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Why You Can’t Rely Solely On Thyroid Blood Tests

Published October 10, 2010

Updated October 13, 2014

Just about everyone with a diagnosed thyroid or autoimmune thyroid condition has received thyroid blood tests to confirm they have such a condition. Some of the common tests include the TSH, T3 and T4 tests (both free and bound), and the thyroid antibodies (TPO, TSI, etc). Reverse T3 is another important test, although many doctors don’t test for this. Although thyroid blood tests do a relatively good job of diagnosing an existing thyroid or autoimmune thyroid condition, they do have some limitations.

Although I do think anyone who is suspicious of having a thyroid or autoimmune thyroid condition should obtain blood tests to help confirm this, there are three primary reasons why you shouldn’t solely rely on such tests:

Reason #1: Thyroid blood tests aren’t completely accurate. In other words, there are people who have a thyroid problem, yet have negative lab results. Sometimes this is due to the reference ranges, as different labs have different ranges. So for example, someone with a TSH of 4.0 might be considered hypothyroid according to one lab, and normal according to another lab. But you can’t always rely on lab reference ranges, as someone with a TSH of 2.5 is considered to be normal by just about any lab. But how about if the person has what is considered to be a normal TSH, but still has thyroid symptoms?

Well, some doctors will say that the TSH isn’t completely accurate, and as a result it is a good idea to look at the thyroid hormone levels, such as tests for the free T3 and free T4. I agree that obtaining multiple thyroid blood tests is better than relying on just one, but there still are situations where people will have negative lab values for all three of these tests, but will still have thyroid symptoms. Many medical doctors will tell the patient they have psychological issues, which for a small percentage of people might be true, but the majority of people will experience actual symptoms, and sometimes these can be severe, even with negative lab values.

Reason #2: Thyroid blood tests usually don’t reveal what the cause of the condition is. With most thyroid and autoimmune thyroid conditions, the malfunctioning thyroid gland isn’t the actual cause of the condition. As a result, while the thyroid blood tests usually tell us whether or not someone has a thyroid or autoimmune thyroid condition (although as you learned in reason #1, they don’t always do this), they don’t tell us what the underlying cause of the disorder is. This is a big reason why most endocrinologists and other types of medical doctors simply recommend thyroid hormone medication for people with hypothyroidism and Hashimoto’s Thyroiditis, or anti-thyroid drugs/RAI for people with hyperthyroidism and Graves’ Disease. They simply aren’t taught how to find the cause of most thyroid and autoimmune thyroid conditions, and so the only thing they know how to do is give their patients prescription drugs to manage the symptoms, or radioactive iodine treatment in hyperthyroid conditions to obliterate the thyroid gland.

Reason #3: Blood tests aren’t preventative. Even though thyroid blood tests aren’t always accurate, in many people these tests do diagnose thyroid and autoimmune thyroid conditions. However, by the time someone receives a positive blood test, they already have a “full blown” thyroid condition. So while blood tests can be very valuable in diagnosing many thyroid and autoimmune thyroid conditions, wouldn’t it be even more valuable to have tests that can help determine a problem before it actually develops into a thyroid condition?

Fortunately, there are tests that not only can help to determine the cause of the health issue, but they also can detect a problem before it leads to the development of a thyroid or autoimmune thyroid condition. Of course most people reading this already have a thyroid issue, and so the purpose of obtaining these tests would be to help determine the underlying cause of your condition. I’m specifically going to discuss three tests which many people with these conditions can benefit from, and then I’ll list three additional tests to consider. Once again, I’m not suggesting that the following tests should replace blood tests, but in my opinion they should be used in combination with conventional serum tests.

Test #1: Adrenal Stress Index. This is a saliva-based test that can help to determine the health of the adrenals. While many labs perform one-sample cortisol tests, usually first thing upon waking up in the morning, the ASI test requires four saliva samples taken at certain intervals throughout the day. This allows the healthcare professional to get a much better idea as to how one’s adrenal glands are functioning. In addition to looking at the cortisol levels, this test also will evaluate the DHEA, 17-OH Progesterone, and Total Salivary SIgA (secretory IgA). Secretory IgA is a valuable test that unfortunately isn’t performed by all labs that do saliva testing. Some wonder whether or not saliva-based testing is accurate, but research has shown that it is very accurate, although this does depend on the lab you use. I personally use the lab Diagnos-Techs, although there are other quality labs out there as well.

Test #2: Hair Mineral Analysis. This is a controversial test with limitations, but if interpreted correctly it can provide a lot of valuable information. The reason for this is because a hair mineral analysis detects problems occurring at the cellular level. In addition to detecting certain mineral imbalances, this test will also evaluate the heavy metals such as aluminum, mercury, cadmium, lead, and arsenic. This is an excellent testing method for children, as it is easy and non-invasive. However, just as is the case with saliva-based testing, finding a quality lab is important to obtain accurate readings. I use Analytical Research Labs because they focus on this type of testing, and they are one of the few labs which don’t wash the hair sample right before analyzing it, which can affect the results.

Test #3: Male or Female Hormone Panel. Many people with thyroid and autoimmune thyroid conditions have hormone imbalances. Although the sex hormones (estradiol, progesterone, testosterone, etc.) can be tested through the blood, I typically will test these through the saliva, which looks at the free form of the hormone. Testing the sex hormones is especially helpful for determining whether a person has estrogen dominance, which can be a potential trigger. In many cases it is also helpful to measure the pituitary hormones FSH and LH. A male hormone panel through the saliva will measure the hormones androstenedione, testosterone, dihydrotestosterone, estrone, progesterone, and DHEA, with FSH and LH being measured in an expanded panel.

By the way, I’m not suggesting that everyone who has a thyroid or autoimmune thyroid condition should receive all three of these tests, as which tests someone receives should be based on their individual condition. The same concept applies to someone who doesn’t have a thyroid condition but wants to determine if they have compromised adrenals or another issue that can lead to the development of such a condition, as well as other health problems. Each of these tests can be extremely valuable, but I also realize that most people don’t have an unlimited budget, and therefore even if someone can benefit from receiving all three of these tests, they might only be able to afford one or two of them.

Three Additional Tests Which Might Be Beneficial

In addition to the three tests I just discussed, here are three other tests which can provide some value:

1. Intestinal permeability test. Many people with thyroid and autoimmune conditions have an increase in intestinal permeability, also known as a leaky gut. Although having a depressed secretory IgA on the saliva test can be a strong indicator of a leaky gut, this isn’t a specific test for determining if someone has a leaky gut. And so if someone wants to confirm or rule out the presence of a leaky gut there are a few different options. The classic test for determining if someone has a leaky gut is the lactulose/mannitol test, which is a urine test. There is also a blood test by the company Cyrex Labs, which measures the immune system response to a leaky gut. Both tests can be valuable, although I prefer the blood test by Cyrex Labs, as it not only can determine if someone has an increase in intestinal permeability, but it also can reveal if someone has intestinal dysbiosis (an imbalance of the gut flora) by measuring the antibodies to lipopolysaccharides, which are from gram negative bacteria.

2. Stool panel. Some healthcare professionals will recommend a stool panel to all of their patients. A stool panel can determine if someone has pathogenic bacteria, yeast, and/or parasites. Depending on what type of stool panel you obtain it also might include markers of gut inflammation, an analysis of short and long chain fatty acids, and whether you have sufficient numbers of lactobacilli, bifidobacterium, and other commensal (beneficial) bacteria. There are also different types of stool panels, as some of them involve DNA testing, while others utilize staining techniques. I’ve used both methods in my practice, and while I don’t commonly recommend stool panels to my patients, when I do utilize this type of testing I tend to recommend a company that utilizes DNA (PCR) testing. The problem with stool panels is that while they can provide some valuable information at times, they can be very expensive, and even with the latest technology false negatives are common. There are many different companies which offer testing through the stool, including Genova Diagnostics, Doctor’s Data, Diagnos-Techs, and BioHealth Laboratory.

3. Organic acids test. Lately I’ve been using this type of testing on a more frequent basis, although it’s still not a test I routinely recommend to my patients. Organic acids are metabolic intermediates, and this test can help to determine whether someone has certain nutrient deficiencies, oxidative stress, problems with methylation, imbalances in the neutrotransmitters, intestinal dysbiosis, and it even provides some detoxification markers. This is a urine test, and there are a few different companies which offer this type of testing, including Great Plain Laboratories and Genova Diagnostics.

Using Tests To Monitor One’s Condition

These “alternative” tests, along with the thyroid blood tests, not only can help to determine the cause of the problem, but they also can help to determine one’s progress when following a natural treatment protocol. It’s great when someone begins a natural thyroid treatment protocol and after a few months of treatment notices positive changes in their blood tests, and then eventually sees their positive blood tests become negative. When I was diagnosed with Graves’ Disease, just about all of my thyroid blood tests were initially positive, and it was a great feeling to see the values improve over time, and I of course was very excited once they normalized.

The same concept applies with these other tests I listed, as it’s nice to perform at least one or two follow ups to see the changes. For example, my first Adrenal Stress Index test consisted of low cortisol levels in the morning and early afternoon, plus a depressed DHEA, and it was nice to see these values normalize when doing a follow-up test. Plus, in addition to experiencing symptomatic relief, this also serves as objective proof that the natural treatment protocol is working.

How frequently should one perform a follow up test? It depends on the individual, but for the blood tests it probably is a good idea to get them tested at least every other month. As for the other tests I mentioned, I usually recommend to do a saliva retest after three months of following the natural treatment protocol, which usually just includes those values that were initially out of range. Since it usually takes longer to see positive changes on the hair mineral analysis I usually recommend retesting this in five to six months after starting the natural treatment protocol. Some people prefer to do the follow-up testing more frequently, as they can’t wait to see the improvement in these tests. So some people will want to have these tests taken every month or two. Testing the blood every month is fine for those who want to do it (or are advised to do so by their endocrinologist), but I think retesting every month might be a little bit extreme for the “alternative” tests, but either way, it is exciting to see the positive changes.

Of course there are some patients who don’t receive positive changes, and these tests are important for this too, as if someone isn’t responding as expected, I obviously want to discover this sooner than later so I can find out the reason why and make any necessary modifications to the protocol. Sometimes a person will be feeling much better from a symptomatic-perspective, but they won’t show much improvement with the blood and saliva tests. With the first follow up blood tests I don’t think this is a big deal, as it does take some time to see positive changes in the blood, but obviously the ultimate goal is to eventually see all of these tests normalize.

In summary, I definitely recommend for anyone with a thyroid or autoimmune thyroid disorder to receive blood tests to help diagnose their condition, as well as to monitor their improvement when following a natural thyroid treatment protocol. But unless if your goal is to take prescription drugs for the rest of your life to manage the symptoms, then it’s a good idea to utilize the other tests I mentioned to determine the cause of your condition, which in turn will help to restore your health back to normal, whenever this is possible of course.

Other Articles You Might Like To Read:

Thyroid Blood Tests vs. Saliva Testing [1]

Stop Treating The Thyroid Gland! [2]

Combining Natural Thyroid Treatment Methods With Conventional Treatment Protocols [3]

Thyroid Antibodies & Autoimmune Thyroid Conditions [4]

Using Bioidentical Hormones To Restore Thyroid Health [5]