The most common question I have been asked lately, from others who have recently been diagnosed, is “What tests should be done?” That is the first of two very important questions. The second is often forgotten, unfortunately. The next question should be, “What should my numbers be?”
For someone who has never been diagnosed with any thyroid issues, a basic TSH (thyroid stimulating hormone) test should be sufficient. If that number comes back within normal range, there is no need for further tests. HOWEVER, this statement can be very deceiving. Know your numbers and your body.
IT IS YOUR RIGHT as a patient to know your actual numbers. Do not accept, “Your tests were in normal range.” The doctor is looking at the exact number, s/he can share that with you. Why do I stress this point? “Normal” is a relative term. “Normal” is a range. Think about the color blue. What shade is your blue? Light, dark, somewhere in between? Is it blue, sky blue, cyan, cornflower, indigo, steel blue, denim, navy or some other shade? This is how thyroid levels work, too. Everyone feels differently at various levels. This is NOT a one size fits all test.
So what can you do?
First, get your actual numbers. If your doctor’s office offers a service like MyChart, where you can see all of your lab results, sign up! If your doctor’s office does not offer a similar service, ask! You are allowed to know your numbers. You are even allowed to get a second opinion should you not agree with your doctor’s decision.
Second, know your body. Know what symptoms you are experiencing. If you don’t feel well, don’t stop fighting.
Lastly, know the optimal levels. Optimal means the most favorable. There are definite numbers at which we feel better and as we get closer to that magic number, we feel good, the further we are from that number, the more symptomatic we will be.
The number to start with always is TSH, as mentioned before. This number should NEVER be higher than 3.0 μIU/mL. Some physicians still work with the old idea that 5 is the magic number, however, endocrinologists now agree the highest acceptable number (“magic” number) is now 3.
So, your TSH is above 3.0 μIU/mL, what do you do now?
Request more lab work. Some doctors will insist that it is unnecessary, but I always tell these doctors, “Just humor me.” Some will claim that insurance will not cover these labs, but most of the time they are covered if the office bills them correctly. If the doctor still refuses, it is honestly time to find a new doctor.
Recommended labs to request
- free T4
- free T3
- reverse T3
- TPOAb (thyroid antibodies which will show if it is an autoimmune disease)
- Vitamin D
What should my numbers be?
- TSH (optimal- 0.5-1.5 μIU/mL, normal- 1.5-3.0 μIU/mL)
- free T4 (normal- 0.8-1.3 ng/dL, optimal 1.3-2.8 ng/dL)
- free T3 (normal- 2.3-3.2 pg/mL, better 3.2-3.7 pg/mL, optimal- 3.7-4.2 pg/mL)
- reverse T3 ratio (free T3/RT3 ratio, healthy ratios will be 20 or higher, total T3″/RT3 ratio, you are looking for 10 or higher) Click the link to be redirected to a calculator to help figure your ratio and understand your numbers. Be sure to match the units of measurement to those on your labs.
- TPOAb (should be under 35 IU/mL. Higher numbers indicate autoimmune hypothyroidism)
- Vitamin D (optimal levels are 50-70 ng/mL)
This post contains so much information, I highly recommend reading it over more than once. Feel free to bookmark this page too, so you can refer to it with your numbers in front of you. Always remember, YOU are your own best advocate. If you don’t feel well, keep checking labs or get another opinion.