Lab Tests for Hypothyroidism

Lab Tests for Hypothyroidism

It’s important patients order the right lab tests for hypothyroidism, adrenal fatigue, and related conditions, otherwise, patients may go untreated. While TSH test has been used as the main test for hypothyroidism over recent years, it is not a reliable measure of thyroid function. Below is a list of lab tests recommended by patients and doctors.  1 2 3 4.


The following is a primary list of lab tests for hypothyroidism run by my doctor. These lab tests provided a baseline for diagnosing hypothyroidism and related conditions. In addition, these primary lab tests are the ones we run regularly to monitor my thyroid health. To help monitor and assess treatment, I find it helpful to track lab test results, body temperature and medicine doses.

FREE T3 Lab Test

Free T3 is the workhorse of all thyroid hormones, measuring the free, unbound levels of triiodothyronine in the bloodstream. It’s important to remember that Free T3 is considered more accurate than Total T3. In hyperthyroidism Free T3 is typically elevated. In hypothyroidism, Free T3 is typically low. 5

According to Stop the Thyroid Madness 6, at the optimal dose of natural desiccated thyroid, with no lingering hypothyroid symptoms and with healthy adrenals, patients tend to have a Free T3 at the top of the range.

On natural desiccated thyroid (lower than 3 grains), with the Free T3 high or above range, and continuing hypothyroid symptoms or even hyper-like symptoms, patient could have adrenal fatigue.

For patients who are not on thyroid medication, a lab test showing high Free T3 could mean they have Hashimoto’s disease or Graves disease. Whereas for patients who are not on thyroid medicine and have hypothyroid symptoms, a lab test showing Free T3 mid to lower range could mean hypothyroidism.

Free T3 Results by Miss Lizzy Hypothyroid Advocate

FREE T4 Lab Test

Free T4 measures the available and unbound T4 hormone. For patients on natural desiccated thyroid medicine with healthy adrenals, a normal lab test will show Free T4 at mid to high range, and Free T3 at the top end of the range. Hypothyroidism generally occurs with Free T4 in the low range, and Free T3 at mid-range or slightly high.

Reverse T3 (RT3) Test

The RT3 test must be done at the same time as the Free T3 in order to calculate the ratio with the results and measurements. According to, divide Free T3 by reverse T3. The amount should be 20 or greater. If it’s less then that you have a RT3 problem. If it’s vastly smaller or larger you may have to move the decimal point to get the units right.

FT3 should be twenty of more times higher than RT3.  (Stop the Thyroid Madness book  page 162-163 for more.)

24-Hour Cortisol Saliva Test for Adrenal Fatigue

This lab test is done at home to evaluate cortisol levels during a 24 hour period. This test helps patients determine if they have adrenal fatigue. In addition the lab test will show the times during the day when adrenal function is too high or too low. Patients with healthy adrenal function will have the follow results:

  • 8 am will be at the very top of the range
  • 11 am-noon in the upper quarter of the range
  • 4-5 pm will be mid-range
  • 11 pm to midnight at the very bottom of the range

It’s important to remember, the rise and fall pattern of cortisol reflects the a person’s energy throughout the day. In simple terms, we have more energy in the morning, yet as the day goes on our energy tappers down slowly until bedtime. When the cortisol pattern is off, it greatly affects our energy and sleep patterns in the following ways:

  • Low morning cortisol may make it hard to wake up, especially before 9 AM.
  • Low afternoon cortisol may cause patients to require a nap.
  • High bedtime cortisol may make it hard to fall asleep.

Two weeks prior to the 24 hour saliva test, make sure to stop all adrenal supplements.

Order the 24 Hour Saliva Test from TrueHealth Labs

Antithyroglobulin Test

According to, testing for thyroglobulin antibodies (also called antithyroglobulin antibodies) is common. If you have already been diagnosed with Graves’ disease, having high levels of thyroglobulin antibodies means that you are more likely to eventually become hypothyroid. Thyroglobulin antibodies are positive in about 60 percent of Hashimoto’s patients and 30 percent of Graves’ patients.

B-12 Test

According to Stop the Thyroid Madness, B12 can can be low in hypothyroid patients due to low stomach acid. The normal range for B12 is 200-900 pg/ml. Though Stop the Thyroid Madnesss indicates a healthy range is on the high end.


The ferritin test measures the level of ferritin, the major iron storage protein in the body 7. The results may vary slightly among laboratories, but in general, normal ferritin levels are 12-300 nanograms per milliliter of blood (ng/mL) for males and 12-150 ng/mL for females.

According to Stop the Thyroid Madness, if your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. Optimally, females shoot for 70-90 at the minimum and men 100-130.

Elevated Ferritin, can indicate inflammation, rheumatoid arthritis, liver disease, hyperthyroidism, adult Still’s disease, type 2 diabetes, leukemia, Hodgkin’s lymphoma, iron poisoning or frequent blood transfusions.

For at least 12 hours before testing and as much as 5 days  before testing, stop taking iron supplements for best accuracy.

Iodine Loading Test

While iodine is an important nutrient for thyroid and whole body health, iodine deficiency is a primary cause of Hypothyroidism. Learn more about iodine. In The Iodine Crisis by Lynne Farrow, the 24 Hour Iodine Loading test is recommended for assessing iodine sufficiency.

People undergoing the test are deemed to be deficient in iodine if they excrete less than 90% of the iodine loading dose. 8

Sodium Test 

The sodium test is often part of the Basic Metabolic Panel. The right amount of sodium is important for health. Blood sodium can also be part of an electrolyte panel.

Normal results for this test are 135-145 mEq/L 9, however Stop the Thyroid Madness noted that healthy folks report 142 and even slightly higher.

Thyroid Peroxidase Antibody (TPO) Test

The TPA antibodies work against thyroid peroxidase and the enzyme that plays a part on the conversion of T4 to T3. TPO antibodies can indicate Hashimoto’s disease. In 95% of patients with Hashimoto’s thyroiditis TPO antibodies are detectable. While in 50-80% of patients with Graves disease TPO antibodies are detectable. 10

TSH Lab Test

TSH is a measure of the pituitary function, therefore it is not an accurate measure of thyroid function. Learn more about why TSH can be unreliable. Here is how TSH can be used in thyroid treatment to:

  • Help determine hypothyroidism only if it’s in the high range.
  • Understand the relative range for you.
  • Diagnose a pituitary problem, not a thyroid problem. Especially if low TSH is accompanied by low Free T3.

Vitamin D test

As explained by Dr. Mercola 11, there are two vitamin D test. The 1,25(OH)D and the 25(OH)D. The correct test is 25(OH)D, also called 25-hydroxyvitamin D. The lab test ranges for 25-hydroxyvitamin D are:

  • Deficient > 50 ng/ml
  • Optimal 50-70 ng/ml
  • Treating Cancer and Heart Disease 70-100 ng/ml
  • Excess > 100ng/ml

Low vitamin D can contribute to thyroid problems 12.

Serum Iron

According to Healthline 13, the serum iron test measures how much iron is in your serum. This test can help your doctor figure out if there is a problem with your iron levels (high or low) resulting in symptoms such as fatigue, weakness, difficulty concentrating, and moodiness.  Though its a less common test.

Stop the Thyroid Madness suggests a value of about 110 for women, and the 130′s for men, based on what they’ve seen on hundreds of lab results. 14

TIBC (Total iron binding capacity) test: measures whether a protein called transferrin, produced by the liver, has the ability to carry iron in the blood. Used to determine anemia or low body iron. If your result is high, and in the absence of chronic disease, you may be anemic. With healthy amounts of iron, this test will be low in the range—about 1/4th above the bottom number.



Aldosterone is a hormone that is produced by the adrenal glands to help maintain the balance of fluids and electrolytes in our bodies through the kidneys. In addition, aldosterone affects blood pressure, as well as regulating salt (sodium) and potassium in the blood. If aldosterone production is not functioning properly, there can be serious consequences to the heart, kidneys and electrolyte balance. 15

According to 16, the normal range for Aldosterone is 4-31 ng/gl.  Low range results indicate adrenal insufficiency.

Stop the Thyroid Madness suggests for women to test aldosterone in the first week of the menstrual cycle, or up until the beginning of the second week. This phase of the menstrual cycle is when progesterone is at its lowest. By the end of the second week in the menstrual cycle progesterone begins to rise. Progesterone can falsely drive up aldosterone.

DHEA test

DHEA is a natural steroid and precursor hormone produced by the adrenals. The truth is that — for the women who need it — adrenal support with DHEA supplementation can make a big difference. I’ve seen it help patients get going again when they feel like they’ve hit rock bottom. But it’s never as simple as just popping a pill. For me personally, supplementing with DHEA was not the right fit but for others it can be effective. On WomentoWomen they like to see estrogen, progesterone, and DHEA in the upper quadrant of normal.

Folate Test 

Folate or Folic acid, is a b-vitamin which can be low in hypothyroid patients. The normal reference range of folic acid in the blood is 2.7 to 17.0 nanograms per milliliter (ng/mL). Low levels of folic acid may indicate anemia, malabsorption, or malnutrition. 17

RBC Magnesium Test

While a lack of magnesium in normal diets can cause low thyroid function, it can be solved with proper diet and supplements. Magnesium deficiencies are common, especially in well-developed countries where processed foods are a part of the diet. Seven out of every ten Americans is likely to have a magnesium deficiency, causing many problems including underactive thyroid (hypothyroidism). 18

Signs of magnesium deficiency include weakness, extreme thirst, muscle cramps, muscle twitching, poor memory, confusion, Type II Diabetes, high blood pressure, fatigue, anxiety and more. 19

For RBC Magnesium results, Stop the Thyroid Mandess suggests a good range is mid to high. 20

Renin Lab Test

Aldosterone and renin tests are used to evaluate if adrenal glands are producing appropriate amounts of aldosterone. The test is also used to distinguish between the potential causes of excess or deficiency. Aldosterone may be measured in the blood or in a 24-hour urine sample, which measures the amount of aldosterone removed in the urine in a day. Renin is always measured in blood.

Low renin can mean primary aldosteronism (Conn syndrome) or Cushing Syndrome. While high renin can mean Secondary aldosteronism, or Adrenal insufficiency.  21


The plasma zinc test can establish zing deficiency. While the plasma zinc test is good at detecting major zinc deficiency, it is not as good at catching minor zinc deficiency. When this happens, a patient can have “normal” zinc results but still be zinc deficient. The optimal range for plasma zinc is 3.8 – 22.9µmol/L ( 90-150µg/dl).


The ACTH Stimulation test assesses the function of adrenal glands stress response to ACTH (adrenocorticotropic hormone). This test is used to diagnose primary or second adrenal sufficiency, Addison’s disease, and related conditions. 22

For details about range, see the simple diagnostic chart.

T7, Total T3, Total T4, Uptake, or any other thyroid labs

These tests are unnecessary 23

When talking with a good doctor, it’s important to know which lab tests for hypothyroidism and track the results over time!


  2. The Iodine Crisis by Lynne Farrow
  3. Adrenal Fatigue by Dr. James L. Wilson
  4. Mary Shomom at
Miss LizzyLab Tests for Hypothyroidism
Why Iodine is Vital for Thyroid Function

Why Iodine is Vital for Thyroid Function

Iodine is vital for thyroid function because it helps in the production of thyroid hormone. According to The Iodine Crisis by Lynne Farrow, iodine is an essential micronutrient needed by every cell in the body. In recent years, iodine deficiency has become a public health crisis because iodine can displaced by environmental toxins. People are exposed to these bromine, chlorine and fluoride toxins every day through drinking water, medications, body products, make up, toothpaste and more. 1

Risks of Iodine Deficiency

The World Health Organization has recognized up to 72% of the world’s population is affected by an iodine deficiency disorder 2 According to Dr. Brownstein, iodine deficiency may result in the following severe medical conditions:

  • Cretinism
  • Mental Impairment
  • Reduced intellectual ability
  • Goiter
  • Infertility
  • Increased risk of of breast, prostate, endometrial, and ovarian cancer
  • SIDS
  • Hypothyroidism
  • Multiple Sclerosis
  • ADHD

Iodine is Vital for Thyroid Function

Iodine is not only necessary for the production of thyroid hormone, it is responsible for the production of all other hormones 3 Since the body does not make Iodine on its own, we need to get iodine from food or supplemental sources.

Brief History of Iodine

For over 100 years, iodine has been known as the element necessary for thyroid hormone production. 4 Records showing the use of iodine as a “universal medicine” date back 150 years. Archaeological records from over 15,000 years ago show iodine use in the form of seaweed [re]Farrow, Lynne. The Iodine Crisis. Devon Press. 2013. xviii.[/ref]

Since the 1970s, we’ve become iodine deficient because bromine has purged iodine from our bodies.[re]Farrow, Lynne. The Iodine Crisis. Devon Press. 2013. page 25.[/ref]

We know from world studies that if you give iodine during pregnancy the babies that come out are usually 20-30 point higher in IQ than their parents – Jorge Fechas, MD, MPH

Do I get enough Iodine from Salt?

First it’s important to know not all sources of salt have iodine. With salts that have added iodine, a significant amount of iodine may evaporate before the salt arrives in your kitchen. The longer iodized salt sits the less iodine remains. [re]Farrow, Lynne. The Iodine Crisis. Devon Press. 2013. page 166-167.[/ref]

In addition, according to Dr. Browenstein, the use of iodized salt has not eliminated iodine deficiency disorders. Studies by the NHANES show iodine levels have dropped 50% in the USA over the last 40 years. [re]Brownstein, David. Iodine: Why You Need It, Why You Can’t Live Without It. Medical Alternatives Press. 2014. page 44.[/ref]

Testing for Iodine Deficiency

Dr. Guy E. Abraham suggests The Iodine Loading Test to determine whether a person has iodine insufficiency. To order the Iodine-Loading Test try FFP Labs at 877-900-5556 or Hakala Labs. 5

Basics of the Iodine Protocol

Dr. Guy Abraham, MD, David Browenstein, MD, and Jorge Flechas, MD have used the Iodine Supplementation Protocol to treat over 4,000 patients with iodine. 6. Read  The Iodine Crisis to understand the Iodine Protocol. Here is a summary of the Iodine Protocol:

  • 50mg Iodine Daily in the form of Iodoral or Lugol’s Solution Tablet Formulation (starting at 12.5mg).
  • Some practitioners may recommend another form of iodine such as Lugol’s Solution Liquid or Nascent Iodine
  • Vitamin C: 3,000 mg per day in divided doses (more be necessary to detox bromide)
  • 300-600 mg magnesium in the form of magnesium oxide, magnesium glycerinate or magnesium citrate depending on preference
  • 200 mpg selenium (patients preferred selenomethionine)
  • 500 mg niacin (B3) twice a day (not niacinimde). Starting at a lower dose to avoid flush.
  • 100 mg Vitamin B2 three times a day, or use the ATP Cofactor instead
  • 1/2 TSP unprocessed sea salt added to meals
  • 1/4 TSP unprocessed salt in 8 oz. water twice daily or as needed for detox
  • A comprehensive vitamin and nutrition program

Lugol’s Solution

Lugol’s solution is a mix of elemental iodine and potassium iodine, first made in 1829. It was named after French physicist J.G.A Lugol. [re][/ref]

Lugol’s 5% the strongest formula legally available in the USA contains Iodine 2.5 mg, Iodide 3.75 mg for a total of 6.25 mgs total per vertical drop.

Buy Lugol’s Solution of Iodine 5%

Lugol’s Solution Tablet Formulation

The tablet formulation of Lugol’s Solution contains the same ratio of Potassium Iodine and Iodine in Lugol’s Solution liquid. Tablets can be more convenient for traveling.

Nascent Iodine

Nascent iodine is an atomic rather than its molecular form of iodine. Because nascent iodine is an iodine atom that has an incomplete number of electrons, it can hold an electromagnetic charge. Nascent iodine has a large energy release.

Since nascent iodine is recognized by the body as the same iodine that is produced by the thyroid, it is absorbed effortlessly by the body. 7.  Nascent Iodine is a highly stable mono-element, nano-colloidal iodine not bound by mineral salts such as calcium or potassium.  This formula allows the body to efficiently utilize every drop to support thyroid and cellular iodine levels.


  1. The Iodine Crisis, Lynne Farrow, p.219-229
  2. Brownstein, David. Iodine: Why You Need It, Why You Can’t Live Without It. Medical Alternatives Press. 2014. page43.
  3. Brownstein, David. Iodine: Why You Need It, Why You Can’t Live Without It. Medical Alternatives Press. 2014. page 25.
  4. Brownstein, David. Iodine: Why You Need It, Why You Can’t Live Without It. Medical Alternatives Press. 2014. page 24.
  5. The Iodine Crisis, Lynne Farrow, p.199-200
  6. Farrow, Lynne. The Iodine Crisis. Devon Press. 2013. page 201.
Miss LizzyWhy Iodine is Vital for Thyroid Function

Iodine Reviews from Amazon

To learn more about iodine, read there iodine reviews from my customers at Amazon. Specifically, these iodine reviews from Amazon are for J.CROW’S Lugol’s Solution of Iodine 5%.

5.0 out of 5 stars “A superior Lugols product” May 7, 2014
By Donald T
This review is from: J.CROW’S® Lugol’s Solution of Iodine 5% – FREE SHIPPING US and Canada (Health and Beauty)
I have researched various iodine and Lugol products as a self-help consumer. Based on my reading of two books on the subject of iodine and based on my own use of various Lugols formulations over 7 years, I can say J.Crows Lugols meets all my expectations for proper composiiton, consistency, and purity of ingredients. It has demonstrated efficacy in eliminating some serious infections in me and my family, including various flus involving bronchitis; also prostatitis; and even mononucleosis; all in 10 days or less. I have recently started using it at very high doses against my own rheumatoid arthritis (which is considered by some doctors to be caused by infection); too early to say if it cures rheumatoid arthritis, but I must say I have much less pain and swelling now. J.Crows Lugols has given me no adverse side effects even at high doses (you must read the books for doses and treatment protocols–use Google). Furthermore, the company is very customer friendly, and they ship very quickly. I know I can buy competing brands for a few dollars less, but I am no longer tempted by the others. This is the real thing.

Perfect for My Thyroid!, April 11, 2014

By Abby

This review is from: J.CROW’S® Lugol’s Solution of Iodine 5% – FREE SHIPPING US and Canada (Health and Beauty)
I was diagnosed with hypothyroidism about 8 years ago. Two years ago, I was cleared and didn’t have to take medication for it any longer. Though I was taking Armour Thyroid and then a naturally compounded formula, it didn’t work for me greatly though my blood tests showed I had improved. I wanted to be more natural, and this product seems to help greatly. I don’t get tired during the afternoon like I use to, and my skin is no longer ashy and dry. Nor is my hair falling out anymore. I will continue using this product.
Miss LizzyIodine Reviews from Amazon

Iodine and Thyroid Health

Thiodine Lugols 5% Iodine –

Iodine is necessary for the thyroid gland’s proper performance. The human thyroid gland is located in the front of the lower part of the neck. All the blood in the body passes through the thyroid gland every 17 minutes. Because the cells making up this gland have an affinity for iodine, during this 17-minute passage the gland’s secretion of iodine  kills weak germs that may have gained entry into the blood through an injury to the skin, the lining of nose or throat, or through absorption of food from the digestive tract. Strong, virulent germs are rendered weaker during their passage through the thyroid gland. With each 17 minutes that rolls around they are made still weaker until finally they are killed if the gland has its normal supply of iodine. If it does not, it cannot kill harmful germs circulating in the blood as Nature intended it should.

 Two drops of Lugol’s solution of iodine works equally well in an adult. When the stress and strain of daily living create a load that is difficult to carry, producing a state of anxiety, and when the day’s problems make it difficult  to relax and sleep well at night, then one appreciates the aid that iodine gives. -D.C. Jarvis, MD from “Folk Medicine”

Folk Medicine in Vermont is interested in three R’s-Resistance, Repair, and Recovery. First the individual asks himself whether his resistance to disease is as it should be. Next, is he able to repair tissue injury due to accident should it occur? Finally, if sickness should come, is his body able to bring about recovery? Somehow during the passing years he has learned that iodine is related to the ability to resist disease.

We learn in Vermont folk medicine, however, that this gland performs other functions besides killing harmful germs in the blood. The first is the rebuilding of energy with which to do the day’s work. There is a definite relationship be-tween the amount of energy you have and your iodine intake.

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The first question in the presence of a condition of depleted energy is, Is the soil of the state in which one lives iodine-poor? Second, is the deficiency being made up by supple-mentary means?All soils containing granite are iodine-poor and Vermont is one of them. This fact is very important to people living in Vermont and well may be important to those living elsewhere. When energy and endurance run low in relation to doing the day’s work, then the taking of iodine needs to be considered.

A second function of iodine is to calm the body and relieve nervous tension. When nervous tension runs high there is irritability and difficulty in sleeping well at night, and the body is continually on a combat basis, organized for fight and flight. All these points stress a body’s need for iodine to lessen nervous tension, relax the body and enable it to or-ganize for peace and quiet, by the building and storing of body reserves against time of need. I have learned through Vermont folk medicine that it is possible to repeatedly change an irritable, impatient, and restless child under ten years of age into a calm, patient individual within two hours’ time by giving one drop of Lugol’s solution of iodine by mouth in a vegetable or fruit juice or in a glass of water made acid in reaction by adding a teaspoonful of apple cider vinegar. I have repeatedly prescribed this in order to make it possible for a mother of a racehorse-type little boy or girl to be able to live comfortably with the child. I have never seen it fail to calm down a nervous child.

 In an adult two teaspoonfuls of apple cider vinegar and two of honey are added to a glass of water. The honey is there because it is a sedative. Then add two drops of Lugol’s solution of iodine to the glass containing the vinegar and- honey mixture, stir it, and sip it during the meal as you would coffee or tea.  Taken apart from the meal it can be sipped like a cocktail. Soon your motor will have slipped into low gear. Your problems and their solution will seem less difficult, and the day’s load of responsibility easier to carry.  In this age of anxiety  the combination of iodine with vinegar and water  will give the harassed individual increased energy and the endurance necessary to carry the daily load. You will find that the wear and tear of daily living is considerably reduced. – D.C. Jarvis, MD, from “Folk Medicine”

A third function of iodine in the human body relates to clear thinking. The mind simply works better when the body is supplied the iodine it needs. Then there is the matter of the storing of unwanted fat. Iodine is one of the best oxidizing catalysts we have. A catalyst is the match which touches off in the body the fire that burns up the food we take in each day. If this food is not properly burned off, it may be stored as unwanted fat.

As you study yourself you will soon learn to tell when you need iodine. When a night’s sleep does not bring you to the beginning of the new day with the energy you are accustomed to have, you will begin to think of iodine. If you learn how to use it, it will restore the capacity to bounce back and sustain your well-being.  D.C. Jarvis, MD, from “Folk Medicine”

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Here is a collection of articles about Iodine, Hypothyroidism, Women’s Health:

Thyroid Disease ‘Raises Birth Risk’ Dr. Mercola

Iodine May Improve Mental Performance Dr. Mercola

Australia is adding Iodine to their bread Stop the Thyroid Madness

A toxin which could explain why SO many of us have Thyroid Disease Stop the Thyroid Madness

Causes of Hypothyroidism (including Iodine Insufficiency)

Thyroid Supplements on Stop the Thyroid Madness

Relationship between Iodine and Thyroid Health

Breast & Womb – What I’ve Learned about Iodine Supplementation

Miss LizzyIodine and Thyroid Health