7 Reasons your Thyroid Lab Tests are Anything but “Normal”

Do you have all of the symptoms of hypothyroidism but have been told your Thyroid lab tests are "normal"? 

I've got some news for you...

Chances are VERY high that your thyroid lab tests are in fact NOT normal and that you are NOT crazy.

But it can feel like you are crazy when you go to Doctor after Doctor and you're told the same thing.

So why is it that every Doctor is telling you that you are fine, despite how you feel?

Let's talk about why your thyroid lab tests are anything but "normal"...


6 Reasons why your Thyroid Lab Tests are NOT normal

​By the time most patients finally come to see me they've seen 5+ different Doctors and they've all been told the same thing.

It can get very disheartening to hear it over and over. 

It's not uncommon for patients to come to me on anti-depressants because other endocrinologists and primary care doctors think that's really what's going on. 

And while hypothyroidism can cause depression, most of the time I find that my patients really are suffering from hypothyroidism - they just don't fit the typical "mold" and so they are misdiagnosed. 

Let me show you why your Doctor may be missing your Hypothyroidism...

1. Your Doctor isn't Ordering a Full Thyroid Panel or he isn't Interpreting it Correctly

There are 2 situations that I see commonly in my office:

  • Doctors aren't ordering the right tests and they are misdiagnosing the patient
  • Patients are asking for the right tests, but the doctors (and the patients) aren't interpreting the labs correctly. 

Do you fall into one of these categories? ​

It's CRITICAL to not only order the right tests, but to understand how to interpret them correctly.

Otherwise you will miss the diagnosis!

​That being said...

​What tests do you need to order?

The "Complete" Thyroid Blood Panel​

Thyroid lab tests

This is my "complete" thyroid blood panel that I order on every patient, let me break it down for you and why it is important...

  1. ​TSH - The TSH gives me an idea of how the pituitary is responding to serum levels of Thyroid hormone. The pituitary has different deiodinases than the rest of the body so it can't be used a marker for tissue levels of thyroid hormone, but it can be helpful if elevated.
  2. Free T3 - How much active thyroid hormone is floating around in the blood. This can be artificially elevated if reverse T3 is high. 
  3. Free T4 - This gives me an idea of what kind of thyroid "store" your body has. Remember that not all T4 will turn into T3 and in the presence of inflammation, leptin resistance or nutrient deficiencies your body may turn T4 into Reverse T3. 
  4. Reverse T3 - This gives me an idea of what kind of stress the body is under, how much inflammation is going on, and what nutrient deficiencies the patient may be experiencing. High levels of reverse T3 are associated with Thyroid resistance and tissue level hypothyroidism. 
  5. Thyroid peroxidase and thyroglobulin antibodies - High antibodies are associated with thyroiditis and autoimmunity. If elevated treatment should be targeted at reducing these values ASAP. During treatment I will track these numbers to make sure we are on the right track. 
  6. Sex hormone binding globulin - This can be used as a surrogate marker for Tissue levels of thyroid hormone. Only two hormones increase this protein, estrogen and thyroid hormone. 
  7. Iron studies - Iron studies are critical for proper interpretation of Thyroid function. In the presence of low Iron thyroid hormone will be less active. 

Now what are the "optimal" levels for these tests?

  1. ​TSH - TSH should be < 2. A TSH < 2 does NOT mean that your thyroid function is normal. I do NOT recommend tracking thyroid function using TSH because the pituitary has not competition with Reverse T3 intracellularly due to its deiodinases
  2. Free T3 - Optimal levels are usually in the upper 1/3 of the reference range. 
  3. Free T4 - Optimal levels are usually in the upper 1/3 of the reference range. Note that Free T4 levels may drop dramatically on pure T3 hormone replacement therapy like Liothyronine, cytomel or sustained release T3. 
  4. Reverse T3 - Optimal levels are as LOW as possible. If > 15 I will start thinking about thyroid resistance at the cellular level or that leptin and/or inflammation are blocking thyroid hormone from getting into the cells. In the presence of High levels of Reverse T3 your Free T3 levels may look falsely "normal". 
  5. Thyroid peroxidase and thyroglobulin antibodies - Optimal levels are as low as possible. I recommend tracking these values if you are being treated for Hashimoto's. 
  6. Sex hormone binding globulin - Optimal levels for Women = 70-80 range. Optimal levels for men = 20-30 range. You can follow the SHBG to see if thyroid hormone is entering the tissues (in this case the liver). As you increase the dose of thyroid hormone this value should increase as well. 
  7. Iron studies - I find that most hypothyroid patients feel better with Ferritin levels in the 70-80 range and percent saturation levels in the 35-38% range. 


Interpreting your tests results is MORE important than simply ordering the right tests.

Thyroid diet 4 week plan side bar

2. Blood levels of Thyroid Hormone are not necessarily what we care about

This is another huge problem so let me explain...

I explain it this way to my patients:

​The blood stream in your body is just a way to move nutrients and hormones to the places that actually need it. 

Your tissues and organs.

The amount of thyroid hormone in the blood is only helpful to us if we KNOW for sure that the hormone and nutrients are making it into your cells.

Most doctors check your blood levels of hormones and assume that if blood levels are "normal" that your tissues must be getting the right amount of hormone.

But, obviously that isn't the case.

What's more important than your blood levels of thyroid hormone is this:

Are your tissues actually getting the right amount of thyroid hormone.

And we are somewhat limited in how we can actually test this - short of doing a biopsy at the target tissue. And it doesn't make sense to biopsy muscle, heart tissue or brain tissue to diagnose your hypothyroidism.

Instead we can use a couple of surrogate markers to evaluate if your tissues are getting enough thyroid hormone:

  1. Your basal body temperature - This can give us an idea of what kind of total energy your body is producing. If your temperature is low you may have a problem getting thyroid hormone into your cells. Read more about testing your basal body temperature here
  2. Sex hormone binding globulin levels - Read above for more information. This will give us an idea if your Liver tissue is getting enough thyroid hormone
  3. Your subjective symptoms! Symptoms come from a tissue level deficiency of thyroid hormone, if you still have symptoms despite being on thyroid hormone - you might not be getting enough hormone inside your cells. 
  4. Relaxation phase of Deep Tendon Reflexes - One of the most sensitive tests to look at is the relaxation phase of deep tendon reflexes. This can actually be tested using sophisticated devices to give an exact number. 

If you focus completely on serum levels of thyroid hormone you are going to miss hypothyroidism at the tissue level. 

This may not be an issue for EVERY patient but it will certainly be a problem for many patients - especially those with "normal" thyroid levels but almost every hypothyroid symptom in the book. 

3. Other hormones influence the action of Thyroid hormone

​If you want to treat your thyroid properly you can't look at each organ system in isolation. 

Your body is like a spider web.

When you pull one string, does the entire spider web magically stand still?


The same thing is true in your body when a hormone system is out of balance.

The other hormonal systems will eventually crash after trying to "stabilize" the problem as much as possible.

It's like limping on your left leg after you hurt your right leg. After 10 days of favoring your left leg both of your legs are eventually going to start hurting.

In the case of your thyroid the two most common hormonal imbalances that can further worsen thyroid function include:

  • Adrenals and Cortisol Levels
  • Estrogen balance with Progesterone

Cortisol and Adrenal Fatigue

Your adrenals and thyroid function are intricately linked. ​

As TSH goes up so too does your cortisol levels.

And this can be a good thing in the short term, but after prolonged elevation you will eventually get symptoms of Adrenal fatigue.

​If you try to evaluate thyroid function without taking into account Cortisol and Adrenal function you are making a huge mistake. 

Not treating associated Adrenal fatigue is also one of the main reasons that patients fail to improve after starting thyroid hormone. 

Do NOT neglect your adrenals!​

Estrogen Dominance and Progesterone deficiency

​Thyroid hormone, specifically T3, helps your body produce adequate amounts of Progesterone

When you have low thyroid hormone you will have low progesterone levels which can lead to an imbalance known as Estrogen Dominance.

This is also why many women with hypothyroidism can have irregular menstrual cycles, decreased libido and infertility. 

Don't neglect other hormone systems when evaluating your thyroid!​

4. If you have Leptin Resistance or High Reverse T3 Levels TSH can't be Trusted

​Inflammatory states and leptin resistance cause chaos to the thyroid system. 

The higher leptin levels get and the higher inflammation gets, the less likely your body is to convert T4 to T3. Instead it will convert T4 to the inactive and thyroid blocking agent Reverse T3.

As Reverse T3 levels increase your body will have a hard time utilizing free and active hormones effectively. 

They are in a sense blocked from entering the cells, and because of this they may stay floating around in the blood stream.

This can lead to so called "normal" blood levels of thyroid hormone which can actually drive down the TSH tricking you into thinking that your lab tests are completely "normal", when in reality your cells are starving for thyroid hormone.

If you have inflammation or Leptin resistance, ​the TSH cannot be trusted unless you are also evaluating Reverse T3, Free T3 and Tissue levels of thyroid hormone 

5. Don't practice "Reference Range Endocrinology"

Reference range endocrinology is a term that is given to Doctors who practice an incredibly basic way of diagnosing, managing and treating thyroid disorders.

​They simply look to see if your lab values fall inside the reference range of the lab results, and if they do, you are considered to be normal. 

Even if you are in the bottom 5% of that reference range, you are still normal.

And that is a huge problem.

There is a big difference between being "normal" and being "optimal".

There's also a huge difference in what being "optimal" means between different individuals!

There will always be people that feel better at lower levels of thyroid hormone, but there are just as much (if not more) that NEED higher levels of hormone to function at 100%!

Low Free t3 and low Free t4

​Above is a classic example of a patient suffering from Hypothyroidism with "normal" lab results, even though her labs are barely within the "normal" range. 

Unfortunately most Doctors (including Endocrinologists) practice this way! If you want to find a Doctor who doesn't you will typically have to look outside of the traditional model. ​

6. Failure to Diagnose and Appreciate Nutrients Required for Thyroid Function

It's silly but outside of the Hospital Doctor's don't appreciate the value of nutrients and supplements in treating disease.

Inside the hospital your Doctor is intimately familiar with something as simple as magnesium: it serves to help stop premature labor and it can even bring your heart back into a stable rhythm when given intravenously.

​Outside of the hospital it's another story entirely!

The truth is your thyroid needs several different nutrients (that are commonly depleted in most people) to function at 100%.

Some of the most common include:

​You can see a list of required vitamins and nutrients to produce and convert thyroid hormone below:

Factors that affect thyroid function

If your "thyroid" labs look normal, but you still aren't feeling great make sure to check out these common nutrient deficiencies which may also play a role. 

7. Not appreciating the effects that Endocrine Disrupting Chemicals have on Thyroid Function

Endocrine disrupting​ chemicals have been shown to reduce T4 to T3 conversion, lower T3 levels in the serum all while NOT altering the TSH

Nowadays detox really needs to be part of your treatment regimen.

At the very least you should actively be avoiding these chemicals that cause these problems.

I would go a step further and recommend that you not only actively avoid these chemicals, but that you also try to detox them from your body!​

You can do this by following some very simple steps:

  • Drinking from filtered water only
  • Avoiding plastics of any kind - especially avoid microwaving your food in plastics!
  • Eat organic, hormone free foods
  • Drink out of glass containers, and store your food in glass containers
  • If you want more info you can read more here

What to do next

If after reading this ​you believe you may not be getting the appropriate treatment I would recommend you seek out a Functional Medicine Trained practitioner for further assistance. 

When it comes to thyroid health I would generally recommend that you find someone skilled at both prescribing thyroid medication and someone that is knowledgable at treating the thyroid naturally.

Your goal, whenever possible, should be to get off and stay off of prescription medication - but realize that isn't always the case.

And some patients may feel significantly better with the right medication to get the ball rolling.

You can find more info about finding a Functional Medicine physician near you by checking out this link here. ​

IFM search for a provider

After clicking the link above you'll be taken to a screen here. Simply enter in the information and you will be able to find someone near you. 

I want to hear from you!​

Do you feel like ​you've been properly diagnosed and treated? What information do you have to share with others who are in the same position as you? Answer in the comments below!

Dr. 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.

Click Here to Leave a Comment Below 58 comments
Cheryl suppnick - March 10, 2016

This info is spot on and i also learned a great deal. I finally found a doc that knows what he stuff. You told me more and confirmed what i have researched. I finally being treated for thyroid imbalance and major hormone inbslance and adrenal faigue. I sm 67 yrs and i truly thought i was loosing my mind. My depression was also insane. I have for years removed plastics, been organic, and tried to be gluten and sugar free. I have lead posioning at 19 times higher than average. Finally i have a doc that is helping me. But this article is Fabulus Thanks do much

    Westin Childs - March 10, 2016

    Hey Cheryl,

    I’m glad that you found someone to work with! Honestly, the hardest part can be just finding the right Doctor. Stay at it, and just remember that the healing process can sometimes go slow – especially with detox. I don’t think I’ve found a single hypothyroid patient that didn’t also have adrenal fatigue – they just seem to go hand in hand.

    Keep up the good work!

Tara C - March 10, 2016

I just had my TSH levels tested.
Mine where .75 which the considered normal
Because it was between .35 and 5.0
I feel it not normal.
They would not do any other tests.
I am under a lot of stress.
I get 6-8 hours of sleep most of time.
I exercise 1-2 hours 5-6 days a week.
I eat healthy.
I also have an IUD.
So not sure on how to fix my problem. And suggestions just for me.
And no I can’t exercise less. It’s my job.

Janet Simpson - March 11, 2016

64 years old, have gained 15 lbs in the last 6 months, tired and depressed all the time. Went to a GP and asked for a thyroid panel (ALL of them) and the lab only did TSH, which was normal. Then scheduled an ENDOCRINOLOGIST appointment and saw the SPECIALIST, who told me if I wanted the other results, I would have to pay because the insurance won’t pay for the rest. No questions about cortisol levels, mineral imbalances, Vitamin D levels, B Vitamin levels, NADA! Money well spent??? I think not. So much for LAMESTREAM MEDICINE.

    Westin Childs - March 11, 2016

    Hey Janet,

    I’m sorry to hear about your situation!

    I’ve never run into insurance issues with ordering tests (and I order A LOT of lab tests), if there is concern you can always call and ask your insurance provider.

    The sad truth is that most people pay a HUGE premium every month ($500-$700) per month for insurance that really doesn’t do much for them. But because of this people tend to stick to the conventional hoping to find answers. As you probably already know 99% of endocrinologists and PCP practice the exact same medicine – test the TSH and if > 5.0 give small doses of synthroid. That just about sums it up.

Alison - March 11, 2016


Just been diagnosed with Hashimoto’s.. The only thing that appears slightly disconcerting is that my Thyroid readings are normal…The only thing that has been detected is that my symptoms are fatigue, and my TSH antibodies are up at 37.. it’s been described to me as an autoimmune problem….that’s attacking my Thyroid…Last summer I was suffering from Hyperthyroidism…and now it’s gone the other way?

My suspicion is that if it’s an autoimmune problem, then that would need to be sorted and diagnosed first, before assuming it’s Hasimotos….At present on Thyroxine 50 mgs, Vit B supplements, probiotics, 5HTP,
Melatonin, seratonin, and DHEA..selenium, zinc, etc. On Xanax half a Milligram at night to keep my adrenals quiet? My real symptoms have been severe fatigue, depression and severe anxiety all of which came on suddenly last summer. I’ve been back numerous times to my GP, and the last blood test normal..

Any other ideas about this confusing outcome would be greatly appreciated..

Kind Regards,

Alison White..

    Westin Childs - March 11, 2016

    Hey Alison,

    You’re not likely to find good treatment for any autoimmune disease seeing your PCP. The general consensus among healthcare professionals is that Hashimoto’s thyroiditis is not treated any differently than Hypothyroidism – just give thyroid hormone and “watch” it. To “cure” or “reverse” autoimmune disease you need a multifaceted approach that includes a combination of treatments.

    I would recommend you start with the basics: tune up your diet, reduce your stress, get the right amount of sleep and exercise to tolerance. You can find more info on this post here: https://www.restartmed.com/diet-low-carbohydrate-high-fat/

    This will help you with those 4 basics. For more advanced treatment (which will likely be required) you will need to see a Doctor.

    Donna - March 21, 2016

    Your situation sounds like mine but I was just diagnosed with Hypo with the autoimmune problem with chronic pain still seeking help reading your comments made me feel hopeful I thought I was the only one 🙁

      Westin Childs - March 21, 2016

      Thanks for the comment, Donna! As long as you remain a big advocate for yourself and for your health you will eventually find the help that you need. If you can find a functional medicine doctor near you that would be best case scenario – but realize you may have to travel to see one.

Barbara - March 14, 2016

Hi,I’ve been taking thyroxine for approx 20years,usually 100mcg, although for a while I was on triiodothyronine,don’t remember why it was stopped. My cognitive function is poor.Im 66 & for as long as I can remember I’ve suffered from low mood & fatigue.Years on antidepressants. For a while now I’ve felt even worse,a year ago GP reduced meds to 75mcg then last Nov it was returned To 100 mcg,at that time tsh was 11.15 & t4 was 11.15 then in Feb this year tsh is 19.6 & t4 is 14.5. Currently on 125mcg thyroxine & hypothermia has improved but not much else. Endo (nhs) was patronizing & disinterested in blood values,told me he would juggle my meds? My mood & nerviness is particularly bad now. What do you advise next?Are there any functional medicine trained doctors in Scotland ?

    Westin Childs - March 14, 2016

    Hey Barbara,

    I don’t know of any functional medicine trained Doctors in Scotland. Unfortunately, to get the kind of treatment you need you will likely have to look outside of the conventional insurance based system – most endocrinologists will all treat you the same way.

    You may benefit from adding back liothyronine, as most people do feel better on T3 in some form – but it is highly individualized. Best case scenario is to find a doctor who is willing to work with you.

Weight Loss is IMPOSSIBLE if You Have This Common Hormonal Imbalance (and how to FIX it!) : The Hearty Soul - March 21, 2016

[…] suffering from Hypothyroidism get your levels checked (Just make sure that they fall within the “optimal range” and not just the “normal range”). I recommend testing for the […]

Paula Ewins - April 9, 2016

after someone put this up on Face Book wholly commendable to you, a fantastic read
currently under a Functional Medicine Practioner in the UK

Highly interesting read

However, as at 20th Jan 2016
TSH 3.3
T3 3.9 pmo/L
Free T4 13.1 pmo/L
Thyroid Peroxidase Ab 28 IU/L
reverse T3 0.21 nmo/L
Cortisol Level AM 39.93 others normal

Iodine (Urine) 20 ug?L (0.16 umol/L
Weight Gain of 2 stone in 9 months
symptoms are there Palpatations, numbness in arm and light headiness
can you please advise , no further thyroid test since Jan
thank you


    Dr. Westin Childs - April 9, 2016

    Hey Paula,

    I’m glad you found it interesting! I am not familiar with the reference ranges and lab measurement units used in the UK so I can’t really give you any information on your lab results. I would however recommend you also get other hormone levels evaluated with special emphasis on insulin and leptin.

      Paula Ewins - April 11, 2016

      THank you
      I am convinced it is my T3 how would you interpret my reading converted into your scale? she has mentioned Natural Thyroid after investigations

      will look into Insulin and leptin testing, she is talking of Gut investigation

      I start my Progesterone treatment tomorrow for 12 days each month fr eastrogen dominance

      thank you

        Dr. Westin Childs - April 12, 2016

        Hey Paula,

        It sounds like you are off to a great start!

        I don’t know the reference ranges that were used on your tests, so it’s difficult to interpret.

Sharon S. - April 24, 2016

I’m looking forward to reading your ebook. I have been treating my Hashimotos for about 16 years with Levithyroxine. I just recently learned about the connection of thyroid issues and gluten. I am working on a gluten free diet. That stuff is in everything! What sparked my autoimmune research was the diagnosis of yet another autoimmune disease, Pernicious Anemia. Dr. Says I don’t have anemia, but I am deficient in B12. I am currently injecting B12 once a week to get my level up from a 61! I have also discovered that I have yet another autoimmune issue with Spondylitis in my spine. I really need a good plan to stop the progression of the destruction of my body!

    Dr. Westin Childs - April 24, 2016

    Hey Sharon,

    Great job! Keep up the good work 🙂 If you have a b12 deficiency you may also be iron deficient, so check for that as well.

Rose - April 27, 2016

I have Hashimoto’s and have discovered an odd pattern with my thyroid levels: when my TSH is becomes lower in range, my Free T4 and T3 also get lower in range. When my TSH goes up in the range, so do Free T3 and T4. One would expect the opposite to happen. I tend to feel better when my TSH is higher (and consequently when my T4 and T3 are higher!). Do you have any thoughts as to why this could be?

    Dr. Westin Childs - April 28, 2016

    Hey Rose,

    I don’t fixate on lab values because they are not 100% accurate. Instead I would focus on what improves your symptoms and shoot for that. If that means a higher TSH, then that’s perfectly fine.

      Rose - April 28, 2016

      Thanks for the reply! I tend to agree, but I am trying to conceive so it’s hard to convince my doctors to treat based on symptoms.

Sonja Rosing - April 27, 2016

Thank you Dr. Westin Childs for bringing hope to Denmark, here we have the same problem with the doctors fixating on “normal” blodtest results. I am going to keep on figting for me and my health, reading your post help me believe that I’m the only person who truely knows how I feel.

    Dr. Westin Childs - April 28, 2016

    Hey Sonja,

    You are very welcome! I’m glad you enjoyed it and keep on fighting! It’s the only way to take control of your health.

Cynthia - May 8, 2016

I was diagnosed with Hashimoto’s December 2015. The Endocrinologist did not really tell me I read the result of the thyroid antibody test. When I asked for more information I was told this is very common many people live with this condition. I have not found a doctor that will take me seriously. I just saw a general practitioner last week who told me that my issues were not thyroid related and increased my antidepressant dosage. I am doing the best I can but I can’t lose the weight. I have many other symptoms but the weight gain is the one that gets me down. I live in a small town in Kansas and having a hard time finding help.

    Dr. Westin Childs - May 8, 2016

    Hey Cynthia,

    Unfortunately that’s how almost every doctor in the insurance model practices. You may want to try and find someone local outside who specializes in the thyroid for further help.

Diane - May 24, 2016

Hello, I just read your article “The connection between your thyroid and Chronic Pain that doctors miss…” which eventually led me to this article.
These symptoms are all me. I have been on Levothyroxine over 15 years. (Synthroid for 10 years before that). I still have symptoms, despite my blood work coming back normal. My Cortisol blood levels have come back extremely LOW many times,so my doctor had me do this infusion test at the hospital to see how my adrenal glands are working. IT came back totally normal. Yet I have just about every symptom of Adrenal Insufficiency. So of course my doctor asked how I feel about anti-depressants. (Despite knowing I can not take them because they actually work the opposite on me!) So what do you do if your doctors do not believe in this? I can’t see another doctor due to finances and limits on insurance. But I truly believe if my Thyroid were being treated properly, my other physical problems would either heal or at least get better. I am in pain management (I have a cyst on the T-10 nerve root and degenerative disk disease from the C down to the L spine) and on other meds I sometimes wonder if I don’t need. the last few months now, I have been gaining a lot of weight, despite watching what I eat. Every day, I feel like I am losing more and more control of my health. Someone told me there are tests that can be done through the mail. Is this recommended? There are no doctors in my area I can see. Any advice would be greatly appreciated!

    Dr. Westin Childs - May 24, 2016

    Hey Diane,

    If you look around the comments section of my site you will see this question asked several times. The unfortunate truth is that you aren’t likely to find the help you need in the insurance model. We currently have a two tiered healthcare system: those with insurance get substandard care and those who pay cash get better care. Some people prefer to hold out and bounce from doctor to doctor hoping to find a doctor that will treat them correctly while others opt to pay out of pocket for quicker results.

    Ordering the right tests isn’t as important as the treatment, and your doctors would have ordered the tests to begin with if they knew how to interpret them.

    Someone like you would probably do quite well on a combination of cortef + T3 therapy, but you just won’t get that from standard doctors.

Linda - June 18, 2016

Dr Westin I need help I have fibromyalgia since aged 20 following a very bad flu which
lasted three weeks and I am 43. within the last 3 years i am feeling worse and had to give up myjob as a kindergarten teacher which I loved.I am seeing a doctor next week who prescribes LDN for fibromyalgia.I have recently removed gluten,coffee,nightshade vegetables and cut down sugar.I have tons of symptoms such as chronic pain,exhaustion,constipation,no libido,brain fog,word loss,tingling in my fingers as well as cold hands and feet.I have another few issues which I am treating low b12 and low vitamin d and possible thyroid issue.Would you mind looking at recent blood results. A fellow sufferer on a health website mentioned I need to add T3 to my system as I should be well with the ranges i am in.Will LDN help this issue or do i need to add T3.Thank you for all the amazing work you do helping where other doctors do not. I live in Ireland so ranges are in European format
Regards Linda

>> CRP 2.10 <3.0 mg/L

Ferritin 76.9 20 – 150 ug/L

Thyroid Function

Free T4 L 11.34 12 – 22 pmol/L

Free T3 6.02 3.1 – 6.8 pmol/L

TSH 2.19 0.27 – 4.20 IU/L

Reverse T3* 16.0 10 – 24 ug/L

T4 Total 80.7 64.5 – 142.0 nmol/L


Anti-Thyroidperoxidase abs 10.9 <34 kIU/L

Anti-Thyroglobulin Abs 20.8 <115 kU/L


Vitamin D (25 OH) L 44 Deficient 175

Vitamin B12 L 185 Deficient 725

Serum Folate 12.27 10.4 – 42.4 nmol/L

cathy thomas - July 15, 2016

I have a Dr that will NOT give me a thyroid panel. I get a tsh and now a tpo I have been losing weight but have come to a stop at 216lbs (still to heavy) not too long ago you sent an email? explaining the thyroid panel and what the tests meant. It was broken into segments and was different than this article. I saved the email incorrectly and it is gone. It is the first time I have seen this information and it was fantastic. Could you please send it again, I would be very grateful, and do you have any information about muscle weakness?

Barbara - September 2, 2016

Hi Dr Childs,

Thankyou so much for this information. I am an Aussie living in NZ. In 2010 I had a total hysterectomy as I had uterine cancer & then in 2011, I had a total thyroidectomy due to cancer in my thyroid – unrelated cancers.

Like others, I get tested for TSH but never the others & when I have asked GPs about T3 medication – it’s a no go zone.

As I read your article I several of the hypothyroid symptoms sounded very familiar to me.

After my thyroid operation I was put on Levothyroxine & initially lost a lot of weight – however, in the last 18months I have been gaining weight, even though I have a very healthy diet & exercise way more regularly than ever.

I know from checkups with my specialist post uterine cancer that weight and estrogen levels contribute to uterine cancer, so I do not want to be putting on the weight that I lost.

Thanks again for your articles on the internet’



    Dr. Westin Childs - September 2, 2016

    Hey Barbara,

    I’m glad you found it helpful! You are correct that estrogen dominance and excessive estrogen receptor activity increases the risk of both uterine and breast cancer.

Kay - September 17, 2016

Hello Dr. Childs,
I have been on Synthroid for Hashimoto’s and Hypothyroid for about 20 years and am borderline diabetic. My endocronologist wanted to put me on a diabetes medication but I controlled my A1C levels by diet. Now I switched to a vegetarian diet and I am gaining weight at an alarming rate still taking Synthroid at the same level (137). My Doctor said my tests are normal but now it appears I am hyperthyroid! Normal range T3 (3.1) and high T4(1.6). My TSH is actually Low (.42). HELP PLEASE! I had breast cancer in 2012 and now am going to go on estrogen blockers. I eat organic, no plastic….any suggestions?
Thanks in advance!

    Dr. Westin Childs - September 17, 2016

    Hey Kay,

    You probably won’t get with help with your endocrinologist, but I would take a look at insulin and leptin levels.

      tiarra - November 1, 2016

      i was told i had thyroid cancer back in may 2016. so i had surgery in june and they removed my thyroid completely! it then spreaded to my lympnodes and i had the iodine-radiation in july! i have now been getting ultrasounds and blood work done since this past summer! they have been changing my medicine and told me today that my thyroid hemoglobin needs to be down at a 0? mines is a 3.6? what does that mean? is that why they brought my medicine up from 112mg to 125mg to help that?

tiarra - November 1, 2016

i was told i had thyroid cancer back in may 2016. so i had surgery in june and they removed my thyroid completely! it then spreaded to my lympnodes and i had the iodine-radiation in july! i have now been getting ultrasounds and blood work done since this past summer! they have been changing my medicine and told me today that my thyroid hemoglobin needs to be down at a 0? mines is a 3.6? what does that mean? is that why they brought my medicine up from 112mg to 125mg to help that?

    Dr. Westin Childs - November 1, 2016

    Hey Tiarra,

    You will have to take those questions to the Doctor that made the recommendations. I can tell you that they were probably referring to your TSH, not your thyroid hemoglobin and post cancer that should be as close to 0 as possible.

tiarra - November 1, 2016

ok thank you!

Christine - November 14, 2016

Hello Dr. Childs,

Thank you for your article, it was very helpful. I am a female 47 years old. 7 months ago my labs were completely normal, but for the last few months I have been noticing that I’m gaining weight, having unusual bouts with depression, my skin is dry, my hair is dry and falling out and my memory is pretty foggy…I just haven’t felt myself. My PCP said I am fine, my Dermatologist ordered another thyroid test and it went up from 3.1 to 3.97 since March. My PCP says I’m fine. I so strongly disagree!
I thank you for making me feel not crazy and wish you were in my local area!


Sue Lynch - January 28, 2017

I think I am doing well and would like to share. This is my background:
I am 62yo female with previous stage2/grade2 estrogen100%/progesterone70% positive invasive breast cancer (5 years ago) had breast conserving surgery, chemo and rads, ovaries removed. However could not tolerate Aramotase Inhibitors so tried living well. So far so good. Why am I telling you all this. Well, because:

I was diagnosed with Graves Disease 25 years ago. Was given neomercazole for 3 years then finally participated in a trial to see how much radioactive iodine treatment could be given to get me to the euthyroid state. So I only had a miniscule amount of RI. Of course, that did not work. Within a short time my tests were revealing hypothyroidism. I have been treated with T4 (oroxin) since. I also have GORD controlled by ranitidine. I am also diagnosed as Heterozygote so iron levels can be a bit out of range from time to time but this is well monitored.

Problems began about 3 months ago with weight gain and the inability to lose that weight, depression and lethargy. My current GP tested Reverse T3 and it was 749pmol/L. With levels that high it was blocking T3 at a cellular level. (My RT3 ratio to FT3 was only 6.9 – should be >20). My body temperature was hovering between 35.5’C and 36.2’C. I also did a Adrenocortex stress profile using 24hr saliva test. Cortisol level good in the mornings but by miday/afternoon low. DHEAS values were good. Pathologist indicated saliva DHEAs/Cortisol ratio normal indicating balanced function of the hypothalamic-pituitary-adrenal axis. Cumyulative DHEA-S indicated Testosterone, fTesto.c SHBG in good range for my age. LH and FSH also good. Oestradiol 60pmol/L progesterone <3 so even though Oestradiol level in good low range for my age and previous cancer, there still exists estrogen dominance which I worry about. I am hoping this will improve with how my GP is managing the high RT3.

She is treating high Reverse T3 by firstly reducing T4 meds in half and slowly adding 5mcg of T3 slow release capsules. Although initially feeling awful I am feeling better since she increased slow release T3 to 10mcg daily.

Latest Thyroid profile is a bit all over indicating I have a long way to go but feel my GP and I are on the right path I think. I am aiming for a RT3 to T3 ratio of 20; To get there I am aiming to get my RT3 down to at least 230 pmol/L; TSH between 0.2-2.0 Mu/l; FT4 22 pmol/L; FT3 5.2 pmol/L;

I am supplementing with VitC; VitD; VitB; Magnesium and Zinc (selenium levels already in good range). Is there anything you think we may have missed or is there any advice you may wish to add.

    Dr. Westin Childs - January 28, 2017

    Hey Sue,

    Make sure you don’t perseverate on certain lab ranges as these ranges are less important than your clinical symptoms and status overall. I have seen patients with high reverse T3 levels do great, and patients who feel terrible with high levels – lab tests can only take you so far.

Sue - January 28, 2017

Thanks, will keep that in mind.

Nala - February 2, 2017

Dr. Childs, thank you for putting together this list. Over the course of 25 years, I’ve seen so many endocrinologist specials, even been sent to Rutgers Medical Department for them to figure out what was going on. All the doctors would laugh at me or brush me off when I’d mention reverse T3. I’ve written to the American Association of clinical Endocrinologists and explained my experience in full.

It still boggles my mind that the endocrinologists never looks at my estrogen levels, considering hormones are their specialty. At least one would think so.

The tyrosine connection in the diagram was a piece of the puzzle. After working with a naturopath, she figured out I have what’s known as variant PKU.

In addition to Fluoride, another thing others should be aware of was the change bread makers made to use Bromide as a dough conditioner and how that also displaces Iodine in the body. Bromide started being used mid ’70s. It would be an interesting exercise to see if thyroid issues increased as bromide became widely used.

I was skeptical of alternative medicine for a long time. Now, I see it as the only way for individuals to truly get healed.

Thank you again!

Jenny - February 3, 2017

Hi Dr. Childs,
I would like to know if you have ever come across patients that have high BUN/Creatinine Ratio after total thyroidectomy (sometimes I have low creatinine serum but most of the time everything is normal but the ratio comes out HIGH). I’m tired of my doctors telling me I might be dehydrated during the blood test (because I drink a lot of water daily), do you know why this is happening?
Ever since my total thyroidectomy (due to cancer) in 2014, I’ve been having nonstop infections around my throat area (once a month visit to the ER to get antibiotic injection) and constant inflammation. My blood test looks “normal” but I feel like I’m only 40% of what I was before (energy, interest in things…etc), lower body icy during winter and about to faint from the heat in summer. No matter what I do (eat extremely healthy, exercise..etc) I can’t lose weight and with very STRICT diet, I still gained 10 lbs post surgery. I’ve seen 8+ endos and non of them tested me for reverse T3…it’s so sad that I can’t find a competent doctor in Los Angeles! What do you suggest I should get tested for? Thank you!!

    Dr. Westin Childs - February 3, 2017

    Hey Jenny,

    Testing should vary based on the person, but a good place to start is with a complete sex hormone + adrenal + thyroid panel.

      Jenny - February 3, 2017

      Thanks for the quick reply! Any idea on why the high BUN/creatinine ratio?

Michelle - March 15, 2017

I am just starting this process and am so happy to have found this among several other valuable sources which have been helping me to NO LONGER IGNORE the many symptoms I have been feeling for so long. I do not have a functional medicine practitioner (yet) to help me interpret my blood work. I have a doctor who is trying to learn more and has agreed to run the labs I have requested, but she does not know how to interpret the results. this site has helped but I’m still not sure what some of it means…

For example, my SHBG = 35 this is way lower than the 70-80 range, what does it mean? Can I send you the results of the other tests?

Mel - March 17, 2017

I am 62 years old. I have had continual weight gain this last year, even though I have reduced the foods I am eating, my portions, & my caloric intake. The last 6-8 mos my hair just keeps thinning to the point of having pattern baldness and needing wig. I had a hysterectomy around 35 yrs old, so have nothing left. No HST in last 10+ yrs, as I have heart issues…3 stents, no heart attack. I have chronic back pain and get epidural steroid back injections 1-4 times a year, dependent upon pain levels. I am extremely tired all the time, no matter how much sleep I get. My skin is dry and itchy a lot. Chronic constipation – meds I take do cause some of that from side effects, but its much worse than it was before the last 6-8 mos. I am cold all the time when others are not. My normal body temp is 97.1. Eyebrows are down to just the hair at the start of the brow – ends are gone. There are some other things that I could list that are on the list of symptoms. I have had 2 thyroid test. This last one a few days ago came back at 1.5 which is in all normal ranges that I have seen. I don’t know what else to do. The worse of them all is the hair falling out; tiredness; weight gain; dry skin, itchy skin, coldness. My doctor says it’s not my thyroid and is chalking it up to menopause? A few months ago all my blood work came back normal except Vitamin D so I started taking that. I also started Biotin. I have seen no benefits of either.

Elizabeth - April 13, 2017

I am 29 years old and have been experiencing syptoms of hypothyroidism for 4 years. I have gone from a 2 to a size 12, gaining approximately 90 pounds over a course of 4 years. I am tired all the time, my thoughts/brain feel foggy, my shoe size has gone from a 7 to an 8 this past year from swelling. My hands and feet are always cold, and recently I have notices my hair is thinning and has gone from wavy to straight. This is a short list of my symptoms compared to the one I gave to my endo. This is the 3rd doctor I have gone to and I am still being told I am normal and to eat and exercise more. I go to the gym 5 days a week, taking spinning/kickboxing/body pump and track everything I eat.

My most recent tests were 3 months ago and came back as:

TSH 2.66 uIu/mL
T4 Free 1.01 ng/mL
T3 131.0 (tested previously, not the recent round)
Sex Hormone 25 nmol/L

What do you suggest I do next? I can’t seem to get my endo to believe anything is wrong, she keeps pushing that I need to work out more but I barely have the energy to do what I am doing.

Please help, I am desperate!!!

Shannon - April 13, 2017

Hello, Dr. Childs,

I am a 43 year old female that started having classic Hashi symptoms after my tubal ligation 4 years ago- Thinning hair, crashing fatigue, voice changes, throat clearing, low libido, gallbladder issues, forgetfulness and a lump about half the size of a Walnut where my thyroid is located. After some pushing, my GP ordered a Thyroid panel and my results came back “normal”. FT4 1.36, FT3 3.1 TSH 1.19, Reverse T3 16.9, Thyroid Perox <1, Thyroglobulin AB <1. The range on the Reverse T3 is 9.0-27.0, so my GP says ithere is nothing wrong. He referred me to an ENT (appt coming up this Tues). What can an ENT do to help? Should I try to find a functional medicine doctor near me? Joshua, TX-Fort Worth, TX area) Thank you for any advice you can offer. This is all so frustrating and I'm feeling a little defeated.

Ashley - April 19, 2017

Hello, Dr Childs,

After years of being told I have an anxiety disorder I spoke to my OB about my symptoms which include Thinning hair, fatigue, throat clearing, low libido, gallbladder issues, forgetfulness, brain fog, etc. We started with an Ultrasound that showed an inflamed thyroid with multiple nodules and an inflamed lymph node. From there we went to an IV contrast CT scan which showed the same things but less concern for the lymph node. She referred me to an endocrinologist who then ran a panel on me T4 total 9 with a reference range of 3.2-12.6, T3 resin uptake 31. with range of 22.5-37., TSH 1.41 with range of .35-5.5, FTI 2.79 with range of 1.05-4.50, Free T3 3.30 with range of 2.30-4.20, Anti thyroid Peroxidase AB <28 with 0.00-60 range, Thyroglobulin AB 5.0 range, Sed rate of 2 with a 0-20 range, ANA Wreflex titer was negative, Metanphtine, Free 0.21 with 0.00-.049 range, Normetanephprine, Free 0.45 with a 0.00-0.89 range. According to the labs everything looks good but I feel terrible. Is there other test besides the ones I listed that she did that I need to ask for? I feel in my heart that I am not having all these problems because of anxiety.


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