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Tests You Need and Optimal Levels as a Hypothyroid Patient

Tests You Need and Optimal Levels as a Hypothyroid Patient
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Originally published on 11th March 2016
Last updated on 18th April 2021

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

(see here why testing Reverse T3 is often controversial and why I’m dubious about whether it’s truly useful. I lean more towards ‘no’, however, you will see other thyroid resources suggesting we must have it checked.)

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.

Related Article: Why It’s Important to Know if You Have 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 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

If you only want to check TSH, Free T3 and Free T4, then you can find a UK option for this from Monitor My Health.

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

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. (UK test option here. 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. (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

For a UK PCOS Blood Test, click here.

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.

Coeliac Disease – A UK test can be seen here.

Other Endocrine Testing

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

Other Testing – these often seem to 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.

Lyme Disease – Find a worldwide test for Lyme Disease here.

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.

About Author

Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial and influential contributor to the thyroid community and has a large social media presence. Her books include "Be Your Own Thyroid Advocate" and "You, Me and Hypothyroidism".

21 Comments

  • Jennifer G.
    December 8, 2021 at 12:21 pm

    Please add me to your newsletter, I can’t seem to figure out where to do so! Thank you!!

    Reply
    • Rachel Hill
      December 9, 2021 at 10:38 am

      Done! Check your email and junk folder for any confirmation emails.

      Reply
  • Brandy Robinson
    March 23, 2021 at 12:00 am

    Please add me to your newsletter. Thank you!

    Reply
  • Diana Osborne
    August 24, 2020 at 1:37 am

    Could you please add me to your newsletter subscription

    Reply
  • Phyllis
    September 26, 2019 at 10:31 pm

    Please send me your emails every two weeks.
    Thank you.

    Reply
  • Norma Shaffer
    July 24, 2019 at 2:25 am

    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.

    Reply
  • Cara Riley
    April 1, 2019 at 10:22 am

    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

    Reply
  • Caz / InvisiblyMe
    March 27, 2019 at 6:11 pm

    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

    Reply
  • ELAINE D KELLER
    February 12, 2019 at 9:32 pm

    New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine. https://www.sps.nhs.uk/wp-content/uploads/2018/11/RMOC-Liothyronine-Guidance-v2.0-final-1.pdf

    Reply
    • Rachel Hill
      February 12, 2019 at 9:33 pm

      This is very helpful- thank you!!

      Reply
  • Julie clegg
    January 7, 2019 at 4:59 pm

    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

    Reply
  • Julie clegg
    January 7, 2019 at 4:59 pm

    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

    Reply
    • Rachel Hill
      January 7, 2019 at 5:00 pm

      Hi Julie. You’ve said you’re borderline hypothyroid, have they offered any medication at this stage? It may help you.

      Reply
  • Marie Arp
    September 16, 2018 at 4:30 pm

    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.

    Reply
  • Margaret Milburn
    August 17, 2018 at 3:31 pm

    I requested Reverse T3 testing, but was told it is not done by the NHS unless you have had Thyroid Cancer – has anyone else been refused this test?

    Reply
  • Dee
    June 5, 2018 at 1:11 am

    Mү spouse and I absolutely love your blog.

    Reply
    • Rachel Hill
      June 15, 2018 at 8:51 am

      Thank you!

      Reply

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