Top 5 Thyroid Tests to Ask For and Why

Are you a questioner? Do you like to know the why behind things? Do you feel like you need more information before you buy in? Sometimes I do and sometimes I don’t but when it comes to my health, I definitely do! I need the what, when, how and why! Getting more information through thyroid lab testing is a great example of how we can answer some of the “why’s” you might be asking. Why do I continue to have symptoms even though my TSH is normal? Why does my doctor refuse to run any additional lab tests? Why do I continue to feel like this when I am being treated for my condition? Why do I continue to feel like it’s a thyroid problem but my doctor keeps dismissing me? Why, why, why? 

One of the biggest challenges in determining what is actually happening with the thyroid gland and other systems involved with thyroid hormones is the ability to get the proper labs completed. Thyroid health is an area where we really need to look at the big picture and how all of the little pieces work together. Research shows that about 5% of the US population has thyroid dysfunction and about another 5% are undiagnosed. That is 5 of every 100 people that don’t know they have a thyroid problem. 

Many conventional doctors, where most of us go for routine visits, base a thyroid diagnosis on a TSH level and sometimes also a total T4. These labs are how they diagnose and decide on treatment with medications, typically Synthroid, a T4 only med. Let’s be fair, though, it is what they know and how they were trained and we can’t expect them to be thyroid experts. Oh, and they also use outdated conventional reference ranges for the labs. It’s no wonder why so many of us are misdiagnosed or undiagnosed and dismissed with continued nagging symptoms. We need to be our own advocates and keep asking “why?” I typically recommend working with a functional medicine practitioner if you can as they take a different approach to your health. They will want to do additional testing and use functional ranges to get more information on why you continue to have problems. 

I’ll share with you a client story. A recent client, let’s call her Lucy, came to me with Hashimoto’s and hypothyroidism. Lucy’s symptoms include fatigue, weight loss resistance, irregular and painful periods, low libido and anxiety. Symptoms that have not improved even though she is being treated for her condition under a physician’s care. The previous labs she sent included a TSH and a free T4 and she is on Synthroid, a T4 only hormone medication. Her TSH is functionally low at <0.5 and her Free T4 is slightly high most likely due to too much Synthroid. What we don’t know is her Free T3, which is the active thyroid hormone that is going to help control all the things that cause her symptoms. Does she have enough T3? Is T4 appropriately being converted to T3? Is too much T4 converting to reverse T3 causing a halt in thyroid hormone function? What are her antibodies? Is her immune system attacking her thyroid? Holy unanswered questions Batman! This is why I want to see the full panel. You get me? 

Knowing these answers will help me help Lucy. If we are looking at an immune system issue, I want to work through diet and lifestyle factors that can make a difference with autoimmune thyroid disease. If there is a problem converting T4 to T3, we can look at ways to optimize it and things that can be hindering the conversion. Do we need to go back to the doctor to try a T3 hormone supplement as well? 

In this blog post, we will talk about how the thyroid works, who should be tested for thyroid disorders, why you should get a thyroid panel run, and the tests in a thyroid panel including functional ranges.

How Does the Thyroid Gland Work? 

The thyroid gland is a butterfly-shaped gland located at the front of the neck below the Adam’s apple. It works in a feedback loop with the hypothalamus and pituitary gland to produce thyroid hormones. The hypothalamus produces TRH, or thyrotropin-releasing hormone, which stimulates the pituitary gland to produce TSH, or thyroid-stimulating hormone, which stimulates the thyroid gland to produce T4, T3, and calcitonin. 


T4, or thyroxine, and T3, or triiodothyronine, are thyroid hormones produced by the thyroid gland. They are what control the body’s metabolism, body temperature, and many other functions. T4 is produced in about 4x the amount of T3 but T3 is about 10x as active in the body as T4. Most of our T3 needs to be converted from T4 primarily in the liver and kidney. 

Here is how the thyroid should work: when there is too much thyroid hormone (T4 and T3) circulating in the body, TSH is decreased and thyroid function decreases in order to stop producing hormones. When there is too little thyroid hormone circulating in the body, TSH is increased in order to increase thyroid function and produce more hormones. There should always be adequate amounts of hormones circulating to be used by cells in the body. 

Who should be tested for thyroid disorders?

According to the American Thyroid Association, anyone age 35 and over should be tested for thyroid disorders and then retested every 5 years after that if within normal ranges. I would absolutely argue that women need to be tested before age 35 and at least every year. The age really depends on symptoms, if you’re having trouble conceiving, and other factors. Thyroid disorders don’t discriminate based on age. You should absolutely be tested if you have multiple symptoms of a thyroid disorder or a family history. Symptoms of hypothyroidism and Hashimoto’s include:

  • Fatigue

  • Weight gain

  • Dry, brittle hair

  • Constipation

  • Depression 

  • Anxiety

  • Puffy face

  • Dry skin

  • Sensitivity to cold

  • Brain fog

  • Irregular menstrual cycles

  • Muscle fatigue and weakness

If you are experiencing 2 or more of these symptoms and aren’t sure if they could be thyroid related, I would encourage you to get tested. Otherwise, you might be treated for the individual symptom(s) that may not improve if it’s related to your thyroid but the thyroid is not addressed. 

Why Run a Thyroid Panel

More information can be very helpful when looking at the thyroid and the typical symptoms of a thyroid problem. Remember that we want to know why! Thyroid testing is a controversial subject where some don’t believe that running a full thyroid panel is useful in the treatment of thyroid disorders. I disagree. I believe in running the full thyroid panel as it can show that problems don’t always just come from the thyroid. The tests can provide information on where there is a break in the chain of events that leads to adequate thyroid hormones being produced and used appropriately. A break in that chain can equal symptoms that won’t go away. Testing only a TSH and T4 can lead to misdiagnosis when we can’t see the other pieces of the chain. 

I also believe in testing thyroid antibodies as over 90% of hypothyroid cases are due to the autoimmune disease, Hashimoto’s. It is important to know if you have an autoimmune disease because if you have one you are at a much higher risk of having another and some autoimmune diseases can go hand in hand. You better believe I would want to know if I am at a higher risk of my body continuing to attack itself in different ways and if there is something I can do to prevent that! Doctors don’t often run them because it doesn’t change their treatment plan. Do you need to run antibodies every time you do thyroid labs? No. Antibodies don’t typically change quickly, but having them tested occasionally is a good idea, especially if you are working on supporting your immune system and bringing them down. Then, you will know if your efforts are paying off or if you need to try something different. 


Click here to access this free guide to thyroid testing.

Tests included in a Thyroid Panel

TSH (1-2 mU/L) - Thyroid-stimulating hormone, produced by the pituitary gland, stimulates the thyroid to produce more hormones when there aren’t enough circulating in the body. TSH is increased when there aren’t enough thyroid hormones circulating as it is trying to signal the thyroid to produce more. It is suppressed when there is too much hormone circulating as it doesn’t need to stimulate the thyroid to produce more hormone at that time. This is the most common thyroid lab tested and often what diagnosis and treatment is based on. A TSH alone is not an adequate marker of thyroid function. 

Free T4 (1.1-1.8 ng/dL) - T4, or thyroxine, is a hormone produced by the thyroid gland. The thyroid gland produces T4 and T3 but T4 is produced in a much greater amount. Free T4 is not bound to a protein and is able to be used in the body. T4 must be converted to T3, the more active thyroid hormone, so it is important to know if the thyroid is producing enough T4. 

Free T3 (3.2-4.2 pg/mL)- T3, or triiodothyronine, is a hormone produced by the thyroid gland. There is a very small amount produced by the thyroid and the rest needs to be converted from T4 in the liver and gut. T3 is the main active hormone and free T3 is not bound to a protein and able to be used in the body. If the T3 level is inadequate, there will still be thyroid symptoms. 

Reverse T3 (10-15 ug/dl or <10:1 ratio of RT3:FT3)- This is the opposite of free T3. Reverse T3 is the inactive thyroid hormone that blocks thyroid receptors and can put the brakes on thyroid hormone functions. Some T4 can be converted to reverse T3 in the liver. This is often seen with illness, increased stress and cortisol, and fasting. 

TPO and Tg antibodies (<4 or negative) - when antibodies are present, this can suggest an autoimmune thyroid disease (discuss with your physician). Antibodies are proteins produced by the immune system to attack against what it thinks are invaders. This blog post will give you more information about testing for antibodies. Many doctors won’t test as it doesn’t change their treatment plan. 

I hope this helps to clear up the importance of getting a full thyroid panel run in order to see all components involved in thyroid health. You don’t have to continue to live with life-affecting symptoms because you aren’t getting the care and treatment you need and deserve. I always recommend discussing these labs with your doctor. You can check with them and your insurance about the cost. Also, don’t be afraid to get a 2nd opinion if your doctor won’t work with you. Be sure to scroll back up and get my free thyroid testing guide, if you didn’t already, to have access to information about these labs and the functional ranges.

In health,


Thyroid Antibodies: Why Test?


Thyroid antibody lab tests are tests often overlooked by physicians when checking for thyroid disease. This is unfortunate because when caught early, the amount and length of time the thyroid is being attacked could be decreased. If you are interested in learning more about thyroid health, click here for my last post. Hang with me here and we will talk about why thyroid antibody tests are important and if you should have yours checked.

What are Antibodies?

An antibody is a protein made by plasma cells in response to an antigen, or a substance the body thinks is a “bad guy”. Each antibody can bind to only 1 antigen in order for the immune system to attack and destroy that antigen. So, obviously, thyroid antibodies set up an attack on the thyroid gland, each one in a different way.

Anti-thyroperoxidase (TPO) antibodies are the most common and are associated with Hashimoto’s Thyroiditis along with anti-thyroglobulin (Anti-Tg) antibodies. Thyroid Stimulating Hormone (TSH) Receptor (TSHR-Ab) antibodies are associated with Graves’ Disease.

Did you know that thyroid antibodies can be present before other thyroid hormones are out of “normal” range?  

So, if I ask you if you’ve had your thyroid labs check and you are like, “yep, my doctor says my thyroid is good”, it is usually only a TSH level that is checked. This lab test can only give us a small picture of what is going on with the thyroid or maybe not tell us anything at all. Antibodies can be present for years before we see a change in the TSH level. This is super frustrating because if antibodies are present, they can slowly destroy the thyroid over time. This will eventually cause the thyroid to not be able to produce hormone efficiently, then causing the change in TSH.

Thyroid antibodies can produce symptoms even when there is no hypothyroidism detected. Symptoms can include fatigue, anxiety, depression, weight gain, general poor feeling and potential for miscarriage. So no, you are not crazy when you tell your doctor you think there is something else going on even though your labs don’t show it.

Thyroid antibodies with a normal TSH can be an early warning sign of Hashimoto’s Thyroiditis, an autoimmune disease. It is estimated that 90% or more of those with hypothyroidism have Hashimoto’s disease. But, not all of those with Hashimoto’s will have elevated antibodies and will need a thyroid ultrasound if symptoms persist. I am one of the few with hypothyroidism and not Hashimoto’s. If there are antibodies present and an elevated TSH, Hashimoto’s is likely in the later stages.

Why are doctors not testing antibodies?

After reading the information above, you may be asking this same question. Right? Many general medicine practitioners don’t think that an autoimmune disease can be treated and reversed. Therefore, there is no need to know if antibodies are present because it doesn’t change their treatment plan. The root cause doesn’t really matter. They will treat the thyroid if the labs show that it makes sense. Or, if they are aware of autoimmunity, they want to suppress the immune system causing more problems and side effects.  

If I have antibodies will I always have antibodies?

There is no cure for autoimmune disease. Once autoimmunity is present, there is always a potential for your immune system to attack your own cells causing problems. There is, however, a way to support the immune system, reverse or decrease autoimmunity and prevent further attack on the body. Nutrition and lifestyle play a large role in supporting the immune system and this topic deserves multiple blog posts! And, just so you know, I care about the root cause and it does matter!

Antibody levels will change in response to underlying causes, like stress, food sensitivities and infections. It is important to also look at the big picture of how you are feeling. If you have antibodies, it is great to have them checked occasionally with your other labs because it can tell you if your interventions are working or if you are maybe having a flare up and need to try something different.

Who should have thyroid antibodies tested?

If your doctor is already doing blood work to check your thyroid health, I recommend asking for a full thyroid panel, which will include antibody tests. It is great to get these labs done and see the full picture from the start. If this isn’t being done, here are some reasons you may want to ask for thyroid antibody tests:  

  • You have another autoimmune disease like celiac disease, multiple sclerosis, Sjogren’s, etc. Once you have an autoimmune disease, you are 3x more likely to develop another one.

  • You have classic symptoms of a thyroid issue but your TSH continues to come back in the “normal” range.

  • You have a close family member with an autoimmune disease, especially Hashimoto’s or Graves’ disease.

  • You’ve been diagnosed with hypothyroidism or hyperthyroidism but have not had antibody tests done.

Antibodies can be an important piece of information when we are looking at thyroid health and thyroid diseases. They do matter and they can be decreased with immune system support. Antibodies can be present long before the thyroid is showing signs of attack and decreased function. As always, be aware of symptoms and be diligent in finding a doctor who will listen to you.

In health,


A Letter to Fitness Instructors

Copy of Dress to Kill.png

Hey all! I hope you are having a great week! This post is a way for me to get out something that has been weighing on my mind lately and to hopefully make a difference.

I have been taking some awesome group fitness classes at the same studio(s) for the past 3 years. I can't even believe I have been going that long since I was so scared to go in the first place but here I am, still taking my place at the barre most days of the week. They offer a wide variety of classes, none of which are easy. They are fast-paced, high energy, kind of addictive and I like them. Maybe I like them too much. I started because I wasn't happy with my body but I've continued because it makes me stronger and better in many other ways. I've mixed up my schedule over the past 3 years with different classes, different times and different instructors trying to find which ones suit me best. I have a few instructors that I prefer and I few that I tend to avoid, but I think that is the same for most everyone. I need someone that plays great music, can keep my attention for the full hour and puts me in a great mindset. I don't think that is too much to ask for (eye wink, tongue out emoji).

Over the last year or so I have been paying much more attention to what is said by the instructors during classes, and it's mostly great. But there have been times that I've thought to myself, "wow, did you really need to say that"? Maybe because of my work with Intuitive Eating. Maybe because I feel that no one should feel guilty about their body size or what they ate or drank last night. Maybe because I feel exercise is not a form of punishment. I am more aware of my previous disordered eating and thinking toward food and exercise, maybe even some orthorexia behaviors. This has made me a little more sensitive to the words spoken during these fitness classes. I know that I am not the only one that is dealing with orthorexia and disordered eating. There could also be some women in the classes with a full-blown eating disorder. So, words matter. They matter a lot to someone who could very easily be triggered by those words to continue the disordered behavior.  

So what kinds of things might be unmotivating or triggering in a fitness class? 

  1. Talking about being there to workout because of something you ate or drank the day(s) before. Food shaming. 
  2. The instructor talking about their own guilt due to eating or drinking habits.
  3. Talking about burning calories as motivation to keep going. 
  4. Showing or talking about a big calorie burn after class. 
  5. Saying that cardio is the most important part of the class. 
  6. Talking about needing to earn something by working harder (earning a meal, a drink, a relaxing day, etc)
  7. Talking about fitting into skinny jeans or a bathing suit and tank top for summer. 

So, I am certainly not saying that these types of comments are causing eating disorders or disordered eating. I am also not saying that I hear them often where I personally do fitness classes. These comments can, however, trigger someone who is already experiencing it to continue with those behaviors. They can change a mindset from positive to negative pretty quickly and put the focus on negative thoughts and behaviors vs. positive ones. And, to the fitness industry, I get it. I get that people are coming in to change their body. I get that people want to be leaner and stronger. I get it. But I think if the focus is on the good stuff, they will want to keep coming back and if they are taking classes like I do, their body will change. 

Here are some eating disorder statistics from The National Eating Disorders Association:

  • Between 3-4% of women and 1% of men will suffer from anorexia at any given time.
  • The best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.
  • Among overweight and obese adults, those who experience weight-based stigmatization engage in more frequent binge eating, are at increased risk for eating disorder symptoms and are more likely to have a diagnosis of binge eating disorder.
  • There is a strong link between exercise compulsion and various forms of eating disorders. 
  • An estimated 90-95% of college students diagnosed with an eating disorder also belong to a fitness facility. 
  • 95% of all dieters will regain their lost weight in 1-5 years.

What are some positive, motivating comments that can be made in fitness classes? There are lots of ways to do this. Dig into the mindset, the psyche, and the heart. We all go to work out for different reasons but we all have a heart and mind in addition to our body. I reached out to one of my fitness instructors a while back to thank her for having positive comments on mind, body, and soul instead of how we look. She nails it every single class! She made a comment in last week's class that she is "bored with focusing on looks" and instead we should be "loving ourselves and our people well", which I totally appreciated. Here are some other ways to provide motivation in a positive way:

  • Share a positive quote or a word to think about for the day
  • Encourage participants to set a goal or intention for the class 
  • Tell the class how great they are doing or how strong they look. It doesn't have to be individualized. 
  • Talk about how lucky/grateful they are to be moving their able bodies.
  • Tell them it is just as effective to do a modified form of the exercise. 
  • Anything else motivating and encouraging that doesn't talk about looks, size or calories/food. 

I love fitness and I love being part of a fitness community. I have my own reasons for going to work out and they might be different from the next person. No matter what those reasons are, we deserve to feel good, positive vibes each time we walk through those doors. Let's put the focus on well-being and not just on calories, food shame and body size. Words do matter and can make a difference in someone's life and their struggles.



How to Have a Body Positive Holiday

Photo credit:&nbsp;Photo by  Pro Church Media &nbsp;on  Unsplash

Photo credit: Photo by Pro Church Media on Unsplash

It's Thanksgiving week and I am really looking forward to some good quality family fun. We are going to eat, drink, play games, laugh and tell the kids no 500 times but it's going to be great. To be honest, that isn't something I usually say around the holidays. I am usually anxious about the food, the drinks, the conversations, and so many other things.

What are we having? What and how much am I going to eat? Is there something for everyone? Did I eat the appetizer too close to meal time? Is there enough food for everyone? Do I eat the crust or not? Do we have to talk about what diet everyone is on? Do we have to talk about how much weight everyone is trying to lose? Do we have to talk about how great everyone else looks in their jeans? Do we have to talk about food the entire time we are together (yes, that often happens with my family!)?

All of these anxieties = eating more = feeling worse.

I am so much more aware of how things and words make me feel as I'm more aware of my problems with body positivity and disordered eating. I also know that the worse I feel about myself, the more I try to manage what everyone else is doing or having. "Wow hunny, that's a lot of stuffing" may be a phrase I've said a time or two.

I really have been much better and happier around food recently and I'd like to just ride that on into the holidays. I try to focus more on the environment and the experience of enjoying time together rather than if my face will be puffy in the morning from my dinner.

Photo credit:&nbsp;Photo by  Annie Spratt &nbsp;on  Unsplash

Photo credit: Photo by Annie Spratt on Unsplash

Not everyone understands the thoughts and anxieties of someone struggling with eating problems ranging from an eating disorder to emotional eating and that's ok. Not everyone understands the triggers that can really send you spiraling into a dark hole of never-ending negative thoughts and that's ok too. So I thought I'd share some tips on how to have a positive holiday gathering while trying to avoid unintentional body and food shaming, especially if you have someone at your gathering that might be a little more sensitive and my guess is that we all do.

1. Avoid talking about weight.

This includes their weight, your weight or anyone else's weight. We are all probably guilty of saying how great someone looks or commenting on how much weight they've lost (or gained...seriously who does that?). It places an importance on weight and weight does not define someone. Compliment someone on their beautiful sweater or something else. Ask about their kids, their job, black Friday plans or anything else that might be important to them.

2. Don't discuss what is or isn't on their plate.

Everyone is in charge of their own plate and what is going in their own mouth. Commenting on their food could make them feel like they are doing something wrong or like everyone is watching them. I don't feel like it's harmful to give a shout out to the chefs during the meal, however.

3. Don't discuss how long you will need to spend at the gym after eating the pumpkin pie!

Just eat the pie and enjoy it for goodness sakes. It won't go to your ass tomorrow, FYI. This should not be normal talk by anyone anyway. But it could validate someone with disordered eating behaviors that might normally have those thoughts. Exercise should not be punishment for eating.

4. Offer an activity to do outside of the kitchen.

Make it easy to step out of the kitchen and not be near all of the food and everyone talking about the food. Have a coloring station. Maybe some board or card games going. Turn on the football game.

The holidays can be a time where it is easy to trigger negative thoughts in someone with current or previous disordered eating. It is obviously unintentional but the brain doesn't always decipher the difference. When in doubt, discuss politics...just kidding =).

Let's be thankful for our loved ones, our able bodies and the food that nourishes them. I am looking forward to keeping the holidays super positive and enjoyable this year and I hope you do as well.

Happy Thanksgiving friends!



Real Talk, Take 2


I went to a local event this week called Food Yeah! put on by Indulge, which hosts wellness events in KC. They had a panel of 5 experts in their own realm of the food world. This included a dietitian, 2 health coaches, a doctor and an organic farmer. They had wine! and we tried The Unbakery and Juicery's juice and protein balls. It was a lot of fun and I even won a giveaway.

This event was a great way to bring together like-minded people to discuss food. Topics included food priorities, diets, fats, where we get our food and why it's ok to not be perfect. The overall messages were great and definitely topics to build conversations on. They agreed that dieting doesn't work. High fives on that! Nutrition is very individual and it's important to find what works best for you when it comes to feeling your best. They agreed that we should be eating fat, in different varieties. They agreed that we should enjoy our food and enjoy the experience that food brings. Yes, yes and yes!

I think the event rekindled my love for food, nutrition and wellness a bit, even though I didn't agree with everything that was discussed. It showed me that there are a lot of people who do care about food and nutrition and a lot of people who still need help finding answers. I've considered numerous times giving up my career in nutrition (because apparently everyone is a nutrition expert) but I keep hanging on. I love wellness and really helping people to be and feel their best and I know I am capable of doing that in some form.

I started this blog back in April after I stopped my part-time gig as a way to continue trying to help and/or motivate others with nutrition and wellness. I also just needed to do something while I figuring out my next move. I named the blog 4ever healthy lifestyle because that's what I feel we all need in our lives - a healthy lifestyle that we can continue forever. It isn't named let me help you yo-yo diet and feel really bad about yourself or just eat veggies all damn day or exercise until you die because that is life. Maybe those names would get me more blog traffic but not the vibe I'm going for.


What is a healthy lifestyle? By definition, a lifestyle is a way in which you live. So a way in which you live healthy, right? It is a way in which you live and treat your body and mind to where you feel your best in all aspects of your life so you can live a long and fulfilling life. Your healthy lifestyle will not look like anyone else's. This may include food/nutrition, activity, stress management, sleep habits, relationships, and/or spiritual health. It should probably contain a good number if not all of these =)

What a healthy lifestyle can provide for you:

  • Consistency - when you adopt healthy habits and make them a priority, consistency is so much easier. You start to crave those healthy habits.
  • Ability to get away from the diet mentality because you have great, doable habits in place that keep you well and happy, which can offer better weight management.
  • More energy, more happiness and more overall enjoyment in life!

What a healthy lifestyle should not provide for you:

  • Strict rules! You do what feels best to you on any particular day. For instance I try to go to the gym 5-6 days a week but there are weeks I go less because my body needs more time off and weeks I go everyday because it feels good.
  • Guilt! It's ok to not be perfect, not follow a diet, miss days of exercise, and not do what everyone else is doing.
  • An all or nothing mentality, especially when it comes to food. This can lead to disordered eating, which can cause a lot more problems.

How do I create my 4ever healthy lifestyle?

This would require more than a blog post to really answer for you individually. The idea is to find some key priorities and make small changes that are sustainable longterm. If you make a lot of big changes all at once, it's harder to stick to it. They need to be your priorities and not someone else's or you won't buy in and work toward your goals. Here are some questions you might ask yourself:

  • What are my ultimate goals? Is it more sleep? Eat more vegetables? Drink more water? Increase the # of push-ups on toes instead of knees? Decrease cholesterol?
  • What are a few small, doable changes I can make to accomplish a goal?
  • What might be holding me back from making those small changes and ultimately keeping me from my goals?
  • Do I need a support person for some motivation? Maybe a dietitian? 

If you are reading this, thank you for coming on this journey with me. My hope is that I am helping you find your 4ever healthy lifestyle with ideas, recipes, information and motivation but not with rules and guilt. I would love to hear from you if you have topics or information you'd like me to post about or if you have made any changes toward a healthy lifestyle. Feel free to comment below.

Have a great week!