Hashimoto's Lab Tests

Recommended Labwork 
I've heard the story many times. A woman goes to her doctor complaining of fatigue, hair loss, weight gain, and perhaps a host of other problems. Her doctor runs a basic blood panel, including a Thyroid Stimulating Hormone (TSH) test. A few days later, her doctor calls and tells her that the test result was "normal." Unfortunately, there's much controversy regarding this one test and you'll likely not hear that from your doctor. For starters, it doesn't tell whether or not an autoimmune disease is running the show. It is also common for the TSH level to be in the lab's 'normal' ranges, despite the autoimmune condition at work. Eventually, the disease will progress enough to finally affect the TSH level, but the attack could take decades before it's progressive enough to be flagged even on an endocrinologist's lab test. A third common problem with only testing the TSH level is that the 'normal' ranges are not based on functional ranges. Most labs have a maximum range for TSH of 5.0 or 5.5, and patients report hypo symptoms when their ranges are higher than about 2.0-3.0. Finally, if Hashimoto's is the culprit, it can cause the TSH to be high or low, or vary from month-to-month. It's simply not telling the entire story.
Diagnosing Hashimoto's is actually fairly easy. The problem is getting the proper blood work. My doctor's ran nothing more than a TSH level and it was 'normal.' I recall my TSH reading 3.2 over a year before I was tested for the antibodies, and I had about a dozen symptoms of hypothyroidism. I asked my doctor's assistant months after checking my TSH why they hadn't bothered to run any other thyroid tests and she explained that they only run those tests if the TSH comes back abnormal. Could this be your doctor's procedure too? After I purchased a full thyroid panel on my own, I had it tested at a local LabCorp. Of course, it led me to detect the disease on my own. I explain more of the details in this Post.

So, the following lab work and functional ranges are recommended by many thyroid experts, functional doctors, and advocates. The bottom line is how you feel, not what doctors ranges read. Many doctor's offices practice the belief that being in good health is the absence of diseases. So, although you have 15 symptoms, you're still healthy because you don't have a disease. Don't let your doctor bully you in to telling you that they aren't necessary or that they are confident that they have enough information to evaluate you. I've learned the hard way that many doctors do not accurately test, diagnose, or treat thyroid conditions, nor does the conventional (involving big pharma companies too) health care system have a comprehensive model for managing Hashimoto's and some hormonal imbalances. I believe that many standard practitioners don't necessarily keep up with new methods and research studies outside of the documents that their pharmaceutical representatives provide to them. I don't believe that these doctors are purposely mishandling their patients either. The old 'get a second opinion' should be replaced with 'do some research on your symptoms', and I'm not necessarily referring to seeking medical advice from Webmd.com or similar sites. I had to trust my own instincts and listen to my body because I knew that the dozens of tests that had normal results were not telling the complete story.

Whenever I want blood tests completed, I actually take a detailed list to my doctor. If at first they are hesitant or shrug them off, I explain my reasoning and offer them some education on the topic, and I've not had a doctor refuse to run a test yet. The more educated I am about the tests, then the easier it is to justify my need for them, and the more likely they are to agree to running the tests. Also, I always obtain copies of my labwork. I keep them organized in files and take them to all of my doctors appointments to use as references.

I don't really pay attention to the lab ranges from the doctors labs anymore because I compare them with functional ranges. The doctor's ranges are used to actually determine diseases and the functional ranges are for determining risk for disease and symptoms. I've included functional ranges below:

Thyroid Stimulating Hormone (TSH)- Functional Range: 1.8-3.0 mU/L (lab ranges vary, but usually go up to about 5.0, which would be well above hypo for me)

Free T4 (Free Thyroxine, FT3)- Usually elevated with hyperthyroidism and low with hypothyroidism. Both can occur in Hashimoto's.
Functional Range:1.0-1.5 ng/dl

Free T3 (Free Triiodothyroxine, FT3)- Measures the amount available to the the receptor sites, which are in the cells. Many patients feel better when their level is in the upper normal range.
Functional Range: 300-450 pg/ml

Reverse T3 (AKA RT3)- An elevated level is commonly due to inflammation or chronic stress, trauma, etc. Some experts speculate that elevated levels of T3 can be caused by elevated RT3.
Functional Range: 90-350 pg/ml

A positive test indicates that the body is attacking the thyroid tissue. The level of antibodies can fluctuate, so some functional practitioners repeat the test if the results are negative and Hashi's is strongly suspected.

Thyroid Peroxidase Antibodies (TPO Ab)-This test is the most important one for diagnosing Hashimoto's. There is really no such thing as a functional range, though labs still have ranges.

Thyroglobulin Antibodies (TGB Ab)- Is not required for diagnosing Hashimoto's, but is helpful because the antibodies often target the thyroid tissue.

Thyroid Stimulating Immunoglobulin (TSI) Grave's disease antibodies- People with Hashimoto's can simultaneously have Grave's disease. Patients with Grave's can also have high TSH levels too. I tested negative for the antibodies. It's possible for someone to have Grave's first and then Hashimoto's, or vice versa.

Because Hashimoto's can affect so many systems in the body, nutritional levels are often compromised. The following list of basic blood work is recommended by many experts because they are often compromised in patients with the disease:

Vitamin D- Functional Range: 55-80 ng/ml (functional range is especially for Hashimoto's patients)
TIBC (Total Iron Binding Capacity)
Vitamin B12
Liver & kidney function panels

Of course, there other tests to consider for proper management of the disease. Some of these tests include testing for allergies, candida, adrenals (very important), etc. The first step is to accurately diagnose the disease and assess it's current state in the body. If you are struggling to obtain adequate support and testing from your current doctor, perhaps it's time to look for a new one. I highly recommend seeking counsel from a doctor, who practices Integrative Medicine.
Search for an Integrated Medicine doctor here:Find a Doctor in Your Area

This video explains the Integrative Medicine approach


  1. What is TSH with reflex to free T4? What is range or is this not a very useful test? Thanks

  2. So my tsh is 0.79 a month later 1.2, vit d of 26, I'm suspecting hashimotos, what do u think? I feel sluggish all the time and almost have every symptom

  3. Thank you so much for this comprehensive article! I do not suffer from Hashimotos, but my daughter does. My challenge is that she is an adult and does not read or want to know that much about this disease. She sees a doctor that only tests her TSH levels and sends her on her way. She does not want me sending her articles or even discussing Hashimotos with her or anything integrative. Thank you for validating me in this article! I am grateful.

  4. THANK YOU VERY MUCH as I sit here reading and losing even more hair. I live in a very rural part of Wyoming compared to my prior residence in Portland, OR where all this was just catching on about wonderful integrative medicine. Here I was just told that my 'levels were just fine three months ago, therefore you don't need a test.' I now do realize how important it is to inform if not educate my doctor of my needs to control this terribly debilitating disease if not properly managed. Thank you again. Sincerely, Northern WY Resident

  5. Hi guys ! So happy to have found this blog. I am 33 years old and 10 months ago gave birth To my second child, I also run a start up agonist that's had immense growth in its short two years. Feeling completely drained and exhausted I felt like I should check my hormones (I just had that "thoght" ) and got a thyroid profile done. TSH results came back at 75. Seventy Five!!!! What!?????? I had them done again, in a different lab; and again 75! So scary !! So I had antibodies done a swell, and was immediately diagnosed with hashimotos and taking 125 Euthyriox. I was supposed to feel better; but I don't. I still have a cloudy and foggy brain; energy levels low; anxiety high; physically and mentally down. Dreaming of one day feeling like myself again!