Tests You Need and Optimal Levels as a Hypothyroid Patient

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Originally published on 11th March 2016
Last updated on 2nd December 2019

As a thyroid patient, the below blood tests are recommended to get the full picture of what’s going on. If you still have symptoms, despite being on thyroid medication, explore these. If you feel well on your thyroid medication, monitor these regularly.

Really, everyone should monitor their thyroid levels. 

You may have to repeatedly ask doctor or try a few different types of medical professionals before you find one who will do all of them. Alternatively, you could order them yourself if this is an option. I have linked to some places below, next to each test.

The results you should be aiming for are also listed where possible.

The Essentials: A Full Thyroid Panel, to include as many of these as possible:

TSH

Thyroid Stimulating hormone. It gives an indication of thyroid hormone levels but doesn’t actually measure them as it is a pituitary hormone and not a thyroid hormone. Read more here. It serves as an average read out over the previous four to six weeks of your thyroid levels.

Free T3

A measure of the active thyroid hormone, T3.

There are binding proteins that attach to thyroid hormones to transport through the blood vessels, to cells all over our body. When they reach the cells, only the unbound ‘free’ hormones can actually be used by the cells. Therefore Free T3 levels (and Free T4) are important to monitor. It’s important to be aware that Free T3 and Free T4 are different to Total T3 and Total T4. Make sure you check ‘free’ levels.

Free T4

A measure of the less active thyroid hormone, T4. The body should convert T4 to T3 but doesn’t for a lot of thyroid patients.

Reverse T3

This counteracts the T3 your body is producing, so it is important to test this wherever possible because the three above could potentially be OK, whereas a hidden overproduction of RT3 can cause ongoing symptoms because your body is attacking the T3 that is produced.

Thyroid Peroxidase Antibody/ies (TPOAB)

This measures the amount of thyroid attacking antibodies in your blood and is used to identify an autoimmune disease like Hashimoto’s Thyroiditis.

Thyroglobulin Antibody/ies (TGAB) 

Also used to identify Hashimoto’s.

Why You Need These

At the very least, you must have TSH, Free T3 and Free T4 tested to get an idea of how you are doing, but also testing Reverse T3 and the two antibody tests can be very beneficial.

It’s worth knowing that you can order full thyroid panels yourself from online laboratories too. Find a UK lab here and a worldwide lab here. Many panels do not include Reverse T3, so I have listed this separately below.

Optimal Thyroid Test Results

TSH – Below 2 or 2.5 on T4 medication, but often close to 0 (suppressed) on T3 containing thyroid medication. More information found here

Free T3 – Upper quarter of the range. More information found here

Free T4 – Midrange or a bit higher. More information found here

Reverse T3 – Low in range

Reverse T3 Ratio – Over 20. Measure the ratio. (UK test available here, US test here.)

TpoAB and TgAB – In range indicates Hashimoto’s is not present or that it is in remission. Over range means you have Hashimoto’s that is not controlled. (UK lab test including thyroid antibodies here and a worldwide lab here.)

Always work with a doctor in evaluating and reevaluating your thyroid hormone levels, keeping in mind your symptoms and overall health as well. We’re all individuals and there is no ‘one size fits all‘, but there are obviously health risks if your thyroid hormone levels, vitamin levels or any others are either too low or too high for an extended period of time. Your doctor should know where they sit best for your health. The given numbers are a guide only. 

Other tests to explore and results most thyroid information sources state to aim for:

Vitamins and Minerals:

Vitamin D 50-80 ng/ml, but as close to the top of the range as possible. (Worldwide test option here.)

B12 – Close to top of range. (Worldwide test option here.)

Folate/Folic acid – In the top quarter of the range. (Worldwide test option here.)

Ferritin – 70-90 ng/ml, being slightly higher for men. (Worldwide test option here.)

Iron, T.I.B.C., Transferrin Saturation – well within range. (Worldwide test option here.)

Magnesium – Mid-range or higher. (UK test here, US option here.)

RBC Potassium – Top quarter of the range. (UK test here, US test here.)

Zinc – Top third of the range. (UK test here, US test here.)

Sex Hormone Testing (for: fertility, sex hormone imbalances such as oestrogen dominance, PCOS)

Oestrogen, Oestradiol
Progesterone
Testosterone
LH
FSH
Prolactin

This UK test checks almost all of these in one go (minus progesterone).

This US lab checks almost all of these in one go (minus prolactin).

Adrenal Health

24-Hour, 4-point Saliva Cortisol Test
8am – Top of the range.
Midday  – Upper quarter of the range.
4-5pm – Midrange.
11pm – Midnight – At the very bottom of the range.

DHEA – Above mid-range.

If your doctor won’t check your adrenals, you can very simply order testing yourself in the UK here and US here.

Gut Health Testing

Candida (yeast overgrowth) – A UK test for Candida can be found here and a US test here.
H Pylori – A UK test can be seen here and a US test here.

Other Endocrine Testing

Diabetes (HbA1c/Haemoglobin A1c/glycosylated haemoglobin) – UK test option, worldwide test option.

Other Testing – Issues with these often come hand in hand with thyroid issues

Cholesterol (Triglycerides, cholesterol, HDL, LDL, Non-HDL, Total/HDL Chol ratio) – UK test, worldwide test.
Kidney Function (Urea, Creatinine, Estimated GFR) – UK test option, worldwide test option.
Liver Function (ALP, ALT, CK, Gamma GT, Bilirubin) – UK test option, worldwide test option.

Click here for more places you can order your own tests from. 

***

Please find references to optimal results here.

You can click on the hyperlinks in the above post to learn more and see references to information given.

If you found this article beneficial, please take a moment to share it so we can help others get better with hypothyroidism and Hashimoto's, whilst also raising awareness. "Be Your Own Thyroid Advocate."

Written by Rachel, The Invisible Hypothyroidism

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16 thoughts on “Tests You Need and Optimal Levels as a Hypothyroid Patient

  1. Rachel thank you for all of your posts. I want to ask you a question though. My niece has Lupus and I’ve seen a large amount of Hypo folks have Lupus and Hashimotos. Do you know how that can be determined or the name of a specific test. Any other thoughts on this subject? Thank you.

  2. Any ideas on how to increase dhea when dhea supplements cannot be tolerated and I am taking as many natural supplements as I can (and eating as healthily as I can on a modified AIP (I can tolerate almonds, so use them as low-carb snacks)? Dr Google could not help me. TIA

  3. This post is so vital, I’m glad you’ve reshared it. Incredibly useful to help patients help themselves as all too often tests are kept minimal (if offered at all) so we need to know what to ask for and have checked. x

  4. My tsh is 0.01 t4 13.1 and t3 4.77 .sub clinical hypothyroidism .I had a total hysterectomy 2 years ago none of hrt patches worked nor did gabapentin .Feel terrible .admitted to hospital with pins and needles down one side of body .I have aching joints .neck pain .profuse sweating. Puffy eyes .anxiety .cold hands and feet ..the list goes on ..at doctors tomorrow is there anything I could ask the doctor , advice please ..so drained with it all .thankyou

  5. My tsh is 0.01 t4 13.1 and t3 4.77 .sub clinical hypothyroidism .I had a total hysterectomy 2 years ago none of hrt patches worked nor did gabapentin .Feel terrible .admitted to hospital with pins and needles down one side of body .I have aching joints .neck pain .profuse swearing. Puffy eyes .anxiety .cold hands and feet ..the list goes on ..at doctors tomorrow is there anything I could ask the doctor , advice please ..so drained with it all .thankyou

  6. I want to sign up for your newsletter.This is the only place that respond with a place to give up my email. Hope you will add me to your list from here. Others links did not take me anywhere.

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