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"...

More...

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...

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

Download more free resources on this page

#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 you 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. Free T3 is the free and active thyroid hormone and, perhaps, the most important thyroid lab test. 
  3. Free T4 - This gives you an idea of what kind of thyroid "store" your body has. T4 is the reservoir hormone your body uses to create reverse T3 or free T3. 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 you an idea of what kind of stress the body is under, how much inflammation is going on, and what nutrient deficiencies you 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. These antibodies can also cause issues in other tissues including the breast (1) and brain (2). 
  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 necessarily mean that your thyroid function is normal. It's not advisable to use TSH to track thyroid hormone as newer studies show this method to be flawed (3). In addition, the pituitary has location specific deiodinases (4) which make it different from other tissues in your body in terms of how sensitive it is to thyroid hormone. 
  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 studiesI find that most hypothyroid patients feel better with Ferritin levels in the 70-80 range and percent saturation levels in the 35-38% range.

Remember: 

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

#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 bloodstream 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 the answer to this question:

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 certainly 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. You can read more about how to test your basal body temperature and how to follow this value while taking thyroid medication 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 and if you still have symptoms despite being on thyroid medication, 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 (5). 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 (6). 

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?

No!

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 impact and worsen thyroid function include:

  • Adrenals and Cortisol Levels
  • Estrogen balance with Progesterone

Cortisol and 'Adrenal Fatigue'

Your adrenals and thyroid function are intricately linked (7).

Changes in your TSH cause changes in your cortisol and vice versa. 

And this can be a good thing in the short term, but after prolonged elevation, you may eventually start to experience the symptoms of Adrenal Fatigue. 

Adrenal Fatigue is a condition in which you have put excess strain on your body and compromised its ability to produce stress hormones. 

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-related issues is one of the main reasons that patients fail to improve after starting thyroid hormone. 

Do NOT neglect your adrenals!​

You can address adrenal function by focusing on several key areas:

Estrogen Dominance and Low Progesterone

Thyroid hormone, specifically T3, helps your body produce Progesterone (9).

When you have low thyroid hormone, you may also experience low progesterone levels which can lead to an imbalance known as Estrogen Dominance.

This imbalance helps explain why many women with hypothyroidism may experience 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 entire thyroid system (10). 

Leptin resistance, a condition characterized by increased cellular resistance to the hormone leptin, may cause a reduction in thyroid hormone production (11). 

Conditions which cause leptin resistance may lead to weight gain (and weight loss resistance), changes to your appetite, and a reduction in thyroid conversion. 

Through these mechanisms, leptin resistance may also contribute to an increase in the reverse T3 metabolite. 

As reverse T3 levels rise, 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 bloodstream.

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 used as the only lab test to evaluate your thyroid. 

As a result, you will need to ensure that you order a complete thyroid lab panel and aim for optimal lab values

#5. Don't practice "Reference Range Endocrinology"


Reference range endocrinology is a term given to the art of practicing hormone management based solely on the lab results. 

Many physicians, and patients, tend to approach hormone management in this way. 

This type of practice is flawed for several reasons:

#1. There is no evidence to suggest that each person requires the same amount of hormone

The exact opposite is true:

The amount, ratio and relative concentration of hormones required in one person is different from the next (12). 

After all, do we all look the same? Do we all react to medications and supplements in the same way? Do we all have the same genetics?

Why would we all require the same amount of hormones?

#2. The standard reference range is too wide and doesn't take into account the age or medical health of the patient

When you are comparing yourself to some "standard", don't you want that standard to be age-matched and healthy when compared to yourself?

Or would you rather compare yourself to someone who is 30 years your senior with multiple medical problems?

The answer is obvious:

When evaluating your hormones, you should aim to compare yourself to a young and healthy version of yourself. 

The problem with standard reference ranges is that they do not take these variables into account and instead create ranges based off people of various ages and health status. 

Lastly, the 'standard reference range' contains a wide range of 'normal' making it difficult to discern between 'optimal for your age' and 'normal'.

Consider this example:  

If you order a hormone test and your result comes back in the bottom 5% of the 'normal reference range' you would be considered normal even though there is massive room for improvement

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. 

You can see that the Thyroxine free (A.K.A. Free T4) is a result of 0.95 and the range varies from 0.89 to 1.76 ng/dL.

While the 0.95 result is very close to being abnormal it is technically still within that broad range and, as a result, many physicians may opt against treatment. 

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 pre-term labor (13) and it can even bring your heart back into a stable rhythm when given intravenously (14).

Outside of the hospital, however, 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:

  • Iron - To check iron status you'll need to obtain ferritin (15), serum iron, and TIBC. Iron deficiency results in decreased thyroid function. 
  • Zinc - This nutrient helps T4 to T3 conversion (16) and acts as an anti-inflammatory agent, and may help improve your immune system. A deficiency in zinc leads to a hypothyroid-like syndrome which is ameliorated with zinc supplementation. The best way to determine if you are zinc deficient is with a trial of zinc supplementation. 
  • Selenium - This nutrient also helps with T4 to T3 conversion, may help decrease autoimmunity (17) and antibody levels in Hashimoto's, and is required for thyroid hormone production. 
  • B Vitamins including B2 and B6 - Activated B vitamins are required for thyroid hormone production and the production of adrenal hormones. Stress and other lifestyle factors can increase the demand of B Vitamins and may lead to a deficiency. 
  • Vitamin D - Low levels are associated with an increased risk (18) of autoimmune disease and may also contribute to fatigue (19). 
  • And many more which you can read about here

​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 affecting the TSH (20). 

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

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

I would go a step further and recommend that you not only actively avoid these chemicals, but that you also try to eliminate 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
  • You can find more tips on how to eliminate and detox here.

Conclusion & 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 knowledgeable in 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.

I've created a resource here which you can use to find a Doctor if you are struggling with your current medical plan. 

Now I want to hear from you: 

Do you feel like you've been properly diagnosed and treated?

Are you experiencing hypothyroid symptoms despite having "normal" lab tests?

What information do you have to share with others who are in the same position as you?

Leave your comments or questions below! 

References (Click to Expand)

7 Factors which make thyroid testing less accurate
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.

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

  1. 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

    • 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!

      • My daughter who lives in Decatur, GA is really sick and she believes its her thyroid, but she can’t find a doctor who has been able to help her. Would you suggest some doctors she might try in the Atlanta area.

        • Hi Jane,

          Unfortunately, I don’t know any physicians in that area. It can be difficult to find a physician who offers the kind of treatment that I outline on this blog.

        • Dr. Chip Reed in Roswell, Ga is the best you will find in Atlanta. It will take a while to get in to see him, but he is worth the wait. Bring this article with you.

    • Hi Cheryl,
      Is it okay if you share with me the name of the doctor that you are working with?
      Are you in the States?
      Thank you,
      Joeni

  2. 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.

  3. 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.

    • 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.

  4. Hi,

    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..

    • 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.

    • 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 🙁

      • 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.

  5. 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 ?

    • 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.

  6. Wow
    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

    Paula

    • 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.

      • 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

        • 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.

  7. Hi,
    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!

    • 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.

  8. 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?

    • 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.

      • 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.

  9. 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.

    • 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.

  10. 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.

    • 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.

  11. 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!

    • 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.

  12. 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

    Immunology

    Anti-Thyroidperoxidase abs 10.9 <34 kIU/L

    Anti-Thyroglobulin Abs 20.8 <115 kU/L

    Vitamins

    Vitamin D (25 OH) L 44 Deficient 175

    Vitamin B12 L 185 Deficient 725

    Serum Folate 12.27 10.4 – 42.4 nmol/L

    • There’s no way to say for sure if one will help or not, I would just try both at some point and monitor.

  13. 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?

  14. 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’

    Regards’

    Barbara

    • 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.

  15. 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!

      • hello!
        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?

  16. hello!
    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?

    • 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.

  17. 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!

    Cheers,
    Christine

  18. 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.

    • 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.

  19. 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!

  20. 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!!

  21. 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?

  22. 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.

  23. 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!!!

  24. 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.

  25. 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.

  26. Desperately seeking a MODERN and INTELLIGENT endocrinologist in the Denver area! They all go strictly by ‘NORMAL RANGES.”

    I’ve been losing my hair over the past year (at the roots), have a hoarse voice, and am fatiqued with joint pain.

    Any referrals or recommendations?

    So frustrated!

    • Desperate for direction: My hair is falling out rapidly.

      Been on oroxin for hypothyroidism for 18 years. I am 62. Six months ago saw my GP with all the symptoms of hypothyroidism however usual lab tests indicated all normal so GP tested Reverse T3. It was 768pmol/L Ref: (170-450) so reduced my oroxin to 75mcg and started me on compounded slow release T3 5mcg raising to 10mcg. I started to feel better but did have an initial reaction to T3 with a malar rash.

      In February TSH 1.4 mU/L; FT4 14 pmol/L and FT3 4.6 pmol/L; RT3 478. I was feeling much better but not optimal. GP suggested raising slow release T3 to 15mcg. Very quickly my hair started falling out. I also had my sex hormones tested (ovaries removed 18 months ago) and in six months E2 <43 pmol; fTesto.c 8pmol/L. These figures had virtually halfed in six months. Last tests I also had my Leptin checked with result indicating I am leptin resistant 45.5 ng/ml (ref: 3.7-11.1).

      My question is firstly, could compounded T3 be causing drop in estrogen and testosterone and cause of my hair falling out. I am naturally feeling very distressed. Secondly, extremely high plasma leptin would have been causing high reverse T3 in the first place so is it worth dropping compounded T3 and going back to usual dose of Oroxin and dealing with the Leptin Resistance and how would I go about that? Sound complicated don't I? Will do anything to get my hair back. Cannot go on estrogen hormone as I am 5 years post breast cancer.

  27. I am 58, healthy, post menopause. I take an HRT, Duavee. I drink distilled water and take lots of vitamins. I eat healthy. I am 5’4″ and weigh 127 pounds. I am reasonably active with moderate stress. I am always cold. I sleep 8-9 hours a night and I am tired all of the time.

    I recently had my thyroid checked and here are the results:
    TSH – 1.96 uIU/ml Ref Range: 0.45-4.5
    Free T3 – 2.1 pf/ml Ref Range: 2.2-4.0
    Free T4 – 1.0 ng/dl Ref Range: 0.8-1.5

    My Dr. does not recommend any medication even though my T3 is below range. Should I just try to add supplements like zinc and selenium? What do you suggest?

  28. Thanks so much for your information! I was frustrated with my doctors that didn’t want to do the thyroid panel and so finally just paid to have a thyroid panel run for myself… our modern age is wonderful that labs will do it directly for us now, and we don’t have to go through the doctor! My results are within the lab normal range, execept for my Thyroglobulin Antibodies, which came back as 20 IU/mL, and the normal range for the lab is < or =1. So reading more, and especially your site, looks like my T3:RT3 Ratio is 0.15, and my other results are not optimal either. I've been suffering through body pain for so many years, joint pain, major body pain, being tired, anxiety, and so many other things… my doctor diagnosed me with Fibromyalgia and put my on Cymbalta. It helps a little but I've never really been happy with the diagnosis. So anyway… I'll be finding a doctor that can help, and read more too. Thanks so much for your information! I really hope that I can finally find some help and feel better!!!!

  29. Hi Dr Childs, i’m trying to work out a fT3:rT3 ratio, as you advised in your article. Which unit measurements do you use (when you say a value of over 0.20 can be considered normal)?
    Thankyou.

  30. I just got an “essential” Thyroid panel done, which I now realize did not contain all the test that I needed. My results are as follows:
    TSH: 1.9
    FT4: 1.3
    FT3: 3.2
    TPOab: 26

    My levels all seem to be within good range, but I still know that I have to be hypothyroid. My normal waking temp is 96.9, I have ice cold hands and feet, depression, sparse outer third of the eyebrows, and more. What are your thoughts?
    Thanks so much!
    -Alex

  31. Hello,

    How do you use SHBG to analyze if thyroid hormone is entering the tissues? I use only 90 mg NDT and my SHBG is 70 [12-60 nmol/L], FT3 5.7 [2.6-5.7 pmol/L], RT3 5.5 [9.2-24.1 ng/dl]. A SHBG of 70 is much higher than the recommended values ​​of 25-30?

    Thank you
    Adam

    • Hi Adam,

      Men should want the SHBG lower than women because SHBG will bind testosterone and potentially reduce free testosterone levels causing further issues.

  32. Dr Childs

    I too am searching for right endo…..third try is close at hand. Your work and counsel helped me to prepare to meet with next endo. I started losing hair in Vietnam and loss all body hair a few years later.

    I have normal not optimal TSH. My Ft4 is at bottom of reference range and Ft3 at top of range….a paradox.

    I have very low platelets, high cholestoral, and bowel issues. People ask me if Ive had chemo…one endo even said that…yet he ran when I said agent orange.

    My situation scares off endos. I served two tours in Agent Orange sprayed areas of Vietnam.

  33. Please call me I need your help I would like to send you my labs or let you take Labs on me I’ve had thyroid cancer. I am double heterogenous MTHFR. I am a veteran and VA keeps telling me I’m okay I am not okay. My quality of life waxes and wanes according to my TSH and T3. Getting the doctors to pull the proper labs is like pulling my teeth out of my head by myself. I need help because I know there is life out there for me that is much less depressing than the one I’m living now.

  34. Hi Dr. Child’s,

    Thank you for being such a great resource. During my last thyroid lab work up, my sex hormone binding globulin came back at 141 and was flagged as high. I am currently taking 2.25 grains of Naturethroid and have been for over a year. My FT3 was at 4.3, so the top of the range but not over. The reason I’m concerned about my SHBG is that I’ve been losing a lot of hair and now can see my scalp showing through. It is very depressing, and I hoped this would resolve on thyroid meds but it has only gotten worse! Is it possible that I’m taking too much medication and that is the cause of the hairloss? I’m really desperate to reverse this before I have to take drastic measures (extensions, wigs) to feel comfortable in public. If you say the optimal range is 70-80, then I’m WAY above that!

    Thank you for your time.

  35. Hello,my tsh is almost always above 3.0.I’ve had two episodes of subacute/silent thyroiditis over the years.Mental and physical energy have not returned to normal.Do you have any guess about what may be going on here?Also renin is either below normal range or barely in it,aldosterone is low-normal.Primary care doctor refuses to do anymore testing on these.Thanks,

      • Dr.Childs thanks for responding.I have tried taking thyroid hormone to bring tsh down but even tiny doses causes extreme anxiety and heart racing.I have many symptoms of adrenal fatigue but none of the many doctors i have seen believe adrenal fatigue exists.I can pass the cortisol stimulation test but still wonder if my adrenals are slow.I feel much better in the evening compared to morning and afternoon.I also am very sensitive to sugar and starches and have hypoglycemic type symptoms if i eat too much of them at one time.Thanks again,

  36. Thanks Dr Childs,
    I have read most of your wonderfully informative blogs.
    I am 66yo on nil medication, I eat and exercise well and I live in Australia.
    After 8 months of headaches and fatigue and lots of doctors scratching their head, I stumbled onto an Osteopath who ordered an extensive Thyroid profile test. For anyone in Sydney, his name is Dr John Smartt.
    My reverse T3 is high, everything else is ok. Because of low sodium issues (probably due to antibiotic resistance??) that I have had before, he advised to consume more Himalayan salt to slowly get my levels balanced.
    He also mentioned that stress levels can be a contributing factor. I teach meditation, so he ruled that out. But I think most people these days have stress related issues, and I am going deeper into my emotional state and life’s purpose as part of my regime.
    No one can hide from stress and suffering, they have a way of guiding us to a better existence. I mention this so that people look deeply at their life’s purpose as part of their wellbeing plan.
    Thanks again for your work, you make a difference. Steve.

  37. Hello. I have been losing my hair for over a month, had increased neck pain, dry feet & mood swings. I just seen my Dr who only tested for T4 (0.8) and TSH (1.2), and he now sent me to my OB. I’m guessing he may think it’s my hormones? I just want to feel better and I know I’m not going crazy! I ordered a Basal Body thermometer to check my temps as well. I just don’t know what to do?

  38. Hello,
    I’m starting to lose hope that I will ever regain, the normal “Angie”, the happy, motivated, outgoing, social, never sick, optimist, energetic, lover of live, “Angie”. I have seen 9 different doctors, all but 1, set in their ways, never looked outside the box, or really dug deep to figure out what is wrong with me. Why?? My life has been in complete shambles for going on 5yrs. Suffering from unbearable symptoms such as, unimaginable Fatigue, aching, painful body from the moment I open my eyes until I lay down to sleep again, swollen feet and hands inflamed all the time, always hot, depressed, ADD symptoms at a all time high, and gets worse everyday, and a list more of symptoms. I keep a detailed journal of every single change, and symptom that has wrecked my life since August of 2014 when the horrible nightmare started. I bring that with me to every doctors appointment and they look at me like I’m crazy or a hypochondriac, except for my current doctor, but he still doesn’t know much on the thyroid, he is a Gastroenterologist. After years of being diagnosed has having Hypothyroidism, he finally figured out I apparently have Hashimotos disease. I have taken many different dosages of Synthyroid, generic Synthyroid, and Armour starting with low doses up to high dosages and still my TSH levels remain either High or too low, never in range for the entire time I have suffered through this, also when put on these medications my symptoms would get worse or a new one would start. I am in agony! I have lost my life, I am unable to work much less get out of the bed. I keep most of my blood work, in search of any doctor that will actually seem to care about what is going on with me and figure it out. Here are some of my recent tests:: High TSH, 6.750- Glucose serum High, 100- Chloride serum Low, 96- Vitamin D Low, 19.5- Thyroglobulin Antibody High, 2.7- Complement Total (CH50) High, >60- Nucleated Cells Synovial Fluid High, 203. Free T4- Normal, Cortisol-Normal, T3- Normal, T4- Normal, Reverse T3- Normal, Selenium- Normal, Testosterone- Normal, Zinc-Normal, Tpo-Normal, Lutein Hormone-Normal, and that’s all the tests that doctors have given me. I beg you for any advice, Help, Tips, or anything. I’m miserable and missing out on life and spending precious time with my kids. I’m 37yrs old and feel like I’m trapped in a 100yr old body. I live in Alabama, where doctors are old fashioned and stick to their ways, I need fresh eyes to see if they can find the key to what is affecting me because I and my new doctor don’t believe it’s just my Thyroid wreaking havoc on my body. I have had a ton of problems with yeast, cold sores, bladder issues, I had to have knee surgery with no injury whatsoever to repair 2 large tears in my Meniscus, after being on a high dosage of Synthyroid, when I started the high dosage a couple of weeks of being on it, a knot of night popped up on my knee cap and got worse from then on, I’m not particularly sure if that’s what caused it, I’m just telling you it was a strange coincidence. I’m telling you anything I can think of that could possibly be the cause of what could be causing my antibodies to attack because I have read that an infection, virus, or something else could be the cause of the attack. Since 2014, since being prescribed Synthyroid, when I started this journey before taking any meds, the symptoms were almost nonexistent, as soon as I was first prescribed Synthyroid the symptoms came on fast and got worse and worse, never letting up, or feeling any better since August of 2014. Please Help Me!!! If you have any questions or I didn’t give you enough info, please let me know. Thank you so much, Angie

  39. Hi there. This is one of the best articles that I have found on the internet. I am searching in complete desperation to figure out what is wrong with me. In july,I was diagnosed with low Vitamin-D level of 14. I started taking vitamin D but it has not helped me. I suffer from limb weakness, constant dizziness, tingling, anxiety, depression, weight gain, and nausea. I Was completely normal at the beginning of this year and my health has ruined my life. I was wondering if it was normal to have all normal thyroid levels except the tgab came back a little high at 5.0 on a scale of 0 to 4.0. normal. I also have a goiter and my mother and sister have thyroid problems. According to my neurologist. Please help. Thanks so much! Jen

  40. I just read through this page and i literally can not believe that so many doctors over look the tiniest things and that there are a lot of people out there are not getting the right treatment or even the right tests! this helped me out very much thank you lots for your knowledge!

  41. Hi Dr Childs
    I am 6 months post TT and am suffering badly from both the after effects of the operation (which I had after 17 years of Graves disease) and from the confusing plethora of information about my situation, which is not helped by the seeming lack of help I’m getting from my clinical team.

    I have been taking 50 mcg of thyroxine, with an increased dose causing me severe problems with dizziness, chest pain and palpitations. I am now suffering extreme insomnia (on average no more than two hours of poor quality sleep per night) and ongoing chest pain.

    My thyroid function assessment is:
    TSH – 80.65
    Free T4 – 15.1
    Free T3 – 2.5
    Reverse T3 – 616
    FT3: rT3 ratio – .403

    From the recommended ranges and from reading your material, this suggests that I need to reduce my rT3 and improve my T3. It does not appear easy in my country to have T3 prescribed, but I am trying to get my specialist to do this. However, nowhere am I seeing any credible explanation of my extremely high TSH levels or how I should address them. All my specialist could offer was that ‘maybe there was something wrong with the lab test’.
    I am now feeling confused and increasingly desperate. I would be grateful for any insights you could offer me.

    Regan

  42. Hello Dr Childs:

    Much of this article applies to “difficult” cases that are not easy to diagnose. That is my problem. I would love to know your opinion.

    My labs and history are posted here: https://forums.t-nation.com/t/high-t-fsh-shbg-low-e2-no-libido-my-lab-results/235796/1

    I’ve done about everything I can — and just about every test I can obtain with no information leading me to a correct answer or solution.

    And yes, I see Endocrinologists and other doctors as part of my journey. Even my Endo has suggested I transfer my file to a teaching/Diagnostic hospital. 🙁

    I know this is an old article I am posting to, but who knows – I might get lucky and you still read the comments!

    Thanks for your time.

  43. I have “normal” lab results but have recently been found to have a nodule and two cysts on my thyroid. I have seen an endo who said my thyroid is fine and she tested me for cortisol imbalance…normal. I’m at wits end trying to figure out what’s going on with my body because I have hypothyroid symptoms. I feel like I’m in a heard of cattle and not worth individual attention or time. It’s really sad and frustrating. Please help!

  44. Hi -I just got a TSH result of 1.34. Definite weird symptoms over the past moths including 15 pound weight gain and water retention. I am starting from square one in my research and don’t even know what to do next. My dr says this is normal range of course. I tried to find the link you referred to to search for a good thyroid doctor but I cannot find it. Can you please point me in the right direction

  45. I really need help figuring out what to do next. I can’t lose any weight, after being grilled by the doctor and basically interrogated over what exactly was i eating and drinking, he finally ran some blood work. Once he realized i wasn’t putting butter on the veggies or drinking soda. I’m not, eating fresh, non processed, balanced, low cal diet. He said something wasn’t working right and we’d figure it out. But of course, once results were back, i had to go online to see them, he didn’t bother letting me know anything. According to lab ranges, everything is ok. I also asked for a full panel, which he said he was doing and its not. I have the TSH, T3 and Free T4 numbers. The rest of the results, were sodium and stuff like that, that I don’t know would be helpful to post here. I’m including the three above, because they look like they are all within range, but I know something isn’t right. He said maybe it was cortisol, but its not like he gave me any advice there. I need to get weight off, I just started blood pressure meds and the sooner i can stop taking those meds the better. Really at a loss here. I don’t understand these results and I really think from other symptoms I have Hypo. I also know, lab ranges can be all over the place and doesn’t mean everything is working at its peak.

    TSH 1.770 u[IU]/mL
    Date: Nov 27, 2017 08:59 a.m. EST
    Reference Range:
    0.300 u[IU]/mL – 4.500 u[IU]/mL

    T3 105 ng/dL
    Date: Nov 27, 2017 08:59 a.m. EST
    Reference Range:
    90 ng/dL – 178 ng/dL

    Free T4 0.75 ng/dL
    Date: Nov 27, 2017 08:59 a.m. EST
    Reference Range:
    0.60 ng/dL – 1.60 ng/dL

  46. My daughter has suffered from extreme fatigue and has had recent testing.
    TSH – Result- 0.53 Range: .045-4.5 Units: ng/dL
    T4,free- Result .07 Range: .08-1.4 Units ng/dL
    T3 -Result 80 Range: 90-165 Units : ng/dL
    T4, Total -Result 4.0 Range: 4.9-11.7 units ng/dL
    Her D3 is also 26 Range : 30–100 ng/dL
    After receiving these results the Doctor then ordered
    T4(Thyroxine),Free by Dialysis
    Results 1.0 Range o.8-2.0 units ng/dL

    He has suggested no treatment. My concern is all other levels are low and TSH is borderline.Her liver enzymes , ALT & AST were elevated and have since returned to normal. Any suggestions are appreciated

  47. Hi Dr. Westin,

    First off, thank you for this excellent information.

    I just recently received my lab results back for Tsh, free T3, and free T4.

    Tsh: 1.8 (normal range)
    free T4: 0.6 (range 0.7-2.5 ng/dL)
    free T3 was 2.3 (range 2.4-4.2 pg/mL)

    TPOab was low and the results said Hashimoto’s was very unlikely.

    I suffer from many symptoms associated with hypothyroidism such as hair loss and dry hair, exhaustion, some mood swings/depression, some irregularities in menstrual cycle in the past few months, low basal body temp, often cold, and brain fog, difficulty losing weight despite a whole food diet and fairly regular exercise.

    Here’s my question: Based on my lab results above, and the fact that my free T3 and free T4 levels are slightly below normal range, would you say I do have hypothyroidism and that I would benefit from thyroid medication?

    I really appreciated how you mentioned the interplay between estrogen and progesterone and how that ties in with the thyroid–I have felt for some time that I am estrogen dominant, due to lack of sustained temps in luteal phase of menstrual cycle.

    My other question is this: if I go on medication for my thyroid and get T4 and T3 levels up, do you think that in itself will also help with my suspected low progesterone levels? Or do you recommend I look into progesterone supplements in addition to thyroid medication?

    Thank you in advance.

  48. Thank you for this article! I have had a lot of issues since 2016 and I am concerned that my doctors are not taking my complaints seriously. Here is my timeline:

    05/2015-10/2016
    gained 40 lbs and have been struggling to get below 190 lbs for over a year even though I eat, sleep, and exercise as best as I can.

    7/29/2016
    pulmonary embolism after 4 months on birth control-TSH 4.5 the highest so far

    8/2016-1/2017
    warfarin therapy. Felt awful the whole time. Dr. not concerned about my thyroid or bodily aches and brain fog.

    5/2017 –
    Began experiencing chronic fatigue, cognitive issues (memory, speech, processing information), dry/brittle hair and nails (pitting and Beau’s lines), hair loss, constipation, and a mix of hypo and hyperthyroid symptoms. Labs revealed normal TSH and some minor inflammation (sed rate 39, C-reactive 1.1, and stool 72.) negative for rheumatoid and celiac

    11/2017 –
    I developed something like ulnaris tendinitis in my right wrist, ring, and pinky finger. X-ray is normal. It has improved but if I ‘overuse’ it immediate regression. I have weird flashes of pain in my knees, ankles, thighs, hips, lower back, and I had gout like pain in my right toe for 4 days in February of 2018. No redness or swelling though. My lower back, hips, and thighs hurt going upstairs or uphill but hips X-ray is normal.

    01/2018
    Low iron: 32 ferritin, 331 TIBC, 10% saturation, 34 total iron
    Low vitamin d- 30
    Low vitamin B12- 303
    FT4 0.69
    FT3 3.3
    RT3 12
    TSH 2.41
    TPO >900 (I had to request this one)
    Healthy CBC and CMP
    I was diagnosed with Hashimoto’s but doctor didn’t seem concerned about my high TPO and RT3 or my low T4. I started iron( Ferrous gluconate) vitamin d, zinc, glucosamine sulfate supplements. My iron has improved by 50% as of 3/22/18.

    I am still waiting for my most recent thyroid labs to come back.

    I saw an Endo recently and he insisted that TSH is the best test and since my TSH is normal didn’t consider the other labs. I am in the process of giving saliva and the Overnight Dexamethasone Suppression Test. I asked if I should wait to do the test until my bupropion and zinc are out of my system and he said no. This goes against what I have read about this test.

    I believe I am experiencing tissue level hypothyroid symptoms (I have been keeping a symptom journal since February of this year) and since my TSH is ‘normal’ no one seems to believe it’s as bad as it feels. I know there are still many things to cross off the list, but I really want to expedite my diagnosis. I am not convinced the wait and see approach is the right treatment for me given my long list of symptoms.

    I apologize for the lengthy post but I would really appreciate your input.

    Thank you!

  49. Very interesting reading. When I was born my body was not producing any thyroid at all, and unfortunately, it took Dr’s a few years to figure it out. I took Synthroid for 35 + years and started to experience weird heart symptoms. I switched to Armour thyroid which I like much better. Just today at a follow-up appt for recent labs the results showed my TSH and T3 both high… TSH 6.33 and T3 is 235.0. My Free T3 is 6.4. Dr wants me to see a specialist. Any suggestions as to the cause?

  50. Alright man… So I tested my Thyroid a few months back and turns out it was low. As per what Defy Medical said.

    But I had a lot of symptoms of what a low thyroid would entail for a dude semi acting like low Testosterone. Very cold at times and sluggish. But wasn’t any evidence of an immune system issue. Went on naturethroid and some symptoms cleared up.

    At the same time, I stopped running a business that was completely stressing me out. So stress levels are a lot lower.

    But this Naturthroid shit is “boiling me” to death almost and racing my heart at night. And I just dropped down to less 1/4 grain.

    Anyway, there are some benefits I’d like to keep if I dropped the meds, and def some I’d like to get rid of.

    So if I have most of the hormonal panels, although they would be skewed with the Naturthroid,

    How can I try to do this the more natural way?

    What nutrient tests do I need to try to fill in the gaps that way?

    And best way to taper off?

    Thx in advance.

  51. Where is a link to find a functional med trained practitioner that you reference? I’m literally desperate. Huge weight gain. Seems like every symptom yet even though my labs are at the high end of the scale my gyn and reg Dr say “normal”. 3 kids. Always energetic and bounce back to 140 at 5’7 and now 50 lbs overweight. Please answer.

  52. Hi Dr. Childs,

    I need help with my 16 yr old daughter. She is 5’4″ and 156 lbs. She is on NP Thyroid 60mg for a few months now. We were on the keto diet and she was starving all the time and gaining weight. She had knee surgery in August and is better now with that, but a lot of hanging in the bed for almost a year now. She’s doing pilates reformer 4/ wk. Her last labs as of 4/13/18 were:
    Glucose 104H
    ALT 37H
    Free T4 1.0(1.6)
    TSH 0.135 (<1)
    TPO 12
    Free T3 5.1(4-5)
    Reverse T3 15.7
    Ferritin 67L(80-100)
    DHEA-S 289.8H(150)
    VitaminD 80.6
    Progesterone 0.2L
    Estrone 103H(<50)
    She is a ballet dancer and this year has been a hard one. Last year she weighed 125lbs. Please help!!!!! Thank you so much!!!!!

  53. This is a great article!! I just had my physical yesterday and my doctor and I have worked on getting me a slew of tests to see where I’m at! Yay! But, the problem I’m running into, especially when looking into testing the “sex” hormones, is finding out when during my cycle I should have them done. I am doing blood, not saliva, testing… Do you have any insight on that? Thank you!

  54. Thank-you so much for sharing so much information. My story is lengthy, but my main reason for writing is to ask about T3 test results when taking Cytomel. My family doc has been working with me. He agreed to place me on 25mg Cytomel to help resolve a problem I was having with a high RT3. When I first started taking the Cytomel, my T3 results went from 4.9, 4.0, 5.2, and most recently – a drop to 2.8! Is this considered normal when taking Cytomel?? The RT3 has successfully dropped, but is it normal for the T3 level to drop as well, even while taking Cytomel? I’m just trying to understand. Again, thanks so much for all the information!

  55. Dear Dr. Westin,
    Thank you so much for your very informative article!
    I have hypothyroidism and chronic adrenal fatigue and am on natural thyroid and adrenal treatments. Have been taking compounded T3 and T4 (over 3 grains daily), iodine 2 x daily, and adrenal glandular pills 3-6 times a day, plus a lot of vitamins, proteins, and minerals. I am an active 70-year-old woman.
    In the past 3 mos though, the compounded thyroid med did not seem to be working well. Was on nature thyroid before December. Hair thinning now, nails breaking, etc. So my new doctor ordered a blood panel, which she said shows that I am now in hypERthyroid mode and must take a very low dose of nature thyroid — 1/2 grain by her calculations! Nature thyroid did work better with 3+ grains, but this big change scares me! So I said if I am hyperthyroid, why do I still exhibit almost all the signs of hyPO?? Big bags under eyes, sometimes fatigue even with the adrenal pills, plus thinning hair, etc. She claimed this can happen even with hyPERthyroid. But I do not have a racing pulse or any of the hyPER symptoms at all.
    I am very confused by these blood test results and do not want to make a move until I have all the facts. What would you recommend I do, Dr. Westin?

  56. Dr. Westin,

    I am a 63-year-old woman that had a total thyroidectomy (cancer) about 6 years ago. It took 3 years to actually get my body well again and levels right, thanks to my regular Dr. that is willing to try natural ideas.

    Last year I lost 20 pounds, exercised regularly and healthy and felt brand new! I was in Colorado taking care of my sick mother, but I also took care of me.

    My mother got better and I came home to Tennessee and got a job at a Memory Care unit in an assisted living. I was doing excellent from June 2017 – December 2017. Then the job became VERY STRESSFUL, my body started aching and hurting and sleep was very restless.

    I found you online and went to the Dr. and asked for the tests that you said I should get. To my surprise, my TSH was 35.84/ my T4 was .82(lowest range of normal) my reverse T3 12.9 (9.2-24.1) and my SHBG was 162.6! Wow, I was in shock.

    I am currently taking Nature Throid 130MG, and have been taking this for several years without any elevations or issues. The Dr. upped my dose to 146.25MG for 6 weeks.

    I sure hope you read this because I need your expertise. Do you think high cortisol is the culprit to all this thyroid madness?

    I have maintained my weight, but I am sure I have lost muscle. I sleep poorly and ache a lot. Since I started feeling really poorly, I cut back to part-time at 24 hours a week at my job. I have done this work for 20 years, but I need to take care of me again.

    Any suggestions?

  57. My naturopath says that when taking just Naturethroid your FT4 will always be at the bottom of the range but all that I am reading says that optimal FT4 is in the top 1/3 of the range. How do you get you FT4 up? I was on 1.25 grains then 1.50 grains and also 1.75 grains and my FT4 has never moved from the bottom of the range.

    • Hi Jennifer,

      It is true that some people notice a suppressed T4 when taking NDT but this is not necessarily considered to be a problem unless you are symptomatic.

  58. Thank you for all this information. It is very eye opening. A lot of Doctors I have seen do not know how to read the levels. It is heart breaking.
    Thank you
    Jen

  59. Hello, I had a Total Thyroidectomy Oct 3rd 2017. I have been taking Synthroid 88mcg and I had my last checkup in March. My levels were “normal” and they sit up an appointment for a year from that time. I’ve recently been feeling off and had more blood work done today. They called and said I’m “normal” but I feel off. I’ve been trying to get back in to see my doctor but I feel like they think I’m crazy. I feel depressed. Agitated. Hungry but feel sick when I eat. Exhausted and not myself. Any advice for me? I know my body and it doesn’t feel right. I’m 31 years old and I feel like I can’t lose any weight.
    Thank you,
    Brandi

    • Hi Brandi,

      The best thing you can do is look into adding T3 to your current medication. T3 tracks better when it comes to symptom management compared to T4 only and there are many studies which show this. You may need to seek a second opinion with someone who is more willing to work with you and alter your medication.

  60. Can you please help me. I am 29 years old. I feel very sick. My hair is falling out. I had to drop out of college due to being so sick. After comparing my lab ranges to optimal ranges some are very low. Last “functional” doctor told me everything was normal. But I do not feel normal. I have spent so much money seeking answers. But do not know where to turn now. This full panel was done in September. What do I do?

    THYROID
    T4, TOTAL (7.9) 4.5 – 12.5 mcg/dL
    THYROID STIM. HORMONE (1.60) 0.34 – 5.60 mIU/L
    ANTI-THYROGLOBULIN AB. (0.1) 0.0 – 5.0 IU/mL
    T3, FREE (2.9) 2.39 – 6.79 pg/mL
    T3, TOTAL (0.69 L) 0.8 – 2.0 ng/mL
    T4, FREE (0.88) 0.58 – 1.64 ng/dL
    T3, REVERSE, SERUM (20) 8 – 25 ng/dL *2
    THYROID PEROXIDASE AB. (1) 0 – 60.0 U/mL

    My results are in parentheses. The lab ranges are beside them.
    Thank you,
    Jen

  61. Hi, Thanks for all the advice on your posts.
    I’m 57 years old and have been on Thyroxine for about 20 years, constantly having my dose altered. I’m suffering with all symptoms of fibromyalgia, but these seem to be very similar to thyroid issues and after joining several online groups really don’t think I have FM. I’ve asked many times for a T3 check and finally my doc said that my T3 is low, but said that they won’t do anything about T3, as T4 and TSH are within range. And my inflammation levels are high, but as they’ve always been high won’t do anything. Yet for years I’ve complaining of brain fog, tiredness, dry skin, hair loss, weight gain, severe cramps, joint issues, muscle pain and the list goes on. I do pilates, swimming and dancing every week. Is there anything that you would recommend for me please.
    Thanks Karen.

  62. Dr Westin, have been very enlightened and informed with the info you provide. Not on any medications. BP & cholesterol very good.
    I am a 57yo post menopausal female currently 25kg overweight and been struggling with weight for decades despite trying lots of things. Recent blood tests have me with a TSH of 23.9 (range 0.5-4) and a free T4 of 11 (range 10.0 – 19.0) no reverse T3 done. Negative for Diabetes. GP has advised retesting in 6-8 weeks but recommends I may need Thyroxine ongoing.
    I would prefer to fix anything naturally. Your recommendations would be appreciated. Sharon from Australia

  63. Can you clear something up for me Dr Childs. I am getting conflicting advice on T3 medication. I am supplementing T4 meds with a small amount (10mcg) of T3 daily. It has been mentioned to me that the body senses the extra T3 and stops converting similar amount of T4 to counter. Could that be true?

  64. Hi I have been told by family I have Thyroid issues.. Fatigue I have had it for many years. I can walk 10 feet and just want to die. I have changed many doctors because they think they are always right.My THS T3 and T4 are always normal. This new doctor has finally tested me for the THYROID PEROXIDASE ANTIBODIES and came back with the number 85 which seems extremely high. I have not seen my doctor yet my appointment is on the 24th… IS there anything I should ask her? Anything I should be worried about? I am 40 pounds overweight, cholesterol off the charts, have cysts all over my kidneys, ovaries, armpit, ears (not sure if this is part of thyroid issues), IBS, the list goes on I am 41 I feel like I am 81 and I need to get on the right track.

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