How to Correctly Interpret Your Thyroid Tests (and Discover Hidden Thyroid Problems)

By |2019-12-23T12:07:16-08:00August 1st, 2019|Hypothyroidism|8 Comments
  • how to interpret thyroid tests

It’s sad but true.

Your doctor is probably looking at your thyroid tests all wrong.

This means that they (and you) are missing vital information that can give you clues and insight into how best to fix your thyroid issues.

Working with clients over the years, I’ve seen a lot of thyroid tests.

I’ve seen clients with TSH levels above and beyond 100 mIU/L (now that’s a lot of inflammation!).

I’ve seen clients with extremely low thyroid hormone levels.

I’ve also seen clients with extremely high thyroid hormone levels who were still extremely hypothyroid.

Yes, it happens more than you might think.

Just about anything is possible when it comes to your thyroid.

So, it’s important to understand how to interpret thyroid tests correctly.

But it’s also important to understand that just measuring the hormone levels in your blood doesn’t tell you what you really need to know.

That requires a different type of testing which I’ll show you a minute.

Now, most doctors (and patients) only look at thyroid tests with respect to the test reference ranges.

If that’s what you and your doctor are doing then you’re missing out on so much more.

But that’s about to change because I’ll be showing some of the common lab test results we see and what they really mean.

And please keep in mind that we look at a number of other tests and test values when working with clients.

So while this isn’t a comprehensive list, it can help you get discover some bigger hidden thyroid problems that need to be fixed.

1. Correctly Interpret Your TSH

Let me start by saying that TSH (Thyroid Stimulating Hormone) is a very inaccurate thyroid test when used alone.

And if your doctor is only testing your TSH, then you need to either ask for additional testing or find a new a doctor who will.

The reason is because TSH is actually very poorly correlated with thyroid function due to the high percentage of false negatives.

In other words, while many doctors will test your TSH and tell you that your TSH is within “normal” range… you’re likely still very hypothyroid.

This is because your TSH is influenced by more than just your thyroid function.

All of the factors below can lower your TSH (to within the normal reference range) while masking serious thyroid issues:

  • Aging
  • Stress
  • Infection
  • Blood Sugar
  • Excessive T4

Hidden Thyroid Problem #1…

Your TSH should be below 1.5 mIU/L (or ideally below 1 mIU/L).

(Note: Having a TSH value above 1.5 mIU/L means you’re still hypothyroid and are at a higher risk of death due to heart disease, which was covered in this article here.)

But keep in mind, even a TSH below 1.5 mIU/L doesn’t mean that your thyroid is fine and healthy.

You still need more information.

2. Correctly Interpret Your T4

Some doctors who are willing to test beyond TSH will also test T4, the inactive form of thyroid hormone.

While this can be useful information it still doesn’t tell you what we really need to know.

Most doctors will simply look to make sure your T4 is anywhere within the test reference range.

However, your T4 levels should ideally be close to the middle of the test reference range.


(Note: Your test, test reference range, and measurement units will likely differ so you’ll need to determine the mid-range for your own thyroid test.)

If your T4 is much below that then this does indicate that there’s a potential problem.

But there’s more we can learn by looking at T4 and TSH together.

Hidden Thyroid Problem #2…

If your T4 level is below the middle of the reference range and your TSH is “normal” or high…

…this is a common sign of estrogen dominance and that estrogen is directly suppressing your thyroid gland from releasing thyroid hormones.

Estrogen has a tendency to inhibit the proteolytic enzymes that are required for your thyroid gland to release the thyroid hormone it has stored.

3. Correctly Interpret Your T3

Unfortunately, most doctors won’t test T3 levels, the active form of thyroid hormone that you and your body depend on.

And this is yet another huge mistake being made by the medical system today.

For those patients who do get their T3 tested, it’s oftentimes interpreted incorrectly as well.

Having T3 levels within the test’s reference range isn’t enough.

Ideally, T3 should be at least in the upper quarter of the test reference range.


(Note: Your test, test reference range, and measurement units will likely differ so you’ll need to determine the mid-range for your own thyroid test.)

But we can also learn more from looking at T3 and T4 together.

Hidden Thyroid Problem #3…

If T4 is normal or high and T3 is low…

…this is a common sign that your liver is not able to properly convert your T4 into T3 efficiently and focus needs to be on improving liver function.

(Note: Liver dysfunction is one of the most common causes of hypothyroidism today and we show you some simple ways improve your thyroid hormone conversion in this article “How to Heal Your Thyroid By Healing Your Liver”.)

Hidden Thyroid Problem #4…

T3 testing in general is a bit more complicated than testing other thyroid hormones.

This is because many patients also have some degree of thyroid hormone resistance that is preventing them from using the T3 that is available.

(Note: Thyroid hormone resistance can be caused by certain parts of thyroid hormone pathway being blocked which is covered in more detail in this article on “How We Overcome Hypothyroidism When All Else Fails”.)

Because of this, some patients require larger doses of T3.

And in some cases, tests can show T3 levels well above the test reference range and these patients feel considerably better when they do.

Unfortunately, most doctors will panic and lower your thyroid medication regardless of whether or not you feel better, even if lowering it makes you feel worse.

While all of these test values can be helpful in discovering some common thyroid problems that need to be fixed…

…it’s important to understand that these tests alone still can’t accurately diagnose you.

There’s still more you need to know.

We still need to know the most important thing, which is regardless of how much thyroid hormone you have available in your blood… can your body actually use it?

You can supplement or medicate with all the thyroid hormone you want, but if you can’t get that thyroid hormone to your cells then it’s all a lost cause.

And you’ll always be hypothyroid.

So, that’s exactly what you’ll discover when you go through the Ultimate Thyroid Testing Protocol.

The Ultimate Thyroid Testing Protocol

This thyroid testing protocol will show you a very different side to thyroid testing than you’ve seen… and help pinpoint even more hidden thyroid problems that need to be fixed.

It’s based on real research and has been shown to be far more accurate than lab testing today… It’s the same thyroid testing protocol that we use with all of clients… and it works.

The Ultimate Thyroid Testing Protocol is the first step to getting the answers you need to start testing and overcoming your hypothyroidism.

If that sounds like what you need, then put this testing protocol to work for you.

Click here to learn more about the Ultimate Thyroid Testing Protocol.

About the Author:

Tom Brimeyer is the founder of Forefront Health and the creator of the popular Hypothyroidism Revolution program series. Specializing in thyroid and metabolism disorders, Tom's work has impacted over 50,000 people spanning more than 60 countries. Tom is also a highly sought after practitioner who runs a successful health consulting practice where he continues to help clients across the globe to take back control of their lives from their devastating health conditions.


  1. Gaia May 11, 2016 at 4:13 pm - Reply

    Hi, thank you for all the information ! Really appreciated
    I jusr read this article and I am wondering how to increase my T4.. I am taking a compound medication composed by:
    75 mcg T4 and 20mcg T3
    there are so many different theories that I feel quite confused..also my TSH is too high..I wonder if you can tell me something. Thank you anyway. Gaia


    FREE THYROXINE * 10.2 pmol/l 12.0 – 22.0

    FREE T3 4.8 pmol/L 3.1 – 6.8

    • Tom Brimeyer May 11, 2016 at 5:14 pm - Reply

      Hi Gaia, if you would like to discuss lab results and a plan of how to improve them then this is best done by consultation. You can contact to get more information and get that set up.

  2. Gaia May 12, 2016 at 11:35 am - Reply

    Thank you Tom.

  3. Melanie May 23, 2016 at 8:01 am - Reply

    Hi!! I just started reading a lot of the information on this website, and its so nice to know there may be hope. Ever since I had my thyroid removed 8 years ago, I have been struggling with how I feel. My tests show that my levels are all normal now, but I still have most symptoms of hypothyroidism along with a very high level of antibodies in my system. I currently take armor thyroid, after trying every thyroid medication possible. Originally my body didn’t convert T4 to T3, the the armor has both and seems to help more than the rest. I still can’t get rid of the sluggish feeling, heaviness, brain fog, memory of a goldfish, overall weak feeling I have on a daily basis. I eat clean and exercise 2 to 3 times a week, however I always feel more tired and weak after doing so. I also have low body temperature. Not one Dr can tell me anything or has been able to help, so I gave up and I deal with it, but it affects everything I do. Do you think this information can help me even though I no longer have a thyroid?

    • Tom Brimeyer May 23, 2016 at 1:14 pm - Reply

      Hi Melanie, the short answer is yes, everything we teach still applies 100%. The only difference is that you will need to supplement thyroid hormone to the degree that you cannot produce it. However, it’s important to understand that just because you take thyroid hormone doesn’t mean that the hormone is getting to your cells. Thyroid hormone can get blocked many places along this pathway. For example, most hypothyroid people can’t convert inactive T4 thyroid hormone to active T3 thyroid hormone that your cells need. Thyroid hormone can also get blocked in the bloodstream, at the cell receptor, etc. You can supplement all of the thyroid hormone you want but if you can’t get the hormone to your cells then you will still be hypothyroid. We focus on all facets of the thyroid. You can learn a little more about this here:

      And I’ve written about recovery from RAI and thyroidectomy here:

  4. Denise May 31, 2016 at 7:44 am - Reply

    Hi There,
    I am wondering if you have what the measurements should be based on pmol/L unit measurements for Freet T3 and Free T4. I can’t seem to find a conversion calculator from pg/ml or ng/dl to pmol/L. I want to make sure I am comparing apples to apples.

  5. Benjamin Sanez June 3, 2016 at 2:47 am - Reply

    Just curious as to when video 2 and 3 are going to become available.

    • Tom Brimeyer June 3, 2016 at 11:00 am - Reply

      Hi Benjamin, you should get them by email.

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