5 Thyroid Lab Patterns That Doctors Miss (And what to know so you don’t)

Why Getting the Complete Thyroid Lab Panel Matters

I've talked before about the importance of getting a complete thyroid lab panel for ALL thyroid patients and today we are going to drive that home. 

If you aren't familiar with the idea of the complete thyroid lab panel then free T3

Back to our topic today...

We are going to focus on thyroid lab patterns that, if present, can seriously impact how you are feeling and your symptoms. 

What's more important, however, is that MOST (if not all) of these thyroid lab tests are missed by conventional doctors and endocrinologists. 

The patterns that I will be discussing are really only visible once you get the entire spectrum of thyroid lab tests. 

Most conventional doctors order ONLY the TSH and maybe the free T4 (if you are lucky). 

This leaves out the added value that free T3, total T3, reverse T3, and thyroid antibodies provide. 

These additional lab tests help you get the COMPLETE picture of what is happening with your thyroid. 

And many of these patterns are simply not visible if you ONLY order the TSH. 

The TSH is a great test, but it has very little utility if used by itself (it really only is valuable in conjunction with the other lab tests). 

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Thyroid Lab Patterns That Doctors miss

Why do we care about these lab patterns?

For starters, they impact how you should approach the MANAGEMENT of your thyroid condition. 

And what I'm really talking about here is your treatment. 

Many thyroid conditions are POTENTIALLY reversible, provided you can catch them early enough. 

If you wait until your thyroid condition is full-blown then it becomes less likely that a complete cure is possible. 

We also know from various studies that hypothyroidism exists on a SPECTRUM. 

What does this mean?

It means that before you feel REALLY terrible you are only going to feel a little bit terrible. 

But what you want to do, as a thyroid patient, is catch those symptoms as soon as possible. 

Also, you should know that just because you have these lab patterns doesn't necessarily require that you start thyroid medication immediately or at all. 

What they mean is that you DO have a thyroid problem but some of these issues (I will mention them below) can be treated naturally without the use of thyroid medications. 

With this in mind, let's jump in: 

list of thyroid lab patterns

*Note: This is an image from the video ABOVE (be sure to watch the video for more information on this topic!).

#1. EARLY Hypothyroidism

The first pattern is something I like to call early hypothyroidism. 

I'm calling it early hypothyroidism because it's really the beginning stages of what will become full-blown hypothyroidism. 

But instead of catching it once you've gained 20-30 pounds and lost 20% of your hair, we are catching it when you gain 5 pounds and when you have minor hair fall/breakage. 

This pattern can be differentiated with these results: 

  • *TSH - Mildy ELEVATED (or high) with any result greater than 2.0 to 2.5 uIU/ml. Most doctors believe that a TSH greater than 5.0 (or so) is a problem but newer studies suggest that a TSH greater than 2.5 is a problem. 
  • Free T4 - Low or normal (can be either) 
  • Free T3 - Low or normal (can be either) 
  • Reverse T3 - Normal
  • Thyroid antibodies - Normal

For the diagnosis of this condition you really want to pay attention to your TSH. 

Your thyroid hormone levels are helpful but the TSH is the most important because we are really looking for early signs that your thyroid gland is struggling. 

Free T3 and free T4 can remain relatively preserved in many thyroid conditions so they aren't always a sensitive marker of thyroid problems. 

This TSH level applies to people both on AND off thyroid medication, by the way!

So don't let that throw you off. 

Early hypothyroidism can be treated either naturally with natural remedies or with thyroid medications because you are ideally catching it early. 

#2. Thyroid Conversion problems/issues

Thyroid conversion issues are OFTEN missed by traditional doctors (endocrinologists and family practice doctors) because they are not even looking for them. 

What makes it worse is that you completely MISS these problems if you don't order the free T3 and reverse T3 (which are most important). 

Thyroid conversion issues refer to problems in how your body ACTIVATE thyroid hormone (how it turns T4 into the active thyroid hormone T3). 

Many people (perhaps even including you reading this) have issues with this conversion process weight gain leads to low thyroid function, prescription medications, or other issues described here. 

How do you know if you have conversion issues? 

Your labs will look like this: 

  • TSH - Normal
  • Free T4 - High or normal
  • *Free T3 - Low
  • *Reverse T3 - High
  • Thyroid antibodies - Normal or high

Notice that the free T3 and reverse T3 are the MOST important labs for identifying conversion issues. 

This is because if your body can't convert T4 into T3 then it will convert T4 into reverse T3. 

This will cause your T4 to stay normal or high, your free T3 to LOWER, and your reverse T3 to RISE. 

This pattern is OFTEN associated with hypothyroid symptoms and makes patients feel worse. 

You can treat conversion issues either by taking T3 thyroid medication, addressing the underlying problem causing rT3 formation OR by using certain supplements (and natural remedies). 

#3. Obesity-related thyroid problems

Obesity is a HUGE problem for thyroid patients because of how the thyroid interacts with your metabolism. 

You probably already know that LOW thyroid function leads to weight gain but you probably didn't know that weight gain leads to low thyroid function

That's right, just being overweight is enough to SLOW down your thyroid function. 

The good news is that you can identify this problem by looking at the right labs: 

  • TSH - Low or normal
  • Free T4 - Normal 
  • *Free T3 - Low
  • *Reverse T3 - High or normal
  • Thyroid antibodies - Normal

Again, you will want to pay close attention to your free T3 and reverse T3 levels. 

One of the tell-tale signs of obesity-related thyroid problems is a LOW free T3. 

If everything else is normal but you have a low T3 (and you are overweight) that is a sign that your weight is negatively impacting your thyroid. 

You might also find that your reverse T3 rises but this typically only occurs once you start trying to diet or reduce your calories. 

natural thyroid supplements version 2

The more you diet to try and lose weight, the higher your reverse T3 will go, the lower your free T3 will go, and the more hypothyroid you will feel. 

THIS is why it's so difficult to lose weight if you have thyroid problems. 

You can learn more about how to actually treat the root cause of obesity in thyroid conditions in my weight loss guide here

#4. Low T3 (also known as euthyroid sick syndrome)

Next on the list is something called LOW T3 syndrome. 

Low T3 syndrome is a problem for many people because they often feel terrible but all of their lab tests (aside from their T3) are normal. 

The official name (that doctors use) for this condition is known as euthyroid sick syndrome. 

I've written about this concept in detail here if you want to read more about it. 

What you need to understand here is that low t3 syndrome, while it presents similarly to obesity-related thyroid problems, is much different. 

Low T3 syndrome usually occurs due to CHRONIC medical problems. 

So if you have conditions like high blood pressure, chronic infections, if you are taking multiple medications, diabetes, and so on, can all cause this condition. 

What happens here is that your body is bogged down by so many chronic medical issues that your thyroid slows down so that your body can try to heal. 

Unfortunately, it doesn't work (unless you reverse these medical conditions). 

You can identify low T3 syndrome by looking at the following labs: 

  • TSH - Normal
  • Free T4 - Normal 
  • *Free T3 - Low
  • *Reverse T3 - High 
  • Thyroid antibodies - Normal

Again, you will want to pay close attention to your T3 level. 

A low T3 is the most common sign here but you may also find that your reverse T3 is elevated (though not always). 

Not all people with low T3 syndrome will require thyroid medication!

In fact, if you can reverse the chronic medical conditions (using diet and lifestyle) then your thyroid should actually improve naturally. 

This is the ideal approach and the one that you should aim for. 

In some cases, however, it is a good idea to use thyroid medication (usually T3 medications) to help you heal even more quickly. 

#5. EARLY Hashimoto's thyroiditis

Last, but not least, is what I call EARLY Hashimoto's. 

Early Hashimoto's refers to the stage where your thyroid is SLIGHTLY damaged and this damage is enough to cause hypothyroid-esque symptoms. 

But even though you are experiencing symptoms, the slight damage is often not enough to manifest in your TSH lab test. 

The result is that your lab tests appear normal but you have both hypothyroid symptoms AND elevated thyroid antibodies. 

This is known as early Hashimoto's and it SHOULD be treated (either naturally or with thyroid medication). 

Early Hashimoto's presents with the following lab tests: 

  • TSH - Normal (or even low)
  • Free T4 - Normal or low (often low)
  • Free T3 - Normal or low (often low)
  • Reverse T3 - Normal
  • *Thyroid antibodies - High (but can also be normal) 

The key here is focusing on your THYROID ANTIBODIES. 

This means you will need to order both thyroglobulin antibodies and thyroid peroxidase antibodies. 

If your thyroid antibodies (either or both) are elevated then the TSH becomes less helpful/relevant. 

It's possible for your TSH to be completely normal in Hashimoto's but still benefit from thyroid medication and still have hypothyroidism. 

Just because you have elevated thyroid antibodies doesn't mean that you NEED thyroid medication, though. 

It's still very possible to treat your thyroid antibodies naturally, provided you are catching it early. 

If you are someone who suspects that you've had thyroid problems for years (or decades) 

Final Thoughts

Understanding these thyroid lab patterns is so important because it will help YOU understand what is happening with your thyroid. 

These lab patterns are often missed or simply ignored by your doctor because they are probably not even ordering the right tests. 

This means it's up to you to ask for these tests and it might even be up to you for some minor interpretation. 

Use these patterns to help guide your management and your treatment!

Now I want to hear from you:

Do you have any of the thyroid lab patterns described above?

If so, which category do you think you fall into?

Are you having difficulty in obtaining the tests needed for diagnosis?

Leave your comments or questions below to keep the conversation going! 

5 thyroid lab patterns doctors miss

This post was most recently updated on October 30th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

4 thoughts on “5 Thyroid Lab Patterns That Doctors Miss (And what to know so you don’t)”

  1. Thank you so much Dr Child’s for all of your wisdom you share. Thyroid patients everywhere are in great need of the correct information you give. I’ve been a nurse for decades and was diagnosed with hashimoto’s in 2014. An endocrinologist told me I didn’t need a reverse T3 level drawn! This shows how the American Society of Endocrinology is poorly teaching these so called specialist! Disgraceful to say the least. I hope everyone with thyroid disorders educated themselves with your infinite wisdom. Thank you again-I’m your biggest fan!

    • Hi Sarah,

      No problem! Glad you find it helpful. And I completely agree. What’s more concerning is that Google has been suppressing this type of information in the search results in favor of the information that leads to poor outcomes. Very sad state of affairs!

  2. gah! I have one you DIDN’T discuss. (I have no thyroid), but T4 and RT3 are normal, TSH is low, but my T3 is very high! This is also the same pattern my daughter has (also had thyroid cancer and thyroidectomy). What’s up with that?

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