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Do You Have Normal Thyroid Test Results, But Still Feel Lousy? Here's Why:

Oftentimes a person will suspect they have a thyroid problem, only to be told they have normal thyroid test results, with no answer as to why they still don't feel like themselves. Sound familiar? Well here's why that happens!

Thyroid Test Results: Beyond Standard Testing

In order to properly detect thyroid disease, we need to do more than just the basic (TSH) test.

Naturopathic Doctors maintain that testing beyond traditional measurements can oftentimes help to identify thyroid problems that wouldn’t otherwise be detected; this can of course lead to appropriate treatment.

If you're like many people who come to us, you’ve had the typical symptoms of thyroid problems and yet traditional thyroid tests haven’t revealed a solid diagnosis. If this is the case, then you may have what is termed ‘functional hypothyroidism’. Additional testing beyond traditional methods can help us detect exactly what's going on, and find a suitable treatment approach.

Depending on what testing reveals, some may need a natural thyroid hormone supplement while other times dietary/nutrition changes along with nutritional supplementation can boost thyroid function.  Or, a person's thyroid symptoms may be caused by a completely different issues - this is why we do more than just look at the thyroid!

How The Thyroid Works

Thyroid stimulating hormone (TSH) is released from the pituitary gland in the brain. TSH stimulates the thyroid gland (located about where you might wear a bowtie). TSH tells the thyroid gland to release two hormones, T4 and T3. These hormones are released into the bloodstream and travel throughout the body. A lot more T4 is produced than T3. T4 really doesn’t do much until it is converted into T3. T3 is what does the ‘magic’, and activates metabolism.

Traditionally, clinicians will only test the TSH and T4; if these thyroid test results are found to be at “normal” levels, you will most likely be told you don’t have a thyroid problem.

A Few Problems...

Firstly, the traditional range for thyroid test results (TSH) is typically around 0.45 to 4.5. This is an extremely wide range for what are considered normal thyroid levels, allowing for varying levels of ‘normal’ thyroid function. If we could compare this to a point scale used in grading, it would be like saying everyone who scores anywhere from 60 to 100 points passes the class. Clearly, this isn’t a level playing field, so to speak, especially when it comes to your health. 

Ideally, we want to see the TSH closer to 1.0. This is like getting an ‘A’ in class, whereas those in the 3 to 4 range are similar to those students getting C’s and D’s. They aren’t failing, but they could be doing a lot better!

Conversion Issues

It's important to have additional thyroid function testing done. Another problem could lie in the body’s efficiency at converting the T4 into T3, the active form of thyroid hormone.

This is why some people, who despite being treated with synthetic thyroid hormone medications, don’t feel any better. These drugs are primarily made of T4; some people don’t do well converting the T4 into T3. If they go on a natural thyroid hormone that has more T3 thyroid hormone in it, they tend to do much better.

Or, the thyroid hormones may be ‘tied up’ to other proteins in the blood, rendering them unable to do their job. Another problem may lie in the thyroid hormone receptor; it may not be ‘listening’ to the thyroid hormones. Still other thyroid problems may be caused by estrogen or cortisol imbalances. It can take a bit of detective work to figure it out sometimes!

All of these situations are possible, despite having normal thyroid test results (TSH and T4), rendering the thyroid hormones ineffective.

In addition, other hormones can cause functional hypothyroidism. Cortisol is a 'stress' hormone that when over or underproduced can slow metabolism. Estrogen, similar to cortisol, can slow the thyroid when it is too high or too low. These hormones can be tested easily using a saliva test.

Other Causes

Certain nutrient deficiencies can affect the thyroid:

  • Iodine is used to make thyroid hormone; not enough may be a factor.
  • Ferritin is a storage form of iron; when it’s low it can slow the thyroid.
  • Low vitamin D can also contribute to symptoms of hypothyroidism.

There may be other causes as well. Because of this, it’s important to have additional testing done, beyond the traditional thyroid function test, to help figure out the cause of what is going on with your thyroid.


After discussing your symptoms, we will order a battery of tests looking at all aspects of thyroid function (and other hormones). We then thoroughly evaluate your thyroid test results taking into account your symptoms as well, not just what the labs say, in order to find a solution for you.

Treatment is always individualized, taking into account each person’s lifestyle, symptoms, and thyroid test results. 
We almost always recommend certain dietary supplements to help provide the raw materials for the thyroid to function properly, and to assist the body in utilizing thyroid hormone more efficiently. Sometimes a person needs a natural thyroid hormone, for which we will refer to a prescribing physician.

It’s always a good idea to seek care from a doctor who is familiar with the concept of functional hypothyroidism and clinical nutrition, and who understands that standard thyroid test results or normal thyroid levels don’t always mean that nothing else is going on.

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