You’ve been exhausted for months. Your hair is falling out. The scale keeps creeping up no matter what you do. Your doctor runs a thyroid test, tells you it’s “normal,” and sends you on your way, but you don’t feel normal at all. Sound familiar? The truth is, when it comes to thyroid health, “normal” isn’t always optimal, and one basic test rarely tells the whole story. Your thyroid is a powerful little organ that influences nearly everything in your body, and understanding your thyroid labs can be the key to finally feeling like yourself again. Let’s break down what’s really happening with your thyroid, which tests actually matter, and how to get the personalized care you deserve.

Understanding Thyroid Tests: The Numbers and What They Really Mean

This magical organ, the thyroid, affects so much of our daily life and how we feel. 

When things are off, we can expect to see a broad range of symptoms, such as:

• Digestion
• Immune Regulation
• Sexuality
• Bone Health
• Hair! (Always frustrating)
• Sleep
• Mood
• Energy
• Eyes
• Memory
• Muscles
• Periods
• Fertility
• Voice
• Stress Tolerance
• Temperature Control
• And let’s not forget metabolism and weight management!

Understanding Thyroid Diagnoses and the HPA Axis

Both high thyroid and low thyroid can cause many of these symptoms, making it very confusing. Hyperthyroid, Hashimoto’s, Hypothyroidism, Subclinical Hypothyroidism, Pregnancy Hypothyroidism, Autoimmune Hypothyroidism, Autoimmune Hyperthyroidism, and Graves’ Disease are all diagnoses of thyroid labs out of balance. The thyroid is what we hear the most conversation about, but a lot goes on in the other organs before we see the effect in the thyroid. 

The connection between the hypothalamus, pituitary gland, adrenal glands, and the thyroid is called the HPA Axis, as it is a chain or line-up of these organs that interact with each other. This Axis is balancing all the needs and demands while we go about our day. Impacts to the thyroid can include environmental, other exposures like viral, but mostly stress, chronic ongoing stress.

The body can only adapt for so long until the balance is thrown off. Usually, the adrenals struggle first, then the thyroid.

The Thyroid Blame Game: Why Testing Matters

The thyroid gets blamed for causing trouble, mostly because it has been easier to test thyroid labs for the last 60 years. Adrenals can be tested by saliva, and it can be helpful for patients to understand their state of adrenal function and what they can do to help support their overall health. However, most experienced practitioners have seen the common stages of adrenal fatigue and can adequately treat it without testing. The thyroid, on the other hand, needs clarity by testing the levels.

Thyroid Tests: What Each One Tells You

Let’s run down the possible test options.

TSH: Controls the release of thyroid hormones, T4 and T3. Both highs and lows can be a huge problem. There is an ideal range for this one. Typically, this is not helpful as a stand-alone test for diagnosis or monitoring of any of the above conditions.

T4: Thyroxine, Total: This is the primary hormone secreted by the thyroid. Bound to proteins in the blood and de-iodinated to become T3, which causes the hormonal action in almost all your tissues. There is an ideal range for T4. Pretty stable hormone and often normal even if there is a problem developing.

T3: Triiodothyronine, Total: The bound form after conversion from T4 in all your tissues. This is very commonly normal, and we rely on other tests to give us clues before we see this one change.

FT3: Free Triiodothyronine is the unbound hormone and is really helpful if hormones are altered in any way, such as pregnancy, hormone shifts, hormone therapy, birth control, other drugs, or if protein levels have been altered in any way. It shows the availability of hormones that is available for tissues to metabolize. Working toward the ideal range is often associated with improved symptoms for patients during treatment.

FT4: Free Thyroxine. This makes up 0.02-0.04% of the total T4 that is circulating unbound in the blood. Really helpful if proteins are altered, such as in estrogen use or birth control use. There is an ideal range for this one, too.

Reverse T3 or RT3: This is an inactive form the T3 and slows metabolism, signifying the body is conserving energy or illness. It can be used to understand brain fog, weight, or fatigue. It can help differentiate illness from actual thyroid disease.

TPO or anti-TPO: antithyroid peroxidase antibodies. We are still trying to understand exactly which part of the peroxidase enzyme these antibodies are binding to, but it interferes with the biosynthesis of the amino acid tyrosine into thyroglobulin. High numbers are interpreted alongside TSH, other antibodies, and symptomatology. These are commonly abnormal lab but most insurance-based doctors do not repeat these once they show up abnormal because they don’t know of any evidence of the numbers changing. 

Fortunately, that is not the case in my world or in my patients, and I love to see my patients work hard to get these numbers back into a normal range. This can indicate one of several thyroid autoimmune diseases. Autoimmune disease can lead to more autoimmune disease as well as a plethora of symptoms. I like to see this process stopped.

Anti-TG: Anti-thyroglobulin or antibodies to a protein made by the thyroid. Problematic whenever high for both high and low thyroid function.

Thyrotropin receptor antibody: Just what it sounds like, an antibody that is trying to remove a part of the thyroid hormone-making process, thinking it is somehow dangerous. A confused immune system. Helpful test in monitoring treatment of Graves’, hyperthyroid, and especially when needed to monitor in less common Graves’ pregnancies. There are several other unique thyroid labs, such as TRH, Tg, TBD, TBG, etc, used for further diagnosis of more specific conditions but less likely. Therefore, I have left them aside to prevent confusion. My focus was on those in 95% of thyroid concerns.

Normal vs. Ideal: Treating the Whole Person

Ideal ranges of thyroid labs can be different for each person based on their medical history, risks, family medical history, and even how sensitive they are, but it is often more specific and a tighter range than a normal range. I tell patients there is normal and then there is ideal. Each person is unique in the way they respond, the medications that will work for them, and their needs may include a need for gluten-free thyroid medication.

Understanding Thyroid Antibodies: Hashimoto’s, Graves’ and More

A note on antibodies. The normal level includes a small number since we genetically have some

antibodies- that’s good. Everybody does. When it crosses the line to high, that’s when we want to pay attention to the immune system’s extra attention to the thyroid and ask some questions.

The Real Cost of Thyroid Testing (And When It’s Worth It)

How much do labs cost? As always, prioritizing our patients’ money is an important aspect of care in our office. Discussions about how a lab test may or may not change a treatment plan are common. As well as asking if we should be using funds for treatment instead of labs at this point in time. Patients always know the cost of a cash pay lab before moving forward, and this can help them prioritize. Sometimes, for patients, knowing helps with anxiety or motivation. 

Follow-up labs can be really important to know if treatment is working. The sooner we can find that sweet balance in lab numbers, the sooner they can proceed with following their dreams. Ranging $200 for a basic thyroid panel is normal as of now. My key question is “Will this change the treatment plan at this point in time?” Remember all those things in life that can be thrown off with thyroid imbalance? That can happen even after diagnosis! So monitoring thyroid symptoms and levels is just as important. 

Generally, if there are no complaints, annual thyroid testing is enough. Sometimes huge life changes can cause changes and medications and/or supplements will need to be adjusted, so patients are encouraged to follow up sooner if they have symptoms or a huge life change, chronic stress, or more than usual stress levels.

Understanding Your Thyroid Labs

Understanding your thyroid lab values can help motivate you to make the healthy changes you need to feel good, get your thyroid numbers in balance, and protect the many functions that the thyroid plays a role in! Treatment in my office is as unique as the person, as there are so many options, including simple cell salts, homeopathy, viral testing, or just plain thyroid medication. However, selenium is one of my favorite thyroid tools – do be cautious, please, since you can get too much. Gluten-free diets, adrenal balance, and stress management seem to get the best results for patients!

If you need a more specific plan, reach out to our office for an appointment.