware of is my dr office told me that insurance companies will no longer pay for a D3 lab test. In the last year I have requested it twice and they will only do it if I agree to pay the approximately $80 out of pocket. Therefore, I have not been recently tested. If you are debilitatingly fatigued, ask for your ferritin levels to be checked. (Your other blood tests such as hematocrit and hemoglobin may look just fine, but they are your checking account and ferritin is your savings account. If you are sick your body draws upon your savings account and deposited in your checking account. So unless your ferritin is checked you don’t know that you are operating on a deficit of iron.) I had been taking prescription Prilosec for acid reflux. Apparently that messes with your body’s ability to assimilate iron from your food because of the way it interacts with B12. My endo checked my ferritin upon request. 10 or below is considered anemic – at one point mine was 3 and at another point it was five. I could hardly stand up and I would lay across the steering wheel and cry because I was so tired but I still had to get out of that car and go grocery shopping. Upon confirming that multiple ways of ingesting iron over the years had not helped me he sent me across the hall to the oncologist hematologist. He reviewed my most recent lab results and said he was satisfied that this low ferritin level was not because of cancer and he ordered an Iron Infusion. 3 hours in an infusion chair then two days of body pain as the iron molecules were breaking down to be assimilated into my system. But then I felt like a new woman for a month! Almost immediately after that I had surgery to repair a hiatal hernia and never took Prilosec again. Just sharing this information in case it will help someone else.
Hi-
I had my thyroid removed after finding follicular cancer. Long story and so frustrating resulting in three surgeries within 3 months. Anyway, I had my year ultrasound and blood work done yesterday and I am feeling disappointed because my levels are weird and I expected them to finally be normal. My medication dosage has changed like 5 times and each time my doctor lowers the dose I go through a couple weeks of re-experiencing all my hypothyroid symptoms.
Basically my blood work says I am hyperthyroid now! My T4 is high, and my TSH is low. Ugh, I have no hyperthyroid symptoms though, I was finally feeling like myself again. I am now lowering my dose again.
Also, one of my cancer markers got higher by a little from my last blood work 6 months back.
I had cut gluten and while I am eating some sour dough bread I am trying to eliminate as much white processed flour and sugar as possible.
I am curious if anyone has had this same strange blood work happen to them? I just don’t want to go back to feeling like one of Ursula’s lost should, exhausted and half awake all the time!
Thanks!
I meant Ursula’s Lost Soul
Everyone says that Norman parathyroid clinic at Tampa Gen. hospital in Florida is absolutely amazing because none of the endocrinologist even address the four hidden little parathyroids that may be just functioning or dead causing all our problems. Check out Norman Parathyroid Clinic and Dr. Norman on YouTube… There is an app to enter various blood work into that lets us know if we are a candidate to be seen there for parathyroid bloodless 20 minutes surgery! That could be why your levels are still strange ?
I am almost 62 and started losing my hair about 2 months ago. So much – and I have had thick hair my whole life. At first I thought is was new brand of color my stylist was using. Well, yesterday I had blood work done and my TSH is 2.58. Also, RBC is 13.2 – range is 12 to 16.5. Hgb is 12.2 – range is11.5 – 15.0. I emailed my doc requesting T3,T4. Hopefully she’ll do it!!!
About 10 years ago my RBC was 13. – my doc said normally he put people in hospital at this low number or transfused them. I went to an endocrinologist – turns out my iron was just low….as I hope that’s what it is now. I was told since I was about 20 that I needed to take iron. I poo-pooed it. I didn’t know what it meant – now I know that it also mean I do not have ENOUGH blood in my system. Any ideas what this is?
Think good thoughts for me…..
Hopefully not thyroid – altho it does run in my family – mom, 2 sisters, nephew.
Hi there. Sorry you are having so many troubles. I am sorry but I don’t knwow what you mean. You are saying that they are telling you that you don’t have enough blood or not enough iron?
Praying for you right now.