Thyroid Basics 101

Thyroid Labs

Many integrative and naturopathic doctors believe thyroid disease should be viewed as a public health emergency.  Research studies show that at least 40 to 80 percent of the population has a thyroid disorder, such as thyroid cancer, subclinical hypothyroidism, or autoimmune thyroid disease, e.g. Hashimoto’s or Graves’ disease.  I have Hashimoto’s which is worrisome to me personally because Hashimoto’s has been identified as a precursor to thyroid cancer in several journal reviews.  Your knowledge of thyroid lab basics will help accurately diagnosis Hashimoto’s as well as help you maintain your ongoing health and wellbeing. 

The percentage of people referenced as having a thyroid disorder only includes those who have already been diagnosed so the statistics are likely much greater.  Given the fact that thyroid disease is often misdiagnosed as some other condition, for example, depression, bipolar disorder or “just part of being a woman” is very sad.

Classic symptoms of low thyroid function:

  • Fatigue
  • Coldness
  • Dry and/or scaly skin
  • Constipation
  • Headaches
  • Overall hormone imbalance
  • Puffiness under the eyes
  • Pre-tibial edema
  • Frequent infections or allergies
  • Feeling sleepy all the time

  • Inability to conceive
  • Pre-menstrual syndrome
  • Unexplained Weight gain
  • Depression (physiological & emotional)
  • Brain fog
  • Raynaud’s syndrome
  • High cholesterol
  • Ankle swelling
  • Lack of motivation
  • Low libido

 Do you have symptoms even though your doctor says your labs are “normal,” or “in range?”

I see this happening every day.  You are more than a lab value, and your symptoms should trump any lab result.  There is such a thing as “in range,” but that doesn’t mean your labs are “optimal.”

There are also other symptoms referred to as “paradoxical” because they aren’t the typical symptoms taught in medical and nursing schools for someone with low thyroid function.  I was taught in nursing school that a rapid heart rate and high blood pressure in someone with a thyroid issue always pointed to too much thyroid hormone and that this meant they were “hyperthyroid.”  The truth is that most hypothyroid patients experience heart palpitations, rapid heart rate, hypertension, high cholesterol, arthritis, erratic blood sugar levels and more in the absence of optimal circulating levels of free T3 (the active thyroid hormone usable by the body).  Too little thyroid hormone can be just as problematic symptom-wise as too much is.

I have often wondered why so many people aren’t diagnosed when apparently, they present with typical and non-typical hypothyroid symptoms.  It took me eight long miserable years and nine doctors to figure it out.  I saw some of the best physicians in my region and not a single one of them could help me.  Then one day by pure grace, I met doctor #10.  I received a proper diagnosis…Hashimoto’s, Celiac disease and pernicious anemia.  I remember how relieved I felt in knowing that I wasn’t crazy; however, this was only the beginning of another very long journey to feeling better.  Having gone undiagnosed for so many years, my antibodies were resistant to lifestyle and dietary changes.

As a nurse, I was trained to assess the PATIENT first . . . And to gather subjective and objective data to make a nursing diagnosis (not to be confused with a medical diagnosis).  Doctors are supposed to be trained in the same way; however, many have moved away from actually laying eyes on the human person in front of them and listening to their reports of symptoms, to primarily relying on lab values on paper.

You are more than lab numbers on a sheet of paper

I know how frustrating this is because I’ve been there!  The term “lab-obsessed” is heard among the thyroid community a lot.  Sadly, some practitioners seem to discount women’s reports of symptoms and instead rely solely upon one or two tests to make a diagnosis.  Before the 1970s, doctors used a patient’s history, physical assessment, and clinical findings to diagnose a thyroid problem.

Fast-forward to today, and we see reliance on only the TSH and T4 tests as the primary diagnostic tools.  The TSH test used in this manner often results in one getting misdiagnosed.  It is also important to mention that many functional medicine doctors view the TSH as outdated with too broad of range, and reports indicate that it is being challenged due to issues with accuracy.  Of course, the thyroid community-at-large already knows this!

Besides, a TSH test is not a measure of thyroid function; the TSH can only measure how well the pituitary gland is working to signal or jump-start the thyroid.  It tells doctors nothing about what is truly going on with the thyroid or why it isn’t responding to the message. And, it certainly isn’t indicative of any autoimmune issue that may be going on.

The TSH should never be used solely to diagnose a thyroid disorder of any kind – it should be utilized as a part of a complete panel of many labs to assess and diagnose why you may be experiencing distressing thyroid-related symptoms.

Side note:  I recently went through a practitioner training 12-week course with the Hashimoto’s Institute, and during one of Dr. Alan Christianson’s lectures he said the ultimate way a physician can rule out Hashimoto’s is by doing a thyroidectomy and dissect the cells & tissues!  Also, the absence of TPO antibodies does not necessarily indicate that you don’t have Hashimoto’s.  If you have hypothyroid symptoms, I suggest checking labs every four months.

Essential Thyroid Labs
It is necessary if you suspect you have a thyroid problem to request the correct labs.  If your doctor doesn’t want to order these markers, there is another way.  Your health is your ultimate responsibility, and no one is going to care more about it than you do!  You may need to take the self-ordered lab option which is very affordable and convenient.  The advanced thyroid lab panel with Ulta Labs is approximately $143. Below are the tests you need:

  • FREE T3 (it must say “free,” otherwise, it is bound
  • FREE T4
  • Reverse T3
  • anti-Thyroglobulin antibodies
  • Thyroperoxidase (TPO) antibodies
  • TSH
  • Ferritin
  • Vitamin D3, 25-OH-Hydroxy
  • Sex Binding Hormone Globulin (SBHB)
  • Thyroid Ultrasound – for baseline and if euthyroid (normal) request one every other year.  Thyroid ultrasound is of particular importance if you are experiencing classic hypo- or hyperthyroid symptoms but your labs are negative for TPO or thyroglobulin antibodies.  Antibodies aren’t always detectable in the blood, and they sometimes take a long time to show up.

Self-Test for Low Thyroid Function – and additional clue

Dr. Broda Barnes is recognized as the grandfather of thyroid health and credited for his expertise, research, and contributions to the discipline of endocrinology.  He put forward and used a simple at home test known as the Basal Body Temperature Test intended to be a tool to help identify potential low thyroid function.  Try it for yourself and be sure to show the results to your doctor.  Doctors love scientific data and numerical values as they should; however, a patient’s symptoms should never be discounted.  Thus, sharing your basal body temperature can’t hurt.  Plus, it shows you are serious about digging deeper into what’s going on with your thyroid.

In the morning before rising from bed for one week, take your basal body temperature under the arm or orally. Document your temperature in a log – an average reading is 97.8 degrees Fahrenheit to 98.2.  Low temps in combination with other findings could point to low thyroid function; but low temps alone could also be related to possible pituitary gland failure, low adrenal function or starvation.

If your doctor won’t order the suggested labs or you still haven’t found a doctor at all, you can self-order your own. Ulta Labs is an excellent provider of self-ordered labs, and they use Quest Diagnostics which is what most doctors rely on as their preferred lab due to their reliability.  Check out the cost-savings by ordering your own (it’s often less than a co-pay after insurance!)

Also, you don’t have to get these all done at once – you may spread them out according to your budget.  For the most basic labs, at least have the following checked:

  • Free T3
  • Free T4
  • TSH
  • Anti-thyroglobulin antibodies
  • Thyroperoxidase (TPO) antibodies

As always, I’m here to guide and support you through your Hashimoto’s thyroid journey.


1. Balch PA(2010). Prescription for Nutritional Healing. New York: Avery.
 Life Extension Media. (2003). Disease Prevention and Treatment: Scientific Protocols
Integrate Mainstream and Alternative Medicine (4th ed., text rev). 1545-1553.