Thyroid Labs Cheat Sheet

[This post is partially adapted from a chapter in The Essential Thyroid Cookbook.]

Feedback has been rolling in for quite some time from our professional reviewers for The Essential Thyroid Cookbook and from other readers who received an ARC (advance reader copy), including our Ambassador team.

It’s overwhelmingly positive, which Lisa and I are of course giddy about.

People are not only diving into the recipes, but they’re also digging into and appreciating the educational component.

The one piece of non-recipe feedback that we’ve received more than any other is how much people are appreciating the section on thyroid testing – specifically the chart I outline with not only the full thyroid panel, but also the functional reference ranges.

When I wrote this section, I didn’t just go to one respected source, I pulled together the opinions of about five functional medicine doctors and thyroid health experts and created an amalgamation of what they feel is an ideal thyroid panel.

Below, you’ll find a one-click cheat sheet that you can print and use the next time you’re getting your thyroid tested. But first…

Naming the problems…
Too often, hypothyroid patients seeking answers from the conventional medical model continue to suffer with symptoms that aren’t traced to a sluggish thyroid. 

Hypothyroidism remains undiagnosed two ways:

  1. Despite symptoms pointing to an under-functioning thyroid, the thyroid is never considered suspect.
  2. Lab testing is limited.

The testing can be limited in two ways:

  1. Doctors operate under the conventional medical conviction that hypothyroidism can be diagnosed via one blood test and one blood test only, thyroid stimulating hormone (TSH), a pituitary hormone that tells the thyroid to do its job.
  2. Many doctors (endocrinologists included) utilize outdated blood lab reference ranges.

This type of thyroid “treatment” leaves many underdiagnosed. Dr. Mark Hyman states, “You may be told you have borderline thyroid problems or sub-clinical thyroid disease and your doctor will watch it. What will he or she watch for? For you to get really sick?”

These archaic practices cast aside a vast group of people who have subclinical hypothyroidism that can trigger a bevy of symptoms, yet cause only slight changes in blood labs, primarily those tests that many doctors never run.

The antibodies that show the presence of Hashimoto’s, thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb), happen to be on the list of thyroid labs infrequently performed.

As the saying goes, “Don’t guess, test.” It’s important to do the right tests and to evaluate your labs based on the functional reference ranges, not outdated ranges that often lead to misdiagnosis, mistreatment (like antidepressants or anti-anxiety drugs), and the passage of time with continued suffering.

Click here for your thyroid labs cheat sheet >

Regarding the evaluation of TSH as a sole indicator of thyroid health, hormone expert Dr. Aviva Romm, author of The Adrenal Thyroid Revolution states, “In a world where medical over-testing is rampant, I have to say, I find myself confounded by the fact that so many physicians are resistant to ordering anything but a TSH – or thyroid simulating test – as the first form of evaluation, when from a scientific and medical standpoint, that test can be normal and there can still be a low functioning thyroid. It’s outdated medical dogma to order solely this test.

“Most of us, whether as doctors or patients, have been led to believe that medical guidelines and practices are pretty much set in stone, and are based on hard reliable facts. The former is definitely not true, in fact, in just the past five years or so, it’s been found that many long-followed medical guidelines aren’t correct. It has been found that sometimes, doing tests or interpreting them inappropriately can even lead to harm.

“On top of this, medical guidelines, while based on hard data, are only as good as the data they are based on, and on what’s known at the time the guidelines are made. So for example, the TSH lab values for normal are based on TSH averages for most generally healthy Americans. But many Americans are under-diagnosed for thyroid disease. When we take an expanded view of thyroid health, and only include the TSH average of people with absolutely no hypothyroid symptoms, the number changes.”

You are your best advocate…
Managing hypothyroidism and Hashimoto’s is an exercise in becoming the CEO of your health. Our cookbook is a great place to start – and will help keep your thyroid nourished throughout your life, even after your hypothyroidism/Hashimoto’s is under control. 

It’s imperative that the relationship you have with your healthcare provider is open and accepting. Dr. Romm states, “You should be able to have mutually respectful conversations with your care provider, to get the answers you are seeking, and to be able to explore your concerns.”

Don’t allow your doctor to use outdated lab reference ranges or to neglect testing for the antibodies that could reveal Hashimoto’s. It’s important to continue to monitor these values to know whether you’re recovering from Hashimoto’s. 

Reject the notion that TSH alone determines your thyroid status. 

Don’t tolerate intimidation or condescension from your doctor – something I know is commonplace because I hear it from my clients frequently. 

Dr. Romm continues, “For many women, the lab tests that doctors currently use, and the way those tests are interpreted, leads many women to be told that they don’t have a thyroid problem, and in fact, they are just fine. This translates as, ‘This is all in your head because I, with my medical degree, cannot find a darned thing wrong with you, Lady.’ And this often results in an antidepressant prescription.” 

Being a recipient of the go-to thyroid drugs, with no conversation about immune modulation, nutritional and lifestyle changes, or drug alternatives may get you minimally treated at best. Dr. Romm says, “As a doctor, I can tell you that in medical school we are taught that doctors know best. But this is often not the case. You are your body’s best expert.” 

Click here for your thyroid labs cheat sheet >


I never see you mentioning people who actually have bad test results but feel great.
I have my antibodies undercontrol but my TSH is always 6-8, but i feel great.
So i wonder what do you think about "Why i feel great if my labs are bad?"
I have been in this state for years.
Does it mean that my body is slowly eating my Thyroid and its hard to predict when total damage will happen or i might have my Hashi under control and i will never see the symptomps and my TSH might actually be around 6-8 for life?


I don’t mention it because people who feel great usually don’t need coaching and support. :)

If your antibodies are under control, it’s not likely that your body is “eating” your thyroid. You have to take TSH in the context of Free T3 and Free T4, but I would ask your doctor about your pituitary health, given that TSH is a pituitary hormone.


I am in a similar state as you. My TSH flucuates anywhere from 3 to 6 and has for over 10 years and my TPO antibodies are under 10. I feel great most of the time. I read about these optimal levels and I sometimes wonder if what is optimal for some may not be for others. I have consulted with several physicians about this and they all have a different opinion. Some even say thyroid disease is actually overtreated. Honestly it makes me anxious and confused to hear the differing opinions. Thanks for your post...I never hear about anyone with similar labs as myself.

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