Janie Bowthorpe, the author of Stop the Thyroid Madness, has compiled a list of lab tests that she recommends for thyroid patients based on over twelve years researching patient experience. She calls them ‘Ducks in a Row’ and advises that all of them need to be in the optimal range in order for NDT to work and patients to feel better. I am writing a summary with a UK focus to make it easier to understand and also to recommend where to get the tests.

Ignore TSH Results

Your GP will always do a TSH test to diagnose thyroid problems but will usually wait until it is above 10 before prescribing Levothyroxine (synthetic T4). In the USA this number has been reduced to 2.5 which means that people don’t struggle for as long with hypothyroid symptoms before accessing treatment. GPs and endocrinologists will then continue to monitor TSH along with Free T4 to check that you are on the correct dose of Levothyroxine.

STTM says this test tells us nothing about thyroid function; it is only good for diagnosing a pituitary problem. Diagnosis and monitoring are better done through the testing of Free T3 alongside Free T4. If you have hypopituitarism your TSH will be <0.8. Further information here: https://stopthethyroidmadness.com/hypopituitary-faq/

The TSH test is even less valuable when you are on iodine and/or NDT. Given that the medical profession is obsessed with TSH when monitoring treatment with T4 it is worth knowing that Dr Brownstein warns that TSH will go up in the first few months of starting iodine supplementation and Janie Bowthorpe says that NDT causes TSH to go down. Further information here: https://stopthethyroidmadness.com/tsh-why-its-useless/

Thyroid UK advises: ‘In America and some other European countries, they have reduced the TSH level to 2.5 which means that anyone above that figure will be treated if they have symptoms of an underactive thyroid.’ http://www.thyroiduk.org.uk/tuk/about_the_thyroid/hypothyroidism.html

Do These Tests For Hypothyroidism Diagnosis

Free T3 and Free T4 (Not Totals)

Along with TSH your GP may offer Free T4 as standard on the NHS, however, these are useless without knowing where your Free T3 is, which your GP may refuse to do. If that is the case then request to see an Endocrinologist. If your GP refuses a referral to an Endo then you can do the test privately.
You can order a finger prick test for Free T3 and Free T4 and do the test at home. This test is also useful for hypothyroid patients who have already been diagnosed and are self-monitoring their NDT and iodine treatment. Be sure to leave 12-15 hours between your last dose of NDT and your blood test or you will get a false reading. T3 patients should leave 12-17 hours after their last dose before testing.

Medichecks Thyroid Monitoring finger prick test includes FT3 and FT4 for £39.00 https://www.medichecks.com/tests/thyroid-monitoring Look out for their special offers and ‘Thyroid Thursday’ discounts.

STTM guidance on interpreting T3

If you are on an optimal dose of NDT with no hypothyroid symptoms and optimal adrenals your FT3 will be in the upper part of the range.
If you are on an optimal dose of T3, or a T3 NDT combo, with no hypothyroid symptoms your FT3 will be at the top of the range or over the range.
If you are on NDT (particularly on a dose lower than 180 mg) with high FT3 and continuing hypothyroid symptoms you may have adrenal fatigue (low cortisol).
If you are not on thyroid medication and your FT3 is high you may have Hashimoto’s, which needs antibodies testing, or Graves disease, which needs the TSI test.

STTM guidance on interpreting T4 lab results:

If you are on an optimal dose of NDT you will have a FT4 around the mid-range with FT3 at the top in the presence of healthy adrenals.
If you are on NDT and have low FT4 and a mid-range or slightly higher FT3 it usually means the T4 is converting like mad to give you the T3 you do have, which means hypo, which requires a Reverse T3 test.
If you are optimal on T3, or an NDT and T3 combo, your FT4 will be low.

DO THESE TESTS IF HYPOTHYROIDISM IS DIAGNOSED

Reverse T3 (rT3)

Reverse T3 is produced to get rid of excess T4 but too much can be made if you have high or low cortisol or low iron which clogs cell receptors from receiving T3. Testing is recommended when:

FT4 is ok and FT3 is low with obvious symptoms of hypothyroidism.
FT4 is low and FT3 is high.
If NDT appears not to be working.

Thyroid Antibodies

If you have been diagnosed as hypothyroid thyroid antibody testing will diagnose the autoimmune thyroid disease Hashimoto’s Thyroiditis.
For further information: https://stopthethyroidmadness.com/hashimotos/

Finger Prick Tests for home testing:

Medichecks Thyroid Peroxidase Antibodies (TPOAb)
Medichecks Thyroid Test Plus (FT3, FT4, TGAb, TPOAb)

Blood sample needs to be taken at a Medichecks Centre:
Medichecks Thyroid Check Plus RT3 (FT3, FT4, TGAb, TPOAb, rT3) £159.00. http://www.medichecks.com/tests/thyroid-check-plus-rt3

Look out for Medichecks special offers and ‘Thyroid Thursday’ discounts.

Saliva Adrenal Cortisol

This test is really important because STTM says that 50% of thyroid patients have a cortisol problem. When hypothyroidism is left untreated the adrenal glands take over causing high cortisol. As they get over-worked cortisol starts to lower. Low cortisol causes fatigue and high Reverse T3 which means the brain doesn’t get the T3 it needs to feel better. Increasing NDT becomes problematic until the adrenals are healthy.

Do not use Medichecks or Regenerus to test adrenal function. The Genova 4-point test is recommended in the UK: https://www.gdx.net/uk/product/adrenal-stress-profile. When checking out use practitioner code A42AQ (Thyroid UK).

Go here to fill out a form and Thyroid UK will send you your results: http://thyroiduk.org.uk/tuk/testing/genova.html

Be sure to read the following list of medications to avoid before taking the test: https://stopthethyroidmadness.com/supplements-and-meds-which-affect-adrenals/

Interpreting 4-Point Cortisol Test Results

Post Awakening should be about 40 (the highest result)
+ 4-5 hours should be about 12.32
+ 4-5 hours should be about 4.75
Prior to Sleep should be EXACTLY 0.33
DHEA will adjust when cortisol is addressed.

More detailed adrenals information in this group here: https://www.facebook.com/notes/natural-thyroid-health-uk/adrenal-fatigue/280209755771682/

Hormone D (Vitamin D3)

Vitamin D is actually a hormone and not a vitamin so Morley Robbins calls it Hormone D. Unless you are getting 20 minutes of sun exposure (without sunscreen) daily throughout the year it is likely that you are deficient in this essential hormone.

If you are deficient Morley Robbins advises to AVOID increasing your levels by taking Vitamin D3 supplements. He recommends Rosita Cod Liver Oil capsules as part of the Root Cause Protocol and optimising Magnesium as the 25(OH) enzyme requires Mg to work properly. Stopping Iron supplements will also help as Iron rusts the 25(OH) enzyme and increase the Magnesium burn rate.

Stop taking Cod Liver oil, or any other D3 supplements, including your multi, 5 days before testing.

Interpreting Results

Morley Robbins says:
‘25-hydroxyvitamin D’ (the storage form) doesn’t need to be above 52.416 nmol/L or 21ng/mL.
‘1,25-dihydroxyvitamin D’ (the active form) should be no more than 1.5 to 2.0 times the above.

Ask your GP to do this test or do the finger-prick test from Medichecks: https://www.medichecks.com/vitamin-d-tests/vitamin-d-25-oh
More information increasing D with the Root Cause Protocol here:
https://gotmag.org/the-root-cause-protocol/
https://www.facebook.com/groups/MagnesiumAdvocacy

Magnesium

Optimal RBC Magnesium values:
6.0 -7.0mg/dl
2.4-2.57 mol/L
3.37-5.77mEq/L
These numbers are the minimum anything less is Magnesium deficiency.

Iron/Ferritin

This test is useful if you are pooling.
The best test is the iron panel which can be done via finger-prick with Medichecks: https://www.medichecks.com/tests/iron-status-check
Ensure you stop iron supplements 5 days before testing. Test on day 15 of cycle, i.e. before, not after, your period.

STTM Guidance
Iron/Total Iron: 23 is optimal
TIBC: optimal 1/4 above the bottom number in the range
Transferrin Saturation: optimal at 25-45% or close to 35%
Ferritin: optimal between 70 and 90 ug/L

Morley Robbins Guidance
Iron: 17.9 mmol/L [umol/L (5.8-34.5)]
TIBC: 51 ug/dL [ umol/L (45-72)]
Transferrin saturation: 25-30% (20-50)
Ferritin: not above 50 ug/L

Low ferritin can occur with high iron due to the MTHFR gene mutation impairing the ability to break it down.

Don’t Take Iron Supplements

Morley Robbins say that taking synthetic iron supplements can lead to serious inflammatory conditions and iron toxic-related conditions including autism. He says that iron can hide in soft tissue which is missed through blood tests. The Root Cause Protocol can bring it out of hiding so it becomes bioavailable and not inflammatory.

Morley says that we all need bio available iron from real foods such as beef liver in the amount of one palm-size piece per week in either liver casserole, added to chilli, ragout, or homemade burgers. Some people buy liver capsules and others make their own by cooking it, chopping it into tiny capsule sizes, freezing, and taking a frozen piece per day with a warm drink. Others whizz it raw in a blender then put onto a baking sheet and freeze for 14 days. You can also freeze in ice cube moulds to add to smoothies.

This is a link to an article by Morley Robbins on iron: https://lookaside.fbsbx.com/file/Morley_Anemic-video-transcript.pdf?token=AWwqcrwbsEpfKzIrJ_MdahIm8a4EO6DQ4gq_YHXmfMEgYKpgX8ftdWVM_XU8XOxe28Dcq1WprF6KfaSU-muBFcExPlX8ouxQ7TOoxtT-fufz-jY_owxS427e2j6WWQxBmD9knKDJhAly0lL4AIthEelU0B8OIS97FUWc0_2lPXDiiQ

More information about The Root Cause Protocol can be found at: http://gotmag.org/the-root-cause-protocol/ .

You can also join the Magnesium Advocacy group on FaceBook: https://www.facebook.com/groups/MagnesiumAdvocacy

B Vitamins

B12
In the UK the B12 reference range is set at 110 – 900ng/l (It is higher in some regions). In the US is it between 200 – 900ng/l, and in Japan 500 – 1300ng/l. STTM recommends being in the upper quarter of the range to feel well.
According to Dr Ben Lynch, due to the MTHFR gene mutation, 60% of the population cannot convert the standard form of B12 that is found in many supplements to the active form of methylcobalamin.
You can increase your levels with B12 injections, or sublingually by sucking Methylcobalamin lozenges, or using a spray which is a better form of delivery than swallowing capsules because the digestive process can inhibit uptake.
Take B12 alongside a good B Vitamin Complex supplement such as Jarrow B-Right which contains the active forms in the correct ratio. B vitamins are water-soluble which means the excess is excreted through urine.
Take B supplements in a split dose at breakfast and lunch to give you energy throughout the day – do not take at night as they can keep you awake. Keep a diary and note down when you started the supplement and how you feel.
Can be tested via finger-prick test with Medichecks https://www.medichecks.com/tests/vitamin-b12-active-folate
For further information: https://stopthethyroidmadness.com/b12/

Folate
The Medichecks range is 2.91 – 50.00 The top 1/3 of the range is ideal.
If you are deficient make sure you take Folate and NOT folic acid which is synthetic and difficult to process into the active form for 60% of the population with MTHFR.

Testing
B12 and Folate can be tested via finger-prick test with Medichecks: https://www.medichecks.com/tests/vitamin-b12-active-folate Look out for their special offers and ‘Thyroid Thursday’ discounts.
Stop taking any B12 and Folate supplements, including your multi if it contains, 5 days before testing.

MTHFR
MTHFR is a genetic inability to process synthetic Folic Acid and B12. More information at: https://www.facebook.com/notes/272836473175677/
DIO2
Mutations in the DIO2 gene decrease the conversion of T4 to T3. If the T4 isn’t converting properly to T3 any unconverted T4 will be making excess RT3.

Summary of STTM Protocol

Recommended Lab Tests: https://stopthethyroidmadness.com/recommended-labwork/
Ducks in a Row: https://stopthethyroidmadness.com/ducks-in-a-row/
Interpreting Test Results: https://stopthethyroidmadness.com/lab-values/

Further Reading

Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment. https://www.frontiersin.org/articles/10.3389/fendo.2017.00364/full

Collection of Research that Shows the Current Use of TSH and T4 only is Flawed. https://paulrobinsonthyroid.com/

NB If you spot any typos or feel that important information is missing please add a comment under the file. 🙂

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