Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism

Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism

The Thyroid Federation International estimates there are up to 300 million people worldwide suffering from thyroid dysfunction yet over half are presumed to be unaware of their condition. Hypothyroidism, an underactive thyroid, is one of the most undiagnosed, misdiagnosed, and unrecognized health problems in the world. It is an epidemic that is sweeping the globe yet doctors are failing to recognize and diagnose hypothyroidism. Hypothyroid patients are falling through the cracks of mainstream medicine, left to suffer debilitating and even life-threatening symptoms. What is going on?

1. Reliance on TSH

According to mainstream medicine, TSH (thyroid stimulating hormone) is the gold standard for the diagnosis and treatment of thyroid dysfunction. This hormone released by the pituitary gland in the brain stimulates the butterfly-shaped thyroid gland in our necks to produce thyroid hormones. Unfortunately TSH alone does not provide a complete picture. Most doctors typically don’t run a full thyroid blood panel nor do they investigate fully the patient’s medical history, symptoms, family history and thorough physical exam. They rely on this one blood test, TSH, leaving millions of people undiagnosed and suffering from debilitating symptoms.

Many patients complain to their doctors of common hypothyroid symptoms yet because their TSH falls in the ‘normal’ range, their thyroid is declared normal. Patients will walk into their doctors’ offices complaining of fatigue, weight gain, and depression, and their doctors will pass them prescriptions for sleeping pills and anti-depressants and tell them to just exercise more, instead of recognizing the underlying thyroid issue.

2. Outdated TSH Lab Ranges

TSH alone does not provide a complete picture. If doctors are going to rely on TSH alone, however, they should at least give consideration to the controversy over the TSH normal reference range and consider this when diagnosing patients. Mainstream medicine relies on a normal TSH range from 0.5 to 5.0 with variations depending on the laboratory. However thyroid advocates and many integrative physicians are fighting to narrow that range to close to 1.0.

Many traditional doctors rely strictly on the TSH range of 0.5 to 5.0 despite the patient’s obvious symptoms. Then, there are other doctors who will only diagnose hypothyroidism once TSH is above 10.0! WHAT? By then your symptoms can be so debilitating you are struggling to live through each day!

3. Failure To Do Full Thyroid Blood Testing

How can doctors diagnose and treat thyroid disorders without doing a full investigation? How can they hope to understand the complexity of their patient’s issue while relying on TSH alone or even a combination of TSH and T4? They are missing critical pieces of the puzzle. Patients are falling through the cracks left suffering debilitating symptoms all because of an outdated medical protocol.

When the pituitary gland in the brain releases TSH, TSH stimulates the butterfly-shaped thyroid gland at the base of our necks to produce the thyroid hormones T4 and T3. The majority of thyroid hormones produced by the thyroid are T4, however T3 is the most active useable form of thyroid hormone that can be used in the cells of the body. The conversion of T4 to T3 is a critical element in this puzzle. By testing TSH and T4 alone, doctors are assuming that our bodies are properly converting the T4 to active T3.

For many hypothyroid sufferers like me, our bodies don’t convert T4 to T3 properly. In the care of doctors who only tested for TSH and T4, my symptoms did not improve if anything they got worse. It wasn’t until I found a doctor open to full thyroid testing including Free T3 that my symptoms improved. She discovered that my Free T3 was low in the normal range (I personally feel my best when my Free T3 is in the top quarter of the normal range) and I was struggling. She was open to exploring the thyroid medication options to find what was right for me and that was a miracle for me. I’m now feeling fabulous despite hypothyroidism thanks to a combination of natural desiccated thyroid and compounded time-release T3. What a difference a simple change in my medication made for me. Thanks to a great thyroid doctor who knew to test my T3 levels, I got my life back. It should be about what works best for the patient, unfortunately in mainstream medicine this is often not the case.

Now to add to the complexity of this, there is a difference between Total T4 and Total T3 versus Free T4 and Free T3. Thyroid hormones are fat soluble and the blood is mostly water. In order for the fat-soluble thyroid hormones to travel through the blood, they need to be bound to protein that act as little taxis to carry the thyroid hormones through the blood vessels to cells all over the body. When they reach the cells, the protein needs to be cleaved off because only the unbound “free” hormones can actually enter the cells and perform their necessary functions. Therefore Free T4 and Free T3 levels are important. Since T3 is the most active useable form of thyroid hormone that can be used in the cells of the body, Free T3 is critically important. Unfortunately most mainstream doctors do NOT test for Free T3 levels. I’ve heard from many Hypothyroid Mom readers from around the world on my blog, Facebook and Twitter that their doctors refuse to test Free T3 and even though they are suffering terrible symptoms on T4-only thyroid treatment their doctors refuse to change their protocol. This is an absolute tragedy!

T4 must be converted into a usable form of T3 before the body can use it. In any given day some of the T4 is converted into a useless inactive form of T3, known as Reverse T3 (RT3). However in times of extreme stress, such as major emotional  or physical trauma, surgery, extreme dieting, chronic stress or chronic illness, the body will convert a larger than normal amount of T4 into this inactive Reverse T3. Your TSH and T4 scores may look ‘normal’ however the person suffers hypothyroid symptoms due to the high levels of reverse T3. Few mainstream doctors test for reverse T3, declaring a patient’s thyroid lab tests completely ‘normal’ all the while their patient suffers debilitating symptoms because their reverse T3 was not tested.

Hashimoto’s disease is an auto-immune disease where the body has turned on itself and attacks and destroys its own thyroid gland. It is a leading cause of hypothyroidism, yet mainstream medicine fails to test patients for thyroid antibodies. You can’t imagine how many followers here at Hypothyroid Mom have let me know after years of struggling with hypothyroidism they were finally diagnosed with Hashimoto’s after insisting on these two thyroid antibody tests – Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb).

A full thyroid panel for hypothyroidism should at least include these 6 key thyroid lab tests:


Free T4

Free T3

Reverse T3

Thyroid Peroxidase Antibodies

Thyroglobulin Antibodies

The issue is that often times doctors do NOT run these 6 tests. If you find your doctor unwilling to run these tests, don’t hesitate to get multiple medical opinions until you find a doctor that helps.

4. Strict Reliance on “Normal” Lab Reference Ranges

One of the greatest errors doctors make in diagnosing hypothyroidism is basing decisions strictly on lab results. Conducting a full thyroid blood panel can at least provide a clearer view of the issues, however even this often does not tell the full picture.

These lab results, for example, do not test what happens to the thyroid hormones once they enter the cells of the body. Every cell of the body is dependent on thyroid hormones for proper functioning. There is no test that measures how well each cell is utilizing the thyroid hormone once it enters the cell. It is therefore possible for someone to have normal blood results but still be hypothyroid due to issues arising within the individual cells of the body.

Each of us is unique and our requirements for thyroid hormones and our reactions to imbalances are all unique. Different people can have different individual ranges ideal for them. A great thyroid doctor is one that treats the patient, not the lab results.

It’s important to get a copy of your lab results to check that all the recommended tests have been done and that your scores are “optimal” not just “normal”. There is a big difference.

7 essential hypothyroidism lab tests & optimal ranges

5. Failure to Recognize Warning Signs and Symptoms

The thyroid gland is the master control center for the metabolic functions of every single cell in our body. Every cell of our body requires thyroid hormones for proper functioning. Therefore hypothyroidism, low thyroid, has the power to disrupt every part of our body and to produce profound changes in every aspect of our health. Unfortunately hypothyroidism is not given the attention it requires by the medical community and is often overlooked and considered a minor condition not worthy of much attention. This disease is vastly misunderstood and disregarded in mainstream medicine.

A look at my post 300+ Hypothyroidism Symptoms…Yes REALLY will show you the severity of symptoms associated with hypothyroidism.

It takes time to do an extensive clinical history with a patient including symptoms, physical examination, medical history and family history, and many doctors don’t take the time. They hurry to rush you off and move on to their next patient.

Then there are those who have no clue at all that your 2 page list of symptoms that you brought to the doctor’s office has any connection to a low thyroid. They note the most obvious signs such as weight gain, depression, and high cholesterol. Instead of connecting them to the underlying issue hypothyroidism, they pass you prescriptions for anti-depressants and statins to lower your cholesterol and advise you to exercise more and eat less.

They fail to connect the dots between your family history of heart disease, auto-immune disease, diabetes, kidney disease, gall bladder disease, liver disease, cancer and/or Alzheimer’s. Many fail to realize these deadly diseases are potentially linked to hypothyroidism.

You walk into the doctor’s office with telltale physical signs of hypothyroidism, including swelling of your face especially the eyelids and below the eyes, obvious signs of fatigue, loss of the outer third of your eyebrows, dry thinning hair, pale dry skin, red irritated dry eyes, cold clammy hands and feet, brittle ridged nails, slowed reflexes, enlarged tongue, hoarseness of voice. Your doctor has no idea your physical symptoms are due to hypothyroidism. You are a walking talking poster child for hypothyroidism, but your doctor does not notice.

Somehow we are overlooked by mainstream medicine.

Perhaps our cries are not loud enough.

It is a tragedy.

READ NEXT: Which is the best thyroid medication?

Take Back Your Thyroid Health! Sign up and never miss a post - it's FREE

About Dana Trentini

Dana Trentini B.S. (summa cum laude), B.Ed., M.A., Ed.M. (2 Ivy League degrees), founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.


  1. Niki Kilian, you developed RA because you have an autoimmune disorder from a leaky gut. Due to a number of reasons. Antibiotics, stress eatting gluten which makes it worse. I was gluten sensitive 8 yrs ago and ignored it and said I am fine. Now I have Hashimoto disease and if I don’t follow a AIP diet to heal my gut lining it could get worse and the antibodies would just keep attacking my body and organs. Read Dr Amy Meyers books and her story. Find a chiropractor who specializes in autoimmune disorders or functional dr. They will help you with blood work etc… to see where you’re at.

  2. I have had all the signs and symptoms of thyroid issues but because my pcp says it’s normal I’m not convinced. I have a very low tsh level but t3 and t4 are on the higher end of normal. I have an enlarged thyroid and have had a thyroid scan. Which concluded multiple cysts. They say they are benign, which may be true but I feel they are covering these up with anxiety and depression meds. It doesn’t help for people to think it’s all in our head either. Our bodies tell us that something is wrong if Dr.s would just take time and listen.

    • Annita Beauchamp says

      Please, please have these “cysts” evaluated further. I’m not trying to alarm you but, my mother had thyroid “goiters” for more than ten years. She also had every symptom of thyroid disease imaginable. Her endocrinologist dismissed all of her complaints. Her PCP ordered ultrasounds regularly but, they only showed the increase/decrease in size. She was 69 years old when this began. Longevity runs in my family. My mother was very active, healthy, and proactive with her health. Three months ago she demanded a biopsy be performed. At the age of 80 she was diagnosed with Papillary Thyroid Cancer. Her endocrinologist has the audacity to say, Well, you are 80 and people can live a long time with this. PTC is very slow-growing.” A wonderful head/neck surgeon at Johns Hopkins, in Baltimore, Maryland, performed her surgery. The tumor had extended beyond the thyroid gland and grew underneath her collarbone. It had also spread to one lymph node. This “wait and see” attitude is costing people their quality of life and their lives. Please search until you find another doctor who will listen to you and do further testing. They have to order what you ask for. God bless you.

      • This really scares me, I was diagnosed with a multi-nodular goiter about 3 years ago. The goiter was found through a brief check-up with my gynecologist. Had an ultrasound, that’s when they discovered nodules, with one nodule biopsied. After that they decided to just “watch” it. I moved to another state and 3 years went by. For the past year, I have been miserable (very tired, foggy feeling, headaches, achy etc) but just pushing forward trying to make day by day. Finally got health insurance and decided to see an endocrinologist (that wasn’t so easy to do either) She ordered blood work and ultrasound. My first visit will be next week. I just got the results my ultrasound showed so many nodules all over thyroid, she only measured 7, with one measuring at 5cm. Blood test she ordered was NOT a full thyroid test order (I now know from the article I just read!) My TSH is 0.886 and FT4 is 0.88 which from research is normal? Every issue in the article I just read I HAVE, not every single day but MOST days. (The swelling of face and eyelids) I have very dry eyes, skin, hair, nails AND NO ENERGY at all, always fatigued. The worst of all is HEAT intolerance which I have not read anywhere. Weight gain when I have been dieting. I have very high heart rate which no one could figure out and 2 years ago unexplained edema. High blood pressure which is somewhat controlled with BP meds with a dietetic. I just think this is all due to my thyroid not functioning but it’s SO hard to find a GOOD doctor anymore that is not rushed and actually cares about their patients. My first visit to a new GP I saw told me I had to make a second appointment because all of symptoms were just to much and there isn’t enough time. She gave me a referral to see endocrinologist and sent me on my way. So frustrating. Sorry for the long reply.

        • Rosemarie Ganoe says

          My TSH jumped to 5.25 …doubled in the last 6 months…t3 and t4 within their normal ranges…but borderline. During that time I had a full old fashioned abdominal hysterectomy. My resting heart rate is almost double. I have all the other stated symptoms. I am now seeing a cardiologist.,.who has also ordered another Thyroid panel in addition to the echo…stress testing and 2 week heart monitor because he thinks I have more going on besides anxiety. Wish me luck. I will comeback and let you know how it goes

          • Niki Killian says

            I’m at the end of my rope, they have been testing me for hypothyroidism for 3 years now. I’ve also been diagnosed with RA, my sister & niece both have hypothyroidism which makes this all the more frustrating. My TSH has been all over the map, I insisted they run my Free T3; but they have never run the reverse T3, Total T3 or the Throglobuin Antibody (they will next week). My Free T3 is avg 2.7 which is low the other numbers are everywhere. I’m tired of being sick all the time, of falling asleep everywhere bc I can’t keep my eyes open. I live in New Orleans and I have heat intolerance which is made worse in the deep south. I’ve never liked summer but this is different. They did find a cyst on my thyroid which of course they say is nothing they are just watching it to see if it grows or shrinks. In the meantime my neck is always visibly swollen (I take tons of pics) to the point that I feel like I’m being choked. I’m so fed up because we have a shortage of specialty doctors here even though we have 2 prestigious university’s no one stays so switching doctors isn’t very easy and also doesn’t seem like it will make much of a difference. Just frustrated.

  3. My doc did run a limited panel. Free T3 looks normal, TSH is low. T4 is low, reverse T3 and antibodies tests were not run. Yet I have most of the symptoms of hypothyroidism including low basal temp on waking. When I was feeling adventurous I tried taking lugols. I felt pumped up and my throat swelled. IMO, I have Hashimoto’s. Any thoughts?

  4. I have been battling Hypothyroidsm for quite some time. Currently my TSH is 78 t4 1000
    Had a right thyroidectomy and now my left thyroid is enlarged to 7×2.8×5
    Having severe cardiac palpitations that my apple watch keeps alerting me. Drs put me on Armor 2 grains.
    I’m scared already had a Cardiac event 2 years ago.
    Had a fna was inconclusive with follicular neoplasms had an ultrasound after. Radiologist did not specify. Now need a IV Iodine CT scan.
    Need to find a Dr in the Schaumburg IL area. My thyroid has stolen my life and continues to do so.
    Trying so hard to learn but the brain fog causes so much confidence then the doctors they do not know what’s going on either. Feel like I’m in a circus show.

  5. Diane Pankonin says

    Thank you so much. I have ALL the symptoms. MyDr. took the blood test and pronounced all was fine, that was over a year ago and it has only progressed NOW I WILL FIGHT FOR THE HELP I NEED!

  6. Lavonda Grammer says

    Do you know of a Dr. in the Central part of Alabama that will complete this service

    • Kay Klimczak says

      I’ve just started my quest for diagnosing my symptoms. Initial lab work said “all is well”. Nothing has changed. I need help.
      I live in Angoon Alaska bear Juneau . Can you direct me to a doctor here ??

  7. I have been hypothyroid since the age of 12, I was given iodine for thyroid . She ne then all doctors have put me on and off snythroid. Every time I have gained weigh and had depression. I was put it on Cytomel 50 mg 3 times a day and felt great for years(22years). I game down with AFib at 62 and had a pacemaker and ablation . Just found out I have mild sleep apenea and breast cancer. My new thyroid doctor wants to put me on snythroid because I show hyperthyroidism due to Cytomel. In he last 2 years I have gained 30 pounds since being on Amour and now snythroid. HELP

Speak Your Mind