Best Tests For Hashimoto’s and Hypothyroidism

Has your thyroid been checked? 

One of the most common conditions for both physical and mental health is thyroid gland dysfunction. Hypothyroidism (or sluggish thyroid) and Hashimoto's disease underlies many other conditions and presents with a broad array of symptoms- constant fatigue, debilitating exhaustion, poor motivation, mood disorders & depression, brain fog, difficulty losing weight, unexplained weight gain, cold sensitivity, female pattern hair loss, sluggish bowels, hormonal issues, constantly getting sick and fertility issues (especially an increased risk of miscarriage in the first trimester). And, the sad thing is that it is one of the most commonly missed and poorly diagnosed conditions.

I think the most common sentence I hear from people is “my thyroid has been checked and the doctor said that its fine”. That is usually followed by something like, “My doctor would ask me later - Are you sure you’re not just depressed or making this up in your head? Here’s a script for Prozac or Xanax”

Well, I’m going to tell you it usually hasn’t been checked properly. Standard medical exam for thyroid is a blood test for TSH. To have your thyroid fully checked and to be able to rule out thyroid issues with confidence, a Thyroid Panel is the only way- TSH, T3, T4, Reverse T3 & thyroid antibodies. TSH is, in fact, the last thing to change and is checking your brain, not your thyroid!

This is in support of all of those who have been told time and time again that their thyroid is fine, and ‘maybe you’re imagining how tired you are’, or ‘it’s all in your head, here’s a script for an anti-depressant’ 😩

When your General Practioner “tests your thyroid” on a blood test, the starting point is TSH (thyroid stimulating hormone), which is made in your brain and stimulates the thyroid to make free T3 and free T4. So, it’s actually testing your brain, not your thyroid. If TSH is in range (0.5-5) then you are told your thyroid is fine. So one patient can have a TSH of 0.55 and another 4.65 (huge difference) and they’re both fine?? I don’t think so!!

The problem is, if you are in range, then no further testing of the actual thyroid hormones gets done 😖🤬!

A thyroid panel is much more thorough and complete. It gives a rounded picture as to what is actually happening with thyroid function and usually, the answers lie within it. It is very seldom that it all comes back ‘normal’. For most, it is an enormous relief to know that something is actually going on biochemically, hormonally, and it’s not just in their head. There is a reason for their constant exhaustion, inability to lose weight, weight gain despite eating very little, depression, cold sensitivity, sluggish bowels, headaches, dry skin, chunks of hair loss, poor concentration, irritability...

Plus, we can then be more specific in how to fix it!

My Story

I was diagnosed with Hashimoto’s Thyroiditis after years of facing a wide range of symptoms: dry skin, fatigue, digestive issues, brain fog, aching joints, headaches, heart palpations, temperature changes, constipation, recurrent infections and constant sore throats.

When I was first diagnosed with Hypothyroidism, I had thyroid antibody levels at 701 IU/ml (normal is under 34) and a normal TSH level (but my symptoms were obviously anything but normal). I, therefore, was not put on medication but just told to carry on as I was until my thyroid would eventually ‘give up’.

In 2015, when my thyroid did finally ‘give up’ – I was put on medication which in part was good as it normalized my TSH levels – but I continued to experience a whole swing of symptoms.

I didn’t make the link straight away that I was feeling the way I was as a result of Hashimoto’s. I’d seen many doctors about how I was feeling and they’d never linked my symptoms to my underactive thyroid. I naively assumed that because I was on medication – I shouldn’t have any Hashimoto’s symptoms.

Little did I know at the time, was that even though the medication was balancing my thyroid function, my antibodies were still high. This meant that the autoimmune attack and therefore inflammation was still going on in my body – causing symptoms.

Through my research what I found was that many people (including myself) can go years before they are diagnosed, as most doctors don’t run comprehensive thyroid panels. Many doctors will often just check your TSH which will not show if there is an underlying autoimmune component. You will need your Thyroid Antibodies (Thyroid peroxidase antibodies – TPOAb and Thyroglobulin Antibodies – TgAb) checked to determine this.


What Testing should I know about?


TSH, T3, T4 Testing

Your TSH is generally the screening test that most doctors will do as a marker of thyroid function. However this can fluctuate, so it may not always show abnormalities straight away, especially in Hashimoto’s. This can mean that Hashimoto’s Thyroiditis is not always picked up until it has advanced.  However, if Hashimoto’s is left untreated, it will eventually present with elevated TSH.

Most functional medicine physicians suggest TSH should actually be around 1 and 2 IU/ml for patients to feel their best.

Other tests I would have checked to give you the big picture would be Free T3 and Free T4 levels. These reveal the amount of circulating hormone available to the body.

N.B. In pregnancy – TSH levels that don’t fall within the optimal range can have serious implications on a baby’s IQ, miscarriage, preterm delivery and even the ability to fall pregnant. There is also an association between increased risk of miscarriage and preterm delivery in those displaying thyroid antibodies. Current 2017 American Thyroid Association Guidelines for pregnancy can be found here. The ‘Australian Thyroid Association” recommends that if you are planning to conceive, ensure that your TSH is not over 2.5 IU/ml and that you are monitored throughout your pregnancy if you have Hashimoto’s Thyroiditis. Be sure to talk to your practitioner if you have any concerns.


Thyroid Antibodies

Many doctors will only check TSH (thyroid stimulating hormone) for thyroid function, however, if you suspect Hashimoto’s Thyroiditis it is imperative that you get tested for thyroid antibodies –  thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).

These thyroid antibodies can become elevated years before TSH is affected, and are associated with the whole range of Hashimoto’s symptoms. (This is why I had been symptomatic for years prior to diagnosis – as my TSH was still within range and I had never been checked for antibodies.)

There are some cases where antibodies are not present but the patient actually has Hashimoto’s. This is generally when there has been so much thyroid destruction and autoimmune inflammation that the body no longer produces thyroid antibodies. In this case, Hashimoto’s Thyroiditis can be picked up via thyroid ultrasound.

Why did my doctor only check my TSH?

Many doctors simply don’t test their patients for Hashimoto’s because the conventional medical model treats autoimmune thyroid disorders in the same way as they would treat someone with a nutrient deficiency induced thyroid disorder.

If you’ve been told that you have hypothyroidism (an underactive thyroid) then you should ask your doctor whether they can also test for Hashimoto’s.

Medications are a great tool and can be imperative for many in overcoming Hashimoto’s. But while medication helps replace the hormones that the thyroid is no longer making, it doesn’t repair the underlying attack in Autoimmune Thyroiditis.

Only you know how you truly feel so chat with your practitioner if your TSH lab results are falling within ‘normal’ range, but you still do not feel right.  

Don’t be afraid to speak openly with your doctor to ensure that you are treated from your symptoms and not just from your lab values.

Lifestyle modifications really helped me on my healing journey – to greatly reduce my thyroid antibodies and eventually remove symptoms.

So, tell me ; have you had your thyroid checked? 

HEALTHAlice Chen