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 Outdated TSH Lab Ranges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. Thyroid doctor Dr. Weston “Wiggy” Saunders posted this important message on his Dr. Wiggy Thyroid MD Facebook page.

Dr. Wiggy TSH 1.5

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, one thing you can do is get yourself a second medical opinion. Here are 30 resources to help you find a good thyroid doctor.

The other option you have is to order YOUR OWN thyroid lab tests without your doctor. Do you know that’s possible?! A trusted online place where you can order lab testing yourself is True Health Labs. They have comprehensive thyroid assessments that include TSH, Free T4, Free T3, Reverse T3, thyroid antibodies and more. The advantage of True Health Labs is that they offer one-on-one results review with one of their Functional Medicine doctors so that you understand your lab test results and next steps.

Use coupon code Limited_5 for 5% off your order for Hypothyroid Mom fans. True Health Labs regularly offers discounts throughout the year so be sure to check the very top of their website to see if there are any promotions going on at the time of your purchase.

If you have a Flex Spending Account (FSA) with your employer, all lab tests ordered online at True Health Labs are FSA-friendly!

Comprehensive Thyroid Assessment for USA (not available in NY, NJ, MA & RI)

Comprehensive Thyroid Assessment Kit for Canada (this kit can also be used in the USA except in NY, helpful if you are not near a Quest draw center, reside in a rural area, or live in Canada)

Comprehensive Thyroid Assessment for Europe

*If you are located outside the areas listed for a particular test you wish to order, contact True Health Labs on their website directly for assistance.

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.

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About Dana Trentini

I founded Hypothyroid Mom October 2012 in memory of the unborn baby I lost to hypothyroidism. Hypothyroid Mom 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 to favorite resources including the Amazon Services LLC Associates Program. Connect with me on Google+


  1. My blood test for thyroid has been normal but I have had the symptoms for a quite a while now. My doctor wants me to have a surgery. My question is, after series of blood test and series of biopsy, why should still have the surgery.

  2. marie carbonaro says:

    What type of doctor is best to diagnose thyroid issues?

  3. patricia c french says:

    Hello!! I went to my family dr the other day and I have been feeling bad just about all my life! I can NEVER wake up refreshed or feeling good!! The dr always checks my tsh and t4 levels and I am on medicine but feel no better!! I ask him to check my T3! He said I don’t need that!!! I asked him that why don’t they do a whole thyroyd paiel because just those two doesn’t show what is really going on! He told me I would have to pay for the extra tests in the panel out of pocket!!! And also I feel as though I have no adrenaline to go on and they did check my cortisol but they do dot do the proper testing!! They only check my blood for cortisol levels in the am , when it should be done throughout the day?? Again he told me that I would have to pay out of pocket for all that!! I am super mad about this because I and many others continue to suffer and possibly die due to all this!! So where do I go to complain about this? The medical board?? I can’t function anymore and I am sick and sick of not getting better!! Thank-you!!

    • Borborygmi says:

      You are right. For cortisol its 24 hour urine collection. They can then do a defamer hazing suppression test to determine the nature of the elevated cortisol level.

  4. Hi There,

    I just got these labs from my endocrinologist and I wanted a different perspective on them.

    Can you tell me your thoughts?

    I am a 47 year old Lebanese female who is “5” ‘4 3/4″ and weighs 169 lbs. I have lost 46 lbs since last December 19, 2015.

    I have PCOS and genetically inherited high cholesterol and high blood sugar. Besides genetics I am a sugar addict and have binge eating disorder.

    I have been pre diabetic off and on for at least 5 years. I have never been diagnosed with diabetes as I have never reached diabetic numbers through a self induced OGTT, A1c tests, fructosamine and fasting blood sugars.

    I am working on my diet and exercise to reduce certain blood markers.

    My blood sugar has come down and I am still working on my cholesterol. The cholesterol was measured by my primary care doctor and cardiologist.

    The blood work below was from last week at my Endocrinologists office.

    My last total cholesterol was 360 but my hdl and triglycerides were in normal range. Taken about a couple months ago.

    Last spring my total cholesterol was 259 coming down from 312. Prior to 312 it was 344.

    When it was 259 my hdl and trigs had also improved.

    I think it went high again because I started eating sugar again. I was still losing weight and monitoring my caloric intake but I went Paleo almost sugar free from December 2015 to April 2016 and that’s when my cholesterol came down from 312 to 259.

    I am back to minimizing sugar intake.

    I also suffer from depression, anxiety and ocd.

    I started gaining weight when I hit puberty and developed PCOS. I have lost and gained weight many times since then.

    I carry most of my weight in my belly.

    I am having a hyperoscopy done on Dec 15. Some hyperplasia was found in my uterus.

    I have never had kids. My period has been regular since my early thirties.

    Please let me know if you need any more information.

    I appreciate your insight!!

    Thank you very much.




    T3, Free: 2.6

    TSH: 2.33



    Fructosamine: 243

    A1C: 5.4



    Insulin: 3.8


    C-PEPTIDE: 1.31

    Vitamin D: 25

    SODIUM 137
    CHLORIDE 103
    GLUCOSE 92
    Bun/Creatinine ratio is not reported when the BUN
    and creatinine values are within normal limits.

    CALCIUM 9.9
    ALBUMIN 4.2
    A/G RATIO 1.4 1
    AST 12
    ALT 13

    Fasting reference interval


  5. Aaron Glen says:

    Um… how can there be visitors from 223 countries around the world when there are only 195 countries….. lost loads of credibility there..

    • There are 195 independent sovereign states in the world, but Google Analytics which calculates the flow of people to Hypothyroid Mom includes over 60 dependent areas and disputed territories to their list. Your point is important though and perhaps “countries and regions” would be the more accurate wording.

  6. Hello, I’ve just found your site. I’m 64 year old female and for past year been trying to find reasons for my sudden weight gain, been to gym and always eaten healthy diet but cannot lose inches or pounds. I have other symptoms too, skin irritation ( dermographia ) when I scratch to point of bruising and have had sudden onset of dandruff, never had before,
    I’m tired for no reason, basically I have most symptoms of under active thyroid but my gp says my blood tests are normal so there is nothing they can do for me. Shall I ask for my records to check results or just go somewhere else to get bloods tested? Thanks

    • Sue, Your symptoms sounds so similar to mine. Yes please get a copy of your lab results and compare them to the chart in this article. Make sure you’ve had them all done and that your levels are optimal not just normal. With the symptoms you have even if you are told your symptoms are normal because that may not be normal for you, get a second medical opinion. Here are resources to help you locate a good thyroid doctor in your area.
      All the best,
      Dana Trentini (Hypothyroid Mom)

  7. Does Hypothyroid Mom EVER answer anyone’s questions???

    • Hi Elizabeth, In the early days of Hypothyroid Mom I answered every comment, every email, every post on my Hypothyroid Mom FB page, but now 5 years later with over one million followers it’s become impossible unfortunately. Do you have a specific question? I do my best with what time I have devoted each week to answering questions. I’ll circle back to check for your question here.

  8. Katie sweeney says:

    This article really helped me understand that my symptoms could be from hypothyroidism. My doctor suspects that I am I have hypothyroidism because my TSH is 8.89. My symptoms include : chest pain, dizinizess, anxiety attacks, insomnia, stomach pain, nausea, confusion, actually loosing weight, and fatigue.. they checked everything but could only find the TSH being too low. I’m just wondering if a reading of an 8.89 is really all that to worry about? Could this really be causing all my symptoms? And how long before the thyroid medication kicks in? Also I seem to feel better in the day and worse at night.. is this a normal symptom?

    • Katie sweeney says:

      I have another checkup with my doctor and I will be seeing a specialist soon, but I just need someone to talk to right now. I don’t feel good at all.

    • Hi Katie,

      Pretty much every system in your body needs thyroid hormone to function, so that’s why you see so many different symptoms that people experience. This is one area where modern medicine often lags behind, so the more you can learn, the more empowered you will be in your healing process. Read a lot of books (Dana’s book list is a great place to start), and find a great doctor who listens to you and takes the time to test everything and get your medication type and dosage right. And who is willing to retest and revisit it when that dosage changes, because it probably will. It’s not a quick thing. If I had to start from scratch again, I would also find a thyroid-savvy functional nutritionist to help fine-tune diet and lifestyle changes (that’s what I’m doing now). Even the best, most cutting-edge doctors don’t have the time to help you walk through those things and stay focused. Even though you still need to be proactive and empowered, the neat thing is that, compared to even a few years ago, there is so much more good information out there now to help you. Hope you are feeling better soon!

  9. Moussa Mhanna says:

    Since 2005 till today i’m experiencing weakness in my front left leg, unable to extend my hip and my foot properly. Also im unable to expand my both hands fingers normally. My quadriseps are weak, i have difficulty climbing staires.
    I did so many tests and biopsies but doctors still have no diagnostic for me, TSH levels are normal as well.
    Do you beleave i have a thyroid gland issue?

  10. I recently got my thyroid checked and the results came back normal, despite feeling like I have the flu 24/7. I went back and asked for a full panel test and the Dr rolled her eyes at me! She said my thyroid is working just fine but I was persistent so she ordered them. I just received a phone call from them saying there was an abnormality and they’re sending them to another lab for further testing.

  11. Alexandra says:

    Just wondering what is your take on desiccated thyroid (prescribed by a Naturopath and filled on the spot at an organic compound pharmacy).
    I read that Dr. Weil now recommends Thyrolar – and not desiccated thyroid. Do you have any data or recommendations?
    I’m just beginning my journey with diagnosed hypothyroidism after a Naturopath finally listened to me, and have just started taking desiccated thyroid.
    Thank you so much for all the information your provide.

  12. I’ve been diagnosed as hypothyroid since 2004 by a neurologist that has since relocated. I’m sure that since then I’ve developed Hashimotos disease. Most lately I have been having chest pains in the heart area, definitely not heartburn. I went to the ER, was admitted overnight, had a stress test. I have low blood pressure, only about 10 lbs overweight, oxygen level was slightly lower than usual. The only thing stress test shows is irregular ELG in recovery phase. I still am having chest pains. I do have an appointment with a cardiologist. Oh, I’m on levothyroxin. Go figure. My family doctor is not familiar and or refuses to do any other testing besides the standard test!

  13. After treatment, how do you know you are back to normal? I have had low TSH for over 10 years and my doctor wasn’t concerned. He had an explanation for every symptom, mostly my age and age related issues. Then I moved. New doctor very concerned and now after many referrals and him looking actively for answers, I just had radioactive iodine to try to address a hot nodule. But I don’t know how I should be feeling at 56 and having a high stress life. I know it sounds crazy but I don’t know what to expect and how to know what is normal aging.

  14. On 2/12/2018 I went to see my endocronologist she said that my thyroid reading was 2.33 she said that it was fine I know that still to low I try to tell her why can she run more test she said that it wasn’t nesesary to do all those test she ask me if I was depress I told her no she said that all the symptoms that I have are related to depresion I am not a Dr but what does my thyroid symptoms have to do with depresion I ask her to run this test:
    TSH FREE T4 FREE T3 REVERSE T3 TPO she refuse to do them what can I do to find a better doctor help

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