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Top Symptoms of Hypothyroidism with Checklist and Lab Guide: ALL the Tests you NEED to Ask your Doctor for

Do you have all of the symptoms of hypothyroidism and yet you are told that your lab tests are "normal"? 

I've got some great news for you...

You're not crazy, and you most likely DO have hypothyroidism

hypothyroidism meme do I look fine?

It's just that your Doctor isn't up to date on current Thyroid knowledge and is most likely not ordering the right thyroid tests and may even be interpreting your labs incorrectly...

This post will teach you what symptoms to look out for, what tests you need to ask your doctor for and how to interpret those lab tests

Let's jump on in: 

More...

Are you Hypothyroid? 

Does this scenario sound familiar:

You recently had a baby, went through menopause or some other stressful event in your life and now you're: gaining weight, your hair is falling out, you are more fatigued than normal, you're skin is dry and you aren't sleeping well.

So you go to the Doctor and have him run some tests, only to be told that your lab tests are completely "normal".

How can that be when you feel so bad?

Instead of thyroid medication you are offered anti-depressants or told that this is just normal and part of "getting older". 

So you go home defeated, exhausted and depressed thinking you have to deal with feeling this way forever.

​If this has happened to you PLEASE keep reading! You AREN'T crazy and you AREN'T alone.

thyroid metabolism reset poster for side bar

The reason I know this scenario so well is because I used to say and do the exact same thing to hundreds of patients...

I know! I used to be that guy. BUT, I've since changed my ways and I'm on a mission to educate Doctors and patients alike.

The truth is that Doctors do want to help you, they just aren't well equipped with the proper tools or knowledge to do so.

That's why it's so important for you to understand these things and be your own advocate. 

​And I'm going to let you in on a secret here...

If you have 5 or more of the following symptoms there is a VERY high chance you have hypothyroidism regardless of what your labs show. ​

List of Hypothyroidism Symptoms with Checklist

Complete thyroid blood tests image

How to use this list:

  • If you have 5 or more symptoms you are likely to have hypothyroidism
  • If you have 6-10 symptoms you are very likely to have hypothyroidism
  • If you have > 10 symptoms you have Hypothyroidism it just hasn't been diagnosed yet

Top 10 Most Common Symptoms of Hypothyroidism

If you have these symptoms there is no need to move on to the Symptom checklist below because these are VERY indicative of hypothyroidism...

​1. Fatigue after sleeping 8-10 hours at night or needing to take a nap daily

2. Weight gain or the inability to lose weight

3. Mood issues such as mood swings, anxiety or depression

4. Hormone imbalances such as PMS, irregular periods, infertility and low sex drive

5. Muscle pain, joint pain, carpal tunnel syndrome or tendonitis

6. Cold hands and feet, feeling cold when others are not or having a body temperature consistently below 98.5 degrees

7. Dry or cracking skin, brittle nails and excessive hair loss

8. Constipation

9. Mind issues such as brain fog, poor concentration or poor memory

10. Neck swelling, snoring or hoarse voice​

Signs and Symptoms of Hypothyroidism

​The reason hypothyroid symptoms can be so diverse is because every cell in your body has a thyroid receptor. So your symptoms will depend on which cells in your body are NOT getting enough thyroid hormone. 

Thyroid hormone receptor

And these symptoms can be DIFFERENT in every single person because each individual cell has a different thyroid hormone requirement and resistance level.

That means you can be thin and hypothyroid!

Read the complete list below: ​

  • Fatigue
  • Lethargy
  • Low endurance
  • Slow speech
  • Slow thinking
  • Poor memory
  • Poor concentration
  • Depression
  • Nervousness
  • Anxiety
  • Worrying
  • Easy emotional upset
  • Obsessive thinking
  • Low motivation
  • Dizziness
  • Sensation of cold
  • Cold skin
  • Decreased sweating
  • Heat intolerance
  • Non-restful sleep
  • Insomnia
  • Thick tongue
  • Swelling of face
  • Sparse eyebrows
  • Low basal activity level
  • Low basal temperature
  • Slow resting pulse rate
  • Long-normal intervals on ECG
  • Swelling of eyelids
  • Dry Skin
  • Dry mucous membranes
  • Constipation
  • Weight gain unexplainably
  • Paleness of lips
  • Shortness of breath
  • Swelling
  • Hoarseness
  • Loss of appetite
  • Prolonged menstrual bleeding
  • Heavy menstrual bleeding
  • Painful menstruation
  • Low sex drive
  • Impotence
  • Hearing loss
  • Rapid heart rate
  • Pounding heart beat
  • Slow pulse rate
  • Pain at front of chest
  • Poor vision
  • Weight loss
  • Wasting of tongue
  • Indistinct or faint heart tones
  • Low QRS voltage on ECG
  • Emotional instability
  • Choking sensation
  • Fineness of hair
  • Hair loss
  • Blueness of skin
  • Dry, thick, scaling skin
  • Dry, coarse, brittle hair
  • Paleness of skin
  • Puffy skin
  • Puffy face or eyelids
  • Swelling of ankles
  • Coarse skin
  • Brittle or thin nails
  • Dry ridges down nails
  • Difficulty in swallowing
  • Weakness
  • Vague body aches and pains
  • Muscle pain
  • Joint pain
  • Numbness or tingling
  • Protrusion of one or both eyeballs
  • Brain fog
  • Cardiac enlargement on x-ray
  • Fluid around heart

​Believe it or not there are even more symptoms, but at this point it's usually not worth going over them because if you have hypothyroidism the chances of you have 10+ of symptoms on that list is VERY high. 

​So what do you do if you have those symptoms and you've been told your lab tests are normal? 

First I would recommend you read this post, and then come back to this page to go over your next step:

The "Complete Thyroid Lab Panel" which you will need to ask your doctor for. ​

The "Complete Thyroid Lab Panel" You should be Asking your Doctor for

​The reason many cases of hypothyroidism get missed is because the Doctor and patient aren't aware of two very important things:

1. The proper lab tests to order

2. How to actually interpret those lab tests that have been ordered

One of the most classic mistakes I see is patients asking me how to get their Doctor to order the right lab tests...

If your doctor didn't order these tests to begin with he/she is most likely NOT the doctor that is going to be willing to help you.

Why?

Because if they understood how to interpret the lab tests they would have ordered them to begin with!

Don't fall into this trap.

thyroid lab testing

You need to know WHICH tests to order but also HOW to interpret them.

Once you find a Doctor willing to work with you get these tests ordered:

(The optimal reference ranges are listed to the right of the lab tests)​

  • TSH - Anything > 2 is a problem, < 2 does not mean you are "good"
  • Free T4 - Preferably the upper 1/2 of the reference range (though note this will number may go down if you are on T3 formulations like liothyronine, in which case you will want to look at the free T3 levels)
  • Free T3 - Preferably the upper 1/2 of the reference range
  • Reverse T3 - Should be < 15, anything > 15 indicates thyroid resistance
  • Thyroglobulin antibodies - Should be < 30
  • Thyroid peroxidase antibodies - Should be < 30
  • Sex hormone binding globulin - In women this should be in the 70-80 range (but it can't be used if the woman has estrogen dominance), in men it should be around 30
  • Free T3/Reverse T3 ratio - Calculate this number by dividing free T3 by Reverse T3, your calculation should be > 0.20 (if < 0.20 this indicates thyroid resistance or low free T3 syndrome)

​Don't go off of the "reference range" that the lab creates. 

You want to use the "optimal range" that I've included to the right of the lab tests above.

There is a HUGE difference in being "normal" and being "optimal" especially when we are talking about very small hormone levels in the blood.

​Lab tests aren't the end-all-be-all either. 

Even if your lab tests come up within the reference ranges I've listed, you could very well still be hypothyroid.

Some patients just don't show hypothyroidism in their lab work, but that definitely doesn't mean they are normal. ​

Why your Doctor says your Lab Tests are Normal when they aren't

There are a couple of things you have to understand about lab testing...

We (both Doctors and patients) like to think that they are 100% perfect but that is so far from the truth.

No test is 100% accurate and thyroid lab tests are no exception.

​We actually don't really care about the blood levels of thyroid hormone in your body.

We only care if that thyroid hormone is actually getting to your TISSUES (like your brain, heart, skin, etc.)

We just make the assumption that if your blood levels are "high" enough they will get to their target destination.

But that turns out to not be true.

What if there is a blockade at the cellular level and thyroid hormone can't leave the blood stream to get into the cells?

That actually happens and the condition is known as Thyroid resistance or Tissue level hypothyroidism.

Tissue level hypothyroidism

​And guess what? 

You'd never know you had it unless you checked your Reverse T3 levels.

Elevated reverse T3 in Hypothyroid patient

Crazy that most Doctors don't know about this condition or how to even diagnose it.

Bottom line:

Don't accept "normal" blood tests!​

What to do if you are on Medication but still have Symptoms

Let's say you're reading this and you've already been diagnosed with hypothyroidism and you're currently on thyroid medication with "normal" labs...

What then?

Are you just des​tined to feel this way forever? 

Thankfully not!

​It's actually not that uncommon for patients to feel terrible on thyroid medication if they fall into one or more of the following categories:

1. They are being treated with Levothyroxine (AKA T4 medication only)

2. They are being treated based on their TSH (and the Doctor keeps changing their medication dose all the time)

​The truth is that MOST patients need some kind of T3 hormone added to their medication regimen to feel optimal. 

​Medications that include T3 hormone: 

  • Cytomel, Liothyronine or Sustained release T3 - This is pure T3 medication and is THE active thyroid hormone. Adding this to your current regimen may improve your symptoms drastically. 
  • Natural Dessicated Thyroid hormone - This medication contains T4 and T3 in addition to other thyroid hormones and may also improve your symptoms significantly. 

What is the "best" dose for each of these? 

Unfortunately it's impossible to say without trial and error. Each patient will need an individualized dose and may require a different amount of T4 and/or T3 to "feel optimal".

Most of my patients fall within these ranges:

  • Liothyronine - 10mcg-50mcg per day depending on the amount of thyroid resistance. The higher your reverse T3 the higher dose of liothyronine you will likely need
  • Natural dessicated thyroid - 1-3 grains and everything in between
  • Combination of NDT + Liothyronine - 1-2 grains + 12.5-25mcg of Liothyronine seems to work well for many patients

​It's also worth pointing out that MANY of you have more than just thyroid problems going on in your body. 

If these problems are NOT addressed, it doesn't really matter how much thyroid hormone you get - you will NOT feel optimal. ​

That includes other hormones, nutrients and the basic 4 foundational pillars of health:

Paleo food pyramid

1. Stress coping techniques - Which would include things like Yoga, meditation or spiritual prayer

2. Proper Whole Food Diet - See a list of diets that work for Hypothyroidism and Hashimoto's here and here

3. Exercise and movement routine - This includes a combination of low intensity exercise (like walking) daily in addition to high intensity exercise once your thyroid function has improved

4. High quality restful sleep​ - You need to be getting 8 hours of sleep per night at least in order for your hormones to function optimally

What if your Doctor Just Doesn't get it​

Guys: 

Life is too short to waste your precious time and energy on a Doctor who isn't willing to work with you. 

If you're meeting resistance from your doctor just stop seeing them and look for a new one. 

Your chances of "educating" your doctor on proper Thyroid function is VERY slim. Any articles you bring them to read will likely end up quickly in the trash. 

Your best bet is to look for a Doctor who specializes in thyroid care and I don't mean an endocrinologist.

Before you go to the Doctor call the office and ask if the Doctor frequently orders Reverse T3 and Free T3. If they do then that's a really good sign they understand how to diagnose and treat the thyroid. 

Alternatively you can also ask if the Doctor prescribes liothyronine and Natural dessicated thyroid hormone, again if the answer is "Yes" you are onto something. ​

​You can also look for reviews online or from other patients. 

Whatever you do make sure you find a Doctor who can prescribe medication.

Many Doctors that practice functional medicine may be more willing to prescribe the medications I listed above, but you still need to do your research.

IFM search for a provider

You can find more info here.

​Helpful Tips and Tricks for treating your thyroid:

​Trouble losing weight? Check out this link

Want to increase your thyroid hormone naturally? Check out this link

Want to know the best supplements for your thyroid health? Check out this link

​Want to see case studies of other patients? Check out this link

Want to know if Levothyroxine or Synthroid is the right medication for you? Check out this link​

I want to hear from you!​

Do you have the symptoms listed above?

If so, what have you done to help them?

Have you tried liothyronine or NDT?

Leave a comment below!​


The Complete thyroid panel
Westin Childs
 

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

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