Basic Thyroid Labs

When it comes to basic thyroid labs, it shouldn’t be this hard.

Insurance may only pay for a TSH lab and a T4 lab.  Unfortunately, this doesn’t give a full picture of what’s going on!  Speaking from experience here.  I’m not a doctor and don’t even pretend to play on on tv (or elsewhere).

Here’s a basic list to request from your doctor:

Free T3
Free T4
TSH
Reverse T3
TPO and TgAb (antibodies for Hashimoto’s) and TSI (antibodies for Grave’s).

Note that upwards of 80% of those with hypothyroidism also carry elevated antibodies that indicate Hashimoto’s.  So while it’s good to check those, if you can’t afford the tests or your doctor won’t check them, assuming you DO have Hashi’s may not be a bad idea, just to err on the side of caution.

And remember: Hashimoto’s is an autoimmune disease that affects the thyroid.  They thyroid is an innocent bystander here! Even though thyroid meds may help a little, getting that diet under control is key as it is with any autoimmune disease.  More on diet in my What Is AIP? post.

Thyroid labs: Free T3 and Free T4 should both be part of your thyroid panel

Free T3 and Free T4 labs measure the free (unbound) T3 and T4 hormone in the body.  Total numbers measure the free and bound hormone, and those aren’t as helpful for determining thyroid med dosage.

Unfortunately, many insurance companies will not cover a Free T3 test, so many doctors will not order it, thinking they are doing their patients a favor.  If your Free T3 is low, you may have fatigue or poor gut motility (having a bowel movement every 3-4 days instead of 1-3x per day), low body temps/feel cold all the time…. I could go on and on here.  Thyroid hormone is needed by every single cell in your body, so if there is not enough hormone to go around, it stands to reason that myriad symptoms and issues can result!

Many feel best with their Free T3 lab in the top part of their lab’s range.  If your doctor will not order it, you can always self-order labs yourself, I do it all the time.   Lots of places online to help you do this, Google is your friend!  My favorite lab linked below.

TSH is a Pituitary Hormone, NOT a Thyroid Hormone.

A word about TSH:  While initially, this test may be helpful for diagnosis, it is not that helpful in determining thyroid med dosage (that is where the Free labs come in!).  TSH may, in fact, become quite suppressed on T3-containing meds like Cytomel, Armour, Naturthroid, etc.

TSH is a pituitary hormone, not a thyroid hormone.  So if your TSH is still quite high while your Free labs are optimal, this may be indicative of pituitary issues, not thyroid issues.

Antibodies – should they be a part of basic thyroid lab panels?

A word about antibodies:  They go up and down and up and down all the time.  Some have antibodies in the 10,000’s, some have them only in the 100’s.  The actual number doesn’t matter *that* much.  Let me repeat that, the actual number doesn’t matter.

What does matter is two things:

One, that you monitor your symptoms.  Some can have antibodies in the 10,000’s and feel great!  Some can have slightly elevated antibodies and feel terrible.  This is because you can have tons of antibodies and they won’t be doing anything.  Just hanging out and… waiting. They haven’t waged their attack yet, but they’re there.

This is an excellent time to remove gluten and dairy 100% from your diet.  For some, this is all they have to do and are on the road to remission. You may or may not need meds.  One way to find out (get a full thyroid panel!).

Two, that you keep an eye on the number to see that it comes down over time.  I don’t test antibodies every time I do thyroid labs.  But that’s just me. Antibody counts fluctuate all the time, and I’ve seen too many people get upset over the fact that their antibody counts went up a few points in 4-6 weeks.

Think of this number as a roller coaster – if there are a few small dips and turns, that’s normal.  If you keep climbing ever higher, time to get to work!

I test maybe once a year to see the general trend.  If those numbers keep going up-up-up, then something is going on.  If dietary and lifestyle interventions don’t help, then it’s time to dig deeper, looking for infections, heavy metal toxicity, mold or chemical issues, other AI disorders (like Lyme disease), etc.

BTW, Antibody counts may *rise* after a diet change…!

If you have changed your diet recently (going gluten/dairy-free or starting the AIP), know that antibody counts may actually *rise* in the next 3-4 months as your body adjusts to your new diet.

When to take meds when having blood drawn for thyroid labs?

It’s best to not take any thyroid meds prior to your labs, as T3 spikes rather quickly in the blood and may give you a false high reading in your labs – and your doctor may want to decrease your meds, which may not be the best thing.  Skip your meds for 12 hours prior to blood work.

I also do all my labs first thing in the morning, while fasting.  This gives a good baseline with fewer variables – for example, food may also affect TSH/hormone levels.  Fasting lessens the chance of this variable affecting labs.

Biotin has also been known to skew labs, so it’s good to stop taking it a few days before any blood work.

If your doctor refuses to order these labs, it may be time for a new doctor…! Know that you can also self-order labs from many places online, I’ve been doing this for years due to insurance issues on my end.  Easy peasey!

Thyroid Hormone Conversion Issues.

I hope this post on thyroid labs has been helpful!

If you are looking for a new doctor to help you wade through the thyroid puzzle, I invite you to check out this post.

If you are overwhelmed, frustrated, and need a pair of ears or someone to walk the journey with you, I would love to be a support to you if you are looking to make either big or little shifts in your life.

As your coach, I will listen deeply, offer empathy, and help you make sense of what’s going on in your life right now.  We can talk about anything that’s on your mind:

• accepting what is
• creating balance in your life
• working through emotions of grief, sadness, or loss
• helping you create new habits or structure in your life
• help you regain control if you are feeling out of control
• letting go of perfectionism when it comes to your health
• how best to manage stress and anxiety
• creating boundaries with family, friends, and co-workers
• giving yourself permission to just be – no matter where you are in your life.

To book your Complimentary “Meet & Greet” Session and Assessment, click here.

Sandy Swanson is a Certified Functional Health Coach (A-CFHC) and a National Board Certified Health and Wellness Coach (NBC-HWC).  You can learn more about her here and more about what coaching is here.