Optimal Lab Values–how to interpret your results
Years ago in a group started by Janie Bowthorpe (which ultimately started the Stop the Thyroid Madness movement before this website went up), we began to notice something VERY interesting. Namely, those people who didn’t have “this” or “that” problem were all falling in a certain place in the range of any test. That was very enlightening.
i.e. it’s not about falling anywhere in those ranges.
See if you can explain all this to your doctor.
TO PREPARE FOR DOING LAB WORK:
a) For most of the below, we learned from our more progressive doctors that you’ll need to be off what you are testing for a minimum of 12 hours, i.e. take nothing the morning of the test. Only take meds or supps after the blood test.
b) For iron, we learned to be off for approx. 5 days based on information from the Iron Institute, i.e. to see what we are “holding onto”.
c) For saliva, we learned to be off any cortisol-containing or cortisol-changing supplement for “up to” two weeks. BUT there may be some things you canNOT get off without having problems, so please work with your doctor.
**NOTE: All the below is copyrighted by Stop the Thyroid Madness. It is not permissible to post it elsewhere without seeking permission from Janie A. Bowthorpe, M.Ed.
(Here’s where you can get a saliva test: https://sttm.mymedlab.com/sttm-profiles/zrt-saliva-adrenal-4-sample–2)
24-HOUR CORTISOL SALIVA–here are the consistent results of people who do not have an adrenal problem:
8 am (or when you normally wake up): at the tip top part of the range (if top of range is 9.5, people are right there, or 9.4, etc)
11 am-noon (or approx. 4 hours after you woke up): in the upper quarter (though not at the very top of provided range)
4-5 pm (or approx. 4-5 hours after the above): right “around” mid-range
Bedtime: at the very bottom (Literally. So if range is 1-4, people are at 1, not even 2)
Here’s an example of one that can be ordered.
Notes: Saliva testing is an at-home test to evaluate your circadian and cellular cortisol levels at key times during a 24 hour period. It’s more accurate than blood cortisol, we saw repeatedly, since the latter measures both bound and unbound cortisol, not cellular levels like saliva, and thus blood can give a false idea of what is really going on. You can look low, yet be high; you can look high, but be low. It’s crazy
For accuracy, patients learned they needed to be off any adrenal influencing supplements, any medication containing cortisol, any herbs that support adrenal function, or zinc or licorice root for “up to” two weeks prior to testing…if possible (It may not be possible for some conditions, though, to be off certain meds or support–work with your doctor on these) Avoid food when spitting into vials. If you wear dentures, remove them to prevent denture adhesives from tainting the spit, says the facilities.
Note: we learned the hard way that it’s impossible to know what is going on if you use a lab facility like Quest that has the range as “less than” or “more than” a number. (i.e. < or >). Here’s one that does not.
ALDOSTERONE: In most ranges, people are falling significantly above mid-range who don’t have an aldosterone problem or low aldosterone symptoms.
Notes: This test measures the adrenal hormone aldosterone which helps regulate levels of sodium and potassium in your body�i.e. it helps you retain needed salt, which in turn helps control your blood pressure, the distribution of fluids in the body, and the balance of electrolytes in your blood. Symptoms of having low aldosterone range from craving salt, low sodium blood test, peeing more or sweating more, blood pressure issues. You can have one more or more. This is best tested in the morning and with no salt intake for 24 hours. Women need to do it in the first week after their period, since rising progesterone can also raise your aldosterone. Testing should not be done with severe illness (aldosterone falls in response to severe illness), during periods of intense stress (aldosterone rises), or right after strenuous exercise (aldosterone rises). Being pregnant can result in doubled amounts of aldosterone.
DHEA: healthy adult patients are at their highest levels in young adulthood and lowest levels as they age, though with low cortisol, the body can push it up to try and change the low cortisol, but can’t achieve that, so it falls all over again.
Measures the mother of all steroid & sex hormones. Usually measured in conjunction with the 24-hour adrenal cortisol saliva test. See above. It’s hard to know exactly where anyone’s DHEA “should” be. We know by what we read that DHEA begins a decline generally in your 30’s, and can be much lower by the 70’s. But here’s something interesting we’ve noticed: in the presence of a low cortisol problem, the DHEA will rise towards the top, attempting to compensate for the low cortisol. But as the low cortisol continues, DHEA falls fairly low in the range.
ACTH STIM (not needed for most, we’ve noted, unless there is suspicion of a serious adrenal problem like Addison’s disease):
The ACTH Stimulation test, also called the Cosyntropin test, measures the ability of your adrenals to be stimulated by the ACTH, a pituitary hormone, and is used to diagnose Addison’s or Cushing’s disease, as well as hypopituitary. Usually done in an out-patient setting and takes only a few hours. A synthetic ACTH is injected into your arm and the response of your plasma cortisol levels are measured. You’ll need to fast, and the test is usually done in the morning. You cannot be on any cortisol medications or supplements. An ACTH plasma test is often done at the same time to measure the amount of ACTH being secreted by the pituitary gland. Your cortisol levels will double if your adrenals are not diseased. The ACTH has not been found to be a good test for the kind of adrenal fatigue manifested by thyroid patients, which is sluggishness, not disease.
FREE T3 (may also say Free Triodothyronine):
a) Those without a thyroid problem have this above mid-range. The except is if the free T3 is above mid-range, and the free T4 is low in the range–the latter can point to a thyroid problem, we’ve noticed.
b) Those who are optimal on NDT will tend to have a free T3 towards the top top part of the range, ALONG WITH a mid-range free T4, patients have repeatedly noticed and reported. Lower and it backfires.
c) Those who are optimal T3-only notice a free T3 at the top if not slightly over.
Notes: Free in front of the active thyroid hormone T3 means you are measuring what is available and unbound.
What if your free T3 is super high with continuing symptoms, and/or a lower free T4? That is called pooling of the T3, and can be a clue you have a cortisol and/or iron issue. If not on thyroid medication: 1) If your free T3 is high, you could have Hashimoto’s disease, which will need the two antibodies tests to discern it, or Graves disease, which needs the TSI test. 2) if your free T3 is mid-range or lower, and in the presence of hypothyroid symptoms, you may have hypothyroidism, no matter how low the TSH. Patients find it’s not a good idea to take any T3-containing product on the morning of a test. Work with your doctor.
FREE T4 (may also say Free Thyroxin/Thyroxine):
a) Those without a thyroid problem have a free T4 slightly above mid-range. This will go with a free T3 also above mid-range for most. There can be slight exceptions
b) Those who are optimal on NDT will tend to have a free T4 MID-range, along with a free T3 towards the TOP part of the range
c) Those who are optimal T3-only will notice a very low free T4 plus a free T3 at the top if not slightly over.
Notes: T4 is the thyroid storage hormone. Free in front of the T4 means you are measuring what is available and unbound. If you 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. Or it can mean pooling.
REVERSE T3 (may also just say just Reverse): Those without an RT3 problem seem to be in the bottom three numbers of any range or slightly below.
Notes: The body produces the benign RT3 naturally to rid itself of excess of T4. Or it goes up in response to the flu, or a physical injury, or when detoxing high heavy metals, and more. But in some cases, such as high or low cortisol or having inadequate levels of iron, it’s made in excess which clogs your cell receptors from receiving regular T3. (See page 162-163 in the revised STTM book for further details.) i.e. if it’s going up and away from approximately the bottom three numbers in most ranges, it’s time to look at one’s iron or saliva cortisol levels.
TSH: The worst test to go by. Why? Because too many patients have found themselves with a good-looking TSH with raging hypothyroidism. By the time it rises high enough, you’ve been hypothyroid for a certain length of time. Better to diagnose and dose by is the free T3 and free T4, NOT the TSH.
Notes: We have noticed that the best way to use the TSH lab test is in diagnosing a pituitary problem, not a thyroid problem. A very low TSH with a low free T3 gives away a hypopituitary issue. We do know that healthy people tend to have a TSH in 1’s and not much higher. We also know that many with clearly hypothyroidism can have a “normal” result sadly which will take years to rise high enough to reveal one’s hypothyroidism. Otherwise, we honestly pay no attention to it.
Supposedly, it measures the actual TSH in your body, called the Thyroid Stimulating Hormone, a pituitary hormone messenger. Yup, they are using a pituitary hormone to tell you if you have a thyroid issue. For example, if your body needs more thyroid hormones, the pituitary gland releases the TSH in order to knock on the door of your thyroid to produce more hormones. So theoretically, the higher the TSH lab test, the more your body is screaming at your thyroid to produce! produce! Creators of the TSH lab test came up with a ‘range’ that supposedly corresponds with healthy thyroid function. So theoretically, if your TSH lab results are higher than the range, it would imply something is triggering your actual TSH to be a little too active in screaming at your thyroid. That something would be a diseased thyroid, called hypothyroid. But there are problems with this method of diagnosis. First, you can have a so-called normal result, yet be clearly hypothyroid with symptoms. Why? Because the TSH test cannot measure if all your cells & tissue are receiving the released thyroid hormones. Some may be (thus the normal TSH result) and some may not be (thus your clear symptoms). Second, if you have Hashimoto’s, you lab results can swing between hypo and hyper, & your lab test may be representing the middle of the swing.
T7, TOTAL T3 (no free in front), TOTAL T4 (no free in front), UPTAKE, etc: useless and outdated for our particular needs….
HASHIMOTO’S RELATED–two antibodies at the minimum
AB (Anti-thyroglobulin): If the result is below the “less than” mark, or in the range provided, you may be fine, but you need to do the anti-TPO shown below, as well. If above range, Hashimoto’s.
Notes: Measures the level of the antibody protein anti-thyroglobulin in order to discern the presence of Hashimoto’s disease. Generally, if this is above the range, you’ve got the autoimmune thyroid disease Hashi’s. (No, we have not observed that it has to be zero to be free of having Hashi’s!)
THYROID PEROXIDASE ANTIBODY (Anti-TPO): In the range seems fine. If this is above the range, you’ve got the autoimmune thyroid disease Hashi’s.
Notes: Measures the thyroid antibody TPO, which will be above the normal level in the presence of Hashimoto’s disease. .
IMPORTANT NOTE: since some with Hashi’s can also have the Graves antibodies, many patients are also testing both TSI and TRAB. TSI stands for Thyroid-Stimulating Immunoglobulin and TRAB stands for Thyrotropin receptor antibodies. TSI 80 or below is considered remission. Ideally, you should have zero TSI. Labs use either >140 or >125 (depends on the lab) as positive for Graves Disease. TrAb should be “undetectable”. Remission is when TrAb (PLUS the above TSI under 80) is less than .9. They also use a test called the TBII but we’re not sure what the perfect levels are for that one yet.
A very small body can show no antibodies, yet symptoms of Hashi’s. They need to talk to their doctor about an ultrasound.
IRON RELATED (and you need all four, NOT just ferritin)
SERUM IRON (also called just Iron or Total iron): In US ranges, women with adequate iron are ‘close to’ 110 (or 109, or 108, or 107, etc….); men who have plenty of iron are “close to” the upper 130’s, based on what we’ve seen on hundreds of lab results. In other ranges such as European or Australian, optimal appears to be the lower-to-mid 20s at the least for women and higher for men.
If you are considerably higher than optimal, you could have the MTHFR mutation which will need testing and treatment. The MTHFR mutation also drives the ferritin low with normal or high iron is many of us, we’ve noted. If all three iron labs are high (serum iron, % saturation, and ferritin, you may have the genetic hemochromatosis and you can ask your doctor for testing for that.
PERCENT % SATURATION of IRON: When iron is good, women tend to be “close to” 35%, or 34, or 33 (or .35, .34, .33 for Canadian ranges), we have discovered, and men go from 38% to 40-45%.
Notes: Measures your serum iron divided by your TIBC. Like all iron labs, you should be off all iron for at least 12 hours before testing to see how your supplementation is doing, or up to 5 days to see what your natural levels are. The latter may be best. NOTE: % Saturation can look falsely good or high if your TIBC is too low!!
TIBC (Total iron binding capacity): When iron is optimal as explained above, TIBC will tend to be in the low 300’s (with a range of 250 – 450) or for other ranges, a little more than 1/4th above the bottom number in the range provided. p.s. Some have a TIBC in the 200’s consistently and no matter what–Janie Bowthorpe is like that and so are others.
Notes: TIBC measures whether a protein called transferrin, produced by the liver, is enough to carry iron in the blood. Used to determine anemia or low body iron. If your result is high in the range and in the absence of chronic disease, you may be anemic. NOTE we do NOT treat the TIBC. We treat the iron and % Sat. The TIBC just gives us interesting information as explained.
FERRITIN: Optimally, females often are around 70-90 with ferritin (Janie’s is 80 or less when her iron is good)….though getting up to the 50’s has been good, too, when iron and % sat are OPTIMAL. Men tend to be slightly above 100, such as 110 – 120.
Notes: Measures your levels of storage iron. NOTE THAT WE DO NOT TREAT the FERRITIN LEVEL. A mistake. We treat iron and % saturation and let ferritin follow in its own accord. But ferritin is interesting to watch, and can also point to INFLAMMATION if it goes high without serum iron being high.
If your ferritin is low along with inadequate/lower levels of iron and % saturation, that usually points to simply low iron, which is common with those on T4-only meds, or undiagnosed, or under-treated. But we do NOT treat that low ferritin. We treat the inadequate iron and % saturation, and over time, the ferritin moves up by itself if it’s too low.
If your ferritin is low with very good or high iron, plus a TIBC in the middle 300’s or higher, that usually points to having high heavy metals and an active MTHFR mutation.
If your ferritin is much higher along with less than optimal iron, it can point to INFLAMMATION, i.e. inflammation causes iron to be thrust into storage, and inflammation is common with certain thyroid patients for a variety of reasons. In less common cases, higher ferritin can be from liver disease, alcoholism, diabetes, asthma, or some types of cancer. But for most of us, it’s just about inflammation from hypothyroidism, or gluten issues, or unknown. So we need to lower the inflammation before taking iron supplements.
If ferritin is high along with a high % Sat and Serum iron, you may have hemochromatosis, an inherited condition. Time to get tested in working with your doctor.
By the way, we learned that we should be off all iron supplementation for at least 12 hours before testing to see what supplementation is doing for us, but 5 days to see your true iron levels.
FEMALE HORMONES (serum is recommended over saliva)
25-32 nmol/L (UK) serum
100-125 pg/mL (US) saliva
440-585 pmol/L (UK) saliva
FSH and LH for cycling women should be 1:1 ratio. If LH is higher, that typically means PCOS. Labs must be taken day 2-4 of the cycle while bleeding.
FSH/LH <10 mIU/mL good/healthy egg reserve (nowhere close to meno–chance of conception, <3 excellent, 3-6 good, 6-9 fair)
FSH/LH 15-20 perimenopause (probably not ovulating every month)
FSH/LH 20-30 menopause almost certainly in progress (ovulation rare if at all regardless of bleeding)
FSH/LH > 30 noncycling/postmenopause
B-12: We noticed repeatedly that an optimal B12 lab result is in the upper quarter of the range. Mid-range can present symptoms of inadequate levels, such as legs falling asleep too easily, or the same with little fingers or other fingers.
Measures an essential vitamin, B12, which can be low in hypothyroid patients due to low stomach acid. It is NOT optimal to simply be “in range”. For example, if your range is similar to 180-900, a healthy level appears to be 800 or higher. In the 500-800 range, you can benefit from taking B12 lozenges, specifically Methylcobalamin. The exception to the latter for some may be if they have both an MTHFR and COMT mutation–the methyl version of B12 can sometimes send out B12 levels way too high.
It has been shown in studies that patients with labs under 350 are likely to have symptoms, which means the deficiency is very serious and has gone on for a few years undetected. Even mid-range has shown to be in adequate. Lab ranges are much too low for B12…in Japan the bottom of the range is 500. The urine test Urinary Methylmalonic Acid, also called the UMMA, can be added since it is a very sensitive detection and if high, will reveal a true B12 deficiency.
FOLATE: Standard range is 3-17, so optimal would be at least the top third of that, we have noted. Higher for MTHFR.
Also sometimes called “folic acid”, this is a b-vitamin which can be low in hypothyroid patients. Folate is important for prenatal development, as well as your blood cell health. Folate works with B12 in the use and creation of proteins. It’s “folate” thats needed instead of “folic acid”, especially if you have MTHFR. We don’t start too high, as for some of us, it can start the methylation process too strongly.
LIVER: Healthy liver function puts the ALT and AST tests in the teens, as noticed repeatedly by Janie in working patient-to-patient.
MAGNESIUM: For RBC Magnesium, you are looking for an RBC result mid-range or higher, we’ve noted.
Thyroid patients can be chronically low in the electrolyte magnesium, which causes a multitude of problems ranging from worsened Mitral Valve Prolapse, less cancer protection, poor muscle development, too much calcium, cramping, and many other chronic conditions. See Janie’s blog post on magnesium.
SODIUM: We’ve noted that healthy results can be “close to” 142.
(can also be strongly related to your adrenals and aldosterone): Measures the levels of the electrolyte sodium, which is outside cells, and has a balance with potassium, which is within cells. Sodium regulates bodily fluid and plays role in major bodily functions. This can be strongly related to whether you have low aldosterone or not. See Adrenals above.
POTASSIUM (can also be related to your adrenals): We’ve noted that patients with healthy levels can be 4.2 and higher. If you do the RBC Potassium, our best knowledge shows it needs to be up in the 70-95% of the range.
Measures the electrolyte mineral Potassium, which is within cells, and has a balance with sodium, which is outside cells. Potassium plays a role in healthy kidney, heart and nervous system function. When potassium is too high, it’s called hyperkalemia; when too low, hypokalemia. It can rise in the presence of low aldosterone (see above under Adrenals), then fall. Best to do an RBC potassium–red blood cell—which measures it in your cells.
Tell the lab tech NOT to use the tourniquet for drawing blood. It can falsely raise your potassium result.
RENIN: Measures the enzyme hormone that regulates the release of aldosterone and is done in conjunction with the aldosterone test. If renin is high in the range along with a low aldosterone, you have an adrenal cause. If both hormones are low in the range, you ‘may’ a pituitary problem. See this study to explain the latter. Always tested along with Aldosterone to see if your problem is due to the adrenals (primary adrenal insufficiency) or your pituitary (secondary adrenal insufficiency).
VITAMIN D test: (25-hydroxy): 50-80 is the most mentioned goal., though a lot of us like to stay in the 60-80 range, also recommended by cutting edge doctors.
Vitamin D plays a role in your immune system and other important actions. Many thyroid patients are low in D due to digestive issues from being undiagnosed or undertreated, plus problems with Celiac or gluten intolerance.
A second Vit. D test you should ask for: Vitamin D1,25, the biologically active form of vitamin D. Why? You could have a genetic problem called the VDR mutation, i.e. the Vitamin D25 Receptor Mutation. Janie Bowthorpe has this mutation. See https://www.stopthethyroidmadness.com/why-you-may-need-another-vitamin-d-test/
When someone overreacts to Vit. D supplementation, it seems to point to a parathyroid problem.
ZINC: Top third of the range is optimal. Also important to test your RBC Zinc to see your cellular levels, because you have good-looking serum zinc and low RBC zinc! That happened to Janie Bowthorpe.
OTHER LAB RESULTS YOU MAY RECEIVE THROUGH YOUR DOCTOR: RED BLOOD CELL COUNT, HEMOGLOBIN (Hgb) HEMATOCRIT (HCT), MEAN CORPUSCULAR VOLUME (MCV), MEAN CORPUSCULAR HEMOGLOBIN (MCH), MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC), PLATELET COUNT, RANDOM DISTRIBUTION OF WIDTH (RDW): Here is a great page explaining what they can mean: http://www.drkaslow.com/html/blood_cell_counts.html
CANADIAN LABS AND RANGES:
Serum Iron (range) Optimal results are usually in the mid-20’s for women, upper 20’s and higher for men)
Percent Saturation: same as US observations i.e. .35/35% for women is the ideal; .38/38% and often a little higher for men.
TIBC: when range is umol/L >45-77, low 60’s is noted when iron is looking good. If range is 50-70 umol/L, usually 1/4th above bottom of range.
Ferritin: range is often 15-200, and optimal for most women is 70-90, for men it’s 110-120.
Note: 60% of patients have a hematologic or neurologic response to B12 supplementation at a level <148 pmol/L
FOR THOSE WHO USE MATH–here’s how to find those “areas” of of lab ranges for thyroid, adrenals and TIBC
Top 1/4 of the range ** Math to do this, subtract the highest number in range from lowest number in range, divide by 4. Subtract this number to the highest number in range
Mid range ** Add lowest number in range to highest number in range. Divide by 2.
Bottom ¼ of the range: Subtract the right number of the range from the left number of the range, divide by 4. Add this number to the left number in the range
FOR THOSE WHO ARE VISUAL FOR THE ADRENAL CORTISOL SALIVA TEST:
Want to order your own labwork?? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/
A great article about the fallacy of ranges: http://www.goodlifehealthcenter.com/2014/09/understanding-the-limitations-of-laboratory-reference-ranges/