If you’ve taken these tests from different companies, you probably know that these ranges often differ. The question is, why is this so? First off, the values in reference ranges are determined by the standard variations of the local population. I.e., the findings made on other individuals in your neighborhood.Â
This involves persons of all ages and health statuses. That means this “normal” reference range is made up of a mix of healthy and unwell persons, something that may affect your results.
It is not that complicated. You only need to examine the reference range and verify that your result falls inside the top to low 30% percentile of that range, depending on what you’re testing for. This is called the “optimal” range. Though this, too, is not always 100% ideal, it’s better than being too general.
For example, a recent study asserts that TSH levels in adults with normal thyroid function tend to be around 1.0 and not just any other random value between 0.450 – 4.500 uIU/mL, as most doctors claim.
The optimal range is the range that would be seen in an active, healthy adult who is free of medical illnesses or metabolic disorders.Â
And this is the range you should aim for, not the generic range derived from statistical analysis of the population in your immediate vicinity. Below is a table that helps you understand normal vs. optimal ranges better.
So How Do You Interpret Your Thyroid Tests?
Your healthcare professional will use reference ranges to compare your test results and assess your current health state because it does give valuable information.Â
However, a true evaluation of a test result can only be determined after your provider has gathered all of the other information about your health, such as the results of a physical exam, recent changes in your health, your health and family history, any medications you are taking, and other non-laboratory testing.
If, for example, you are experiencing low energy, memory problems, constipation, and other symptoms, but your TSH and T4 readings fall within the normal range, your doctor will often tell you there isn’t a problem with your thyroid.Â
However, this is not true. Irrespective of what your results say, if you’re not feeling healthy, that’s a sign that your doctor may be missing something. As we proceed, you will see why some of these issues arise. That said, let’s get to work on the interpretation, shall we?
TSH Interpretation
A normal TSH reading (when the test value falls within the range) indicates that your thyroid is operating normally. TSH levels that are too high can indicate that your thyroid isn’t producing enough thyroid hormones, a condition known as hypothyroidism.Â
Low TSH levels may indicate that your thyroid is producing too many hormones, a condition known as hyperthyroidism.
This can be perplexing since it would appear that if there is a lot of TSH being created, there should be a lot of thyroid hormones being made as well.Â
However, this isn’t the case because your thyroid gland must be functioning well for your TSH to be effective at all. In other words, because the thyroid hormones T4 and T3 are low in people with an underactive thyroid, the pituitary gland responds by raising TSH to increase T4 and T3 production. In the case of an overactive thyroid, the opposite occurs.
Keep in mind that the standard TSH range is approximately 0.4-4.5 mIU/L. A low TSH level is between 0.1-0.4 mU/L. If it’s between 0.1 and 0.5 mU/L, then that’s subclinical hyperthyroidism.Â
TSH that’s lower than 0.1 mU/L is known to be overt hyperthyroidism. If it’s over ten mU/L, then that’s overt hypothyroidism. An optimal TSH reading should be less than 2.
Now, let’s analyze the traditional medicine approach to the interpretation of a TSH that falls between 4.7 and 10 mU/L. For traditional practitioners, this value will mean that you have subclinical hypothyroidism.Â
However, from a holistic view, if your optimal level of TSH is between 1-2 mU/L and your test shows a TSH of 3.0-3.5mU/L, that means you have subclinical hypothyroidism and are well on your way to experiencing full-blown hypothyroidism, especially if you already have symptoms of hypothyroidism.
At this stage of thyroid illness, you could take the right actions to stop your thyroid from damaging further if the underlying causes of your increased TSH are minerals and vitamins deficiencies, unhealthy diet, gut problems, overload of heavy metals, or other toxins in your system.
In the opposite spectrum, if you have a very low TSH and you are treated with T4 and T3 medicines, you will have a suppressed TSH, and that doesn’t mean you have hyperthyroidism.Â
Personally, I have a suppressed TSH of 0.005 mU/L and normal T4, T3, and FT3 without symptoms of hyperthyroidism as a result of taking a compound T3 medicine.
Note that a suppressed TSH does not always imply that your thyroid is overactive. You can have a suppressed TSH while still experiencing low thyroid symptoms. This is usually the case if you have low thyroid symptoms, including weight gain, fatigue, hair loss, and depression, despite having a low TSH. Â
If you truly are hyperthyroid, you should experience the symptoms of hyperthyroidism. Common symptoms of hyperthyroidism include diarrhea, excess sweating, mood swings, excessive hunger, irritability, restlessness fatigue, panic attack, and heat intolerance.
T4 Result Interpretation
A high T4 level implies that your thyroid is hyperactive or that you have hyperthyroidism. Anxiety, unintentional weight loss, diarrhea, and tremors are all symptoms.Â
On the other hand, a low Free T4 level indicates hypothyroidism. Even in the subclinical and early phases of thyroid illness, these FT4 results may appear normal.
If you have a high TSH level and a low FT4, this suggests that you have hypothyroidism caused by thyroid gland illness. Hypothyroidism caused by a pituitary gland issue is indicated by a low TSH and a low FT4. Low TSH and a high FT4 is another sign that you have hyperthyroidism.
T3 and FT3 Interpretation
If your T3 or FT3 test is higher than normal, then that’s a sign of hyperthyroidism. Low T3 and FT3 levels could indicate hypothyroidism.Â
Thyroid patients with low free T3 levels (even if their TSH is normal) lose less weight and experience more thyroid symptoms than those with greater free T3 levels.Â
T3 test results are frequently matched to T4 and TSH test findings to make a more accurate conclusion. However, though the standard range is 0.82 – 1.77 ng/dL, FT3 Optimal levels are usually in the top 1/3 of the reference range.
RT3 Interpretation
You have too much Reverse T3 in your body if your Free T3/Reverse T3 ratio is less than 0.2. Low triiodothyronine (T3) levels and excessive reverse triiodothyronine (RT3) levels are often a sign of euthyroid sick syndrome.Â
Euthyroid sick syndrome is a health issue where the serum quantity of thyroid hormones is low in individuals with acute critical illness, and calorie shortage, especially after major procedures. Ideally, RT3 should be as low as possible.
Thyroid Antibodies
An increased level of thyroid antibodies may indicate an ongoing autoimmune attack. Thyroglobulin antibodies and thyroid peroxidase antibodies (TPO) are present in high concentrations in autoimmune spectrum disorders like Hashimoto’s, and they are crucial signs that hypothyroidism may be due to an autoimmune cause.
 In response, the pituitary gland produces more TSH, resulting in a high blood level. While testing for antibodies can help with the initial assessment of hypothyroidism related to autoimmune thyroiditis, tracking their levels over time can’t help with determining the progression of hypothyroidism or the patient’s responsiveness to medication.Â
When it comes to Grave’s disease, apart from the thyroid blood tests, a test known as thyrotropin receptor antibody (TRAb) is used to check for grave’s disease in a patient. If this test comes out positive, then that’s a sign that you have grave’s disease.Â
Also, a radioactive iodine absorption test, which indicates whether high amounts of iodine are gathering in the thyroid, may be used to confirm a diagnosis of Graves’ disease.Â
Thyroid hormones require iodine to be produced, thus if the gland is absorbing unusually large levels of iodine, it is clearly creating too much hormone, and that can cause grave’s disease. If these tests are unclear, your doctor may perform special imaging tests, such as a CT scan or an MRI to confirm.
Thyroid Binding Protein
In a situation where your TBG is high, but thyroid hormone levels are low, then it’s an indication that you may have hypothyroidism.Â
If, however, your TBG value is low but your thyroid hormone levels are high, hyperthyroidism is the most likely diagnosis. Meanwhile, an elevated TBG level typically points to hypothyroidism or liver disease, while a decreased TBG means hyperthyroidism and malnutrition.
Thyroid Blood Test Patterns
- A normal TSH, FT3, FT4, and antibodies test result shows your thyroid is functioning normally.
- Low TSH with high FT4 and FT3 reflects primary hyperthyroidism.
- Whenever your TSH is high or greater than 2.0, and your T3 and T4 levels are low (bottom 20-30%) while your thyroid antibodies and Rt3 tests are normal, you have hypothyroidism.
- A high TSH but normal T3 and T4 levels show that you have subclinical hypothyroidism.
- High TSH and low FT4 and T3 suggests primary hypothyroidism.
- Normal or low TSH, plus high T4 and T3, show hyperthyroidism which could be because of an issue with the pituitary gland signals or from an issue with the thyroid hormone receptor.
- Normal TSH with low T3 and high T4, normal antibodies, and high RT3 point to hypothyroidism caused by a T4 to T3 conversion issue.
- Low TSH, plus low T4 and T3, point to hypothyroidism, especially those resulting from an issue with the hypothalamus or pituitary signals which control the thyroid gland.
- Low T3 and normal T4, plus high rT3, and normal-to-low TSH level depicts a condition known as nonthyroidal illness or sick euthyroid syndrome. This means you have a serious illness different from thyroid dysfunction.
- A fluctuating or normal TSH, plus low T3 and T4, and increased antibodies with normal RT3 shows that you may have Hashimoto’s thyroiditis.
- A TSH level that’s very low (almost 0), plus high T3 andT4, coupled with a positive Antibodies test result, plus low to normal RT3, are often a sign of Grave’s disease.
- A normal TSH with a low T3 and T4 level (often within the lower 10-20%), plus normal antibodies and high RT3, shows that you may have obesity.
How Traditional and Holistic Doctors Interpret Subclinical Hypothyroidism and Hyperthyroidism
When it comes to range, these doctors consider anything from 4.7 to 10uU/ml subclinical hypothyroidism. However, a decreased TSH can also be a sign of hypothyroidism. But, most times, when this is the case, symptoms don’t show up often because T3 medicines are suppressing them.Â
Meanwhile, for subclinical hyperthyroidism, doctors consider anything between 0.1-0.4 subclinical hyperthyroidism.
To them, you’re fine if your TSH is still between 4.7 and 10. But a TSH that’s greater than 10 uU/ml means hypothyroidism and is then treated with Levothyroxine monotherapy.Â
Traditional doctors treat individuals with subclinical hyperthyroidism with drugs like Methimazole in tiny doses. These medications function by inhibiting thyroid hormone production and the conversion of T4 to T3 in the thyroid gland.
Now, holistic practitioners tend to not only measure TSH alone but also Free T3, free T4, reverse T3, thyroid antibodies, and inflammatory markers. In addition to this, they use the optimal ranges to compare results.Â
According to these ranges, TSH levels above 2.0 uU/ml are indicative of hypothyroidism and are treated with thyroid replacement therapy, preferably a mix of T4 and T3, depending on conversion status.Â
The doctor will also wait watchfully, monitoring the progress of the patient by re-conducting the tests and always keeping an eye on their symptoms as well.
For clinical hyperthyroidism, anything less than 1.0 is a sign of hyperthyroidism. However, this is not always the case as a person’s TSH result can appear low, but the person will still be fine. Â
This is why holistic practitioners often search for the underlying cause and examine your symptoms to determine if treatment is necessary. Where necessary, a holistic doctor will likely use basic lifestyle adjustments, the use of tailored supplements, exercise, and other natural treatments to combat subclinical hyperthyroidism.
Why Do You Feel Unhealthy When Your Thyroid Results Say You're Within Range?
This thyroid test thing can be quite complicated, no doubt. But you must understand that just because your thyroid test results show that you fall in the “normal” range does not necessarily mean you’re safe.Â
If despite the good result, you still feel symptoms of hypothyroidism or hyperthyroidism, then you should discuss this with your doctor.
 There is a lot of overlap between findings from healthy people and those with disorders for many tests, so there’s still a chance there’s an unreported problem.
Some persons with the disease have lab test results that are within the reference range, especially in the early stages of the condition.
Hormones like Estrogen, progesterone, testosterone, DHEA, and Pregnenolone tend to reduce when menopause sets in. Meanwhile, there are many symptoms of menopause and hypothyroidism that overlap.Â
For example, fatigue, weight gain, slower thinking, feeling cold, depression, constipation, abnormal periods, and muscle weakness are symptoms of hypothyroidism. But they are also symptoms that come with menopause.Â
Therefore, you might want to check your hormones too to determine whether what you’re feeling is merely an effect of menopause or a sign of hypothyroidism.
Also, even if test values are “normal” according to the reference ranges, it’s worth noting that, while theoretically normal, it might not be the greatest option for a person, especially if they’re suffering unusual symptoms.Â
In the case of suppressed TSH, for instance, you may feel symptoms of hypothyroidism even when your T4 and T3 levels are normal.Â
Meanwhile, studies have shown that TSH suppressed for a long time can have serious illnesses like osteoporosis. This is a condition that causes the bones to become weak and brittle.
Likewise, an abnormal result may not necessarily imply that you are ill. A test result outside the reference range could indicate a problem or not.Â
Because many reference values are based on statistical ranges in healthy persons, you may fall outside the statistical range— especially if your value is near the expected reference range— and still feel good.
Whether or not you feel better after taking your medication is probably more relevant than your lab tests— optimal or not. Usually, your clinical presentation or symptoms describes your thyroid health better.
This is why it is essential to take the full thyroid panel and mention both the results of your tests and your symptoms when talking to your doctor.Â
So irrespective of whether your test results reflect it or not, if you’re experiencing hypothyroidism symptoms, the medicines need to be adjusted or add a compounded form of T3 to your treatment.Â
Surveys show that hypothyroid patients complain about the same symptoms for over ten years. You don’t want to fall into this group. Don’t let your doctor convince you that you are okay just because your TSH or your T4 are in the normal range.
The Role of Ultrasound in Thyroid Health Evaluation
Thyroid tests don’t have to end with thyroid blood tests alone because these tests aren’t entirely reliable on their own. One of the other evaluations that provide further information is ultrasonography.
 If you’re wondering what thyroid ultrasonography is, it is the use of high-frequency sound waves to obtain pictures of the thyroid gland and locate inflammation in a quick, non-invasive way.
A thyroid ultrasound tells your physician whether the nodule is a fluid-filled cyst or simply solid. It, however, doesn’t reflect whether the nodule is benign or cancerous.Â
What makes this test is so important is, when thyroid antibodies are negative, thyroid ultrasonography is critical in the differential diagnosis of hypothyroidism. It’ll help your doctor see the parenchyma and evaluate whether the thyroid is there.
Ultrasound provides for precise measurement of a nodule’s size and can be used to evaluate if a lesion is shrinking or expanding during treatment. During a thyroid needle biopsy, if the nodule cannot be felt easily, ultrasound can help to increase accuracy.
Thyroid Tests Rules
- The first rule is to take the full thyroid panel test. Do this at least the first time you’re testing. The test includes TSH, FT4, FT3, TT3, TSI, TgAB, and TPOab.
- It is advised that you take the text between 6 to 9 am. Though your thyroid fluctuates all through the day, it is around this time that your thyroid peaks. Also, try to take the test close to the same time every time.
- If you’re a woman, don’t test between 10-20 of your menstrual cycle. This is because your progesterone—which influences thyroid function— tends to be higher than usual during this period.
- Go in a fasted state. Generally, food has been shown to impact thyroid stimulation, which can mess with your result.
- Do the test before taking your thyroid medication. The artificial hormones induced from thyroid medication can make your hormones seem more abundant than they actually are. You can postpone taking your meds for an hour or two, so you take the test first.
- Avoid biotin 1-2 days before the test.
- Repeat the test no less than six weeks after your last test. Also, it is recommended that you do the tests every three months to 6 months as a way of monitoring your thyroid health periodically.
Can You Order Your Own Tests?
The answer is YES! You can order your own thyroid tests online without a prescription from a doctor.
When the kit arrives, you’ll use disinfectant to clean your finger before pricking it with a small lancet to collect blood. After that, you’ll put about five small drops of blood on a test strip, place it in a package that comes with the kit and return it to the lab for testing.
Everything you’ll need is included in the package. After you transmit the test strip, the lab will email you the results via an electronic gateway that you will sign up for when you purchase the kit.Â
Most kit suppliers can deliver results in a few days, which is better than the time it takes for in-person lab results. Some of these companies include LetsGetChecked, EverlyWell, HealthLabs, and others.
However, you can also let your doctor order the test for you or take it in a laboratory. Plus, even if your at-home examination reveals abnormal thyroid levels, your doctor will almost certainly order a new blood sample and thyroid panel to validate the findings.
There are also companies that partner with various labs to make lab testing generally easy for people. When looking to take your thyroid tests, these companies are another option. A doctor’s order is not required.Â
Hence no visit to the doctor is required. This method is known as direct access testing (DAT). Prior to the availability of DAT, patients had to see a doctor at least twice: once to obtain the requisition form (lab order) and the second time to receive and interpret lab test results.
Now, you don’t need to go through all these hassles. You can avoid these visits and save time and money. To take this test, you’ll need to order it and then simply walk into the most convenient lab locations the company provides to drop your blood sample.Â
The result would be ready within 3-5 days and interpreted by a doctor. Some companies that offer this kind of service include Life Extension, health-test-direct, and My One Medical Stop (MOMS).
Conclusion
Over the years, there have been many controversies concerning thyroid function tests and result interpretation. Despite decades of practice, traditional endocrinologists and holistic medical practitioners have not seen eye to eye on this topic.
For starters, because there is no direct link between T3 levels and the risk of overt hypothyroidism, many traditional doctors will not test T3.Â
Furthermore, due to the risk of reactive hyperthyroidism, the T3 replacement medicine Cytomel (liothyronine) is not even recommended for the treatment of hypothyroidism, reducing the significance of T3 in directing thyroid treatment.
Integrative practitioners, of course, won’t have any of it. In their opinion, the number of active hormones circulating in the blood, specifically free T4 and free T3, not TSH, is the genuine indicator of a person’s thyroid health.Â
They claim that TSH is an imprecise measurement since it can fall within normal limits even when a patient has Hashimoto’s disease, meaning that free T3 provides a more realistic picture of thyroid function. This is why they consider Low free T3 a good reason for thyroid hormone replacement treatment.
We also see some controversy as regards testing for RT3. While conventional doctors wave it off as unimportant, integrative practitioners feel that a high RT3 or an imbalance in the RT3/T3 ratio is a definite marker of hypothyroidism.
Meanwhile, there is enough data from holistic and integrative doctors that treat thousands of patients successfully. According to this data, ordering complete thyroid panel tests like TSH, Total T4, Total T3, Free T3, RT3, and thyroid antibody tests are the correct way to diagnose and treat thyroid patients.Â
These tests will give the whole picture of the health of the thyroid and help the practitioner determine the underlying cause.
The Bottom Line
Whether your results are in the lower range, higher range, or out of range, they must be carefully evaluated, preferably using the “optimal” test reference range. Then you should match these results to your symptoms.
For this reason, you must seek out an experienced doctor who is willing to collaborate with you to make you healthy. You should be able to freely discuss alternative therapy solutions without fear of being judged.Â
And you should be able to work together to consider the benefits and drawbacks of each option. This way, you can make a sound decision.Â
If you have doubts concerning the care you are receiving, seek a second opinion or request that your records be transferred to a different doctor — preferably an integrative or Naturopathic doctor with experience in thyroid and bioidentical hormones treatments.
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