Thyroid Issues? These Are The 7 Tests You Need.

As someone who has a long history with thyroid disease it’s one of the health topics that I am most passionate in speaking about. I was diagnosed with Graves’ disease in the 6th grade, and with Hashimotos thyroiditis and hypothyroid after graduating college.


Thyroid disease has impacted my family as well, and there are several women that I’m close to that have received similar diagnoses to me or have even experienced thyroid cancer.


Thyroid disease primarily affects women, and its women that I’m most passionate to serve through my Functional Medicine practice. Thyroid health intersects with so many areas of our wellness – our gut, our hormones, our nutrition, and stress response.

Too often in my practice I see women come in and the only thing they can tell me about their thyroid health is their thyroid stimulating hormone (TSH) levels. This is not a criticism of these women, but an observation about what mainstream medicine usually gets wrong: thyroid health doesn’t exist in a vacuum and can’t be reduced to a single lab marker. Understanding the root-cause of our thyroid issues requires that we take a wide lens.

Although no list could be completely comprehensive these are the lab tests that come up most frequently in my suggestions to clients seeking to improve their thyroid health. What I love most about this list, is that these labs provide an actionable critique of our wellness from a Functional Medicine Nutrition perspective. What do I mean by actionable critique? For a long time, I would get an autoimmune thyroid panel run every six months and then head into my doctor’s office to discuss the results. They would look at my lab markers and say things like, “Your autoantibody levels seem really high. Have you changed anything in the last six months?” Of course, I usually didn’t have a good response to this question. Naturally there are a lot of things that could have occurred over the last several months and, even though I was trying to be really really healthy, I guess there could always be room for improvements, right? These appointments always felt like trips to the principal’s office and I would leave feeling downcast and even fearful. Usually these appointments triggered a lot of confusion, further mistrust of my body, and fear-motivated restrictive dieting – you’re talking to a 2-year AIP diet ‘black-belt’ right here! The lab tests that we were running didn’t give me any real homework, it just made me more and more apprehensive about working with health professionals to have lab tests run.

As someone who’s stood where you stand now, I can tell you that having the root-cause(s) of your condition confirmed by a Functional Medicine test is as liberating as it is gratifying. Knowing the source of the chronic inflammation that continues to drive thyroid issues takes the abstract and unknown and turns them into real-world next steps.

1. The Full Thyroid Panel I already touched on this a little bit earlier but testing TSH alone is not going to provide you with enough information about how your thyroid is functioning or where there may be opportunities to make changes in your nutrition to optimize thyroid health. A full thyroid panel should include all of the below markers:

  • TSH
  • Free T3
  • Free T4
  • Reverse T3
  • Thyroglobulin antibodies (TAA)
  • Thyroid peroxidase antibodies (TPO)

The last two markers are used to diagnose autoimmune thyroid. The majority of the women struggling with hypothyroid (some estimate as high as +90%) are unaware that it’s autoimmune thyroid that’s provoking their symptoms. It’s important to point out too that there are quite a few people who won’t have a positive test result for these autoantibodies and need to have a thyroid ultrasound to confirm an autoimmune diagnosis.

Is your doctor resistant to ordering these tests for you? Check out my pro-tips on working with your doctor to get what you need!

2. Vitamin D Frequently, vitamin D gets pigeonholed as a ‘bone nutrient’. It’s true that it is important for our bone health, but we learn more about its activities every day and it’s finally starting to get some of the credit it deserves as a modulator of immune function and inflammation. Since we already established that a high percentage of women with thyroid issues fall within an autoimmune spectrum, vitamin D is going to be an essential test that could point us to an opportunity to reduce inflammation. Although most doctors won’t see you as deficient until levels fall below 12 ng/mL, in Functional Medicine we look for more than just sufficiency and find opportunities to optimize. Optimal levels for most women will be around 50 ng/mL, possibly even higher for those with autoimmune. Vitamin D is a nutrient that can cause toxicity at ultra-high doses, so it’s important to closely watch your levels while supplementing and work with a Functional Medicine practitioner to come up with the appropriate vitamin repletion plan for you.

3. CBC and Ferritin Iron is super important for thyroid health as it plays a role in producing TSH – the pituitary hormone that stimulates your thyroid to produce more hormone – and low levels can contribute to hypothyroid. As important as this is to thyroid health, you may not be surprised to learn that it’s much more common for those with hypothyroid to have anemia than those with healthy thyroid. Your Complete Blood Count (CBC) and serum ferritin levels can be used as important indicators of your iron status and reveal a potential source of low thyroid.

4. Food Sensitivity Food sensitivities are a symptom of something called intestinal hyperpermeability, or leaky gut. Our intestines are made up of cells that have the special ability to allow selective permeability – it’s their job to decide who’s in and who’s out. When our gut is functioning optimally, it keeps food particles “in” while allowing nutrients “out” when they are absorbed by the body. Inflammation triggers leaky gut which allows particles from the foods we eat to escape. These particles lead to more inflammation, which increases leaky gut, which leads to more inflammation, and so on. Food sensitivity panels are blood tests that measure our body’s immune response against foods that may have escaped our leaky gut. Using this information, a Functional Medicine practitioner should be able to tell you not only which foods you’re having an inflammatory response to but also gauge how severe your leaky gut may be. Some of the most commonly reactive foods for those with autoimmune thyroid are wheat/gluten (which, as a food actually causes leaky gut – even in healthy individuals), milk/casein, and egg.

5. Hormones Hormones and thyroid are closely linked and it’s important to establish if hormonal imbalances have triggered your thyroid dysfunction. The test that I prefer to use when analyzing my client’s hormones is called DUTCH (Dried Urine for Testing Comprehensive Hormones) Plus which looks at adrenal and sex hormones – both of which influence thyroid health. Chronic stress is something plaguing a lot of the women I support. Stress works against our thyroid by driving up inflammation, provoking hormone imbalance, and limiting how much active thyroid hormone is made available to our cells. The DUTCH Plus test goes the extra mile and also measures your sex-hormones, such as estrogen, progesterone, and testosterone, to give valuable insight into where adjustments can be made to bring the thyroid (and all of your hormones) back into balance.

Not sure where your hormone health is at? Let’s connect!

6. Nutrients and Toxins Great nutrition is key for thyroid health – and obviously our overall health too! Poor diet, drug use (prescription or over-the-counter), and sluggish digestion can be common sources of depletion’s in thyroid-essential nutrients. Nutrients such as iodine, selenium, zinc, and tyrosine are all very important to producing thyroid hormone. Likewise, nutrients like B vitamins, vitamin C, and magnesium (among many others) play key roles in supporting immune health and reducing inflammation. In my own personal experience, I have found enormous benefit to having my nutrient status assessed comprehensively using tests that look at sensitive markers for vitamin, mineral, amino acid, and essential fatty acid deficiencies.

The best nutrient panels will also test for toxins and evaluate your body’s ability to detoxify. Environmental toxins not only drive inflammation and cell injury but they can also interfere with our body’s ability to utilize nutrients. Understanding which toxins may have been injuring your thyroid can be an important step in your healing journey. Once we can see where gaps may exist, we can rebuild your health by making pointed changes in your diet, lifestyle, and supplements.

The test that I favor when working with thyroid clients on their nutrient and toxin status is the ION Profile. Curious to see what this test looks like? Email me and I’ll send you a sample report!

7. Gut Testing The relationship between your gut and your thyroid is a reciprocal one – imbalances in the gut can provoke thyroid problems, just like thyroid can negatively influence gut health. Getting to the root-cause often requires that we explore gut health in a very detailed way. It can be hard to divine what issues are present in the gut, so many Functional Medicine practitioners will utilize stool tests to study your intestinal health. For example, this level of testing can show how well you’ve been breaking down and absorbing the foods in your diet. It can also provide clinicians with a clear picture of which bacterial species are present in your gut, and whether there are any pathogenic microbial, fungal, or parasitic issues driving inflammation and autoimmunity. Often times the results of stool tests can be the breakthrough ‘ah-ha’ moment that many clients have been waiting for.


Which lab tests are right for you? Much of that will be determined during on our initial 90-minute consult where I’ll be able to gather clues from your health history. Based on the unique story that you have about the factors that have influenced your health over the years, I’ll know where we need to leverage more testing to get you back on track.

Are you ready to experience a breakthrough with your health? Make an appointment so we can get started!


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