Thyroid Blood Tests and Their Role in Diagnosis

August 4, 2011

If you or your doctor suspect you have a thyroid problem, the first step in diagnosis for many practitioners is to perform a blood test. The test usually done to evaluate thyroid function is the Thyroid Stimulating Hormone — or TSH test.

Actually, many practitioners seem to think that diagnosing a thyroid problem is as simple as having blood drawn, sending it to a lab, and then seeing whether the results are flagged by the lab as abnormal.

Unfortunately, this method fails patients on a number of levels.

First, even if you agree — and some physicians don’t — that the TSH is all that is needed to diagnose a thyroid condition, the medical community can not even agree over what the “normal range” should be for the TSH test.

Until late 2002, the reference range for the TSH test was approximately 0.5 to 5.0. TSH levels below .5 were considered hyperthyroid (overactive), and levels above 5.0 were considered hypothyroid (underactive.) Then, the American Association of Clinical Endocrinologists and National Academy of Clinical Biochemistry recommended a narrowing of the range, to take into account that people in the upper end of the range were actually evidencing early, but active, thyroid disease. Their guidelines recommended that doctors and laboratories follow a new range of 0.3 to 3.0. Surprisingly, almost four years later, some doctors and many labs are still using the old range, and some practitioners are practicing according to the new range. So the same TSH level — 4.0 for example — could be diagnosed as hypothyroid by one practitioner, and normal by another.

AACE has estimated that the new guidelines would double the number of people who have abnormal thyroid function, bringing the total to as many as 27 million, up from 13 million under the old guidelines. And actually, some experts are now saying that the new guidelines would mean that as many as 59 million Americans have a thyroid dysfunction. So, the fact that there is disagreement on these most fundamental testing guidelines represents a serious oversight for many millions of undiagnosed — and ultimately misdiagnosed — thyroid patients.

Second, reliance on the TSH test overlooks the research that has shown that testing for the presence of thyroid antibodies may help detect thyroid disease in its early stages. And, if Hashimoto’s antibodies are detected, for example — a sign that the immune system has turned on the thyroid — but TSH has not yet elevated, treatment with thyroid hormone can actually prevent progression to overt hypothyroidism.

Third, and perhaps most important, reliance on the TSH test as the sole means of diagnosis fails to take into account the importance of a clinical examination, as well as family and personal history. To diagnose thyroid disease, a practitioner should palpate the thyroid, feeling for enlargement, nodules or lumps. Your face should be examined for evidence of puffiness or swelling, and loss of eyebrow hair. Your blood pressure, pulse, and any weight changes should be evaluated. Your hair should be examined for thinning. Reflexes should be tested. Your eyes should be looked at for signs of thyroid eye disease. Skin should be examined for extreme dryness, hives, pretibial myxedema, and other potential signs of a thyroid condition. Having any past personal history, or family history of thyroid problems, also raises the index of suspicion for a thyroid problem dramatically. The current method, in which clinical observations and history are trumped by blood test results, does a tremendous disservice to patients, and in reality, makes doctors unnecessary, as “diagnosis” becomes solely a matter of reading a blood test result.

Blood tests for TSH can be a part of thyroid diagnosis. But the TSH test should never be the only factor in making a diagnosis.

Your practitioner should perform a hands-on physical examination, and if you have hypothyroidism symptoms or a personal or family history, a thorough practitioner will often perform thyroid antibodies tests in addition to TSH tests.

Ultimately, some practitioners believe that even in the absence of abnormal TSH (by even the new narrower guidelines), symptomatic evidence of hypothyroidism should be treated with a low therapeutic dose of thyroid hormone replacement, to evaluate response. In this situation, a practitioner is attempting to determine if symptoms will resolve without any adverse effects from the medication (such as high heart rate, or elevated blood pressure).

Ultimately, the most important message for patients: do not accept “your thyroid test was normal” as an appropriate response from your practitioner, because, as you can see, it doesn’t mean you don’t have a thyroid condition. Be sure to ask the right questions, and insist on the right type of tests and examination, to ensure that you are getting the best possible care.

(June 2006)

Mary Shomon is an internationally-known thyroid patient advocate, and is author of a number of best-selling health books, including Living Well With Hypothyroidism and The Thyroid Diet. Since 1997, she has run the Internet’s most popular thyroid patient sites: Thyroid Site  and

Written By: Steven F. Hotze, M.D.

Steven F. Hotze, M.D., is the founder and CEO of the Hotze Health & Wellness Center, Hotze Vitamins and Physicians Preference Pharmacy International, LLC.


Leave a Reply

Your email address will not be published. Required fields are marked *

Contact Us

"*" indicates required fields

By filling out the above, you agree to receive educational, informative emails on alternative medicine and hormone balancing. You will have the option to unsubscribe at any time.


AboutHotze Health & Wellness Center

Since 1989, Hotze Health & Wellness Center has helped over 33,000 patients get their lives back using bioidentical hormones that restore hormones to optimal levels, strengthen immune systems, and increase energy levels. Our treatment regimen addresses the root cause of hypothyroidism, adrenal fatigue, menopause, perimenopause, low testosterone, allergies, and candida.

Led by best-selling author, radio host and leading natural health expert, Steven F. Hotze, M.D., our medical team has over 100 years’ combined medical experience backed by a staff of nearly 100 caring professionals who provide an environment of hope and extraordinary hospitality for each of our patients, who we call our guests. It is our deepest desire to help you obtain and maintain health and wellness naturally so that you may enjoy a better quality of life, pure and simple.



Do you want to live a healthy, happy, purpose-driven life? Do you want to restore your health so that your loss of energy, weight gain, joint pain, depression and lack of drive or motivation won’t hold you back from achieving your personal and professional goals?

Dr. Steven Hotze wants that for you, too. In fact, in his powerful and passionate video entitled, “What I Believe”, Dr. Hotze shares how his Christian worldview and pivotal experiences have ignited a deep desire to offer the message of hope and optimal health to all who need to hear it.

Follow Us

As seen on:

  • ABC
  • Fow News Channel
  • NBC
  • CNN
  • The Biography Channel
  • Bloomberg Businessweek
  • The Early Show
  • Good Morning Texas
  • Great Day Houston

Our Doctors

At Hotze Health & Wellness Center, our doctors are changing the way women and men are treated through the use of bioidentical hormones. Our natural treatments have helped over 33,000 individuals with hypothyroidism, adrenal fatigue, menopause, perimenopause, low testosterone, allergies, candida, detoxification and nutritional deficiencies.

Meet our doctors

Guest Testimonials

Elizabeth C.

"At 36, I felt like I was 90 – exhausted, depressed, and cold all the time, and now I have a life of energy, focus, restored libido, and a renewed desire to be present with my family!”

Read More guest testimonials
Pam White
Pam White
At Hotze Health and Wellness YOU can truly find restoration of your health and vibrant life! You will find the most caring and effective healthcare available! Don't hesitate call them today!!!
Ron Guidry
Ron Guidry
Doctors are not the final authority in our journey of achieving/maintaining health and wellness but having a good team of doctors in your support and guidance community is not only helpful it is wise and also essential. The team and staff at Hotze Health and Wellness are health professionals that you can trust to help you navigate all the misinformation that may be keeping you separated from your optimal level of health.
Caral Reeves
Caral Reeves
Hotze Beauty is a first class facility! Extreme level of professionalism , knowledge & genuine care❤️‍🩹
Julie Hryszko
Julie Hryszko
I’ve been a guest at this facility for 15 years. They are the most efficient, thorough and caring group of individuals I’ve ever experienced. Dr Hotze looks to change the way a typical doctor treats patients and looks for root causes to eliminate medical issues instead of treating “symptoms”. My life has improved 100% since my initial visit. The cost of the treatments are worth it.
Shavon Sisson
Shavon Sisson
Always a great experience dealing with everyone at Hotze Heath and Wellness! Everyone is kind and helpful.
Kori Misson
Kori Misson
I cannot accurately describe in words how I feel about this practice and the entire staff. I have had quite a few health issues throughout the years, rheumatoid arthritis, sjogrens, weight gain, hair loss, irritability, and that is just the beginning. I had pretty much given up on feeling good, just decided to "live with it" and hope for the best. Two very close friends love the Hotze Wellness Clinic and they have experienced life changing health. Made my appointment and from the beginning I felt heard. Not a in and out fast food style practice. They are looked and are looking at my entire body for overall health and wellness. Connections from mind and body to clinical blood work, even dental questions....they care and I feel as if I can trust them. I am on a path to complete wellness and my goal is to have my RA back in remission as it once was....make yourself a priority. Having hope is an incredible feeling!