Optimal Lab Values–how to interpret your results
Below are lab tests and information to help you interpret your results…because most results have NOTHING to do with being “in range”–they have to do with “where” you fall in a range. All the below will also help you steer your doctor with the right interpretation based on successful patient experience.
Note that for most of the below, you’ll need to be off what you are testing for a minimum of 12 hours, i.e. take nothing the morning of the test. For saliva, you need to be off any cortisol-containing or cortisol-changing supplement for up to two weeks. To order your own labs, see the link at the bottom of this page.
Note: if you see an error or a lab that should be added, use the Contact at the bottom of this page.
24-HOUR CORTISOL SALIVA TEST: An at-home test to evaluate your circadian cortisol levels at key times during a 24 hour period. Those will healthy adrenal function will have the follow results:
8 am: at the literal top of the range
11 am-noon: in the upper quarter, and often about a quarter below the top
4-5 pm: mid-range
11 pm to midnight: at the very bottom.
A DHEA above midrange is good, but 8 can mean the adrenals are compensating for a problem.
You will need to be off any adrenal support supplement, any medication containing cortisol, any herbs that support adrenal function, or zinc or licorice root for at least two weeks prior to testing. Avoid food when spitting into vials. If you wear dentures, remove them to prevent denture adhesives from tainting the spit.
AB (Antithyroglobulin) Test: Measures the level of the antibody protein antithyroglobulin in order to discern the presence of Hashimoto’s disease. Generally, if this is above the range, you’ve got the autoimmune thyroid disease Hashi’s. It the result is below the “less than” mark, or in the range provided, you may be fine, but you need to have done the other antibody test as well–the TPO shown below.
ALDOSTERONE test: Measures the adrenal hormone aldosterone which helps regulate levels of sodium and potassium in your body–i.e. it helps you retain needed salt, which in turn helps control your blood pressure, the distribution of fluids in the body, and the balance of electrolytes in your blood. If you are mid-or-below in the range, which is often 4.0 – 31.0 ng/dl , there is reason to be suspicious that your adrenals aren’t producing enough, since healthy adrenals will generally put you in the upper range.
This is best tested in the morning and with no salt intake for 24 hours. Women need to do it in the first week after their period, since rising progesterone can also raise your aldosterone. Center of this range is 17.5.
Testing should not be done with severe illness (aldosterone falls in response to severe illness), during periods of intense stress (aldosterone rises), or right after strenuous exercise (aldosterone rises). Being pregnant can result in doubled amounts of aldosterone.
Women should test their aldosterone in the first week after menstruation when progesterone is the lowest (higher progesterone raises aldosterone)
B-12 lab test: Measures an essential vitamin, B12, which can be low in hypothyroid patients due to low stomach acid. You are looking for an optimal B12 lab result at the top of the range.It is NOT optimal to simply be “in range”. If your range is similar to 180-900, a healthy level is 800 or higher. In the 500-800 range, you can benefit from taking B12 lozenges, specifically Methylcobalamin. It has been shown in studies that patients with labs under 350 are likely to have symptoms, which means the deficiency is very serious and has gone on for a few years undetected. Lab ranges are much too low for B12…in Japan the bottom of the range is 500.
The urine test Urinary Methylmalonic Acid, also called the UMMA, can be added since it is a very sensitive detection and if high, will reveal a true B12 deficiency.
DHEA test: Measures the mother of all steroid & sex hormones. Usually measured in conjunction with the 24 hour adrenal cortisol saliva test. See above.
FERRITIN test: Measures your levels of storage iron, which can be chronically low in hypothyroid patients. If your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are in the 50′s, you are scooting by. Optimally, females shoot for 70-90 at the minimum (Janie’s is 80 when her iron is good); men tend to be above 100 and optimally close to the 130′s. If your ferritin is much higher, you could have hemochromatosis, a genetic disease in which too much iron is absorbed. But a more common reason is having INFLAMMATION, which will thrust iron into storage. In less common cases, higher ferritin can be from liver disease, alcoholism, diabetes, asthma, or some types of cancer. Or it may be normal for YOU. Men are generally higher than women without having the above problems.
You should be off all iron for at least 12 hours before testing to see what your body is hanging onto, and 5 days to see your true iron levels.
FOLATE test: Also called folic acid, this is a b-vitamin which can be low in hypothyroid patients. Folate is important for prenatal development, as well as your blood cell health. Folate works with B12 in the use and creation of proteins.
FREE T3 LAB TEST: T3 is the active thyroid hormone. Free in front of the T3 means you are measuring what is available and unbound. Those on an optimal amount of desiccated thyroid, with no lingering hypothyroid symptoms and in the presence of healthy adrenals, tend to have a free T3 at the top of the range.
If you are on desiccated thyroid (especially if lower than 3 grains) and find yourself with the free T3 high or above range in the presence of continuing hypothyroid symptoms, or even hyper-like symptoms (anxiety, shakiness), it’s a clue you have adrenal fatigue, aka low cortisol
If not on thyroid medication: 1) If your free T3 is high, you could have Hashimoto’s disease, which will need the two antibodies tests to discern it, or Graves disease, which needs the TSI test. 2) if your free T3 is mid-range or lower, and in the presence of hypothyroid symptoms, you may have hypothyroidism, no matter how low the TSH.
You should NOT take any T3-containing product on the morning of a test.
FREE T4 LAB TEST: T4 is the thyroid storage hormone. Free in front of the T4 means you are measuring what is available and unbound. Generally, those on an optimal amount of desiccated thyroid will have a free T4 mid-range or higher when their free T3 is at the top and in the presence of healthy adrenals.
MAGNESIUM LAB TEST: Thyroid patients can be chronically low in the electrolyte magnesium, which causes a multitude of problems ranging from worsened Mitral Valve Prolapse, less cancer protection, poor muscle development, too much calcium, cramping, and many other chronic conditions. See Janie’s blog post on magnesium. For RBC Magnesium, you are looking for an RBC result mid-range or higher.
PERCENT % SATURATION: Measures your serum iron divided by your TIBC. You want your saturation to be 25 – 45%, with a goal of 35%, and men closer to 40-45%. Like all iron labs, you should be off all iron for at least 12 hours before testing to see how your supplementation is doing, or up to 5 days to see what your natural levels are.
POTASSIUM LAB TEST: Measures the electrolyte mineral Potassium, which is within cells, and has a balance with sodium, which is outside cells. Potassium plays a role in healthy kidney, heart and nervous system function. When potassium is too high, it’s called hyperkalemia; when too low, hypokalemia. It can rise in the presence of low aldosterone, then fall. Best to do an RBC potassium–red blood cell—which measures it in your cells. We’ve noted that patients with health levels can be 4.2 and higher.
Tell the lab tech NOT to use the tourniquet for drawing blood. It can falsely raise your potassium result.
RENIN LAB TEST: Measures the enzyme hormone that regulates the release of aldosterone and is done in conjunction with the aldosterone test. If renin is high in the range along with a low aldosterone, you have an adrenal cause. If both hormones are low in the range, you have a pituitary problem. Always tested along with Aldosterone to see if your problem is due to the adrenals (primary adrenal insufficiency) or your pituitary (secondary adrenal insufficiency).
REVERSE T3 TEST: This test has to be done at the same time you do the free T3, and you then measure the ratio between the two by dividing the RT3 into the Free T3. The body produces the benign RT3 naturally to rid itself of excess of T4, but in some cases, such as high or low cortisol, it’s made in excess and that excess clogs your cell receptors from receiving regular T3. (See page 162-163 in the STTM book for further detail)
SERUM IRON: Measures the small amount of your circulating iron which is bound by the transferritin mentioned above. It’s a small amount since most your bodily iron is bound to proteins like transferrin and ferritin. You are looking for 110 for women, 120 or higher for men.
SODIUM test: Measures the levels of the electrolyte sodium, which is outside cells, and has a balance with potassium, which is within cells. Sodium regulates bodily fluid and plays role in major bodily functions. We’ve noted that healthy folks will have this at 142 and even slightly higher.
THYROID PEROXIDASE ANTIBODY (TPO) test: Measures the thyroid antibody TPO, which will be above the normal level in the presence of Hashimoto’s disease. Generally, if this is above the range, you’ve got the autoimmune thyroid disease Hashi’s. It the result is below the “less than” mark, or in the range provided, you may be fine, but you need to have done the other antibody test as well–the AB shown above.
TIBC (Total iron binding capacity) test: measures whether a protein called transferrin, produced by the liver, has the ability to carry iron in the blood. Used to determine anemia or low body iron. It your result is high, and in the absence of chronic disease, you may be anemic. With healthy amounts of iron, this test will be low in the range—about 1/4th above the bottom number.
TSH LAB TEST: Supposedly measures the actual TSH in your body, called the Thyroid Stimulating Hormone, a pituitary hormone messenger. Yup, they are using a pituitary hormone to tell you if you have a thyroid issue.
For example, if your body needs more thyroid hormones, the pituitary gland releases the TSH in order to knock on the door of your thyroid to produce more hormones. So theoretically, the higher the TSH lab test, the more your body is screaming at your thyroid to produce! produce!
Creators of the TSH lab test came up with a ‘range’ that supposedly corresponds with healthy thyroid function. So theoretically, if your TSH lab results are higher than the range, it would imply something is triggering your actual TSH to be a little too active in screaming at your thyroid. That something would be a diseased thyroid, called hypothyroid.
But there are problems with this method of diagnosis. First, you can have a so-called normal result, yet be clearly hypothyroid with symptoms. Why? Because the TSH test cannot measure if all your cells & tissue are receiving the released thyroid hormones. Some may be (thus the normal TSH result) and some may not be (thus your clear symptoms). Second, if you have Hashimoto’s, you lab results can swing between hypo and hyper, & your lab test may be representing the middle of the swing.
The best way to use the TSH lab test is in diagnosing a pituitary problem, not a thyroid problem. A very low TSH with a low free T3 gives away a pituitary issue.
VITAMIN D test: (25-hydroxy vitamin D lab test) measures the level of the hormone vitamin “D”, which plays a role in your immune system and other important actions. 50-80 at the minimum is your goal in the range. Many thyroid patients are low in D due to digestive issues from being undiagnosed or undertreated, plus problems with Celiac or gluten intolerance.
OTHER LAB RESULTS YOU MAY RECEIVE THROUGH YOUR DOCTOR:
RED BLOOD CELL COUNT, HEMOGLOBIN (Hgb) HEMATOCRIT (HCT), MEAN CORPUSCULAR VOLUME (MCV), MEAN CORPUSCULAR HEMOGLOBIN (MCH), MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC), PLATELET COUNT, RANDOM DISTRIBUTION OF WIDTH (RDW): Here is a great page explaining what they can mean: http://www.drkaslow.com/html/blood_cell_counts.html
ACTH STIM: The ACTH Stimulation test, also called the Cosyntropin test, measures the ability of your adrenals to be stimulated by the ACTH, a pituitary hormone, and is used to diagnose Addison’s or Cushings disease, as well as hypopituitary. Usually done in an out-patient setting and takes only a few hours. A synthetic ACTH is injected into your arm and the response of your plasma cortisol levels are measured.
You’ll need to fast, and the test is usually done in the morning. You cannot be on any cortisol medications or supplements. An ACTH plasma test is often done at the same time ot measure the amount of ACTH being secreted by the pituitary gland.
Your cortisol levels will double if your adrenals are not diseased. The ACTH has not been found to be a good test for the kind of adrenal fatigue manifested by thyroid patients, which is sluggishness, not disease.
T7, TOTAL T3, TOTAL T4, UPTAKE, or any other thyroid labs: useless
Want to order your own labwork?? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/