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Hashimoto's and Hypothyroidism. Proper Testing is Key

Hashimoto’s is the #1 cause of an underactive thyroid, accounting for 90%- 97% of cases of hypothyroidism.  Hashimoto’s is an autoimmune condition that results in the immune system attacking the thyroid gland. This attack causes damage to the thyroid, eventually resulting in the gland losing its ability to make thyroid hormones. Hashimoto’s, and the autoimmune process, likely developed 5-10 years prior to the time you were diagnosed. In the early stages, the TSH screening test for Hashimoto’s often comes up normal. In the late stages of Hashimoto’s, the TSH will become elevated, allowing doctors to make a diagnosis of hypothyroidism. Testing for thyroid antibodies can help a person determine that they have Hashimoto’s, and can uncover the condition many years before there is a change in TSH.

Many cases of thyroid problems are missed because most doctors don't perform a comprehensive test panel. I spent almost a decade suffering from debilitating fatigue because I only had my TSH tested. If you suspect that you may have thyroid disease or know someone who may be, here's a list of tests to take to your doctor.

Top 6 Thyroid Tests

Here is a comprehensive list of the Top 6 thyroid tests take to your doctor and can ask for tests for Hashimoto’s and hypothyroidism. Be sure to request a copy of your thyroid labs so that you can see them yourself and ensure that they are interpreted correctly. 


  1. TSH (Thyroid Stimulating Hormone)
  2. Thyroid peroxidase antibodies (TPO Antibodies) 
  3. Thyroglobulin Antibodies (TG Antibodies)
  4. Thyroid Ultrasound 
  5. Free T3 
  6. Free T41 


TSH- This is a pituitary hormone that responds to low/high amounts of circulating thyroid hormone. In advanced cases of Hashimoto's and primary hypothyroidism, this lab test will be elevated, the case of Graves' disease the TSH will be low. People with Hashimoto's and central hypothyroidism may have a normal reading on this test.  

Thyroid peroxidase antibodies (TPO Antibodies) and Thyroglobulin Antibodies (TG Antibodies)- Most people with Hashimoto's will have an elevation of one or both of these antibodies. These antibodies are often elevated for decades before a change in TSH is seen. People with Graves' disease and thyroid cancer may also have an elevation in thyroid antibodies including TPO & TG, as well as TSH receptor antibodies. 

Thyroid Ultrasound- A small percentage of people may have Hashimoto's, but may not have thyroid antibodies detectible in the blood. Doing a thyroid ultrasound will help your physician determine a diagnosis. 

Free T3 & Free T4-These tests measure the levels of active thyroid hormone circulating in the body. When these levels are low, but your TSH tests in the normal range, this may lead your physician to suspect a rare type of hypothyroidism, known as central hypothyroidism.  

If your doctor will not order these tests for you, find another doctor.   

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