Why You Have Thyroid Symptoms But Your Labs Show You're Normal

I can't tell you how many clients I've worked with, plus friends/family who were told that their thyroid labs were completely normal - no single blood test result came back as high or low, and all the while, they were losing hair, dealing with fatigue, stubborn weight gain, dry skin, and all of the other classic symptoms that come with low thyroid function.

Maybe your labs say everything's normal. How could that be? Is it all in your head?

It's not! Let's explore why and what you can do...

In this article:

Signs and symptoms that should make you suspect your thyroid
Why you should be skeptical of lab results that tell you you're 'normal' when you're having thyroid symptoms

Signs and symptoms that should make you suspect your thyroid

The thyroid controls everything, so naturally, ALL parts of your body and body functions are affected when you've got a thyroid issue -- think of it like the body's thermostat that gauges & sends the signal to the other functions to kick on or off.

Here are some signs your thyroid is out of balance:

Missing the outer third of your eyebrows
Feeling tired & fatigued, no matter how much you sleep (also: increase in sleeping hours or increased ability to sleep longer)
Unexplainable muscle aches, tightness, or soreness
Dry, flaky, and/or scaly skin
You feel cold (cold hands, feet, tip of nose)
Unexpected, unexplainable weight gain (sometimes sudden and comes on fast) & difficulty losing weight
Coarse hair or sudden change in hair texture (used to feel soft, now feels like straw), including hair loss
Increased anxiety or feelings of nervousness
Feeling of overwhelm under pressure
Sudden, random panic episodes or sudden feeling of adrenaline surge
Digestive issues like chronic constipation or diarrhea

Are you the 'thyroid type'?

I've worked with enough thyroid patients and clients that I've begun noticing a pattern!

While this isn't a formal scientific or controlled experimental process, I've made some observations and found that the likelihood of a thyroid issue, whether functional hypothyroidism or autoimmune, could possibly be greater for you if:

Other people in your family have thyroid or autoimmune conditions like hypothyroidism, Graves, or Hashimoto's.
You are an endurance athlete or exercise intensely (cardio, 60+ minutes) 5+ days per week
You have a 'Type A' personality
Your friends would call you a perfectionist or you have high expectations of yourself
Your friends would consider you chronically overcommitted
You've experienced some kind of trauma, whether recent or in childhood
You go for long periods of time without eating or skip breakfast
Your diet includes notable amounts of sugar, gluten, and dairy
You decide short yourself on sleep fairly often (3-5 times/week)

Then again, there's no specific profile or type - just observations. If none of these points describe you but you're experiencing some of the symptoms I described above, read on to learn more.

My story: Why you should be skeptical of your 'normal' thyroid blood test results

Lab testing failed to identify my thyroid issue, and you could be in the same boat too. Here's my story.

Before I had any health challenges, I was a marathon runner who ran 6-7 days a week and usually no less than 5 miles/day. Over the years, I'd been iron deficient (and being a female runner, my risk was higher) and one summer, I began to feel worn down and short of breath on my runs - I wasn't recovering as well as expected, and easy runs became tough. This happened over a period of about 2-3 months. Of course, I went to see my friendly neighborhood doctor, and she ran several blood tests to narrow in on what could be wrong, including: a thyroid panel, Vitamin B12, Vitamin D, and Iron/Ferritin -- all the usual causes for fatigue. In a phone call a few days later, she told me my labs all came back normal, except for a Vitamin B12 deficiency. Without even so much as questioning WHY my B12 levels could be off, I took some B12 for a few months and continued running competitively.

Two years later, I was diagnosed with Hashimoto's - autoimmune hypothyroidism.

Recently, I decided to compile my entire medical history, including labs from when I was generally pretty healthy. Since I never actually saw the lab report from that low B12 episode until years later, I was shocked to discover that I'd even had a low thyroid issue back then... a full year or two before I even had any symptoms!

How could that be? Why didn't my doctor notice or tell me?

Conventional and Functional Lab Reference Ranges

The problem is with the thyroid panel and lab reference ranges, because they're not sensitive enough to detect when there really are issues. Reference ranges are two numbers that form the 'window' inside of which you're considered healthy. When a blood test result comes back even the slightest bit above or below the reference range, it gets flagged on the lab test page as "Out of Range," signifying to your doctor that something's off and he/she should investigate.

The labs that developed normal & healthy thyroid ranges unknowingly included people with thyroid dysfunction in their sample, widening the normal range significantly.

The thyroid can take a good beating before any symptoms emerge, so thyroid problems can go undetected for years. This is how those sick people ended up skewing the reference ranges for normal.

We call this the conventional range, the window defined by the labs, and it's pretty wide. For TSH, for example, some labs indicate 1.0 - 4.5 uIU/mL is normal. {More on what this actually means later - just focus on the numbers.} If you're inside of this conventional range, the result means "you're not really really sick." I've seen people losing hair in clumps rocking a TSH of 3.0 uIU/mL. Not ideal.

Then, there's the functional range.

A functional range is the reference range that means you're healthy and thriving when you're within normal levels. That's quite a difference from being not-really-really-sick, right? To give you an idea, the functional range for TSH is somewhere in the .5 - 2.0 uIU/mL. Much narrower.

To recap:

Within conventional lab reference ranges = "You don't have a clinical disease or illness."

Within functional lab reference ranges = "You're healthy and thriving."

In my situation, my TSH was 4.4 uIU/mL when my doctor told me my thyroid was normal (or, at least, nothing notable) because it was within the reference range. But, conventional doctors usually don't investigate anything beyond what the lab test page spits out as Low or High. It's not the fault of the physician, but the training they get. Many are simply not aware and as I like to say it: You don't know what you don't know.

Had we looked at my thyroid results using a narrower functional range, my TSH would have been flagged as High and we would have identified the early stress on my thyroid. This is why I'm such a firm believer in functional medicine, working with functional medicine practitioners (doctors), and functional lab reference ranges -- and I hope you will be too.

Perhaps, in another timeline, I would have been able to change my lifestyle to be friendlier and more supportive of my thyroid before it became so overworked it nearly failed, and before my immune system was impacted.

Whether for yourself, friends, or family members, I hope you can learn from my experience.

If you're noticing the early symptoms of a stressed thyroid, don't be afraid to ask your doctor for a thyroid panel test, educate yourself on what the results mean, and take control with some small changes that may save your health and your thyroid.

Takeaways: Thyroid Testing Tips

If you're experiencing any symptoms from the list above, consider that it could be your thyroid.
Always ask your doctor to send your lab results report - don't just accept a verbal summary.
Work with a Functional Medicine Practitioner (Doctor) or someone who understands functional ranges for thyroid labs to get a true picture of your thyroid health.