I get it. You have all the typical thyroid symptoms, yet your doctor is telling you that your thyroid blood markers are normal.

Well, it’s most probably true, your standard thyroid blood markers are ‘normal’, but that is exactly where the problem lies. With one in eight women likely to have a thyroid disorder in their lifetime, I find it astonishing that standard blood tests for thyroid health is still only looking at the same two markers they have been looking at for years.

Your thyroid was most probably assessed by checking thyroid-stimulating hormone (TSH) and thyroxine (T4). In fairness to doctors, they are actually taught that TSH is an accurate and sensitive marker for thyroid disease. In truth, it most probably is, if you are willing to wait till your thyroid is nearly completely damaged or destroyed.

It is estimated that it can take up to ten years or longer for your thyroid disease to present with an elevated TSH.

Before we can look at the best testing, let’s just quickly recap how the thyroid works.

Thyroid Testing

How your body makes thyroid hormone

You can read more here. When your body is low on thyroid hormone, the pituitary gland will secrete TSH, that will prompt the thyroid to produce T4 and T3 (triiodothyronine). This is dependent on sufficient levels of iodine, as your thyroid requires iodine to make T4 and T3. Your body will make approximately 80% of T4, compared to 20% of T3, but it is worth keeping in mind that T3 is four times more powerful.

Since there is less T3 available, the body will use the enzyme 5-deiodinases to convert T4 into T3. During periods of stress, illness, infection, starvation, trauma, theses enzymes can fail to convert T4 to T3, but instead convert T4 into reverse T3. This therefore makes the T3 inactive, resulting in less active thyroid hormone (T3) available for your body to use.

Main problems with the current testing model

As you can see, there are key markers at play and the current model is not taking into account some of the key players in thyroid health. Furthermore, these makers are looking at those who are already sick.


  • Only looking at two markers
  • Reference ranges based on sick people

Key Markers to test for

In functional medicine we look at optimal ranges over normal ranges and more importantly, we also look at personalising these. I will explain.

Whilst optimal ranges are REALLY important, I have come to learn that individuals are all unique and someone with Hashimoto’s might have a TSH of over 20, despite being on T4 and T3. The interesting thing is that they are feeling well and healthy. Whilst testing is important and I couldn’t work with a thyroid client without a thyroid panel, I always work off their symptoms and how they feel whilst getting guidance from the test.

When you assess the thyroid on a functional level the test should include: TSH, Free T3, free T4, Reverse T3 and thyroid antibodies. This test enables you to assess whether the thyroid is functioning well and whether thyroid hormone is working optimally in your body. The conversion from T4 to T3 (the active form) is key, which makes a thyroid panel at this level the gold standard.

So whilst, TSH, is a helpful marker, it is not actually telling us whether sufficient thyroid hormone is being converted to the active form and how well thyroid hormone is being used at a cellular level.

Thyroid Lab Markers

When are you likely to need a full thyroid panel?

Personally I feel that women presenting with ongoing hypothyroid symptoms should prioritise this test. It can be a game changer for life. I so wish I had done it sooner. I truly wish that I knew then what I know now. Understanding your thyroid health, is the first step to regaining your health. It doesn’t mean you understand the root cause of the problem, but you are one step closer to getting there.

Hypothyroid symptoms include:

  • Persistent fatigue
  • Unexplained weight gain or struggling to lose weight
  • Constipation (sluggish thyroid = sluggish metabolism)
  • Hormone imbalance (PMS, irregular periods). You need T3 to make sex hormones
  • Infertility or Miscarriage
  • Anxiety, low mood or Mood Disorders. T3 is involved in serotonin
  • Hair loss
  • Aching joints and muscles
  • Difficulty concentrating or remembering things

For a more comprehensive list, click here.

In a lot of other instances, women are already on thyroid medication, but the doctor is still only checking TSH and free T4. If this is you, then I highly recommend that you invest in a comprehensive thyroid panel too.

How can I get the test?

All my thyroid clients will get access to the test. My packages vary, but unless you have done testing already, a thyroid test is essential. First, you need to schedule an assessment call, which is free. The call is used for us to understand exactly what we need to be targeting and how to get your back to feeling your best.

As mentioned earlier, the testing is only a small part of the picture. Over and above this, I like to assess the whole picture, so that we can understand the root cause of your thyroid imbalance. There are many potential root causes, and to be honest in my experience it is generally more than one.

Some of these include gut health, adrenal functioning, nutrient deficiencies, infections, inflammation, blood sugar imbalances, stress, hormones, medication and more.

So often in conventional medicine, a thyroid disorder is isolated to the endocrine system. Sadly, this is NOT true and this approach does not work. In fact, most cells in your body have thyroid receptors, so thyroid problems can impact every system in your body and vice versa.

Testing is the first step to improve your health

Looking at the whole picture is the only way that you can truly support the thyroid and get someone feeling healthy and well again. Whilst thyroid medication is a life-saver for millions of women across the world, it doesn’t reverse or fix anything.

Understanding the root cause and treating the problem and the cause, is different from managing the problem with medication. First, before any of this can happen, a comprehensive functional lab test is the only way that you can truly know what’s going on with your thyroid.

Book a free assessment if you would like to get your thyroid tested.

Still not sure, then watch this video.

Nutritional Therapist Cheshire, Health, Nutritionist Cheshire, Functional Medicine Cheshire, Rootcause Solution


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422478/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856718/
  3. https://www.uptodate.com/contents/lithium-and-the-thyroid
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568739/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966235/
  6. https://ard.bmj.com/content/61/1/70
  7. https://pubmed.ncbi.nlm.nih.gov/20103030/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321289/