Normal Lab Testing
Thyroid Function Tests (TFTs) are among the most commonly requested lab investigations. For most of the population, interpreting the lab work is fairly straightforward when we look at a combination of TSH, T4 and perhaps T3. Learn more about the routine lab work here.
As doctors, we learn to diagnose thyroid disease through a combination of clinical findings (signs/symptoms) as well as blood tests. Sometimes, the blood work doesn’t make sense. We expect the following:
Confusing Lab Results
Results of thyroid function tests can seem confusing, either because they conflict with the clinical symptoms or because they appear in an unusual pattern with each other .
As a Naturopath, a high proportion of my patients fall out of the normal paradigm of thyroid testing; they often have ‘confusing’ results. This article focuses on the common causes of these results. Establishing a correct diagnosis is very important, and depends on careful clinical assessment, combined with further lab, radiological and genetic testing .
How Do Anomalous Thyroid Function Tests Arise?
There are a number of scenarios, each of which we will address below, but they generally fall under one of three categories :
- Altered ‘normal physiology’
- Genetic defects
- Interference in one or more lab assays
Patients and doctors alike must recognize the sources of these anomalous tests and see the pitfalls of relying purely on blood work when making diagnoses or treatment plans. A structured approach to further investigate abnormal lab tests is required to ensure resources are not wasted and make appropriate treatment recommendations.
How Do These “Confusing” Lab Results Present?
Legend: ↔: normal ↑increased ↓decreased
First let’s recap a normal, expected result (this is how most patients will present):
↔TSH, ↔FT4/FT3 EUTHYROID 
- This is a healthy, normal thyroid
↑TSH, ↓FT4&FT3 HYPOTHYROID 
- Possible causes: autoimmune thyroiditis (Hashimoto’s, atrophic), post-radioiodine therapy/thyroidectomy, hypothyroid phase of thyroiditis, drugs (amiodarone, lithium, TKI’s, ATD’s), iodine deficiency or excess, neck irradiation, Riedel’s thyroiditis, thyroid infiltration (tumor, amyloid), congenital hypothyroidism 
↓TSH, ↑ FT4/FT3 HYPERTHYROID / THYROTOXIC 
- Possible causes: Graves' disease, toxic multinodular goiter, toxic adenoma, thyroiditis (post viral, post-partum), drugs (amiodarone), excess Iodine intake, excess thyroxine ingestion, pregnancy-related (hyperemesis gravidarum; hydatidiform mole), congenital hyperthyroidism 
The ‘confusing’ results can present in a number of ways.
The causes are listed here, and a brief summary provided further below. More in depth articles may be reached by clicking the links provided.
- Subclinical hyperthyroidism, recent treatment for hyperthyroidism, drugs (pharmaceutical and recreational), NTI (non-thyroidal injury), assay interference ,
- Subclinical hypothyroidism, poor compliance with thyroxine, malabsorption of thyroxine, drugs, assay interference, NTI (non-thyroidal injury) recovery phase, TSH resistance , 
↔ or ↓TSH, ↓FT4/FT3
- NTI (non-thyroidal injury), central hypothyroidism, isolated TSH deficiency, assay interference , 
↔ or ↑TSH, ↑FT4/FT3
- Assay interference: FDH (familial dysalbuminemic hyperthyroxinaemia), thyroxine replacement therapy (including poor performance), drugs (amiodarone, heparin), NTI (including psychiatric disorders), neonatal period, TSH-secreting pituitary adenoma, resistance to thyroid hormone, disorders of thyroid hormone transport or metabolism , 
Common Causes of Confusing Thyroid Lab Work
There are various cases of the above alterations to thyroid blood work. If you every have abnormal thyroid results that DO NOT fall into the usual categories, make sure your doctor is investigating these possible contributing factors.
- Drug/Medication Interactions with Thyroid function
- Poor Compliance of Thyroxine Therapy
- Altered Thyroid Binding Proteins
- Non-Thyroidal Illness or Sick Euthyroid Syndrome
- Assay Interference
- Resistance to TSH or TSHoma
As you can see, there are various reasons thyroid blood test results may come back and not look as expected. They seem confusing, but with deeper analysis, we can investigate any of the above causes of anomalous thyroid rest results.
Interested in learning more?
Read on in our series of articles on Thyroid Health!
About the Author - Dr. Johann de Chickera
Dr. Johann is a licensed naturopathic doctor and co-owner of Absolute Health and Wellness. He completed his 4-year degree at the Canadian College of Naturopathic Medicine (CCNM). His clinical focus lies in chronic disease, such as those related to the Gastrointestinal, Endocrine, and Immune Systems.
His approach to medicine relies on working with the patient to come up with a feasible, multi-factorial approach that addresses all complaints at once. He employs a strong background in diagnostic medicine and human physiology and pathology to diagnose and treat. His treatment involve a combination of nutritional counselling, botanical medicine, eastern medicine (acupuncture), nutraceutical supplementation and hands on physical medicine.
To book in please call us at (519) 442-2206 or click here.