5 Thyroid Lab Patterns That Doctors Miss

5 Thyroid Lab Patterns That Doctors Miss

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 a 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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The Complete List of Thyroid Lab tests:

The list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose and manage thyroid disease correctly!


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 by 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 markers 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 the most important). 

Thyroid conversion issues refer to problems in how your body activates 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. 

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

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 obtaining the tests needed for diagnosis?

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

is your doctor missing these thyroid lab patterns?

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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21 thoughts on “5 Thyroid Lab Patterns That Doctors Miss”

  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?

    • Hi Bonnie,

      If you are taking thyroid medication then that’s a manmade thyroid pattern :). The patterns listed here occur naturally.

  3. I have had symptoms for years, though mild. My TSH, T3 and T4 are always low/normal. I had my TPO antibodies tested 4 years ago and they were negative. Tested again last week, they were at 57. I’m guessing I’m in early hashimotos… I got a referral to an endocrinologist, so hopefully he will run all the tests and we can get some more definite answers. Thanks for this post! My Dr. said normal thyroid antibodies could be into the hundreds… I didn’t agree with that. ;-p

    • Hi Katrina,

      Elevated antibodies are never normal! In regards to your other comment, it’s highly unlikely that your endocrinologist is going to order these other tests. When I said that most doctors don’t understand thyroid function I was including both endos and PCPs. In fact, and I think most people would agree, endos tend to be the worst because they remain 100% convinced that their way is the right way.

  4. My ND doesn’t follow what you discussed here. I’m at my end wits with Endos and NDs. Is there any way I could see you so that I could be in remission in once. I’ve been battling with this for almost 10 years now. Thank you.

  5. Does all the above also apply if you don’t have a thyroid…my last test results were for the following
    TSH 2.08 T4,FREE 15.3
    T3,FREE 8.0 which came back as high…
    Thank you Aileen

    • Hi Aileen,

      Yes, lab tests don’t care whether you have a thyroid or not. They provide info and that info helps direct treatment. Hope this helps!

  6. Hi Dr. Childs – As always your posts are great resources for understanding thyroid problems – especially when it is difficult to find a medical professional to unravel the issues. It would be wonderful to have a “print” button so as to print the text in continuity without text being obscured and in a compact format. Thank you again for your ongoing educational materials.

    • Hi Barbara,

      There should be a print button near the social media icons. It isn’t a perfect replica of the post, but it should get the job done!

  7. This is such a problem in the UK. Our NHS doctors simply won’t do tests beyond TSH. Only if that is high or low will they do further tests. And if you try to explain this stuff you get labelled as a difficult patient. So we either have to pay for a private doctor (and not all of them get it either) or we have to work it out ourselves.
    Thank goodness for people like you who are helping us do that. It is literally the only chance for most of us.

  8. Thank you Dr. Child’s for a very educative post. It’s very difficult to get doctors to test the whole gamut to see where the problem lies.
    One pattern I don’t see here… normal TSH, low Free T4, normal Free T3. I don’t understand what to further check or do by way of diet/supplements in this situation.

    • Hi Madhavi,

      I agree. This blog post just went over the most common lab patterns that doctors miss but there are MANY other patterns which exist but were not discussed here.

  9. One multi-nodular gland removed over 15 years ago. I’ve been hypo for three years including on and off hair loss. My functional doctor told me to increase my NDT slowly, but I felt worse and went back to my 120 mg. I’ve had high RT3 the last three years. 19, 22 and now 27. My general and Functional didn’t say anything about it. I’ve made an appointment with and Endocrinologist who prescribes NDT, to see what he thinks. My last 2020 labs: RT3 serum 27 Range 10-24. FT4 1.62 ng/dl. range 0.89-1.76 ng/dl. They ordered T3 total which was 1.9mg/ml range 0.6-1.8mg/ml. TSH 0.10 uIU 0.550-4.759.

  10. I have hashimotos, I have known for a decade. My first endocrinologist “lost” my entire file and gave me the wrong medication while I was pregnant. My current endocrinologist told me at my most recent appointment that I feel so awful because I had babies and I’m fat and depressed and sleep deprived. Even though she had my labs in front of her. She’s a DO also and she wouldn’t even consider another solution apart from medication, said changing my lifestyle or diet wouldn’t change a thing, and ordered an ultrasound and a lab test for my vitamin d levels. No doctor has ever ordered the TG antibodies for me and I’ve been told they only matter if I have graves.

    • Hi Katie,

      From the perspective of most doctors, they don’t matter because they don’t change how they would treat you, but it’s still really good information to have! This is especially true if you are using natural treatment options as I recommend here.

  11. Dr. Childs,
    I wish you would go into more detail about rT3, and all of the tests for that matter. You talk about if it’s high if it’s low, that is NOT helpful. After finally talking my doctor into doing rT3 she has no idea what to do with the information. She will tell me about my other results but NEVER mentions the rT3 results. I have to admit, I’ve read numberous articles about rT3, everything from the results should be Zero, or between 9.2 – 15 and so many others that I am no help to her or more importantly, to myself.
    It’s one thing to recommend the tests that should be taken but if SOMEONE doesn’t provide the rest of that information, such as the RESULTS and what they mean then don’t bother recommending tests. You seem to expect us, the patient without a thyroid gland to know what the test results mean. I am aware that every lab has their range, and so WHAT? I had a ferritin test taken about 4 months ago, results very low. I brought my levels up to the very low edge of normal according to the LAB. So my doctor thinks everything is just fine now. She didn’t bother to ask how I was feeling.
    I would like a COMPLETE explanation of a rT3 in non-medical terminology. I have had the medical terminology explanation and I still can’t process that. WHY is it important to have a Free T3 , in other words why would a doctor think they should order a rT3 in the First place? Can a rT3 be taken at another time, a week or 2 after all tests have been taken? What exactly does the rT3 show? Does it show that Free T3 isn’t workign properly and being elimated by rT3 or building up in the blood but not being used?
    1. What is a Reverse T3 – exactly? In plain English.
    2. What do the results mean?
    3. What are the proper ranges I should be looking for in my results and when I know the answer to that question, WHAT does that result mean? How do I piece that into the puzzle of the other tests?
    4. What do I compare it to? The Free T3? The Free T4?
    5. When I compare what should I be looking for? High, Low, normal results (whatever that is) compared to Free T3? or Free T3 high low compared to rT3?
    6. What does rT3 results mean to me, the person without a thyroid?

    If you’ve ever put together a jigsaw puzzle, a big one and laid it out on your kitchen table, but you can’t find the one missing piece, that’s what it’s like to tell people these are the tests you SHOULD HAVE but I’m not going to tell you where that missing piece rT3 is or how to find it. So I have a gigantic puzzle sitting on my table with at least one missing piece, so the puzzle is NOT complete, so I cannot interpret what the puzzle is or what it means and even if I find the missing piece, rT3 how does it fit into my puzzle?


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