A Practitioner's Guide to Hashimoto's Lab Testing

Sometimes it’s not easy to get proper Hashimoto’s lab testing from conventional doctors. Often they just test TSH and send you on your way. Unfortunately, this one lab test will not give you the big picture you need to not only understand the status of your thyroid gland but the functioning of your endocrine system as a whole. That’s why it’s really important to find a doctor that will do a full thyroid panel.

A diagnosis of Hashimoto’s means that your endocrine system is suffering the consequences of other systems in your body dysfunctioning. It doesn’t necessarily mean the problem is due to your thyroid gland. The root cause of this diagnosis could be blood sugar dysfunction, nutrient deficiencies, silent infections, stress or all of the above.

More About Thyroid Stimulating Hormone (TSH) and Hashimoto’s

When experiencing any of the long list of Hashimoto’s symptoms, you’ll probably be inclined to go to the doctor to get lab tests to confirm your suspicion. However, you might be faced with some resistance from your doctor for testing. Most likely, they will only want to test your TSH.

What is TSH?

TSH (Thyroid Stimulating Hormone) is a pituitary marker and ultimately tells us how our pituitary gland is functioning. It can give us the information that the body does not have enough T4 (the precursor to the active thyroid hormone T3) floating around in the body. The problem is that just because the TSH is low, it doesn’t mean that you all of a sudden need to take a synthetic T4 medication which doctors will often suggest.

You may need to adjust your stress levels to take the burden off your adrenal glands and your pituitary gland!

There is so Much More to the Thyroid Lab Testing Than TSH!

If your doctor does give you resistance in getting a full thyroid panel, you can get most of the tests online for a reasonable price at Let’s Get Checked. They also provide a free connection to a physician to get the results analyzed.

Hashimoto’s Lab Tests Resource

My clients often ask me what thyroid lab tests they should be asking for from their doctors and I am more than happy to give them a list.

Since it is such a common question though, I also thought I would write up this article for you to use as a resource when you need to request a thyroid lab panel from your doctor (who is hopefully willing) to do all the tests AND interpret them.

I have also created a free Hashimoto’s Lab Testing Guide that you can refer to and take to the doctor’s office when you request the tests. This printable also will educate you about what each of the test results mean, optimal reference ranges, troubleshooting and includes a lab results tracker sheet. Download that below.

The Thyroid Hormone Cascade

Many newbies to Hashimoto’s think that Hypothyroidism and/or Hashimoto’s is only about the T4 hormone. They feel satisfied when they’ve gotten a diagnosis and then their doctor prescribes them Synthroid or another T4 medication.

What ends up happening though is months or years down the road when they aren’t feeling better on the medication, they question if this T4 solution is really the answer. They realize it’s not and that the problem can actually stem further upstream before Thyroid Stimulating Hormone (TSH) is even triggered.

Alternatively, sometimes they get on different medications, continuing to mask the symptoms and not address the root cause. Other times they choose to dig deeper and work with a practitioner that discovers the root cause and actually helps them remit their symptoms, by removing the root cause so the body can heal itself.

This is the Complex Cascade of How the Active Thyroid Hormone T3 Actually gets Created and Used in the Body.

The endocrine cascade for the thyroid hormone is actually quite complex and interconnected with many other organs and systems in the body. Here’s a rundown.

TRH (thyrotropin-releasing hormone) secreted from the Hypothalamus and sent to the Pituitary Gland.
TSH (thyroid-stimulating hormone) is then signaled to be released from the Pituitary Gland.
TSH goes directly to your thyroid gland stimulating it to release thyroid hormones (which can only be produced in the presence of iodine and the amino acid tyrosine).
Specifically, tyrosine is converted into thyroglobulin which then attaches to different numbers of iodine atoms to produce T1, T2, T3, or T4.
T4 is the primary outgoing hormone that is excreted by the thyroid gland.
T3 is then created in the liver, gut, skeletal muscle, brain and thyroid by the conversion of T4 to T3.
1. Only a small amount of T3 can also be excreted from the Thyroid.
  1. **Since much of our T4 is stored, whatever part of the body that is closest to that stored T4 that needs more active thyroid hormone (T3) is what triggers the conversion process.
Much of the T3 and T4 floats around in your bloodstream bound by Thyroxine-binding Globulin (TBG) which renders the hormone unavailable until converted.
The feedback loop starts again when the hypothalamus notices there is not enough thyroid hormone in available to use. The process starts at #1 again.

As you can see, obtaining the active thyroid hormone T3 is quite a complex process and requires several HEALTHY organs and glands to get the job done.

This is why it’s important to get tested for more than just TSH.

Getting the big picture and all the pieces to the puzzle is much more helpful than only seeing one piece of the puzzle. Don’t you agree?

Which Lab Tests to Request for Hashimoto’s

Keep in mind that there are other tests outside of thyroid lab tests that will help provide an even clearer picture of the endocrine system as well as other systems in the body that affect the thyroid. They are things like Cortisol, Estrogen, HbA1C, CRP, WBC, RBC, Iron, Vitamin D and A, Homocysteine, Zinc, Selenium and more. In reality, the endocrine system is a complex system of relationships. However, in this post, I will only be discussing thyroid lab markers.

Hashimoto’s Lab Testing

TSH – Thyroid Stimulating Hormone
Total T4 – Thyroxine
Total T3 – Triiodothyronine
Free T4 – Free Thyroxine
Free T3 – Free Triiodothyronine
Reverse T3 – Reverse Triiodothyronine
TBG – Thyroxine Binding Globulin
FTI – Free Thyroxine Index
TPO – Thyroid Peroxidase Antibodies
TgAb – Thyroglobulin Antibodies
Thyroid Ultrasound (optional but nice to have for confirmation of Hashi’s, to assess damage to the thyroid and rule out any nodules or cysts)

Optimal Reference Ranges for Your Hashimoto’s Lab Testing

Don’t be fooled. Conventional medicine uses less than optimal reference ranges for diagnosis. If you want to know the optimal reference ranges to assess your lab results, be sure to download the Hashimoto’s Lab Testing Guide below.

Go to Your Next Appointment Armed with a List of Thyroid Lab Tests to Ask For

Now that you know how complex it is for our bodies to produce the active thyroid hormone T3 as well as which thyroid tests are important and why (if you downloaded the Hashimoto’s Lab Testing Guide), you can walk into your next appointment confidently because you know what to ask for. Remember, if your doctor is not willing, you can order your own lab tests as Let’s Get Checked.