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 Outdated TSH Lab Ranges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?

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About Dana Trentini

Dana Trentini M.A., Ed.M., 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. Tina Kelley says

    I am sinking fast. I can’t find a doctor that will stop telling me everything is normal, yet I am falling apart. Does anyone know if there is a doctor in Central Pa and Md area that will help me, please?

    • This happened to me too. So frustrating! Spent so many wasted hours on money on docs that just didn’t get it and didn’t pay attention to my debilitating symptoms. Seems most “Western” docs – including most Endocrinologists- do not understand how to treat someone for thyroid issues if their labs are “normal”. You will soon learn (I hope) that there is “optimal” and it will make a big difference. You will have to educate yourself and become your own advocate. Check out
      Hopefully you can find a doctor that gets it. Try looking here for a functional MD (who can prescribe). Good luck!

    • Hi. This was me, too! I thought I just wrote a long but helpful reply, but I don’t see it posted. Ugh. Will quickly post two resources here and will check back tomorrow to see if my original reply appears.
      Check out:
      To find a functional MD. That’s your best bet when labs are “normal” but not optimal.
      Also check out stop the thyroid madness book and website anc FB group for tons of good info and advice.
      Good luck!

    • Ernestine Ross says

      The Doctors in PA only prescribe the generic drug Leverthroxine. I had to move to Florida to be placed on Armour Thyroid. Lost 50 lbs in 6 months. In addition, there is another drug you might try: Naturethyroid. Both drugs are out of pocket, but are worth it. Always try to take the real drugs, not generics if you can. Insist on it! Good Luck

  2. Hi, does anyone know of a great endocrinologist near the Fort Lauderdale/Miami area? Or where can I get help with my search?



      Did you ever find someone? I’m in ft Lauderdale and cant find anyone that will even answer the phone let alone call back?

      • Ernestine Ross says

        Palm Beach Diabetes & Endocrine Specialists.
        550 Heritage Drive
        Jupiter, Florida
        Dr. Pepper
        They have several locations. Go on line to find the telephone Number.

      • Ernestine Ross says

        Palm Beach Diabetes & Endocrine Specialists, P.A.
        550 Heritage Drive, Suite #150
        Jupiter, Florida
        Dr. Pepper
        They have several locations. The phone number is on line

  3. Amelia F Dennison says

    I have all the sign of hypothyroidism.. Im freezing 110% of the time,Ive lost 75% of my hair,gaining weight for no reason, extremely tired all the time,major moodiness, constipation,brittle nails,my eyes get extremely sore by the middle of the day, plus I have also suffered 4 misscarriages in the past. I also and the hardest one to deal with is the lower extremity swelling. I went to my doctor for my annual physical and ask her to do blood work and I just got the results today and she said it came back normal wondering if there’s a chance she could have missed something

  4. My doctor did a T3 test it came back as hypothyroid then did a T4 and it came back normal. He wanst to wait 3 months and repeat. However I have all the signs hair loss, extreme dry skin, weight gain. I dont know if its related but now am experiencing sudden leg weakness to the point they are trying to give out under me and I have to sit down.

  5. Help, I am showing all the signs of hypothyroidism, but Doctor said my test are fine. Does anyone know of a really good endrochronologist in the Denver, CO area?

  6. Toni Zarzynski says

    Would like to know if anyone knows of good endocrinologist in Milwaukee Wis area??? My present MD on my last check up said only TSH is proven to be needed for thyroid test!! I have hosimoto! My initial TSH 10 yrs ago was 12. I now run 2.5 but not up to par. I’m 65 yrs old.

    • Diane Smith says

      Have you gotten a replay to your question of a good endocrinologist in Milwaukee area? I live in the general area also and would like to find a good doctor. I go to a family dr. now and am also only tested for TSH and have been on levothyroxine for many years and have extreme hair loss. Please let me know if you found someone. Thanks!

  7. Deana Barker says

    I have a question. I had total thyroidectomy in 2009. What thyroid tests should I have done. Is it different with no thyroid? I mostly have my Dr just do TSH and Free T4. Ive only had the T3 done once and dont remember what it was. Here lately my Dr is just doing the TSH😞.

  8. Suzanne Papa says

    My daughter has had symptoms of a thyroid issue for years. She has had abnormal uterine bleeding since age 10. They keep putting her on different birth control pills. She also has anxiety and now depression.
    Past month and in the past she has been breathless. Slow reaction times, sensitivity to heat and mostly cold. She’s always cold but she always feels clammy and warm. She is also very anxious and in distress. She seems to be very agitated when she gets anxious. Sometime she can talk very fast and other times very very slow. She bleeds almost Every single day. But all they do is keep throwing different antidepressants and anti-anxiety meds and telling her that she really needs to go into a psych hospital. Because all of her symptoms are psycho somatic. I’ve never seen her like that she was actually afraid to leave her bedroom today. She didn’t want to go to school. She’s the type of kid who is actually going to be able to graduate at the end of her junior year at age 16 because that’s how smart she is. But now she’s getting 60s and 70s on test that she normally gets one hundreds on.
    Every single day. But all they do is keep throwing different antidepressants and anti-anxiety meds and telling her that she really needs to go into a psych hospital. Because all of her symptoms are psycho somatic. I’ve never seen her like that she was actually afraid to leave her bedroom today. She didn’t want to go to school. She’s the type of kid who is actually going to be able to graduate at the end of her junior year at age 16 because that’s how smart she is. But now she’s getting 60s and 70s on test that she normally gets one hundreds on. She is starting to lose her friends because she can’t function. I’m extremely worried about her but I cannot find anybody that is willing to even consider that she has a thyroid issue because her TSH test was normal. But that’s the only test they did and no one will order another one. They said they want to see her in the office again. Well she’s got three doctors appointments next week including one with her therapist and one with her psychiatrist and her eye doctor because her contacts are no longer working because her eyes feel funny. And my sister is also in the hospital with cancer. She she is starting to lose her friends because she can’t function. I’m extremely worried about her but I cannot find anybody that is willing to even consider that she has a thyroid issue because her TSH test was normal. But that’s the only test they did and no one will order another one. They said they want to see her in the office again. Well she’s got three doctors appointments next week including one with her therapist and one with her psychiatrist and her eye doctor because her contacts are no longer working because her eyes feel funny. And my sister is also in the hospital with cancer. She had surgery on Monday and we are still awaiting the pathology results. This is just not a good time to schedule 1 million appointments in a week. Where they won’t change what they’re going to do anyway. I don’t know what to do. If I take her to the ER the writer office being an anxious kid. Where she’s just struggling. She struggling for air sometimes it seems.. When she coughs whenever she gets upset because she feels like she always has a lump in her throat. She is becoming more and more fearful by the day and I’m afraid that they are going to put her into a psychiatric hospital because she’s in obvious distress but they don’t think it’s a medical issue. I really do believe it is. And so does her psychiatrist. She’s been on seven different anti-anxiety medications and antidepressants and none of them have worked. She gets is the horrible side effects from them. And the reason they’re not working is because there’s a medical issue going on but the doctors are just not willing to explore. Whatever happened to diagnostic medicine. It just seems like they don’t care. I’m so done with this. I’m actually scared for her after reading some of the stuff that I’ve read over the last couple days. And I have a minor in biology. So I can understand the medical terminology to a point.
    But it’s still confusing to me. Mostly because I’m very sleepless. I’m up with her a lot to try and keep her calm. They put her on Xanax and that’s not even touching her agitation. All it does is make her more foggy. She is extremely dizzy all of the time and this was before she was put on Xanax. She feels weak and her reactions are slowed. But this week she gained 5 pounds for no reason at all. I just don’t know what to do anymore. Your article was very enlightening. But I know no doctor is going to take anything I say seriously. The doctor is it actually begin or begun to threaten me that if I don’t put her on an antipsychotic that they will no longer see her as a patient Paternal grandmother had thyroid cancer. My own dad had brain cancer. My sister at 42 years old has and endocrineal carcinoma. And my sister is the poster child of how not to get cancer. Three of my grandparents have also died of cancer. As well as four of my dad’s brothers. I believe that doctors have their heads in the sand and I really cannot believe the reaction that I’m getting from them. Thank you for listening.

    • I’m so sorry to read all of this and wish the best to your family- has anyone checked your daughter for Diabetes?????

    • My irregular bleeding was always connected to my thyroid! I had thyroid cancer when I was 28. It wasn’t supposed to rerun but it did when I was 33. I have a dr that says the only medicine for a cancer patient is Synthroid. With my medicine and labs “normal” I still have negative symptoms. But one thing I can say is that every time my meds were to low and had to be adjusted is when I would bleed heavily or for weeks at a time. Dr. Never told me that was connected but for me it was every time. OBGYN didn’t make the connection either. As soon as meds were “ok” again my bleeding would be back to normal. Good luck!

    • I have a similar story myself. Does she have problems sleeping?

    • Constance Adams says

      I’m looking for answers too, and you’re right: reading your daughter’s symptoms, they most certainly match every symptom that details. Don’t give up. Don’t let anyone tell you you’re wrong. Doctors are taught to “Listen to the mother” because mom’s notice things that go wrong. You are your daughter’s best patient advocate and your daughter needs your help. Find an “integrative” or “functional” doctor to order the six thyroid tests and hang on tight to your little girl. If the doctor won’t listen, call another. Sometimes women physicians listen better to women patients. Keep asking…Praying for you both.

  9. I am 9 months out from having a total thyroidectomy due to Graves’ disease. I was originally diagnosed 12 years ago and have had 4 bouts of hyperactive thyroid in the last 12 years and each time I have been able to treat it with ATD’s. This last bout the methimazole was not working at all even on very high doses so my endocrinologist suggested either RAI or surgery. After the consultation we decided surgery was the best route and I recovered quick and felt so much better just a few days later. However as soon as my levels began creeping into hypo I felt horrid and was always freezing. I have been in every 6 weeks with blood draws trying to figure out the best dosing. This last time my Total T3 was 100ng/dL and free T4 was .95ng/dL and tsh is .005. I’m a little frustrated because my endo turned my care over to a PA and I don’t think she knows what to do. Because my tsh is still so suppressed she said she believes I’m being over medicated and dropped me from 112mg Levothyroxine to 107mg because my other labs are technically within normal limits. I’m wondering where this information came of the optimal levels you have posted. When I first had my consult post surgery the endocrinologist said he would keep my levels within the upper normal range. But I feel like they are too worried about my tsh and not the other numbers. Should I ask for a RT3 to be drawn or is that included in the total T3? I also asked about possibly trying NDT’s and she pretty much shut that idea down saying they don’t really prescribe those in their clinic, which I can’t figure out why not? I’ve tried calling and asking to see the dr instead of the PA because I frankly think she doesn’t know what she is doing, but the office won’t let me. What would you do? Should I change dr’s? Should I demand to try a NDT? Should I get other labs? I had my antibodies tested prior to surgery and they were super elevated as expected with graves but have not had them tested since. I’m just at a loss for what to do as I’m still a bit tired and I’m confused why they are dropping my medication levels each time. I feel like she’s solely focusing on my TSH levels and not the whole picture. Let me know what you think I should do! Thanks so much!

  10. DONNA BECK says

    Thank God for this site and others like it.Whether hypo or hyperthyroidism it is critical to get it in check,and functioning at it’s best levels.NOTE: I read an article that if there was a catastrophic loss of blood …to the body, like hemorrhages where considerable blood loss is present. When blood pressure drops because of hemorrhage…the petuitory gland suited in our brains( also secretes chemicals that are important ,to be further turned into essential chemicals to run the body.)That gland is sometimes damaged as a result of drop of blood volume and pressure.With damage to it comes a lack of secreted chemicals that the thyroid needs in (total) with other secreting sources of thyroid helping secretions. I had such a serious hemorrhage in child birth…which may effect me in the long run…something which I did not know till now…Aug. 22nd. 2018. I’m delantzy.

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