Why your thyroid lab work keeps coming back normal even though you have symptoms

"I'm experiencing all the symptoms, but my thyroid lab work keeps coming back as normal."

Are you one of the many women who are feeling this way?  I have multiple people tell me every week that their doctors keep telling them everything looks "fine" when though they definitely do not feel fine!

Are you experiencing one or more of the following symptoms?

  • fatigue
  • brain fog
  • digestive complaints
  • hair loss
  • skin issues
  • weight gain
  • anxiety
  • depression

Your symptoms are probably not just in your head, regardless of what you have been told.  You know your body better than anyone and are the best person to determine if something is feeling off.

In this post, I want to equip you with 2 things:

1. An understanding of WHY your blood work may come back "normal" even in the presence of symptoms

2. A thorough list of lab work to perform (that you may need to specifically request from your doctor OR order yourself)

Number One: Why Your Blood Work May be "Normal" even in the Presence of Symptoms

There are two main reasons for this: 

The first reason is that abnormalities in blood work do not always show up at the early stages of thyroid disease.  Here is a quick snap shot of the 5 stages of progression, as adapted from Dr. Izabella Wentz' book Hashimoto's Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back.

Stage One:  Genetic Predisposition to Autoimmune Response on Thyroid Gland (Hashimoto's)

Stage Two: Symptoms start arising, although typical lab work will not show abnormalities in tests like T3, T4, or TSH

Stage Three: TSH (Thyroid Stimulating Hormone) may start to show up as elevated and symptoms progress

Stage Four: Continued elevated TSH, as well as low T3 & T4 begins showing up on blood work. Most doctors will start prescribing medication at this stage.

Stage Five: Autoimmune Response may develop into other diseases such as lupus, MS, etc.

You will notice that most blood work abnormalities do not start showing up until stage 4, although symptoms start as far back as stage 2.  The reason your lab work may be reading as normal is because the disease has simply not progressed enough to start showing up in the biomarkers.

The second reason your blood work is coming back as normal may be because the standard range of "normal" is too broad, depending on where you receive the test. Let me explain:

Currently (as of 2017), most labs consider normal TSH range to be between .2-5 (some even go up to 8) micro-international units/ml

However, 95% of people WITHOUT thyroid disease measure TSH BELOW 2.5 micro-international units/ml  

Many functional Medicine Doctors are finding that most people feel best at the range of .5-2.0 micro-international units/ml.

Do you see how the standard of "normal" can vary from doctor to doctor?


Number Two: A thorough list of lab work to perform (that you may need to specifically request from your doctor OR order yourself)


Typical thyroid lab work usually includes the following:

1. TSH (Thyroid Stimulating Hormone)

2. Free T4

3. Free T3

These three basic tests will most likely tell you if you are currently producing enough thyroid hormone, as well as if you are converting T4 to T3 effectively.  Like I mentioned above, however, a thyroid imbalance doesn't always show up in theses specific markers until further along in the progression.  Getting the following additional tests (especially antibodies) can often indicate imbalances quicker. 

A few other tests to ask for:

1. Reverse T3

Elevated Reverse T3 can be an indicator of poor T4 to T3 conversion, which is often due to stress or nutritional deficiencies.

2. Thyroid antibodies:

-Thyroid Peroxidase Antibodies (TPO)

-Thyroglobulin Antibodies (TG)

Thyroid antibodies can be an effective measure of the autoimmune response against your thyroid gland.  Elevated levels can even show up before other tests, providing early detection.  If you can catch an autoimmune attack before it progresses, nutrition and lifestyle interventions can often prevent the further need for medication and other medical procedures. 

There are multiple sources to order your own tests, including Ulta Labs and Direct Labs. You may also be able to request these from your doctor. 

Please continue your day knowing that:

  • you are not crazy
  • your symptoms are not made up
  • and most importantly, there are powerful ways to address your imbalance through nutrition and lifestyle strategies

If you are not quite sure where to start or are wondering if your symptoms might be indicating the early signs of thyroid imbalance, I offer free 30 min. health consultations over phone or Skype.  I would love to listen to your story and support you in your movement toward restored health.  Click on the button below to request a free session: