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Who enjoys rolling up their sleeve and getting a blood draw at the lab or the doctor’s office? (Hint: No one!) Many people who have not been diagnosed with a thyroid problem have no idea if or when they should have thyroid testing. And for people with hypothyroidism, thyroid blood tests are an unpleasant but necessary part of their thyroid care. Things can become even more problematic when you try to determine how often to get tested!
Ahead, questions and answers about when you should schedule thyroid bloodwork.
Hypothyroidism symptoms typically include fatigue, depression or anxiety, weight gain (or difficulty losing weight), brain fog, low sex drive, and hair loss, among others. Because these symptoms are so common to many conditions, many people with an underactive thyroid are never tested and diagnosed – but should be! If you have these symptoms, consider having diagnostic testing – including Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb) – to evaluate your thyroid function. The American Thyroid Association (ATA) recommends screening people with symptoms associated with thyroid conditions.
According to the ATA, thyroid function should be tested in all adults, including asymptomatic persons, starting at age 35 and again every five years afterward. It’s also important to mention that the typical bloodwork done for an annual physical, even after age 35, usually does not include thyroid testing.
According to the American College of Physicians, women 50 who have one or more thyroid symptoms should receive thyroid screening.
If you have a family history of thyroid conditions, you are at risk of developing a thyroid problem yourself. You should also be aware that this risk appears to be highest in women who have first-degree female relatives – grandmothers, mothers, sisters, and daughters – with thyroid conditions. The ATA indicates that more frequent screening is appropriate in people with risk factors – such as a family history of thyroid problems. They don’t specify a testing frequency, but some women with a family history of thyroid condition monitor their thyroid status with annual thyroid testing.
Even if you previously had normal thyroid function, you should schedule periodic thyroid screening tests if you’re taking a medication that can alter your thyroid function. The most common drugs that affect the thyroid include lithium, amiodarone, interferon, and interleukin-2. Experts recommend that you have a complete thyroid panel done before starting the medication. You should test again within 6 months of starting the drug and then test every 6 to 12 months. (Also, remember that you should always get tested at the first signs of any hypothyroidism symptoms.)
Women with infertility, recurrent miscarriage, or who are undergoing fertility treatment should have a complete thyroid evaluation. Unfortunately, some infertility workups and fertility clinics do not routinely include thyroid screening or testing, leaving it to patients themselves to advocate for thyroid testing.
If you’re trying to conceive or are pregnant, the American Association of Clinical Endocrinologists recommends thyroid screening before pregnancy or during the first trimester. The American College of Obstetricians and Gynecologists takes a less vigilant approach and recommends against routine screening for pregnant women. Instead, they advise physicians to be aware of the symptoms and risk factors for thyroid conditions – including after childbirth – and evaluate their patients only when indicated. Given the extent to which undiagnosed and untreated hypothyroidism can affect pregnancy and the importance of early diagnosis, patients should consider following the AACE’s clinical practice guidelines at a minimum. Keep in mind that many women insist on thyroid screening before conception and again during the first trimester.
When you are being treated for hypothyroidism – but you have new, continuing, or worsening symptoms --- it’s always a good time to ask for a complete thyroid panel. Nonspecific symptoms like depression, high cholesterol, or weight gain are common in hypothyroidism. As a result, some thyroid patients end up with prescriptions for antidepressants and cholesterol medications or diet and exercise recommendations instead of an order for thyroid lab work. Until your thyroid labels are optimized and your symptoms relieved, Paloma recommends frequent and regular testing.
When you’re newly diagnosed with hypothyroidism and start on thyroid hormone replacement medication, doctors should ideally test your thyroid hormone levels every four to six weeks, so they can evaluate your thyroid levels and adjust your dosage. The goal is to achieve optimal thyroid levels and symptom relief.
Any time you have a thyroid dosage adjustment, you should ideally get retested anywhere from 4 to 8 weeks later to assess the effects of the change. (Note that some doctors will adjust your thyroid dosage without specifying additional testing. You could end up on the wrong dose until your next regularly scheduled thyroid test, which could be as long as six months or a year!)
The different categories of thyroid hormone replacement drugs include brand name and generic levothyroxine tablets, Tirosint liquid and gel cap forms of levothyroxine, generic liothyronine and brand name Cytomel tablets, natural desiccated thyroid (NDT) drugs, and compounded thyroid drugs. If you change the type of medication you’re taking, you should always be rested four to eight weeks later. This recommendation also applies when switching brands in the same category, changing from a generic to a brand, or going from a brand name to a generic.
Experts recommend that people with hypothyroidism get 30 grams of fiber daily. But a high intake of dietary fiber can interfere with the absorption of your thyroid medication, and change your thyroid hormone levels. So, if you have recently ramped up your fiber intake significantly or started taking a high-fiber supplement – or you’ve gone from a high-fiber to low-fiber diet -- you should have a complete thyroid panel done.
Also, some patients with autoimmune thyroid disease follow specialized diets, like the Autoimmune Protocol (AIP) diet, to help reduce thyroid antibodies. You should get thyroid testing before you start your therapeutic diet, and periodic followup testing to evaluate your results.
Your thyroid dosage is, in part, dependent on your body weight. Many patients who gain a significant amount of weight need an increased dosage of thyroid medication to maintain optimal thyroid levels. Similarly, significant weight loss may make you overmedicated, with symptoms of an overactive thyroid, on your current dose. If you have gained or lost a significant amount of weight, it’s time to get your thyroid tested.
The following is a partial list of common drugs and supplements that can affect your thyroid levels. If you start or stop any of these medications or supplements, it’s important to have your thyroid tested.
- Proton Pump Inhibitors
- Iodine (including kelp and bladderwrack)
- Fiber supplements
Early treatment of thyroid dysfunction in pregnancy is vital to the health of both mother and baby. Many experts recommend that if you’re hypothyroid and planning to conceive, you should have preconception thyroid testing to ensure optimal levels for fertility and pregnancy. According to the ATA, the TSH level should fall in the reference range of 0.1 and 2.5 mIU/L during the first trimester of pregnancy. Many experts recommend maintaining the TSH at this level before conception for a better pregnancy outcome.
Experts recommend that if you’re hypothyroid, you should have a plan with your doctor before pregnancy to increase your thyroid dosage as soon as pregnancy is confirmed. In our book Your Healthy Pregnancy with Thyroid Disease, my co-author Dana Trentini and I recommend that a hypothyroid woman test for pregnancy as early as possible after conception, and not even wait until a missed period. As soon as pregnancy is confirmed, it’s also essential to have a complete thyroid panel right away, followed by a consultation with a thyroid practitioner to evaluate whether any immediate dosage adjustments are needed to protect the pregnancy.
Hypothyroidism in patients who are pregnant can be complicated. A 2019 study published in the British Journal of Medical Practice summarized the challenges of hypothyroidism in pregnancy:
In practice it is challenging to achieve adequate gestational thyroid function in women with hypothyroidism. About 30–60% of levothyroxine-treated women have suboptimal thyroid function in early pregnancy, including a proportion who remain overtly hypothyroid through pregnancy. The reasons for this are practical as well as physiological. Hypothyroid women generally require a 25–50% increase in levothyroxine dose on conception but dose adjustments are often inadequate, absent, or instituted late.
According to the American Thyroid Association guidelines for hypothyroidism, a pregnant patient should have thyroid monitoring every four weeks until around 20 weeks and at least once more at about 30 weeks. Many women choose a more aggressive schedule and have thyroid testing at least three times during the first trimester and again in both the second and third trimesters.
The ATA recommends that follow-up testing be performed in a hypothyroid woman at around six weeks postpartum. Because thyroid imbalances can contribute to postpartum fatigue, depression, and difficulties with breastfeeding, many women choose to get tested earlier, during the first two weeks after their baby’s arrival.
Getting a blood draw at a lab or doctor’s office can be inconvenient, expensive – and even painful for some people. Paloma Health’s Complete Thyroid Home Test kit makes it easy, affordable, and painless. With a Paloma test kit, you test at home with painless fingerstick testing. The panel includes Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). You also have the option at checkout to add Reverse T3 (RT3) and Vitamin D tests to your panel. Just order your kit online, follow the easy instructions to take your samples, and send your test kit back to our certified lab in the prepaid mailer. Your results come back quickly to your secure online portal.
Realistically, getting diagnostic testing and following blood tests testing can be a challenge. Some doctors resist patient requests for a thyroid test. Others offer only a serum TSH, and not a full thyroid panel. And in providing care to hypothyroid patients, some doctors have a one-size-fits-all policy of only testing annually. Getting those physicians to order thyroid lab tests more frequently or as needed may be challenging. Also, be aware that some HMOs and health insurers limit their coverage and approvals for thyroid lab testing and will only approve semi-annual or annual thyroid testing. Paloma Health’s philosophy is that patients should be tested as often as needed for optimal hypothyroidism care. That’s why Paloma has made its thyroid testing so affordable and convenient. It’s easy to test on a schedule that meets your needs with a Paloma Complete Thyroid Home test kit. Order yours now at the Paloma site.
If you still have unresolved clinical symptoms of hypothyroidism, you should be able to be treated by a knowledgeable physician who understands that optimal thyroid care may require frequent testing and adjustments to your thyroid hormone replacement dosage. Many Paloma patients choose to get test kits from Paloma every three months. Quarterly thyroid testing helps them carefully monitor their thyroid function and work with their doctor to assess the impact of dietary and lifestyle improvements in real time! Please reach out if you would like to discuss the opportunity to work with a Paloma practitioner for your thyroid care.