Is there a “Best” Thyroid Test? A Simple Guide to Thyroid Testing

is there a "best" thyroid test? a simple guide to thyroid testing

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is there a “best” thyroid test? a simple guide to thyroid testing

getting a complete thyroid hormone blood test is critical to understanding and evaluating your thyroid function

complete thyroid testing includes so much more than the tsh

free t

free t normal & optimal ranges

free t

free t normal & optimal ranges

free t3

free t4

this list represents the and complete thyroid panel

this list isn't necessary each and every time you get your blood drawn

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high levels of indicate that your body may not be producing enough thyroid hormone

this relationship confuse patients because a high tsh means that you are likely hypothyroid

if there are low blood levels of thyroid hormone your pituitary will sense this and it reacts by increasing tsh levels in an attem to tell the thyroid gland to produce more thyroid hormone

this logic is then applied to thyroid hormone replacement

as you take thyroid hormone your tsh level will fall as the pituitary senses this thyroid hormone in the blood

some studies have shown that patients who take t only thyroid medication to lower their tsh to the "normal range" still exhibit lower t3:t levels compared to age-matched controls

free t

the next test we need to talk is probably more important than the tsh and that is free t3

free t is critical because it is the active thyroid hormone in your body

free t represents the amount of free and active thyroid hormone floating around in your blood

some of this thyroid hormone is bound to a protein )

by assessing your free t levels you some insight into how your body is metabolizing thyroid hormone

this process is known as thyroid conversion and it occurs in peripheral tissues

evaluating your free t is necessary to understand how your thyroid is functioning in the peripheral tissues

free t normal & optimal ranges

if you are taking t containing medication then evaluating your free t level becomes more difficult and less reliable

low free t levels

you see an example above of a suboptimal free t3 level but still "normal

checking your reverse t give further insight into the conversion process in your body

the example above is from a patient who just finished the hcg diet who presented

this high reverse t is likely a compensatory reaction from the dramatic drop in weight and meant to help lower her metabolism to "protect" the body from the rapid weight loss

free t

your free t4

free t give you insight into how your body is absorbing thyroid hormone

by assessing free t levels before and after initiating thyroid hormone you can determine how you are absorbing thyroid hormone

high levels of free t4

free t normal & optimal ranges

free t levels can change depending on the type of thyroid hormone you are taking

your free t level

your t level in these cases is usually not as important as your free t3/reverse t3 ratio

checking your thyroid antibodies should also be a necessary part of a complete thyroid panel

that basically means wait until the autoimmune process has caused enough damage to finally alter your tsh to a certain level as to require thyroid hormone replacement

in most cases the reference range is accurate as in the case below

assuming estrogen levels are normal this test help determine ​if your liver is assimilating and converting thyroid hormone in your liver

in hypothyroid states the shbg will be low

high shbg levels may have consequences on other sex hormones in the body

shbg should be part of the complete thyroid panel but its use is somewhat nuanced

the full thyroid hormone panel includes the following tests: tsh

are you having trouble getting a complete thyroid panel

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if your cells are taking up enough thyroid hormone

the lack of these functions results in hypothyroid like symptoms and specific changes to thyroid hormone that you pick up

in this post

more

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tsh

normal & optimal ranges

reverse t

reverse t normal & optimal ranges

thyroid antibodies

thyroid antibody normal & optimal ranges

sex hormone binding globulin

sex hormone binding globulin normal & optimal ranges

final thoughts

thyroid testing - what's important and why

there's a lot of confusion surrounding thyroid testing which make things complicated if you are a patient suffering from hypothyroidism

in most cases

but is this actually true? is it supported by scientific evidence

the answer to that question is not really

there are actually many situations in which the tsh falls short and doesn't tell the "whole story" of what is going on in your body

in some cases

this is really important because certain thyroid medications influence your thyroid values in different ways

in some cases

tsh

reverse t3

thyroid antibodies

sex hormone binding globulin

total t3

this list should be drawn before you start taking medication and it should be drawn if you are worried that your symptoms are consistent

remember that while testing is critical to proper diagnosis and evaluation

taking this list to your doctor and demanding them to order these tests may not be helpful

if you have to ask

many physicians are set in their ways and unwilling to change their regardless of data

instead

i've found that these foods cause the most problems

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this list includes optimal ranges

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tsh

the tsh level stands

under normal physiologic function

tsh levels usually rise in response to a feedback loop in the body that exists to tell the brain when enough thyroid hormone is present

when doctors give patients thyroid hormone they then use the tsh to determine when the body has "enough" thyroid hormone in the body

eventually

in some cases

euthyroid sick syndrome - this condition results in hypothyroid like symptoms but patients tend to have "normal" tsh levels

beyond these conditions that may alter the effectiveness of the tsh as a marker of thyroid status

patients taking t to a "normal" tsh also consumed fewer calories

these findings match my observation in clinical practice as it relates to hypothyroid patients being treated

most of my hypothyroid patients are consuming very few calories

while the tsh may not be the best test it still has value so don't discount it completely

normal & optimal ranges

so how you use the tsh appropriately

monitoring your tsh while taking thyroid medication is very important

instead

in addition

the optimal range

this assumes a standard range of to 4.5

generally

the example above is a patient

in most cases

patients in this range will be told that they are "normal"

many physicians will use the standard reference range of 0.3 to 4.5 instead of the optimal range of less than

when you are first evaluated make sure you evaluate your tsh

all of the positive actions we associate

directly activates nuclear receptors on each of your cells and changes genetic transcription which results in increased metabolism

in order

euthyroid sick syndrome

in some states

this state presents

systemic inflammation

chronic yo-yo dieting

rapid weight loss

certain medications: beta blockers

recurrent chronic infection

chronic stress

hormone imbalances and hyperglucagonemia

like tsh

doctors give patients t thyroid medication

it turns out that this be evaluated by testing your t4 and t3 both before and after treatment

if you see that t levels have increased

however

reverse t

reverse t is another very important thyroid lab test and it gives a lot of information

reverse t is an inactive thyroid metabolite

remember when we discussed that your body convert t4 into t3

it also turn that t4 into reverse t3 instead of t3 which inactivates the thyroid metabolite

this system is meant to act as a brake and is a thing in certain situations

however

states of chronic stress

patients

reverse t also give insight into how much competition your body has

in most cases

patients

reverse t normal & optimal ranges

if you are taking t4 thyroid medication you will want your reverse t3 to be less than

the standard reference range usually varies between 9.0 to

a reverse t3 greater than

this is another syndrome were tsh levels falsely predict peripheral tissue levels of thyroid hormone

in most cases

remember to evaluate your reverse t in conjunction

the more rapid you lose weight the ​higher your reverse t will be and the slower your metabolism will be

this usually occurs

safe weight loss does not result in this type of rise in the reverse t3

in some cases

levels also give insight into how your body is converting thyroid hormone

normal levels of t do not necessarily indicate that your body is utilizing thyroid hormone in peripheral tissues

tirosint - but this isn't necessarily a thing unless you are also converting this t to t3

conversely

the example above is very common in patients

this tsh represents a "normal" level but certainly a "sub-optimal" level and most likely consistent

thyroid antibodies

the presence of these antibodies indicates that a likely autoimmune and inflammatory component may be the underlying cause of your hypothyroidism

autoimmune thyroiditis is thought to be the #1 cause of hypothyroidism in the us

the presence of antibodies indicates a condition which can be treated through lifestyle and dietary changes and alters treatment

the presence of elevated antibodies

this is important because

the conventional approach is to take a "wait and see" approach

does this sound like a approach

not really

instead

it has been established that various factors including environmental triggers

doesn't it make sense

course

which is why it is important to know if antibodies are elevated in your body

another important reason to identify if antibodies are present in your body is that your thyroid function tests may change over time due to this issue

patients

you find more information testing and treating elevated antibodies in this detailed post

thyroid antibody normal & optimal ranges

your antibody levels should be as close to zero as possible

the reference range indicates that normal antibody levels should be less than

this patient on the other hand obviously has elevated antibody levels

change this value

sex hormone binding globulin

sex hormone binding globulin is one of the few tools we have which attempt to give insight into how your body is absorbing and utilizing thyroid hormone

estrogen

thyroid hormone

this information then be used as a surrogate marker

it's not a perfect test

in women

in men

you then track the shbg

sex hormone binding globulin normal & optimal ranges

sex hormone binding globulin only be used in certain instances

oral estradiol then your sex hormone binding globulin will be artificially elevated and the absolute value of this test diminishes

likeweise

final thoughts

alter treatment

as a reminder

has it helped determine what is happening in your body

are you converting thyroid hormone appropriately

why not

leave your comment below

references

dr. westin childs

dr. westin childs is a doctor of osteopathic medicine. he provides well-researched actionable information hormone-related disorders and formulates supplements to treat these disorders

he is trained in internal medicine

you read more his own personal journey here

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