Does this sound familiar? Your doctor says, “Your TSH (thyroid stimulating hormone) is normal” yet you’re struggling with fatigue, brain fog, stubborn weight gain, gut issues, hair thinning, cold intolerance, anxiety, or depression.
If so, what they may have overlooked telling you is that TSH is just a screening test and does not provide a full evaluation of thyroid functions.
It tells us how loudly your brain is asking your thyroid to work, but does not tell us how well your thyroid is producing hormones, whether those hormones are converting to, or how well your cells are actually using them.
If you’re experiencing symptoms like those listed above, you likely need a complete diagnostic thyroid panel, not just TSH.
What A Complete Diagnostic Thyroid Panel Includes
Here is an outline of what a full thyroid workup should include and what each test is measuring:
- TSH – Brain signaling to the thyroid
- Total T4 – How much thyroid hormone is being made
- Free T3 – The active hormone your cells actually use
- Reverse T3 – Shows if stress, illness, or inflammation is blocking active T3 from sitting in the cells
- T3 Uptake – Evaluates if the active Free 3 is sitting in the receptor and turning on the cell
- Anti-TPO antibodies – Screens for autoimmune thyroid disease (Hashimoto’s)
- Anti-TG antibodies – Another critical autoimmune marker
In naturopathic functional medicine, we look at function, not just lab ranges!
Many patients are told their thyroid is “fine” while only the TSH has been checked and they continue feeling exhausted, foggy, inflamed, and frustrated. This happens because:
- You can have normal TSH, but low Free T3
- You can convert T4 into Reverse T3 instead of active T3
- You can have autoimmune thyroid disease for YEARS before TSH changes
- You can have hormone resistance at the cellular level
Basal Body Temperature: A Simple At-Home Clue
Your thyroid helps regulate body temperature. One simple way to track thyroid function is by monitoring your basal body temperature in the following way:
- Keep a thermometer by your bed
- Take your temperature immediately upon waking
- Do not move, drink, or get up first
- Track it for 5–7 mornings
A consistently low basal temperature (often below 97.8°F) can suggest low thyroid function, especially when paired with symptoms.
Keep in mind: This is not a diagnostic tool, but it is a powerful clinical clue. You still need to talk to your doctor.
Symptoms That Deserve Full Testing
You should consider a complete thyroid panel if you have any of the following symptoms:
- Chronic fatigue
- Brain fog
- Weight gain or inability to lose weight
- Constipation or gut issues
- Depression or anxiety
- Hair thinning or dry skin
- Cold intolerance
- Hormone imbalances
- Infertility or menstrual irregularities
- Autoimmune conditions
The Bottom Line
If you have symptoms, you deserve answers. TSH alone does not tell the whole story.
We need to move from, “Your labs are normal” to, “Now we understand why you don’t feel normal” and talking to a naturopathic doctor who looks beyond just the test is a first step.
