It’s not uncommon for people experiencing symptoms indicative of a thyroid condition to have negative serum blood tests. This includes the TSH, thyroid hormone levels (i.e. Free T3 and Free T4), thyroid antibodies, reverse T3, etc. When someone mentions this to me then I’ll recommend for them to do other types of testing, such as testing the adrenals through the saliva, looking at secretory IgA to help evaluate the health of the immune system and gut, they can look at the hormones estrogen and progesterone, etc. But what should one do when all of these tests are also negative?
The truth is that rarely is someone who has a thyroid or autoimmune thyroid condition negative with ALL of the different tests. One problem is that these other tests can be costly, and most people can’t test for everything. And quite frankly, there are dozens of different tests to choose from. Here are some of the “alternative” tests available:
Adrenal testing through the saliva
Hormone testing (progesterone, estrogen, testosterone, etc.)
Hair mineral analysis
IgG Food Intolerance testing
Tests for toxins (BPA, PCBs, VOCs, heavy metals, chlorinated pesticides, etc.)
Oxidative stress profile
Bacterial Overgrowth of Small Intestines
There are other tests besides the ones I listed, but the two points I want to make is that 1) most people won’t be able to afford to test for everything I listed here, and 2) it isn’t necessary to test for everything I listed. If someone did obtain all of the testing I listed above, there is an excellent chance that we would find some values which were out of range. This isn’t only true of people with thyroid and autoimmune thyroid conditions, but other people as well. Fortunately, a lot of good information can be obtained by doing a thorough case history and asking the appropriate questions during the initial consultation, which will greatly help in determining which tests are a priority.
How Do You Know Which Tests To Order?
When recommending tests to patients, I typically choose those that are most likely to give me the information I need to find the underlying cause of the condition. So while all of the tests I listed above can be valuable, some are more important than others. For example, it’s common for people to have compromised adrenal glands, and this can definitely be a factor in one’s thyroid or autoimmune thyroid condition. This is one of the reasons I test the adrenals in most people. The gut also is compromised in a lot of people, and the saliva panel I recommend also tests for secretory IgA, which can give an indication if someone has gut problems, although this doesn’t just relate to the gut. If the results are inconclusive then I very well might recommend doing a specific test for intestinal permeability. But if I suspect someone has a leaky gut then another option is for the patient to save the money on additional testing, and just put them on a leaky gut protocol while continuing to monitor their symptoms and the results of the blood and saliva tests.
There are certain tests I would like to do on everyone if they were accurate, but unfortunately this isn’t the case with all of the tests I listed above. An example of this is food intolerance testing. Some natural healthcare professionals require all of their patients to obtain a food intolerance panel. Some examples include the ELISA IgG4 panel and the ALCATZ. Both of these can provide some valuable information, but they also are notorious for false negatives. Believe me when I tell you that if food intolerance testing was completely accurate I would recommend this type of testing to everyone so that they would know which foods they should avoid. The problem is these tests are very expensive, and there is a good chance that there will be some false results, which means the person who gets this test will avoid some of those foods they react to, but not all of them.
Plus, if someone has a leaky gut then these tests can become even more unreliable. According to Dr. Natasha Campbell-McBride, who is the creator of the GAPS diet, “Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are ‘allergic’ to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere. From my clinical experience it is best to concentrate on healing the gut wall. Once the gut wall is healed, the foods will be digested properly before being absorbed, which will remove most food intolerances and allergies.”
What Should Be Done When Some Of The More Important Tests Come Out Negative?
Let’s get back to the main question. If someone has gone through all of the necessary testing, and everything comes back negative, then what should they do? Here are a few things I recommend:
1. Make sure all of the necessary testing has been done. When someone tells me they have done all of the necessary tests, sometimes this is true, but other times it isn’t. So you do want to make sure to at least do some of the more important testing. Of course one of the challenges is knowing which tests are truly necessary. To be honest, sometimes even the healthcare professional doesn’t know for certain, as they will initially recommend those tests they feel are necessary, but they might end up recommending other tests at a later date.
2. Make sure the tests have been interpreted correctly. Most of the time this doesn’t seem to be a problem, but every now and then I’ll consult with a patient who worked with a different healthcare professional who didn’t do a good job of interpreting the tests they recommended. For example, I’ve had some patients who obtained the Adrenal Stress Index test from a different doctor, and their cortisol levels and DHEA were within normal limits, while their secretory IgA was well out of range. But some doctors aren’t concerned about this as long as the other values for the adrenals look fine. Similarly, some will do hormone testing and will only look at the LEVELS of estrogen and progesterone, but won’t pay attention to the RATIO of estrogen and progesterone, which is important. Not too long ago I had a patient whose medical doctor ordered an iron panel, and both the serum iron and % saturation were out of range, and the ferritin was 11 ng/mL, which is extremely low, but was within normal limits according to the lab reference range. But the medical doctor didn’t tell her anything was wrong, and so the patient assumed that she was fine in this area.
3. Keep in mind of the functional reference ranges for different tests. I just gave an example of the iron panel where ferritin was within the reference range (10 to 150 ng/mL according to that specific lab), but was on the low side at 11 ng/mL. Ferritin has to do with iron storage, and a low ferritin is the first sign of an iron deficiency. And so once it dips below 40 to 45 ng/mL there is a cause for concern, even if it is within the lab reference range. The same thing can be said for 25-OH Vitamin D, as most labs have a reference range of 30 to 100 ng/mL. But for optimal immune system health you want the levels to be at least 50 ng/mL, and 60 or 70 would be even better. I’ve given a couple of examples regarding serum tests, but the same concept applies for other tests as well. For example, if someone does a saliva test to look at the cortisol levels, the cortisol could be within normal limits, but on the low side, which might indicate problems with the adrenals.
4. Re-evaluate and do other tests if necessary. Sometimes it is necessary to do additional testing. For example, I don’t initially conduct a comprehensive pathogens profile on my patients. But if someone has gotten to the point where their adrenals and gut appear to be healthy and strong, and if they are still experiencing certain symptoms (i.e. fatigue, bloating/gas, etc.), then I might recommend doing a comprehensive test for pathogens. Can’t I just include this test initially? Sure I can, but in addition to this test being expensive, I don’t find this test to be necessary to do initially in most of my patients. Of course if I do suspect problems with pathogens after going through the initial consultation then I very well might recommend such testing. Many times if I suspect a pathogen problem I will just put the person on some natural antimicrobials (i.e. garlic, berberine, oregano oil, turmeric, etc.), and then if this doesn’t work a pathogens profile might be necessary to obtain
5. Focus on eliminating toxins. There are numerous tests for toxins available. For example, one can do testing for heavy metals through the hair or urine. The company Metametrix has a Toxic Effects Core Profile, which includes about one dozen of the common toxins. Although I think it’s great that such comprehensive testing for toxins is available, the test is very expensive, and of course doesn’t test for every type of toxin we’re exposed to, but only the most common ones. I think it’s safe to assume that just about everyone is toxic, and as a result I usually recommend for my patients to do things to help detoxify the liver. And there are times when people might need to utilize other methods of detoxification such as infrared sauna therapy and/or colon hydrotherapy. If someone has reached the point where all of the serum and alternative tests look good but they are still symptomatic, I will usually have them focus on eliminating toxins for a few months. In some cases it can take awhile to greatly reduce one’s toxic load, but hopefully they will at least begin noticing an improvement in their symptoms after a few months.
So if you are experiencing numerous symptoms, yet all of the different tests you obtained were negative, then hopefully the information in this post will be of value. There obviously is a reason behind someone’s symptoms, and so if everything comes out negative then in most cases it does come down to doing more detective work. I realize this can be frustrating, and when this happens most medical doctors will simply tell the patient they need to live with the symptoms. But if this describes your situation then please don’t give up hope, as you need to remember that there always is an underlying cause that is responsible for one’s symptoms. In some people it can be challenging to find out the cause, but I can assure you that something in the body is out of balance which is responsible for the symptoms.