It is no secret that hypothyroidism is an extremely common condition in the United States.  One of the most common questions we get is about proper thyroid testing.  In this article I’ll highlight WHY thorough thyroid testing is so important.  The picture we chose for this article was that of a chain.  We chose this picture because if the thyroid physiology breaks at any of the links, a patient will end up with classic thyroid symptoms such as hair loss, fatigue, depression, weight gain, and constipation.

For proper thyroid activity we need the brain to signal the pituitary, then the pituitary to signal the thyroid, the thyroid needs to make T4, then the body needs to convert T4 to T3, then the T3 needs to hit an active receptor, then the mitochondria need to carry out the activity the thyroid hormone asks the cell to do.  If there is a break down at any one step a patient will end up with symptoms of low thyroid.  However, a person who has the chain broke at the thyroid itself needs different treatment than a patient who has the chain broken at the mitochondrial level or at the brain level.

Thyroid Testing Basics

Thyroid map

This is our thyroid road map. It shows how the brain connects to the thyroid gland and all the steps that must happen in order to achieve our end result of healthy thyroid energy.

As a quick review, I recommend the following thyroid tests for anyone wanting to investigate a possible thyroid health problem: TSH, T4, T3, free T4, free T3, Reverse T3, Thyroid Binding Globulin/T3 Uptake, TPO antibody, TAA/TGB antibody.

I also recommend you do this as part of a complete blood panel which includes inflammatory markers, iron markers, CBC which looks like this: CBC w/ Diff, Serum Iron, Ferritin, TIBC, C-Reactive Protein, Glucose, LDH, HbA1c, Lipid Panel, Comprehensive Metabolic Panel, Vitamin D, Homocysteine, and Magnesium. 

Thyroid Tests Pattern #1: The Brain the pattern no one sees

The first pattern we need a whole thyroid panel to appropriately view is when the brain dysfunction is at the root cause of the dysfunction.  This happens when  TSH is lower than it should be.  If we have TSH, T4, and T3 all in the lower half of the range you have this pattern.  The key to fixing this will be in getting a healthier brain.

Thyroid Tests Pattern #2: The Thyroid: Hashimoto’s – The most common pattern

We have so much highlighting this pattern I will add a link to other articles.  The thyroid tests that are abnormal are TSH, TPO antibody, and TGB antibody which all go high.  The key to fixing this pattern is realizing it is all caused by the immune system!  Thus the only way to truly get better is to take the focus off the thyroid and put it onto the immune system.

What is Hashimoto’s Disease? – Restorative Health Solutions

Thyroid Tests Pattern #3: Thyroid Conversion from T4 to T3 – The 2nd most common pattern

The Thyroid tests that go abnormal here are the T4 and the T3.  What you will find most often is the T4 is normal to high, but the T3 is low.  The body has plenty of T4, but fails to convert it over to T3.  Because T3 is the active thyroid hormone that docks in the receptor, we get hypothyroid symptoms due to the low T3 levels.

Thyroid Testing: Forgetting T3 Will Sabotage You

Thyroid Tests Pattern #4: Free T4 and T3 vs Total T4 and T3

The thyroid tests that go abnormal in this pattern are the Total T4 and T3 vs the Free T4 and Free T3.  To keep it simple “Total” hormones are how much you make.  “Free” hormones are how much is actually available.  Think about Total hormones as the $$ you have in your retirement accounts and Free hormones as the $$ you have in your checking account.  We want money in BOTH our checking account and retirement account, but you’ll acutely feel low money in the checking account.  The key to fixing this pattern typically lies in balancing other sex hormones such as estrogen, progesterone, and testosterone.  This can be done through detoxification and we love the DUTCH hormone test in our office.  You can find out more information about this fabulous by simply googling DUTCH hormones.

Thyroid Tests Pattern #5: Poor Cell Receptor Sensitivity

Once the thyroid hormone docs on the receptor it needs to trigger the production of energy in the mitochondria.  If there is adequate T3 free hormone (We like to see the free T3 around 4), then if the patient still has thyroid symptoms we look at receptor health.  The biggest factors in receptor health are inflammation, cortisol/stress, vitamin A, and the methylation pathway of detoxification.  If the thyroid tests are fairly healthy, and free T3 is > 4 then odds are you have one of the above 4 issues inhibiting the thyroid receptors from working properly.


The Thyroid is not an island. Treating TSH only and not looking at all the links in the chain set a patients up for failure

Conclusions: The Thyroid is not on an island

So much of helping people with their thyroid is not about the thyroid gland itself, but how other aspects of your health can block or inhibit your thyroid function. There is so much more you can do for thyroid problems than just adjust the medication dosage up or down!  There is so much more to look at than just the TSH test.  To truly regain your health, find the break in your thyroid chain and get to the real, core solution

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