Hashimoto’s Thyroid Panel

Fasting Required: No
Specimen: Blood
Results: 3–5 Business Days

Why This Panel Is Different

Many physicians screen thyroid function using TSH alone, sometimes adding Free T4. While helpful, that limited approach may miss:

• Early autoimmune thyroid disease
• Fluctuating thyroid patterns
• Impaired conversion of T4 to T3
• Stress-related thyroid suppression

This comprehensive panel goes beyond basic screening and helps determine whether autoimmune activity is affecting the thyroid gland, and how well thyroid hormones are being produced, converted, and utilized.

What This Panel Measures — and Why It Matters
TSH (Thyroid Stimulating Hormone)

• TSH signals the thyroid to produce hormones.
• High TSH may indicate an underactive thyroid (primary hypothyroidism).
• Low TSH may indicate an overactive thyroid or pituitary dysfunction.
• TSH is a regulatory signal — but it does not tell us why thyroid function is abnormal.
• Free T4
• Free T4 measures the amount of circulating thyroid hormone available for conversion into active T3.

This tells us:

• How much hormone the thyroid is producing
• Whether replacement therapy is adequate
• If protein-binding issues are masking abnormalities

Free T3

• Free T3 is the active thyroid hormone that affects metabolism, mood, energy, heart rate, and temperature regulation.
• Some patients have normal TSH and Free T4 but low Free T3, suggesting:
• Poor conversion from T4 to T3
• Stress-related suppression
• Chronic illness effects

Reverse T3 (rT3)

Under stress, inflammation, or illness, the body may convert T4 into reverse T3, an inactive form of thyroid hormone.

High reverse T3 can:

• Block active T3 at the cellular level
• Contribute to symptoms of low thyroid function despite “normal labs”
• Reflect metabolic slowdown during chronic stress or illness
• This helps explain cases where symptoms persist despite “normal” conventional testing.

Total T3 and Total T4

These measure overall hormone levels, including hormone bound to proteins.

They can help:

• Identify binding abnormalities
• Recognize T3 toxicosis
• Clarify discrepancies between total and free hormone levels

TPO Antibodies (Thyroid Peroxidase Antibodies)

This is one of the most important components of a Hashimoto’s evaluation.

• Thyroid peroxidase (TPO) is an enzyme necessary for producing T4 and T3.
• In Hashimoto’s thyroiditis, the immune system mistakenly targets this enzyme, producing anti-TPO antibodies.
• Elevated TPO antibodies indicate:
• Autoimmune attack against the thyroid
• Ongoing inflammation
• Gradual destruction of thyroid tissue

In early stages, thyroid levels may fluctuate as antibodies intermittently damage thyroid cells. Patients can move between normal, hyper, and hypothyroid patterns before permanent underactivity develops.

Identifying antibodies early allows for:

• Monitoring progression
• Addressing immune triggers
• Supporting thyroid tissue before advanced failure occurs
• Why a Functional Medicine Approach May Be More Beneficial
• A standard treatment model often prescribes synthetic T4 (levothyroxine) when TSH rises above range.

While this may normalize TSH, it does not always address:

• Poor T4-to-T3 conversion
• Elevated reverse T3
• Ongoing autoimmune activity
• Nutrient deficiencies affecting thyroid function
• Inflammation or stress physiology
• A comprehensive approach evaluates:
• Hormone production
• Hormone conversion
• Immune activity
• Inflammatory burden
• Nutritional cofactors

This broader assessment can help determine whether:

• Autoimmunity is present
• Thyroid dysfunction is fluctuating
• Stress physiology is contributing
• A more individualized treatment strategy is appropriate

In Summary

• This panel goes beyond “Is the TSH normal?” and helps determine:
• Is the thyroid under autoimmune attack?
• Is hormone production adequate?
• Is hormone conversion functioning properly?
• Is stress or inflammation suppressing metabolism?

For patients with fatigue, mood changes, weight shifts, hair loss, cold intolerance, brain fog, or fluctuating thyroid labs, a more comprehensive evaluation may provide clarity that basic screening does not.