Did you know that there were decades of successful treatment for hypothyroid that involved nothing more than dosing you by symptoms? The TSH lab didn’t even come into existence until the mid-1970’s.
Today, the tables have completely turned. We now live in a lab-obsessed society, where most doctors completely ignore your thyroid symptoms and make your man-made lab results the holy grail of diagnosis. And diagnosis and treatment based solely on labwork for thyroid is a consistent failure, leaving millions of patient either undiagnosed, or undertreated.
Even worse, when labs are used, the majority of doctors are only doing the TSH (thyroid stimulating hormone) and total T4 to diagnose or treat you, neither which give an accurate clue to your hypothyroid condition. Additionally, ranges are made the “end-all” of normalcy. Who reading this hasn’t been told they are “normal” because an ink spot on a piece of paper falls within a dubious range, yet your body screams with NON-normal symptoms?
So…when you visit your doctor, you have to be outspoken about your symptoms. Symptoms should be the conductor of the orchestra, and labs are simply adjuncts for more knowledge. Then, when labs are mentioned, below are those we recommend you insist to your doctor that you want. Farther down, you can see explanations of all labs.
* TSH But this lab is only for diagnosis of hypopituitary, NOT to diagnose or dose your hypo by.
* Free T4 and Free T3 (note the word “free” – important.)
* Thyroid Antibodies (anti-TPO and TgAb. YOU NEED BOTH.)And add these in, since they can be low in thyroid patients:
* Ferritin (and do stress FERRITIN, not just RBC)
* Adrenal Cortisol levels (but we strongly recommend saliva tests, not the one time blood test your doctor will do. See below, because you don’t need a prescription)
* B-12 and Folate
*RBC Magnesium and Potassium
* Vitamin D (25-hydroxyvitamin D lab test…plus others your doctor may recommend.* Reverse T3 (to be tested when your Free T4 is in the upper part of the range with continuing symptoms. You need to do it at the same time you do free T3 to measure the ratio)
Below are lab facilities you can use without a prescription. Most are saliva testing, some are blood testing, and another is both saliva and blood – the STTM lab packages! (Saliva is highly recommended to test cortisol. Salivary glands have a high blood flow, and the “free” hormones from your blood (red blood cells and plasma) easily filter through your saliva glands into saliva where they can be measured accurately. So saliva tests better reflect your free and useable “bioavailable” hormones in your blood, thus making them more relevant.) We do not recommend saliva for sex hormones.
NOTE: some of these facilities are requiring a prescription for a Reverse T3 test. Sad.
LAB WORK packages designed specifically for readers of Stop the Thyroid Madness. Use the discount code STTM10 which will give you 10% off the already low prices! STTM Thyroid and Adrenal Lab Packages You can choose just saliva for cortisol, or use LabCorp facilities around the US for blood draws.
LAB WORK packages designed specifically for readers of Stop the Thyroid Madness -STTM Thyroid and Adrenal Lab Packages You can choose just saliva for cortisol (which is six times in a 24 hour period), or use LabCorp facilities around the US for blood draws.- LAB WORK from ZRT LABORATORIES Saliva and a blood prick test…or one or the other. Adrenal Function Test for cortisol. The blood spot test kit uses a finger prick and several tests can be done from a single sample. They state it’s on par with serum needle blood draw tests, though you can do this right in your own home. THIS IS ALSO A PLUS SINCE SALIVA CAN FAIL TO DETECT THYROID ANTIBODIES. One downfall: it’s at least $100 more expensive than saliva. http://www.salivatest.com/
- LAB WORK from Direct Labs/Sabre Sciences. Use the Hormone Panel-Female, which will do 7 samples for estradiol and progesterone, 1 sample for testosterone, 6 samples for cortisol, and 3 samples for DHEA, collected at designated days and times. Also included is the Electrolyte panel of sodium, potassium and chloride. $307 www.directlabs.com/ Or you can just do the Special Thyroid Panel (forget their Complete Thyroid Panel – it also adds the useless T3 uptake, T7 and total T4).
- LAB WORK from Vitamin Research Products Saliva Test kits including iodine, adrenals. They can do New York residents.
- LAB WORK from Canary Club. This website is not a lab, but offers saliva for cortisol, plus more. Saliva for antibodies or female hormones not recommended by many patients. Shows screwy results. (Canary Club used to offer Diagnos, Tech, but as of late March 2009, they are removed. Probably a good thing, since some patients were finding results through Diagnos Tech which did NOT match their symptoms or other saliva results.)
- Finland: Test kits from Genova diagnostics via MDD Terveyspalvelut: http://www.mdd.fi/
- Germany: Saliva testing and helpful facility http://www.hormonselbsthilfe.de/
- United Kingdom Labwork from Lab21: Click on Chemical Biochemistry to find Saliva: http://www.lab21.com/healthcare/index.php#
- United Kingdom Labwork from Red Apple Clinic. Thyroid, Adrenals, and others. (thanks to Crunchie for this info). www.redappleclinic.co.uk
- Australian Labwork from Analytical Reference Laboratories (ARL) or PathLab You can order the kits yourself, but you won’t be covered by Medicare (national public health insurance) so you have to pay in full. Or you can convince your doctor. Just ring either of these labs and ask what doctor in your area uses their kits. ARL: 568 St Kilda Road Melbourne,Victoria, Australia, 3004; (61 – 3) 9529 – 2922; fax (61 – 3) 9529 – 7277 info@arlaus.com.au. or PathLab: 68 Burwood Highway, Burwood, Victoria 3125, (61 – 3) 8831 – 3000; Fax (61 – 3) 9808 2247; (Nutritional Laboratory Services), Ed Sorich Integrative Medicine Dept; www.pathlab.com.au
- Curious about your D levels? Go here: www.virginiahopkinstestkits.com/vitamindtest.html or you can use the STTM labs in #1 and #2 above for Vit. D and B-12 with a discount through Healthcheck.
NOTE: several labs above provide you with the term “Cortisol Burden” and a number. Cortisol Burden is the combined value of all 4 saliva cortisol readings for the awake period of that particular day. It can tell you if you are making more or less than the average.
ABOUT RANGES: Each lab facility can have different ranges, so it’s important to evaluate YOUR results by the ranges provided by the lab facility you used. But, we especially like the free T3 represented on this page, since the free T3 range is especially wide!! Dr. Domissee of Arizona remembers using a lab that also had a range more like this one, and we hope to see a return of this. The current free T3 ranges are often far too narrow!
***CLICK HERE TO READ HOW TO INTERPRET YOUR LAB RESULTS.
TSH: This is the abbreviation for Thyroid Stimulating Hormone, and is also known as thyrotropin. It’s produced and stored in the Pituitary gland, and is released to stimulate your thyroid to release more hormones. When your TSH rises high, it means your thyroid isn’t doing it’s job, and the TSH is saying “Produce! Produce!” On the other side of the coin, when the TSH goes low, it can mean your thyroid is overproducing, called hyperthyroid. But remember: there’s a huge different between the REAL TSH in your body, and the TSH lab test. Patients have consistently found the TSH lab to be a lousy measure, and more specifically because of a questionable “normal” range, causing a patient to go for years without diagnosis. Additionally, the TSH often lags behind what is really going on, or it can be affected by factors including hypopituitary, acute stress, extreme illness, or the first trimester of pregnancy, etc. Additionally, you can have a very low TSH during a one time lab test, yet have an untested high TSH a few days later. That fluctuation is indicative of Hashimoto’s or an attack of the thyroid, causing swings between hypo and hyper. And once you start on treatment, patients have noted that when they are kept within the range – even at the lower end – they continue to have symptoms! It is totally useless? No. A low TSH lab test in the presence of a low free T3 and symptoms to match hypothyroid can point to hypopituitary. This condition means your pituitary fails to send a message via the TSH to your thyroid to produce. Causes can range from a tumor on the pituitary gland, to severe head trauma, to radiation, surgery or infection. Go here to read more.
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ARE YOU A SMOKER??? There is evidence that those who smoke have a lower TSH than those who don’t. That can be a disaster in our TSH-obsessed society, and your diagnosis of hypothyroid can wane. So there is wisdom in refraining from smoking the day of your lab blood draw. To see a research study on smoking and your TSH, go here.
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Free T4: T4 is the storage form of thyroid hormone, called levothyroxine or l-thyroxine, and it’s “main” purpose is to convert to the active hormone T3. There are two llabs: one will simply say T4, and the other will say free T4. If you only have the T4, aka the total T4, you are measuring both bound and unbound T4, and it fails to tell you what is free and useable. The free T4, on the other hand, shows the latter. Make it clear to your doctor that you want the FREE.
Free T3: T3 is the active thyroid hormone, also called triiodothyronine, and can be the most important lab you will do. Same as above, you need to specifically request the free T3 to reveal what is unbound and available. You can have a so-called normal TSH, but if your free T3 is low in the range, that is a strong sign of your hypothyroid status. Though most of the T3 in your body is produced by the conversion of T4 to T3, there is also a direct release of T3 from the thyroid. T3 is the active hormone which is responsible for your overall good health, metabolism, immune strength, etc. A good level of T3 is what prevents chronic low grade depression, high cholesterol, dry skin and hair.…the list is endless. When patients are raising their Armour, their optimal dose is most often the amount that gets their free T3 at the top of the range, if not slightly over in some patients, with no hyper. The free T4 is often mid-range, and the TSH is most often suppressed. The latter does NOT equate to having osteoporosis or heart problems, as many uninformed doctors will rotely state. Instead, patients have reported their bone density IMPROVED, as did some heart issues.
ANTIBODIES: Antibodies are proteins produced by your immune system in response to a problem. If your labs come back above-range for thyroid antibodies, you can have an autoimmune thyroid disease, also called thyroiditis or Hashimoto’s, which means your thyroid is being attacked. There are two forms – one set targeting your thyroid peroxidase (an enzyme that is important in the production of your thyroid hormones) and the other targeting your thyroglobulin (a protein carrier for your thyroid hormones). It is not uncommon for one to be in range, and the other to far out of range. The latter fact is why you need BOTH tested. Make sure you are taking Selenium, since studies show it can help reduce the TPO antibodies. I have not yet found research as to if it can lower the thyroglobin antibodies. Even with the presence of antibodies, you can initially have a so-called “normal” TSH and the lack of symptoms. But down the line, you WILL get symptoms of the attack, which can include vacillating between hypo and hyper, and eventually becoming a raging hypo. So, it’s important to “tackle the attack”, and patients have found great success when they are willing to dose high enough with Armour. Armour, when raised high enough, appears to remove the signal that creates the attack.
IMPORTANT: if your labs show that you have antibodies, all labwork has to be thrown out the window when it comes to using them for diagnosis. Why? Because antibodies mean an attack is going on, and an attack means you will swing between hypo and hyper. One lab will look hyper, and the unknowing doc will tell you to decrease your Armour…when in reality, you need to INCREASE your Armour to eventually STOP the attack. With antibodies present, you have to dose by the elimination of symptoms, NOT labs. A large goiter or thyroid gland can accompany some cases of Hashimotos. Or, you can feel a discomfort when you swallow, and a tightness around the neck area. Elevated thyroid antibodies have been linked to a wide array of non-thyroid diseases including chronic inflammatory bowel disease and diabetes.
ADDITIONAL LABS TO CONSIDER: Many thyroid patients have benefited from getting other labwork, including DHEA, testosterone, progesterone, estrogen. The creator of this site found her testosterone to be quite low, even though she had no symptoms of it. Her doctor helped her start supplementation and she found the surprise result of the complete removal of low back pain upon waking. Other female patients with low sex drives found that the testosterone supplementation renewed their drives. We are seeing more labs being done for Vit. D, as well as other minerals. Highly recommended. *To read a good article on Saliva vs. Blood tests, go here.
*Click HERE to see OPTIMAL LAB VALUES…i.e. what your lab results mean and where you want to be.
