Just recently a patient came into my practice feeling fatigued, moody, was having heavy periods, no libido, and was bothered by constipation. She also wasn’t sleeping well – waking up too early in the morning and unable to fall back to sleep, and she’d gained 7 pounds in just a couple of months even though she hadn’t changed her eating habits.

All are signs of hypothyroidism.

We talked. She really didn’t feel that stress was causing her symptoms – nothing in her life was really that troublesome. She had no outlier symptoms that suggested another diagnosis. She was pretty sure something was wrong with her thyroid so she’d asked her primary doctor to check her thyroid labs before scheduling to come see me for an more integrative medicine consult. He’d checked her thyroid stimulating hormone (TSH) test only, and told her that since it was still in the normal range, even though it was at the upper end of normal, she did not have a thyroid problem. He sent her on her way suggesting that maybe an antidepressant would be good to consider.

But her labs weren’t normal. One step over a very thin line and she’d have had a slam dunk diagnosis of the most common thyroid problem: hypothyroidism. And in fact, this is what I diagnosed. She started appropriate treatment and her energy and symptoms quickly began to improve!

This is a typical story.

Getting to The Bottom of Thyroid Testing

While not all hypothyroid-like symptoms turn out to be a problem with the thyroid or thyroid hormones, we do know that statistically, hypothyroidism is an under-diagnosed condition. In fact, only about half of Americans with a thyroid problem know they have one, and it is estimated that this can be as many as 4-10% of Americans

Hypothyroidism is the most common thyroid problem, and Hashimoto’s disease, an autoimmune form of hypothyroidism, is the most common form of all. Women are much more likely than men to have thyroid problems. Hypothyroidism can appear at anytime but is especially common after childbirth and is prevalent in woman in their 40s and 50s.

Yet so many doctors seem reluctant to do an adequate work-up of thyroid function. Some even refuse! This seems strange given how common thyroid problems are, and yet they are quite willing to freely prescribe antidepressants. My patient’s doctor was doing just what we were all told to do in medical school – check the TSH and if that’s within what we were told is the normal range, there’s no problem. But there’s much more complexity to thyroid testing than that! Sadly, so many women are left believing that their symptoms of depression, fatigue, joint aches, weakness, weight gain and more are all in their head! Perhaps this has even happened to you.

In reality, your symptoms could be due to hypothyroidism.

What is the Thyroid?

The thyroid is a butterfly-shaped gland that sits at front of your neck and sets your entire metabolic rate. Thus it controls your weight, whether you feel sluggish or energetic, mentally crisp or foggy, cheerful or blue, and is involved in the control of everything from your cholesterol to your female hormones.

When your thyroid is not functioning optimally, you can feel dull, tired, constipated, gain weight, your skin gets dry, your hair can become dry and even fall out, your muscles and joints might ache, your periods become irregular, you might have fertility problems, brain fog, sugar and carb cravings (because your body is desperate for energy!), high cholesterol even if your diet is amazing, and a host of other large and small symptoms.

What is Hypothyroidism?

Hypopthyroidism is a term used to describe a decreased metabolic state that is due to inadequate amounts of – or functioning of – thyroid hormone. Ninety-five percent of all cases are due to what is called “primary hypothyroidism.” This means that the thyroid gland is acting sluggish – or sometimes barely responding at all. This can be due to a number of reasons ranging from leaky gut to autoimmune disease.

Alternatively, we can be producing thyroid hormones effectively, but we can have “thyroid hormone resistance” similar to the way we can have insulin resistance. Our cells are not picking up and effectively using the active thyroid hormone we are making. We can also be making enough of the inactive form of thyroid hormone but not be effectively converting it to the active form.

While hypothyroidism can also be due to more serious problems in the hypothalamus and pituitary, this is rare. However, chronic or substantial stress can suppress the pituitary gland enough to interfere with thyroid hormone production.

Symptoms of hypothyroidism include:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Unexplained weight gain
  • Cravings for sugar and carbohydrates
  • Puffy face
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness and stiffness
  • Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Impaired memory (“Brain fog”)

Because these symptoms are so common to so many women, hypothyroidism is often dismissed as “just normal symptoms” or depression! One patient of mine was accused of overeating by her primary doctor as the cause of her weight problem when she actually had a thyroid problem!

The 6 Key Thyroid Tests

There are 6 key tests that can unlock the mystery of your thyroid function and are what your doctor should be looking at. Thyroid testing should be simple to obtain from your primary doctor or local lab. However, the nuances may take some skill to interpret, depending on the results, and your doctor might be resistant to ordering more than the TSH test. That’s where an open-minded endocrinologist or a skilled Functional Medicine doctor can be of help!

In this blog I will discuss key thyroid testing. In a subsequent blog I will discuss interpreting the results to understand your situation, the variations that can point to whether you have an underfunctioning thyroid gland, thyroid hormone conversion problems, or thyroid hormone resistance. In yet another blog I will address the causes, prevention, and treatment of thyroid autoimmunity.

In my practice, if my patient’s symptoms are highly suggestive of hypothyroidism, I will run the entire thyroid panel described below right up front. If there are other diagnoses that are equally likely, I will run just the first 3 tests (Panel 1), and if these come back borderline or positive for thyroid or thyroid hormone problems, I will then add in the remainder of the test panel (Panel 2). I will also sometimes recheck test results for TSH, FT3, and FT4, if normal in a newly symptomatic patient, in 6-12 weeks, because I’ve occasionally seen initial testing be normal then a short time later, voila – the tests come back confirming the problem. 

Thyroid Stimulating Hormone (TSH)

Thyroid Stimulating Hormone (TSH) is produced in a part of your brain called the pituitary gland. The job of TSH is to tell the thyroid gland that it’s time to get busy producing more thyroid hormone. When the healthy thyroid gets this chemical message, it produces two hormones: triiodothyronine (T3) and thyroxine (T4),

The normal range for TSH is somewhat controversial. Most labs consider the upper range to be between 4 and 5 mU/L. However, many experts – even in conventional endocrinology – believe that the upper end of normal is actually more like 2.5-3 mU/L. This is based on the fact that when Americans without any hypothyroid symptoms have this test done, that is the most usual upper range.

Many integrative and functional medicine doctors find that their patients feel their best at an upper limit of 1.5-2 mU/L.

My patient was one of these people. At a TSH of 4 she was really at the upper limit of normal, over the preferred upper limit according to some docs, and well over the 1-2 mU/L upper range! This controversy and discrepancy of opinion over the normal upper range for TSH is one of the most common reasons that women get under-diagnosed for hypothyroidism and suffer with unnecessary symptoms that can seriously interfere with health and quality of life.

In most cases hypothyroidism occurs because the thyroid gland is sluggish – that is, it is having trouble producing T3 and T4. This can be due to a variety of reasons ranging from nutritional deficiencies to autoimmunity. So TSH gets pumped out in a higher amount to try harder to stimulate the thyroid gland into action. Think of it like this: You are TSH. Your best friend’s house is the thyroid gland. When you go to visit your friend you knock on her front door. If she doesn’t answer, what do you do? You knock louder to get a response. In just the same way, the TSH amps up to knock louder, hoping to get an answer. That’s why an under-functioning thyroid shows up as high TSH on lab tests. However, TSH can be normal in the presence of hypothyroidism in some cases, and you can still be having the symptoms of low thyroid when TSH is normal because of poor conversion of T4 to T3 (see below) or because of thyroid hormone resistance at the level of your cells.

When stress is suppressing the pituitary gland enough to interfere with producing TSH, you might see low or normal TSH levels in the presence of low thyroid hormone production (T3 or T4), and hypothyroid symptoms.

Thyroid Hormones (T3 and T4)

Triiodothyronine (T3) and thyroxine (T4) are the hormones produced by your thyroid gland. T4 is produced in a much larger amount and is then converted to T3, the active form of the hormone, as needed to up-regulate metabolic functions. T3 and T4 are sent out into your bloodstream where they are responsible for the thyroid’s actual work of controlling your metabolism. Free T3 (FT3) and Free T4 (FT4) are called this because they are not bound to proteins in your blood, making them free to perform their work in your cells – keeping your metabolism appropriately revved up for your optimal health.

Measuring FT3 and FT4 is important because they are the indicators of thyroxine and triiodothyronine activities in the body. A high TSH and low FT4 and FT3 indicate hypothyroidism. A normal TSH, normal FT4, and low FT3 can indicate T4 to T3 conversion problems, and a normal or high TSH, normal FT4 and high FT3 can indicate cellular resistance to FT3 which can still lead to hypothyroid symptoms because the active hormone can’t get to the cell to do its job.

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Thyroid Antibodies

Thyroid antibody testing is ordered to diagnose autoimmune thyroid disease and distinguish it from other forms of thyroid dysfunction.

The two thyroid antibody tests that I order are Thyroid peroxidase antibody (TPOAb) and Thyroglobulin antibody (TgAb). Some people do have an autoimmune thyroid condition but don’t initially test positive. If positive, antibody testing can be repeated every six months to trend improvement while you are working with an integrative physician to address possible underlying causes.

Reverse T3 (rT3)

Reverse T3 is the third most abundant form of thyroid hormone. When your body wants to conserve – rather than “burn” – energy, it will divert the active T3 into an inactive “reserve” form. This might happen when you are sick, under stress, or undernourished. If TSH and FT4 look ok, but FT3 is low this can be because it is being diverted into rT3 – which will be elevated. It is worth checking rT3 if there are obvious symptoms suggesting hypothyroidism, but the typical tests aren’t demonstrating low TSH or low FT4. There is some controversy amongst conventional doctors about the utility of this test – I personally find it very useful.


Additional Testing

If labs return showing that there is hypothyroidism, then I also test for deficiencies of selenium, iron, and zinc and make sure there is adequate dietary intake or supplementation if needed, and look for environmental factors that can interfere with iodine utilization, for example, fluoride and bromide exposures from water and flame-retardant products, respectively. I will then also start to look more closely for other underlying causes, for example, gluten intolerance, heavy metal exposure, and other environmental triggers.

Talking with Your Doctor About Thyroid Testing (or Switching Doctors)

As a doctor, I can tell you that in medical school we are taught that doctors know best. But this is often not the case. You are your body’s best expert. After all, you live with you all the time! And you have a right to ask for basic testing and receive it. We’re not talking about tens of thousands of dollars in MRI’s and CT scans here – we’re talking about modest amounts of blood work.

That said, do discuss your symptoms with your doctor because there’s a lot of hype in the natural medicine and natural products world, and your doctor is possibly just trying to protect your from the opposite problem – getting OVER-diagnosed or misdiagnosed with a thyroid problem – and believe me, I’ve also had many patients who were put on thyroid medications by integrative practitioners when these meds were not needed.

If you are unable, however, to have an honest conversation with your doctor, if you feel your doctor is not listening or is condescending, then that’s another issue. You should be able to have mutually respectful conversations with your care provider, to get the answers you are seeking, and to be able to explore your concerns. If you can’t, then figure out whether the obstacle is in your being unable to speak up because of a perceived power differential (many of us become weak in the knees when we face our doctors, especially if we feel vulnerable about our health) or whether your doctor is just not communicating respectfully. And make the change!

Wishing you energy and happiness,



Get the first chapter of my new book The Adrenal Thyroid Revolution, FREE right here.

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  1. Thank you for the in-depth explanation of the thyroid function. I’ve been learning about the endocrine system in my masters in nutrition degree, but your explanation really illuminates it for me! Also, I’ve been battling my own issues with SIBO, nutritional deficiencies and potential thyroid issues and this blog post inspired action to follow-up with my integrative doctor and push for more thyroid testing! Thank you thank you thank you! I’ll be sharing your article with my classmates.

    • What medications do you recommend to treat hypothyroidism? Synthyroid or Armour? Ive been prescribed both but have had a hard time finding the correct dose. It seems to interfere with my hrt. I’m 42 and post menopausal due to hysterectomy. My doctor doesn’t think that it interacted with one another but I’m certain it does.
      Thank you for this article. It has helped me and my husband to better understand hypothroidism.

  2. Dr. Romm –
    This was such an excellent article! I have never had any doctors that I have spoke to about Hypothyroidism be able to explain all of this like you just did! I am in Dallas Texas….do you know of any independent labs that I could have these tests done at? My doctor is very good, but does not see that I might have a thyroid problem and just keeps saying that I am borderline and we should just keep watching. My sister has been diagnosed with Hashimoto’s through another doctor in Florida. My TSH level has been going up and down over the last 4 years….It was at a high of 7.3 level and currently as of a couple of months ago at a 6.59. In 2011 it was 4.07? Thx for any info you can help me with!

    • Switch docs. You have to go to someone who will listen. Believe me, i went undiagnosed for years which only put me even further behind when i did get treatment. I love my current doc, and will see her for everything else, but i finally stepped out and am seeing a new doc for just my thyroid. She is willing to go places with my care that no other doc has ever even mentioned.

  3. Hi Aviva,
    I actually found you because I have an Aviva in my family too and I love your name, (I think you are a B-schooler)
    anyway, I am sure I have what you are talking about. I have a Son who is three, I nursed him for two years and over that time lost all my baby weight only to gain back 20lbs as soon as he stopped nursing.
    It’s been a nightmare, I have a long history of fighting my weight but right now I weigh as much as I did going into my third trimester of pregnancy.
    my question is this, if I want to get pregnant again should I weight to fix my thyroid later?
    I’m not pregnant now but want to be,
    I am actually seeing a doctor today for the first time in a long time.
    You are amazing!!!

  4. Thank you so much for all of your helpful articles, and, great recipes. I hope you will address what tests are necessary for those already on thyroid replacement and still experiencing symptoms

    • Hi Cissy
      Thank you! The tests are actually the same — to help you trend medication responses and find the best meds and doses! But much more to come in future blogs and a super special thyroid health course I’ll be offering in the spring! Warmly, Aviva

  5. Dr. Romm, thank you for this article as I’m about to undergo some thyroid testing. Quick question though – is high blood pressure a symptom of hypothyroid? I didn’t see it mentioned here, but I’ve seen it mentioned on other sites. I have high blood pressure and my doctor is suspecting that I have sleep apnea although she also said it could be due to thyroid issues. Thanks for all you do!

  6. Thank you so much for this wonderful article and for all that you do and share. I am grateful to be receiving your blogs and to be learning such important information. I very recently switched doctors because the guy I saw only a few times, brushed me off anytime I told him what I thought was going on with MY body. I agree with you wholeheartedly that no one knows your body better than you; especially if you are in tune and aware of your bodies messages. He treated me as if I was ignorant and shouldn’t care so much about the changes in my body. When I asked him if my blood sugar could be rising (pre-diabetic range) because of un-balanced hormones, he sharply said NO and his body language told me the conversation was over. Luckily a doctor from our local hospital just made the change to become an Integrative doctor and opened private practice and after one visit with her, I am making progress. She did order a TSH, T3 and T4, among several other tests that make complete sense for my situation. I am excited to be receiving the care that I deserve and know that I need in order to reach optimal health once again. Hats off to caring, awesome doctors like you and the one I just found!! Big Aloha to you!

    • Hy Bryony
      These can range from missing nutrients to genetic factors to antibodies to heavy metals, even, binding the receptors at the cellular level.
      Hope that answers your Q!
      ~ AR

  7. Great article. I wish all doctors were more informed like this instead of going “by the numbers only” instead of treating the patient and listening to the symptoms. I would have like to hear you say something in regards to Natural Dessicated Thyroid for treatment. After full blown Graves, then Radioactive Treatment, and 20+years of treatment with Syncrap (aka Synthroid only), I come to learn about Stop The Thyroid Madness. This book has saved my life. Now I’m my own advocate and fighting for optimal treatment with a physician who is willing to go on the journey with me. Please keep up the good work. Knowledge is power. Thanks!

  8. Wow, I can’t believe this article appeared in my newsfeed tonight on Facebook! I am struggling with several issues right now and just not feeling “right”. My Dr. said everything looked fine with my bloodwork in June. I am looking at my TSH-FT4 test and my value is 2.36. Now, I am wondering if it really isn’t ok, and if I should try seeing a different Dr.. I am at my wit’s end with these symptoms. Thanks so much for the informative article.

  9. I have been diagnosed with Hypothyroidism few years ago .condition is now under control with medication and I am very keen to get more info


    Shiranee wijesena

  10. This is a great article, a problem that is heard so many times of doctors treating the lab results and not the patient. I have had my experiences with a few endocrinologists who have sent me on my way with no help because my thyroid labs were all within what is considered normal range. I was very symptomatic, and on the edge of nonfunctioning, with an enlarged thyroid. Its been a very long and frustrating path! I was fortunate to find a Naturopathic who has listened and prescribed me some much needed thyroid medication. I am happy to say in the past 4 weeks I have been close to 85 percent symptom free! However, even with most symptoms disappearing, my endocrinologist was upset that I was taking thyroid medication when she deemed my thyroid wasn’t even an issue and has advised me to stop taking it and get a sleep study! The tests and procedures I have gone through to get answers, and what seems to be illogical diagnoses (i.e lack of sleep), has made me lose complete faith in the medical community. At this point I’ve just been confused between the conflicting information of what my naturopathic and my endocrinologist tell me. Being a mother of 2 young boys, I’m just trying to survive the day to day – and well the thyroid medication has helped me do this! Wishing there were more doctors with your thinking in Arizona!

    • Bridgette,
      I too live in AZ and am very concerned about my thyroid and how it may relate to our 4 year long trouble with infertility. May I ask which Naturopath (name & city) you see what was able to help you in regulating your thyroid? I am becoming more and more disappointed in the medical community here.
      Thank you in advance!

    • Go with your gut! Each person is so unique. And i have been there, just surviving, and its aweful. You know YOU and nobody else on the planet can hear what your innervoice is saying. Get what you need, and switch docs if that is what this means. Ask around. Surely there is a hidden gem of a doctor near you.

  11. Thank you for this post, doctor. I feel like I’m losing my mind when I see my PCP complaining of extreme fatigue, insomnia, constipation, and always cold! I’ve maintained a normal weight the last five years, but recently put 7 pounds on for no reason – I’m a clean eater (120 pounds). She said my TSH is fine – 2.63. I’d love to go to a functional medical doctor, but it would cost out of pocket, so this is frustrating that normal medical doctors don’t want to investigate my thryoid further. I bought natural herbs (Gaia makes thryoid support herbs) and I’m trying to make sure I get iodine, but I’m still tired and sleepless!

  12. Thanks so much for this post! I would LOVE to see a post on PCOS (herb recommendations, etc.). I have read that a lot of people with hypothyroidism also have issues w/ other hormones, PCOS, metabolism. Everything seems to be connected!

  13. What exactly is T3 uptake? I’ve seen tests run where TSH, free T4, T3 uptake and Free Thyroxine Index are looked at. Are these tests missing looking at free T3? Thanks!

  14. This is so wonderful to read. I’ve been doing some sleuth work for the past few years as oddities in my health have been popping up. After a time of acute stress (leading to an onset of chronic stress) I developed intense skin rashes that no one seemed to be able to figure out. I tried diet changes, different lotions, eventually “patching” the problem with fluocinonide cream. I’ve battled fatigue and lethargy, always feeling cold, thinning hair, irregular menses, much more irritable and mentally different, extremely dry skin…. Also of importance is that my sister has had hypothyroidism for years now. The medical world didn’t want to pay attention to my requests for hardcore thyroid testing. After recently going through two early miscarriages (when up to that point I’ve always been a fertile Myrtle!) I decided to just do the full battery on my own. My Ft3 was 3.2, Ft4 was 0.7, ThAgAb <20, ThAbs 1 and TSH 3.35. From what I understand this would seem to point pretty clearly to hypothyroidism in your book but not to the medical communities eyes. I would love to hear your thoughts on starting to treat this primarily with supplements or if you would recommend medications. I am just ready to feel normal again.

  15. I have to say I enjoyed reading all about hyperthyroidism and the tests , I’ve known about them and gone through them for all of my life as I have congenital hypothyroidism!! It’s not that common but it’s great to hear that I should be testing my reverse t3 and also to check my iodine levels which the endocrinologist never test this when I visit routinely !! Ladies if you feel not quite right push to get tested especially if unexpectabt weight gain is a issue!
    I know when my dose isn’t at the right level and I’ve now gotten to the point where i tell the specialist “no” I don’t feel right if you drop my dose and they listen otherwise I will continue on my current dosage ! I hope they find a cure one day
    Thanks Jess

  16. Hi Aviva,

    I have followed your blogs for a few years now and always love coming back to them. Thanks for compiling all of this information. When you bring up additional supplementation, don’t forget the most basic one: iodine!

  17. I was put on thyroid medication about 2 months ago. It helped for about a week and then all my symptoms came back. What does this mean?

    • Hi Kathryn,

      This is Megan from Dr. Aviva’s team. I am sorry to hear that your symptoms have returned, I imagine that feels incredibly frustrating. Be sure to download Aviva’s new free Thyroid Insights Ebook — you can download it from her website. It is loaded with really helpful information that can hopefully help lead you to the root of what is going on with your thyroid. Beyond that, it may be best to work with an integrative practitioner who can help you do some digging. I hope this helps.

      Megan- Dr. Aviva Romm Nutritionist

  18. I have a similar problem in that my doctor was “treating the results, not the patient” and yet my problem is just the opposite of all the comments I’ve read. I am completely asymptomatic–and yet my TSH numbers are “off the chart” high (17+). I switched doctors when mine wanted to put me on medication so I would “feel better.” I’m 59, active, normal weight, healthy and often mistaken for being much younger–why take drugs!. My new doctor is concerned abt my high numbers yet understands my aversion to medication. I’m trying to bring my number down naturally to prevent any damage to my thyroid. I’ve read tons on the thyroid and many blogs and don’t ever see anyone with my situation. Any thoughts?? Please help!!

  19. Great article. What causes low T3 conversion? And how can you support your body to increase the amount of T4 that is being converted?

    • Yes – much more to come on this in blogs and my next book! But in short, it is typically nutritional or stress because the body stores T3 as reverse T3, but environmental, hormonal, and other factors can also contribute. Promise, more to come! 🙂

  20. How often do you recommend retesting thyroid labs in hypothyroid people? (I was low T3 with everything else normal… should I just get T3 retested, or the both panels again?)

    • Hi Allison, If FREE T 3 is low, then this is hypothyroidism – I recommend retesting after 6 weeks on a steady dose of a medication if you’re taking one, or 3 months if trying a natural approach – then every 6 months once your levels are normal until they’ve been normal x 2 years. And yes, recheck rT3, TSH, and antibodies.

  21. I have been on Levothyroxine, then changed to Synthroid. Both make me feel nauseous. I know this because I stopped the levo and the nauseous went away, so then got Dr to change to Synthroid. Same thing. What happens if you just don’t take any medication. Or should I see if Dr will put me on WTE. THANKS

    • Hi Janice,

      oye, that sounds frustrating. You DEFINITELY want to work with your doctor to find the medication and dose that works for your unique body as there are many variables! Best of luck and stay tuned for more from Aviva on this subject.

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  22. Hi Dr. Romm,

    If TSH is normal (2) and free t3/t4 (and bound t3/t4) are all just under normal, does that mean hypothyroid?


    • Hi Alexandra,

      Thank you so much for your comment and please know that Aviva LOVES hearing from you. Unfortunately she really can’t answer person questions about labs. If you are concerned and or you would like a second opinion, We recommend looking on the website of the Institute for Functional Medicine (https://www.functionalmedicine.org/) for a practitioner in your community.

      Warm wishes,
      Megan- Aviva Romm’s executive assistant and online nutritionist

  23. Hi, I just read this post and had some questions concerning my lab results. I got tested for TSH (1.48uIU/ml), total T4 (6.3ug/dL), and total T3 (84ng/dL). I was tested because I had given birth a month and a half before this test and my son was born with congenital hypothyroidism. I had thought they were testing me for antibodies as well but I cant find it anywhere. My question is, one what do the letters after my result numbers mean and how do they relate to your chart? Also am I correct to think that I should get retested for free T4 and freeT3 instead of the totals? I’m also curious what you think if you are familiar with Ray Peat’s writings about thyroid issues?
    Thank you so much for any insight into this, I’m trying to figure out what to do next because I have a few of the symptoms of hypothyroidism (low basal temp, 97.3 often) although the Dr. tells me my results are normal.

    • Hi Willow!
      I am the nurse practitioner in Dr Romm’s practice, and I often hop in to answer comments and questions since Dr Romm doesn’t always have time to get to them all!
      The letters after your results represent the units of measurements. IU – international units, ml = milliliter, ug = microgram, ng = nanogram. We tend to look at free T3 and free T4 rather than total, which is why your numbers don’t match up with what you see in the article. It may be helpful to request these tests, as well as antibody testing.
      Best of luck to you!
      ~amanda, APRN

  24. I have been treated with levithyroxine for 43 years and finally decided to see an Endrocronologist. I had the 6 tests done before I saw him. He said I am taking the right dose. I have problems sleeping and am having a hard time losing weight. He seemed really puzzled about the lack of sleep but was quick to suggest his weight loss program. He is having me do a metabolic test and the rolling labs:
    Anti thyroglobulin
    Cortisol- am
    Hemoglobin A1C
    Thyroglobulin Quantitative
    Does this sound right to you? If this doctor does nothing for me. I am going to try a functional doctor.

  25. Hi Aviva,
    Based on my test results listed below, do you think I need to go on a thyroid medication or can I continue taking adaptogens that help me with the feelings of exhaustion, anxiety, stress and the tired/wired feeling that can make it hard to fall asleep at night. Your assistance with this is greatly appreciated as you have helped me so much with so many things and I have referred you and your book to so many friends and family.
    Free t3: 217 (This was considered Low , why is it so low?)
    Thyroid peroxidase antibody
    Thyroglobulin 4.2
    Thyroglob Ab <0.9
    Free T4 1.1
    TSH: 2.8.

    • Hi Alona, Sorry, I can’t comment on labs without seeing you as a patient first. However, please be cautious of practitioners over-treating for thyroid problems! Best, Aviva

  26. What is considered positive for antibodies? My tpo is 20. Is that considered confirmed hashimoto? (Tsh is now 2.2 (down from 3.3 with unithroid), t4 is 2.6 and t3 is 1.02). Thanks for the informative article.

    • With a TPO of 20 and normal TSH, I personally would not give a diagnosis of Hashimoto’s – I would just recheck antibodies again in 6 months and then possibly every 6 -12 months to make sure they’re not going up. After 18 months of this, and if no symptoms, I’d just check once every few years. Warmly, Aviva

  27. Hi. I’m confused by the information given. I was diagnosed with Hashimoto’s in 2008 and then have been on a .25mcg of Synthroid since then, since it keeps me within normal range.

    In the past six months or more, I have had severe fatigue, weigh gain (8-13 pounds), water retention (rings don’t fit, puffy face). I was on a nonstop Rx of NUVA ring to stop periods and reduce my endometriosis (had excision surgery in Dec 2016) and while on it, I had insomnia issues, my cortisol levels (urine, saliva) were elevated (my endo had the testings to rule out hypercortisolemia, which were not completely conclusive in her opinion) and so I requested to stop using the ring in March. By early May, cortisol levels went back to normal, I initially lost three pounds, sleep now soundly 7-9 hours a night, but the other nine pounds won’t budge and I have been working out with a trainer who keeps upping my weights because I am so much stronger, but my body fat % has gone up 2% in seven weeks versus down and I am still exhausted by midday. I do not eat processed foods and my diet is fully organic. I don’t even do dairy and keep calories at 1200/day. I have been mildly anemic for years (and I do eat organic, grass fed red meat), so I tried taking an iron supplement, but got the flush and rash on the second day of taking it.

    My TSH is .77
    T3 2.34
    T4 is 1.2

    Based on your scores, only my T4 is within normal range, correct? My endo is willing to increase my synthroid dose to 37.5 to see if that helps. Do you have any other recommendations?

    Thank you

    • Hi DM,
      Sorry, can’t comment on individual labs! I’d work with your endo on this since it sounds like he/she is willing to adjust with you – this would take adjusting meds and trending symptoms and labs. If TSH and FT3 are normal, however, i’d not treat – and you really can’t go lover on TSH – you run the risk of ending up HYPERthyroid which has serious risks.

  28. Dear Aviva,
    Thank you for a GREAT article!
    I’m wondering a bit about the optimal levels of FT4 and FT3 – is it correct that the optimal level of FT3 is higher than the optimal level of FT4? This confuses me since it contradict what I’ve learned about FT4 and FT3 from before ( which has been that FT3 being mainly produced intracellular, and therefore showing up in lower blood levels than FT4). Would be very grateful if you have time for a brief explanation of this!

    All the best,

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