Episode 15 | Thyroid Lab Panel: The Care and Keeping of Your Thyroid

Thyroid Lab Panel | The Care and Keeping of Your Thyroid

In this episode of The Wholistic Greatness Podcast, I outline exactly what labs to get when you either visit with your endocrinologist, your primary care or your Naturopathic doc and why. Being our best and strongest means doing our research and advocating for ourselves. To be honest, affording a Naturopathic doctor can be challenging and hard to find one you can trust especially if you are new to this holistic health journey. So, if your insurance covers your annual visit and labs, this is the post to reference to get the 411 on all things thyroid labs! As always, there is a free printable to print and bring with you when you head to your next appointment.

What you will learn this week:

In this day and age, we must be the best advocate for ourselves when it comes to health and wellness. Trusting your doctor to make sure you are A-OK can be misleading. We must not only find a health practitioner that is willing to partner with you on your holistic health journey, but be up on the latest news of holistic healthcare. I personally work with a wonderful PA that understands my approach to health and will order the labs that I need after we discuss my “why”. I also have worked with Natropathic Doctors who fully support my approach as well, but they are out of pocket pay and I try to navigate the cost of my labs carefully.

Finding out “where you are” in your thyroid health can be nerve wrecking and intimidating to say the least. I have experienced this myself as a person who is well versed in the subject. I want to trust my doctors, but I must remember they are trained in Western Medicine and not Functional Medicine. In saying this, they know how to take care of me if I need meds or find myself in a crisis state, but in a preventative state they are not the one to draw advice from. I have had many a blank stare come back at me when all my labs look “great” to them and I am asking for other labs to be drawn.

This is a blog post about monitoring your labs and comparing the lab results to functional medicine ranges and not Western Medicine ranges. The people that were tested for Western medicine lab values were drawn from a not so healthy segment of the population. So, the Western medicine lab docs are comparing your labs to labs of unhealthy people. So if your lab results were normal, then you are sick! In functional medicine, we look at measurements from a narrower range of normal. The desire here is to have healthy labs and call that normal.

It is a good practice to get your labs drawn yearly and if you have out of range functional lab results, get them done every three to six months depending on your lab values. Most importantly, advocate for yourself and find the perfect fit of a health professional for you which is a person that understands preventative medicine and embraces your health history.

Symptoms of Thyroid Disease

Before we start, let’s chat about symptoms. You may think you are just tired or getting old, when in all actuality, you may be experiencing thyroid disease. Once you record your symptoms, rest, hydrate, and eat a nutrient dense diet, yet you find that you still have these symptoms, it is time for a doc appointment and labs. This list is not exhaustive and you may not be experiencing all of them.

Lethargy
Weight Gain
Brain Fog
Hair Loss
Increase Anxiety
Tingling or numbness in hands
Goiter
Dry skin and hair
Heavy menstrual periods
Irregular heart rate
Increased sensitivity to cold
Depression
Muscle Weakness

Record Your Symptoms

Remember to always record your symptoms. Record what they are, how long you are experiencing them, what you were doing when experiencing, and possibly what you were eating. It is imperative your your health practitioner to know how you are feeling. This is part of healthcare. Your symptoms are just as important as your labs. Take the time to record. It is worth it!

Could you say you are experiencing any of these symptoms? If so, keep a record of any and all symptoms you are experiencing. Document the symptoms, time of day, what you were doing, and possibly, eating and share them with your health professional. If you are still reading, then you most likely need to get these labs drawn. Let’s take a look at what the labs are and why you may need them.

Tests at a Glance

The following are a list of INITIAL tests that are highly recommended to have done with followup of any labs that fall into abnormal functional medicine lab ranges. Many of these tests can be ordered through your primary care physician or specialist and covered by most insurance companies. I will outline them in priority and in sections:

Thyroid Panel

The normal range of these lab tests will vary depending on the lab analyzing the sample. Test results need to be compared to the reference range of that specific lab. This means that you need to compare your results to the same measurement as before (i.e., compare ng/dL to ng/dL). Normal ranges for adults generally fall between these values.

TSH (.5-2.0 uIU/mL)
Total T4 (5.0-12 mcg/dL)
Total T3 (80-190 ng/dL)
Free T4 (1.0-1.5 ng/dL)
Free T3 (3.0-4.0 ng/dL)
Reverse T3 (9.2-24.1 ng/DL)
Thyroid Peroxidase (TPO) Antibodies (0 -15 IU/mL)
Thyroglobulin (TgAb) Antibodies (0 - 0.9 IU/mL)
TSI (>0 IU/mL)
TBII (>0 IU/mL)
Thyroid Ultrasound

“This is a list of INITIAL tests that are highly recommended to have done with followup of any labs that fall into abnormal functional medicine lab ranges.”

The Why Behind the The Thyroid Panel

TSH (.5-2.0 uIU/mL)
Total T4 (5.0-12 mcg/dL)
Total T3 (80-190 ng/dL)
Free T3 (3.0-4.0 ng/dL)
Free T4 (1.0-1.5 ng/dL)
Reverse T3 (9.2-24.1 ng/DL)
Thyroid Peroxidase (TPO) Antibodies (0 -15 IU/mL)
Thyroglobulin (TgAb) Antibodies (0 - 0.9 IU/mL)
TSI (>0 IU/mL)
TBII (>0 IU/mL)
Thyroid Ultrasound

Testing is done to determine “where you are” at that moment. It can determine if your current interventions are working and if you need to implement new interventions. Always keep track of your symptoms if you are experiencing anything unusual. Thyroid disease can begin before symptoms start. For this reason, it is imperative to see what’s “under the hood” via lab work before you start experiencing problems.

I believe that if you have a history of thyroid disease in your family, ANY kind, you should start getting your thyroid labs done on the start of puberty, unless you see symptoms happening before this happens. If labs are normal, having your levels tested every year is sufficient. If labs are outside of range, every three to six months is preferable.

There are many blood tests that can be done to assess thyroid function, yet the tests indicated in this post are the ones I start with each time.

TSH (Thyroid Stimulating Hormone) is actually a pituitary hormone that responds to low/high amounts of circulating thyroid hormone. TSH is used by health practitioners as a screening test for thyroid disease in general, Hypo and hyperthyroidism. If you are on medications for your thyroid, it is used to test for monitoring the correct dose of medication. The TSH test is not a one stop shop. You need to be able to look at the big picture and pull full thyroid panel. A normal TSH does not mean you are out of the woods. For example, elevated anitbodies, could indicate a thyroid condition called Hashimoto’s disease or even Graves Disease.

The Total T4 lab shows how much T4 is in the blood. T4 is a thyroid hormone that has four iodine units. Iodine is used by the thyroid in production of thyroid hormone and is ingested through the foods we eat. There is more T4 in your body than T3, but it is T3 that is the active hormone. The Total T3 lab shows us the total amount of the metabolically active thyroid hormone. It allows a doctor to check your body’s ability to convert T4 to T3 and to rule out an overactive thyroid.

Free T3 and Free T4 are tests that measure the levels of active thyroid hormone circulating in the body. When these levels are low, yet your TSH tests in the normal range. The free T4 & free T3 test is useful measure to determine if a person is properly converting thyroid hormones.

The reverse T3 (rT3) test measures how much of the free active T3 is able to bind at thyroid receptors. RT3 is produced in stressful situations and binds to thyroid receptors but turns them off instead of activating them. So when you are in a stressful situation, your body produces rT3 to give it a break and to prevent you from becoming hyperthyroid. This is an evolutionary adaptation to slow your metabolism in times of famine. When assessing your rT3 results, it is important to watch for trends of your levels going up. High rT3 due to stress has a snowball effect on hypothyroid symptoms. The adaptation by the body producing rT3 is not useful in our high-demand society when we must work and take care of our children, spouse, parents, etc. This test is sometimes used to identify cases of poor T4 to T3 conversion, or thyroid symptoms that are due to adrenal stress, instead of thyroid malfunction or autoimmunity.

There are various types of antibodies against the thyroid gland that can be detected in thyroid disease. The thyroid antibodies indicate that the thyroid gland has been recognized as a foreign invader by the immune system and that the thyroid gland is under attack. These antibodies can be detected for decades before changes in the other “standard” thyroid blood tests your primary care physician may pull on routine. That is why it is important to include antibodies in your blood work each year. You could have your standard thyroid TSH drawn each year and it be in the “normal range”, but your antibodies could be running high indicating that you, in fact, have a thyroid issue.

The thyroid peroxidase antibodies (TPO antibodies) and thyroglobulin antibodies (TG antibodies) are most commonly associated with Hashimoto’s Disease. There will be an elevation of one or both of these antibodies. TPO antibodies are the most common and have been reported in 5-38% of the population, depending on the study. Thyroid antibodies are often elevated for decades before a change in TSH.

The most common antibodies found in Graves’ disease are TSH receptor antibodies, including thyroid-stimulating immunoglobulin (TSI). This marker is elevated in >90% of people with Graves’ disease. TSH receptor binding antibody (TRAb), also known as TSH-binding inhibiting Immunoglobulin or TBII, is elevated in >50% of people with Graves’ disease. Both labs can be used for diagnostic purposes and monitored to track remission.

A thyroid ultrasound will help you and your physician determine whether you have changes consistent with Hashimoto’s (such as a rubbery thyroid, shrunken thyroid, enlarged thyroid, or if abnormal growths in the thyroid are present). Some growths may indicate an autoimmune process, others may indicate benign nodules, and others may signal cancerous nodules. It is recommend that at least one ultrasound for every person, especially women of childbearing age. If you have an ultrasound and see any of the listed abnormalaties, it is recommended to check your thyroid one time a year.

“Thyroid disease can begin before symptoms start. For this reason, it is imperative to see what’s “under the hood” via lab work before you start experiencing problems.”

Free Printable to Take to Your Doctor's Appointment

As always, I want to make taking care of yourself as easy as possible! I have created a PDF that outlines the list of thyroid tests provided in this post. I hope you take the time to download and tuck this away for your next appointment to embrace your #wholisticgreatness.

Book References From Podcast

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I am Claudine Phillips, a Registered Dietitian, Yogi, and wife and mom to 3. I blog, vlog, and podcast my experiences to a healthy and wholisitc lifestyle to inspire you find your #wholisticgreatnessl. I termed the phrase #wholisticgreatness to embrace spiritual, emotional, and physical health in order to become your best self. I share my personal stories as well as partnering with guests as they share their inspiration, tactics, and strategies to be their best selves! I can be found speaking locally and nationally, blogging, vlogging and connecting with you on my podcast, The Wholistic Greatness Podcast, and on all the socials at @claudinephillips. I can’t wait to connect!

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