Hashimoto’s hits you with such a wide variety of symptoms that diagnosing it can be tough. Fatigue, weight gain, mental fog, sadness, lack of motivation – all these can point to psychological disorders and doctors (like most of us) are prone to taking the most obvious path first. You’re stressed… here, try this pill. Even when Hashimoto’s presents with physical symptoms like hair loss, dry skin, constipation, swelling of the tongue, muscle weakness, and more alarmingly, heart disease, a practitioner may treat each symptom individually instead of looking at them as part of a larger issue.

On top of that, Hashimoto’s autoimmunity in its early stages can cause both hypothyroid and hyperthyroid symptoms unless the thyroid gland has been compromised to a point where thyroid problems are clearly indicated.

And as if that wasn’t enough for us to deal with, a doctor who suspects Hashimoto’s may order lab tests only to have those lab tests come back normal. That’s when so many of us are told we’re fine, it’s just exhaustion, try this antidepressant, etc.

They stop testing at TSH

Hashimoto’s is diagnosed by measuring thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TgAb) but before some doctors will consent to ordering those (or even just a full thyroid panel), they will test TSH (thyroid stimulating hormone). If that is within what a given lab considers normal, many practitioners will rule out thyroid problems even though it’s well known that TSH alone doesn’t provide a very clear picture of what’s going on in the thyroid. After all, antibodies can be present for years and years before elevated TSH will show in tests!

Normal ranges vary from lab to lab

The normal reference range for TSH is already extremely broad and some doctors won’t diagnose thyroid issues until TSH goes above 10.0! Lab ranges for s complete thyroid panel and antibody tests also vary from lab to lab and what’s considered normal can be incredibly broad. Some vocal experts in the Hashimoto’s, autoimmunity, and hypothyroid communities are calling for practitioners and labs to use narrower ranges of normal and for these same groups to look not just at normal but also optimal ranges.

Negative antibodies doesn’t mean ‘all clear’

When symptoms suggest Hashimoto’s but antibody tests are negative, many doctors will take a Hashi diagnosis off the table. But the body’s autoimmune response isn’t constant – a patient can test negative now and positive in the future. Also, some autoimmune patients are also coping with stressed and weakened immune health and these people may not be making sufficient antibodies to test positive for Hashimoto’s even though the damage to the thyroid gland has already been done. 

Immune activation can cause Hashi-type symptoms

Autoimmune disease can be symptomatic before your body has attacked an organ to the point of no return because of inflammation. You may not yet be hypothyroid according to your lab tests but that doesn’t change the fact that Hashimoto’s is having an effect on your wellness.

So if you’re symptomatic and you suspect Hashimoto’s thyroiditis or you have every marker for hypothyroidism but your labs are coming back normal, you’re not alone! Today’s thyroid treatment is largely focused on managing labs. If you begin a course of treatment and your newest lab work comes back within accepted ranges, your practitioner may declare you well even if you feel anything but!

We know from experience that there’s something very discouraging about feeling ill but seeing all those “normal” numbers in lab results. At that point, it’s helpful to acknowledge that doctors aren’t gods and that you really do have some degree of power over your health. We are proponents of looking for the root cause of thyroid symptoms – and that can mean trying AIP, using Dr. Izabella Wentz’ or Dr. Amy Myer’s protocols, adding supplements, or addressing emotional health concerns and stress. It may take a while for you to find what works for you, and the results might not be perfect. While some people feel nearly 100% better when they go off gluten, dairy, and soy, others find only minimal relief and have to explore triggers other than food.

But even some relief is better than no relief, and feeling just a little bit better may give you the energy and focus you need to keep looking for your key to remission.