Not Just TSH!

A review of thyroid laboratory testing

It's important to work with a practitioner who will look at your whole health story, ask the right questions, and order the right labs in order to develop a treatment plan that will work most effectively for your unique health situation.

Here are the key thyroid labs that I use in my practice and the questions they help me answer:

TSH:  To what extent is the brain signaling the thyroid to make more thyroid hormone? 

Free T3 & T4:  Is there an insufficiency or imbalance in the amount of active (T3) and precursor (T4) thyroid hormone circulating in the bloodstream? Are you converting T4 to T3 properly? 

Reverse T3: Is there too much thyroid hormone being converted to inactive Reverse T3 instead of T3 (active) hormone? 

Antibodies to TPO & Thyroglobulin:  Are autoimmune processes in your body attacking the thyroid gland?

Complete Blood Count (CBC) & Ferritin: Are you anemic? Iron-deficiency anemia is common in women with hypothyroidism.  Macrocytic anemia due to deficiencies in folate or B-12  is also a possibility.

Vitamin D :  There is an association between low vitamin D and hypothyroidism and Hashimoto's. 

Other labs to consider:  Adrenal and sex hormone levels, nutrient testing, food sensitivity testing, MTHFR and other genetic testing, labs to check for chronic infections and for other autoimmune processes in the body. 

Thyroid ultrasound: are there changes to the thyroid tissue that suggest an autoimmune process? Are there any concerning nodules? 

Re-testing:

If you are on thyroid medication, it's important to have your TSH, Free T3 and Free T4 tested after a change in type or dosage of medication. 

If you are being treated for Hashimoto's, it's helpful to periodically re-test antibodies to determine the effectiveness of treatment to calm autoimmunity.