I wish I had a dollar for every time one of my clients said, “My doctor tested my TSH and he/she said that my thyroid is fine, but after reading your symptoms list, I’m thinking that I still have a thyroid problem.” Really, your doctor said that your thyroid is fine? Then why are you so exhausted and moody? Why is your hair falling out and your estrogen high? Why are you putting on weight? Why are you having a hard time losing weight despite your best efforts? Why are you lethargic, not sleeping well, and so sensitive to cold? Why do you have unexplained soreness and stiffness and have mad cravings? Among other problems?

One of my current client’s doctor recently dubbed me “parasitic and predatory” when my client showed this doctor the full list of thyroid labs I gave her (listed below) and the doctor emphatically stated that TSH was the only test my client would need. Hmmmm, defensive much? Don’t want to be shown up by someone who didn’t go to med school? Feeling inadequate? You should.

Herein lies the big honkin’ problem with conventional thyroid “treatment” and all of the people running around fried, exhausted, and overweight. True, being fried, exhausted, and overweight can be the result of other issues, but often times, it’s a thyroid problem that most doctors are clueless about how to investigate. By using old guidelines and limited thinking, conventional medicine glosses over the millions who suffer with low thyroid function (hypothyroidism).

If the thyroid is our master gland of energy and metabolism, and you’re fatigued and overweight, you owe it to yourself to completely rule out hypothyroidism by getting the full range of labs performed by a doctor who is open-minded, understanding, and well-informed, not myopic, condescending, and arrogant.

When it comes to thyroid labs, most doctors only check thyroid-stimulating hormone (TSH), which does not give a full picture of how the thyroid is functioning. Its nickname is Thyroid Stimulating Hooey (thanks, Janie Bowthorpe) and many doctors are married to it as the single indictor of thyroid function. TSH tells you how your pituitary gland is talking to your thyroid, but tells you nothing of overall thyroid function. In fact, even the interpretation of this test is incorrect most of the time.

Truth be told, TSH isn’t wholly irrelevant, but it tells only part of the story. TSH increases when thyroid function drops, and decreases when the thyroid is working. So you want low TSH. The majority of doctors believe that anything over 5.0 or sometimes even 10.0 is worth treating. However, according to many functional medicine doctors, anyone with TSH over 3.0 is hypothyroid.

But … “normal” or “low” TSH doesn’t necessarily mean that you aren’t hypothyroid. TSH is simply not the end-all-be-all for thyroid testing.

The list below includes the two, yes two tests for thyroid antibodies that would indicate the presence of Hashimoto’s, an autoimmune thyroid condition. Getting doctors to recognize a thyroid problem, run the proper tests, know how to interpret those labs, and treat adequately is often challenging in that it may require a change of doctors and a new way of thinking. Add to this the fact that most doctors know little about how to treat an autoimmune condition, including Hashimoto’s, and patients’ hypothyroidism can still be mistreated.

There is no drug, no pharmaceutical for any autoimmune condition. So even if a doctor knows what Hashimoto’s is, many won’t run the tests for it because their course of treatment wouldn’t change. They would do nothing differently for their patients. Most will tell you that autoimmune conditions are lifelong conditions. Not true. You deserve to know if you have thyroid antibodies, which indicates thyroid tissue attack. If you have Hashimoto’s, and you’re simply trying to mask symptoms with drugs, you’re barking up the wrong tree.

One more thing about antibodies. Sometimes, doctors will run one antibody test without the other. What good does that do? If you end up getting tested for the antibody that you don’t have, it can be interpreted that you don’t have Hashimoto’s, when in fact you might. So it’s critical to have both tested.

“Another reason doctors don’t want to connect thyroid disease with weight gain is that they simply don’t understand very much about nutrition, metabolism, and the thyroid. They know the basic symptom list, they know how to do a thyroid stimulating hormone (TSH) test, and they know how to write prescriptions. But they don’t know about nutrition. You’ve heard the old bromide about how most doctors spend about an hour on nutrition in medical school. Well, in addition to that hour, they spend a couple of hours on thyroid disease, and that completes their education on nutrition and metabolism. The complexities of the endocrine system, the delicate interplay that goes on between hormones, the brain, the stomach, the appetite, and the ability to store and burn fat, are not topics most doctors have studies or even understand.” – Mary Shomon

Tell ‘em, Mary.

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You can say you heard it here first:        

T3 – This is the “big daddy” of thyroid hormones, affecting almost every physiological process in the body, including heart rate, growth and development, body temperature, and metabolism.
T4
Free T4
Free T3 - Again, T3 is the “big daddy”, and the “free” in front of the T4 and T3 tells you what is available and unbound and therefore usable by the body. Without the “free,” the labs are only measuring the total of what’s there, which tell you nothing about what is available for use.
Reverse T3
TSH (thyroid stimulating hormone)
TPOab and TgAb - The two thyroid antibodies tests. Positive antibodies confirm autoimmune thyroiditis (Hashimoto’s).   

As the old saying goes, “It’s best to test, not guess.”