Every Thyroid Panel Should Include These Markers

Next time you go to the doctor and get thyroid lab testing, it is critical that you get your thyroid antibodies tested, and not just your TSH and T4.

What most doctors order for thyroid labs

Doctors and healthcare providers are taught in medical school to screen for TSH and Free T4 first, to determine if someone’s thyroid is over- or under-reactive.

The theory behind this is that TSH and Free T4 will be the first markers of thyroid function to appear abnormal if there is a thyroid problem present.

If the labs they order show normal TSH and normal Free T4, they will usually not order additional thyroid labs, and they will tell you that your thyroid function is ‘normal.’

Thyroid antibodies are the definitive marker of autoimmune thyroid conditions

Autoimmune thyroid conditions include Hashimoto’s thyroiditis (typically presents as hypothyroid) and Grave’s disease (typically presents as hyperthyroid).

Autoimmune thyroiditis is marked by elevated levels of antibodies (our own immune cells) that attack the cells and tissues of the thyroid gland.

image from Stassi, G., & Maria, R. D. (2002). AUTOIMMUNE THYROID DISEASE: NEW MODELS OF CELL DEATH IN AUTOIMMUNITY. Nature Reviews.Immunology, 2(3), 195-204. doi:http://dx.doi.org.ezproxy1.apus.edu/10.1038/nri750

The two antibodies that detect autoimmune thyroid conditions are anti-TPO (anti-thyroid peroxidase) and anti-TG (anti-thyroglobulin).

This autoimmune destruction or inflammation of the thyroid gland causes the amount of thyroid hormones (T4 and T3) to be abnormal (too high or too low, depending which type of thyroiditis is present).

This leads to symptoms, including, but not limited to:

  • weight gain
  • weight loss
  • constipation
  • hair thinning
  • hair loss
  • puffy face
  • depression
  • brain fog
  • inability to regulate body temperature
  • fatigue and/or weakness
  • dry skin
  • goiter (enlarged thyroid gland)
  • heavy or irregular menstrual periods
  • irritability
  • abnormal sleep

Most of the time, if your doctor suspects you have a thyroid condition based on the symptoms you’re reporting, he/she will order a panel of thyroid markers that only includes TSH and Free T4, but might also include Free T3.

These markers are not specific to autoimmune thyroid conditions, but they are still thought to be the ‘best’ way to measure thyroid function and risk for autoimmune thyroid problems.

But, its time to change this way of thinking about thyroid function, because, quite frankly, its wrong.

Here’s why:

Around 70% of patients have thyroid antibodies elevated before other thyroid markers are abnormal

I was recently published as part of this new study where we looked at 4,581 patients who had multiple thyroid panels including TSH, Free T4, anti-TPO, and anti-Tg run over a 2 year period.

We classified test subjects into two groups: A1 (euthyroid at first visit, but converted to subclinical/overt hypothyroidism in follow-up visits) and A2 (euthyroid at first visit, but converted to hyperthyroidism in follow-up visits).

We found that 73% of hypothyroid subjects (from group A1) and 68.6% of hyperthyroid subjects (from group A2) had anti-TPO 252 (±33) and 277 (±151) days prior to the onset of the thyroid dysfunction, respectively.

To translate in plain English, out of those 4,581 patients, we had one group who were normal thyroid on visit one, but hypothyroid (under-active or ‘low’ thyroid) at visits two or later…

…and the second group was normal thyroid on the first visit but hyperthyroid (over-active thyroid) on the second or later visits.

In the first group, with hypothyroidism, 73% of them had anti-TPO an average of 255 days before other thyroid markers were abnormal (TSH or Free T4).

In the second group, with hyperthyroidism, 68.6% had anti-TPO an average of 151 days before other thyroid markers were abnormal (TSH or Free T4).

Advocate for yourself

Doctors are trained not to request labs that are unnecessary, largely because insurance companies don’t want to pay for very much.

This prevents doctors from requesting lab tests that can detect things like thyroid conditions earlier than if you wait until a much more serious problem exists.

If you suspect you have a thyroid condition, when you visit your doctor, discuss research such as that linked above, and explain that you would like to have your thyroid antibodies tested as part of your laboratory workup.

If your healthcare provider will not order those, you can pay cash out of pocket through many labs that cater to direct-to-consumer markets, usually for around the price of a copay or lab deductible through your regular doctor’s office.

What else should you measure?

Remember that the thyroid gland does not function in a vacuum. Just because the thyroid is malfunctioning, does not mean that the thyroid is the actual root problem.

In addition to autoimmune inflammation in the thyroid gland, there are other problems, such as nutrient deficiencies or excesses that can impact how the thyroid functions.

In addition to measuring a thyroid panel that includes thyroid antibodies (anti-TPO and anti-TG), other nutrient-specific lab tests that are complementary to thyroid function include:

  • vitamin D
  • zinc
  • selenium
  • iodine
  • vitamin A
  • B vitamins, and particularly B12
  • methylmalonic acid (will be high if B12 conversion is low)
  • vitamin C (usually low in hyperthyroid patients)
  • magnesium

If you suspect you have a thyroid problem, and want more information about lab testing for this or other conditions, including the nutrients listed above, feel free to contact me about working together to identify whether this may be a problem for you.

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