ICF and National Board Certified Holistic Life & Wellness Coach
Hashimoto’s: I have Hashimoto’s. What does that even mean? Seems like a silly question, but it inspires the follow-up: When did I choose to acquire this Hashimoto’s thing? Most of us would say oh HELL no, I would never ever dream about choosing a stupid…
Wondering what to tell people who don’t understand your need to go gluten-free or change up your diet? Been there, done that. It can be so frustrating when people don’t understand (not always their fault) or don’t care (not much you can do there). You…
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).
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.
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.
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.
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.
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.
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!
Many of us with thyroid conditions are “poor converters”. This means that our body has trouble converting T4 into the useable T3.
And here’s the kicker: synthetic meds like Levothyroxine or Synthroid contain only T4, which means trouble for us poor converters!
This is a quick and easy explanation from Dr. Datis Kharrazian (if you haven’t read his book “Why Do I Still Have Thyroid Symptoms If My Lab Tests Are Normal”, I highly recommend a read):
You can read the full post from Dr K here.
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:
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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.
Fatigue is a huge issue from which many of us suffer. We’re talking beyond busy lives and being tired (aka not getting enough sleep at night). This is mind-numbing fatigue. Where you simply can’t move. Muscles don’t respond, your brain doesn’t respond. Like our little…
So many of us with thyroid conditions are put on synthetic meds like Levothyroxine or Synthroid. These meds contain synthetic versions of the thyroid hormone T4. However, many of us are “poor converters”. This means that our bodies have trouble converting T4 into the useable…
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.
So, what labs to get? A full panel consists of:
Free T3
Free T4
Reverse T3
Antibodies: TPO and TgAb (for Hashimoto’s) and TSI (for Graves).
NOTE: Some sources say that upwards of 80% of those with hypothyroidism also carry the antibodies to the autoimmune disorders Hashimoto’s and Graves. Still, it’s good to check and monitor antibodies just to be sure – and to make sure that the antibody counts aren’t rising crazily. Keep in mind that you can have elevated antibody counts and few or no symptoms – but if the antibody counts keep going up, something is going on. Best to figure it out and get it in check before you DO start to have symptoms!
Now, a word on TSH. I’ve said this before and I’ll say it again: TSH is a pituitary hormone, NOT a thyroid hormone. If the body is not making enough thyroid hormone, the pituitary gland signals the thyroid to make more hormone by stimulating it (with TSH, aka Thyroid Stimulating Hormone).
When the TSH levels go down, some doctors may think that that’s good enough and move on. However, it’s best to check the Free T3 and Free T4 labs as these will give you a clearer picture of what exactly is happening in your blood. The Free labs test the unbound hormones. Other labs (T4, total T3, etc) may test the bound and unbound – which doesn’t give as clear a picture.
If you are on an optimal dose of thyroid replacement hormone (levothyroxine, Synthroid, Amour, Naturthroid, Westhroid, etc) your Free labs should be in the upper parts of your lab’s range. Not just “in range”, but the *upper* parts.
Also, when on an optimal dose of T3 containing thyroid meds it is quite common to see a very suppressed TSH. This is to be expected and no cause for alarm, remember that TSH is a pituitary hormone, NOT a thyroid hormone. If there is enough thyroid hormone circulating in the body the pituitary gland will have little reason to stimulate the thyroid gland to make more.
If you are optimally dosed (Free T3 and Free T4 in the upper parts of the range AND your symptoms have lessened or disappeared completely) but still have a high TSH, this may indicate a pituitary issue, not a continuing thyroid issue.
To recap:
– stop taking biotin a few days before labs
– stop taking thyroid meds 12 hours before labs
– do labs first thing in the morning, fasting
– get a FULL panel, not just TSH.
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. Easy peasey!
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Too much information? Feeling confused? A coach can help. Learn more about working with me one-on-one.
New to Hashimoto’s Thyroiditis? Need guidance and help? Learn more about my online course, “Reimagining Hashimoto’s”. If you are new to Hashi’s or just need some guidance when it comes to thyroid disease (yeah, it can be overwhelming, complicated, and frustrating), I invite you…
