People mistakenly think many symptoms are caused by thyroid problems. In my experience, most providers do insufficient thyroid testing and many alternative providers or books mistakenly convince patients they only have a primary thyroid problem. Many patients look up information on the internet, which is very limited and often misleading, and then think they know all about thyroid labs.

People mistakenly think many symptoms are caused by thyroid problems. In my experience, most providers do insufficient thyroid testing and many alternative providers or books mistakenly convince patients they only have a primary thyroid problem. Many patients look up information on the internet, which is very limited and often misleading, and then think they know all about thyroid labs.

Primary thyroid problems are actually rare. You know you have one when your thyroid treatments provide complete relief of your symptoms and the thyroid labs are easy to correct. Most thyroid treatments do not relieve symptoms very well because you don’t have a primary thyroid problem and/or your abnormal thyroid labs are secondary to something else. Most patients and many clinicians have never heard of secondary thyroid problems and try to adjust thyroid supplements without much benefit. The patient continues adjusting thyroid treatments in frustration until they find a clinician experienced in treating the many causes of secondary thyroid problems.

Most of us were trained to test only TSH and sometimes T 4 levels. I always recommend we check at least 6 thyroid blood tests and will order more as needed. An abnormal TSH test doesn’t necessarily mean you have a thyroid problem. TSH levels reflect hypothalamus – pituitary – thyroid interactions. You should not assume the hypothalamus and pituitary system is operating correctly if your TSH is normal. You should find a clinician familiar with the many things that affect the hypothalamus and pituitary if your TSH is abnormal if you are not responding to thyroid treatments well*.

Abnormal TSH should be followed up with T 3, T 4 levels and other labs. T 3 is the primary thyroid hormone and must be converted in the liver and kidneys via enzyme systems into reverse T 3 (inactive) or T 2 (active)*. Thoroughly confused now? Good, by now you might realize most patients and many providers are challenged understanding thyroid lab tests.

Interpretation and treatment of tests should be left to experienced clinicians who order full thyroid evaluations as needed. So far, I’ve only found one MD who considers some of the many problems listed here, but doesn’t do a good job of explaining them to the patient. I waste a lot of appointment time with frustrated patients explaining these complex tests when the time could be better spent formulating and adjusting treatments as needed. If a patient wants to spend valuable and limited appointment time trying to understand what most MDs and NDs don’t understand, I’m certainly happy to do that, but would rather focus on other issues.