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Essential Thyroid Tests You Need to Know About

If tomorrow your doctor tells you that you have an issue with your thyroid, you may not be sure how to begin treating it – am I right? If so, you would not be alone. Thyroid disorders are foreign to many people, despite their increased rates – it’s estimated that tens of millions of people across the globe now suffer from thyroid-related issues. But, because the surge in thyroid problems is relatively new (the last 40 years has shown the most significant increase), many people are unaware of their effects. Plus, research shows that up to 60 percent of people with thyroid disease are unaware of their illness.

Unless you have a medical background or are close to someone who has suffered from a thyroid-related disease, chances are you are not ultra-familiar with them. So, it is no wonder that most people have no idea what lab tests to inquire about if they ever find themselves in a scenario that requires them. I have found that many of my clients end up getting the same couple of routine lab tests that their doctors recommend, but what they do not realize is that there are other important labs they should be considering as well.

Before we jump into what lab work you should be getting done if you fear you may have a thyroid problem, let us take a step back to get a better understanding of why you may require certain tests. For starters, the thyroid is a little butterfly-shaped gland that resides in your lower neck. For a tiny gland, it sure has a lot of important responsibilities. The thyroid secretes hormones that control growth and development, moderate your body’s metabolism and drive numerous neurotransmitters to your brain. Some of the most significant neurotransmitters that the thyroid is involved with include serotonin, adrenaline, noradrenaline and dopamine – all of which affect how happy you feel and how motivated you are. If you were recently diagnosed with a thyroid illness, is it starting to make sense why your weight and mood might be fluctuating lately?

As I mentioned, cases of thyroid illness have skyrocketed over recent years. Women are more prone to thyroid diseases than men and it is common for us to experience them later in life – often after pregnancy or during middle age. It is now understood that one in four women has a thyroid imbalance and almost half of people over the age of 50 have some kind of thyroid inflammation (a precursor to thyroid imbalance). With thyroid irregularities so common these days, it is scary to think that they are a major cause of anxiety and depression, among other unideal repercussions. The two most common thyroid imbalances are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid). Some key signals to watch out for that can help to alert you of whether you may be experiencing a thyroid issue are:


  • Constant tiredness
  • Depression
  • Anxiety
  • Weight gain
  • Brain fog
  • Constantly feeling cold


  • Weight loss, despite an increased appetite
  • Sleeplessness
  • Anxiety
  • Feeling uncharacteristically jittery
  • Breathlessness
  • Fast heart beat
  • Constantly feeling hot

If any of these signs are familiar to you, I recommend getting some critical thyroid lab work done. Most people are urged by their healthcare practitioner to only get a TSH test done. Do NOT settle for a TSH test alone—it only measures your thyroid stimulating hormone.  You can still have undiagnosed thyroid problems if your TSH levels are reported as normal!

Here is the list of labs I recommend for anyone who suspects they may have a thyroid imbalance:

  • TSH: the American Association of Clinical Endocrinologists states that anything over 3.0 is considered abnormal and requires further investigation. Optimal Range: 1.0-2.o mIU/L.
  • Free T3 (active): This is the more active, usable form of your thyroid hormone. Optimal Range: 3.0-4.0 pg/mL
  • Free T4 (inactive): This will tell you the levels of free or active form of T4. This will be low in cases of hypothyroidism but can be normal in subclinical, early stages of thyroid dysfunction. Optimal Range: 1.0-1.5 ng/DL
  • Thyroid antibodies: high levels of thyroid antibodies highlight an autoimmune attack against the thyroid. The overwhelming majority of low thyroid cases are on the autoimmune spectrum, the most common being Hashimoto’s disease.
    • Thyroid peroxidase antibodies (TPO): Optimal Range: 0-15 IU/mL
    • Thyroglobulin antibodies (TG): Optimal Range: 0-0.9 IU/mL
  • Liver function tests: 95% of T4 is “activated” in the liver, so a healthy liver is crucial. Elevated AST, ALT, GGT are considered to be abnormal.
  • Ferritin level: ferritin is needed to transport the active T3 into the cells for activity to occur. Ferritin must be above 90 for this function to operate properly.
  • Testosterone: elevated testosterone levels can lead to hypothyroid symptoms. Optimal Male Range: 280-1,070 ng/dL; Optimal Female Range: 15-70 ng/dL.
  • Insulin: hyperthyroidism is associated with insulin resistance and decreased insulin resistance, so it is important to pay attention to insulin levels. Optimal Fasting Range: 70–130 mg/DL.
  • Melatonin: elevated melatonin levels may block thyroid hormone synthesis.
  • Cortisol: prolonged increased cortisol levels can have adverse effects on the thyroid gland. When cortisol level tests are performed between 6 a.m. and 8 a.m., the Optimal Range is 10–20 mcg/dL.
  • Vitamin D: 25 OH vitamin D is the test to ask for. While the conventional definition of Vitamin D deficiency is anything under 30 ng/mL, the Optimal Vitamin D Range is between 60 and 80 ng/mL.
  • Micronutrient Test can be beneficial to check for the following deficiencies: iodine, zinc, magnesium, selenium, B vitamins and vitamin C.

Since gut health is integral to optimal thyroid function, I also recommend getting these tests done:

  • GI-MAP – This panel includes bacteria, parasites, fungi, viruses and more. It also measures antibiotic resistance genes and virulence factors that contribute to pathogenicity.
  • Small Intestinal Bacterial Overgrowth 2-Hr – This breath test from Genova Diagnostics screens for SIBO.
  • GI Effects Comprehensive Profile – This panel uses DNA analysis to go even further than the standard processesfor identifying GI disorders.
  • GI Pathogen Screen with H. pylori Antigen – This panel screens for ova, parasites, bacteria, fungi, yeasts, and occult blood. It also checks for antigens to Helicobacter pylori, Entamoeba histolytica, Cryptosporidium parvum and more.

Luckily, it is likely that your doctor will be able to effectively treat your thyroid imbalances with various medications. However, in order to know what dosages and types of medications to keep you on, your doctor must keep track of your levels by conducting these tests regularly. While these thyroid tests can be helpful, the final step should be to treat you as the human, not the blood tests. Countless women with thyroid imbalances have not been treated by their physicians because, while their thyroid numbers were high or low, they were considered to be within a “normal” range. How you feel and the symptoms you are experiencing are much better indicators of thyroid function than relying solely on standard blood test ranges. At the end of the day, you need to listen to your body and advocated for it by pushing for the right tests.

If you are feeling overwhelmed, do not hesitate to reach out to me at to set up a one-on-one session to go over any blood work!



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