Thyroid Lab Test Explanations (Part 2)

Bluestone Health Group LLC

Thyroid hormone testing, assessment and treatment may be one of the most complicated and misunderstood aspects of medicine. In fact, if you follow the research, this misunderstanding (whether intentional or out of ignorance) has harmed and led many people to unhealthy outcomes, prescription medication which doesn’t help and a massive thyroid hormone problem in the US.

How many of you know someone with a thyroid problem? How many of you reading this currently have a thyroid issue or are taking some sort of thyroid hormonal support? Does your doctor run more tests than simply TSH? How many of you think you have a thyroid problem only to be told your numbers are fine, when later to find out your doctor only tested one thyroid marker?

This article is Part 2 of my Totality of Sleep series. (Part 1 can be found here.) This will cover the lab testing required for a proper assessment of thyroid function. This is not a comprehensive list of all the physical symptoms to look for while assessing for thyroid dysfunction. Any doctor NOT testing ALL of these numbers at an initial assessment of your thyroid is NOT getting a clear picture, and therefore cannot give proper treatment options nor be able to advise you how to maximize and heal your thyroid. (Some doctors may not use every test I use, but a list very similar is required. Some doctors use certain urine tests with great results.)

INITIAL ASSESSMENT REQUIREMENTS

This section will be touching on the ideal ranges I look to see. These ranges have come from years of experience and numerous references. Ratios of function are much more important than any solitary number or value and all must be taken into account to get a clear picture of overall thyroid function from a lab perspective.

TSH - 0.7-0.9 mU/mL

Once the thyroid is fully optimized TSH is a great measure of overall function. In the beginning it is an absolute terrible number to gauge thyroid function. As you can see, the ideal range is very small. The reason I mention this is a great measure after you have optimized is that iodine status plays a massive role in TSH levels and without optimizing iodine, TSH has very little meaning to overall function.

Total T4 - 55-65x more than Total T3

Total T4 is useful in the sense that when the units are standardized and compared with Total T3 one can get a gauge of how well the thyroid is producing hormones in addition to the balance. This is a measure of all the T4 in the body, bound and unbound/free.

Free T4 - >1.38-1.8 ng/dL

Free T4 gives a great gauge of the free or unbound T4 circulating the body. Low free T4 is a great indication the thyroid gland is underperforming and will help aid in finding ways to optimize. Having low free T4 (below 1.37 increases the risk of metabolic syndrome, with the lower the free T4, the higher the risk.

Total T3 - TT4:TT3 = 55-65; TT3:rT3 = 12 +/- 2

Total T3, I find to be one of the more useful measures when it comes to testing the thyroid. T3 is the active hormone, the one your body uses. T4 is more of a circulating storage vesicle of thyroid hormone, which still requires activation/deiodination to form active T3. As discussed earlier, when comparing T4 to T3 you want to have 65x more T4.

TT3:rT3 measures how well your body is using T3. Reverse T3 (rT3) is a form of T3 that is useless to your body. It can be thought of as an inflammatory marker. It protects your body from using too much T3 in a state where the body cannot handle it. A simple analogy for this is your body being a car with thyroid hormone being the gas. If you have a 1992 rusted out Honda Civic (obese, high blood pressure, diabetes, etc.), pumping your body with pristine, high octane gas (perfect T3) would lead to the car and engine blowing up (i.e., heart attack, stroke, death, etc.). This is a great measure of how well your body is converting T4 to T3 and also if your body is converting T3 to active T3 or if it is converting to rT3, which would indicate your body isn’t ready for optimal thyroid function.

Free T3 - 3.4-3.8 pg/mL

Personally, I use more ratios when assessing the thyroid than singular values. I offer this more as a perspective to see how narrow the range of perfection is. When this is low, it is a great indicator of a need to address thyroid function and find the ways you will need to improve it.

Reverse T3 - TT3:rT3 = 12 +/- 2

As a rule of thumb the reverse T3 should be within the lab ranges as a total number, and be used as part of the ratio listed above. Reverse T3 is an inactive form of T3 and indicates an inflammatory state and/or a nutrient depleted state, in that the body doesn’t have the required nutrients to convert T4 to T3 in a healthy, optimal way.

Thyroid Antibodies - TPO and ATG = no detection

Thyroid antibodies are a great indication of immune system stress, in addition to being indicators of Hashimoto’s, Graves’ Disease and other autoimmune conditions. Thyroid antibodies are very commonly elevated in a multitude of autoimmune states.

TPO specifically requires iodine to function normally. When high, it is a very reliable indicator of deficient iodine and/or toxic levels of bromides, fluorides and chlorides. Depending on the level of TPO certain measures must take place in order to correct.

Serum Iodine - 92 Um/L

Serum Iodine does have a wide range of ‘normal’ on the lab test, but anything below 92 can be thought of as deficient. Iodine is nearing an all time low in history. Iodine is not talked about much anymore as iodine deficiency has been thought to have been eliminated. This is a falsehood. Goiters were all but eliminated with iodized salt, a century ago, and now are raging back with a vengeance. A very tiny amount of iodine is required to avoid a goiter, and the lack of a goiter is NOT an indication you have ideal iodine. Now we know that iodized salt is not the end all be all of iodine replacement, and we also know how bad table salt is for health, blood vessels and inflammation. Time to start addressing.

Many functional medicine doctors use a 24 hour loaded iodine urine capture test to assess for iodine, which is a bit more of an accurate test if one wants to be as accurate as possible. I am still waiting to find a client with perfect serum iodine, which is why I prefer the serum test. It is easy and requires one tube of blood, as opposed to collecting 24 hours of urine.

SUMMING UP THYROID ASSESSMENT TESTS

As you can see above, it takes quite a few tests to get a gauge on how the thyroid gland and system is functioning. It requires multiple tests on the actual hormones and antibodies. Using math to perform basic ratio calculations is a requirement as this is a system of check and balances. The system regulates itself and should be tested as such. Iodine is the primary nutrient needed for the direct assessment of thyroid function, and you will see below, many other Accessory Tests must also be performed. These tests are not traditionally thought of as thyroid tests, but are required to be in perfect balance in order for the thyroid system to be functioning ideally.

ACCESSORY TESTS - The Body Environment

  • CBC w/ Diff

  • Comprehensive Metabolic Panel

  • GGT

  • Homocysteine

  • D3-OH

  • DHEA sulfate

  • Total and Free Cortisol

  • Ferritin

  • Total Iron, % saturation, TIBC

The accessory tests listed above are only accessory in the sense they aren’t directly related to the thyroid gland assessment, but should be part of any general initial assessment anyway. Many of you know the importance of iron in terms of thyroid function. GGT is a measure of the glutathione system of which liver function and selenium are massively important for thyroid function. DHEA sulfate is one of the best markers for adrenal function. Vitamin D is part of the nuclear receptor family, meaning it is required at ideal amounts to help the body function at its absolute peak. It is very easy to begin to grasp the complexity of this, while also seeing that for ideal thyroid hormone function, one must be healthy on all accounts. There is no one pill fix. It requires the whole body to be in harmony.

SUMMARY

This article was written to help educate on the complexity of thyroid hormone. Thyroid hormone is one of the most important hormones in the body and is not only required to be optimal for great sleep, it is required to be optimal for you whole body to function at its best.

Upcoming articles:

  • Dopamine: My Personal Optimization Strategy

  • Deep Sleep Supplementation and Strategies

  • REM Sleep Supplementation and Strategies