Blood tests can be an important tool in healing Hashimoto’s as it’s necessary to have objective ways to measure the effectiveness of strategies used in improving health.  Many GPs will only measure TSH but is this really enough?

What should you be testing?  I’ve compiled a list of some essential blood tests, along with a brief description of each. Most of these tests are generally part of a regularly yearly check up.  Unfortunately, they may not be used to monitor the status of a chronic disorder such as Hashimoto's, and even less likely to be used to identify and address the root causes.

Essential Tests

Full Thyroid Panel

• TSH or thyroid-stimulating hormone is a hormone produced by the anterior pituitary to control the thyroid gland's production of the T4. An elevated TSH is a sign that the body needs more thyroid hormone.  A low TSH is associated with a hyperactive thyroid that is producing too much thyroid hormone or a situation called Anterior Pituitary Dysfunction, where the anterior pituitary slows down the production of TSH.
• T3 is the most active thyroid hormone and is primarily produced from the conversion of T4 in the peripheral tissue. Free T3 is the unbound form of T3 measured in the blood.  Levels may be decreased with hypothyroidism and is associated with selenium deficiency.
• T4 is the major hormone secreted by the thyroid gland. It’s production and secretion from the thyroid gland are stimulated by TSH. Deficiencies of zinc, copper, and vitamins A, B2, B3, B6, and C will cause a decrease in the production. Free T4 is the unbound form of T4 in the body. It will be decreased in hypothyroidism and is associated with iodine deficiency.
• Thyroid peroxidase (TPO) is an enzyme inside the cells of the thyroid that attaches iodine molecules to a tyrosine molecule to form T4. TPO antibody test measures the level of antibodies in the blood that attacks the TPO enzyme inside the thyroid cells. Elevated levels are found in Hashimoto's Thyroiditis.

Whole Blood Count (WBC)

WBC is helpful in measuring the status of the immune system and can also identify anemia, which is common in autoimmune disorders such as Hashimoto's.

• Total WBCs - The total White Blood Cell (WBC) count measures the sum of all the white blood cells. Increased WBC’s levels are associated with acute bacterial or viral infections and may be seen in people who eat a diet of highly refined foods.
• Hemoglobin is the oxygen-carrying molecule in red blood cells. Low levels of hemoglobin are associated with anemia.   Measuring hemoglobin is useful to determine the cause and type of anemia and for evaluating the efficacy of anemia treatment. Another measure of anemia is hematocrit.
• The RBC Count determines the total number of red blood cells found in a specific volume of blood. Decreased levels are primarily associated with anemia.
• Ferritin is the main storage form of iron in the body. Decreased levels are strongly associated with iron deficiency. Increased levels are associated with iron overload, an increasing risk of cardiovascular disease, inflammation, and oxidative stress.
• MCV measures the volume of an average single red blood cell.  An increase or decrease in MCV can help determine the type of anemia present. An increased MCV is associated with B12, folate, or vitamin C deficiency
• Platelets are the smallest of the formed elements in the blood. They are necessary for blood clotting, vascular integrity, and vasoconstriction. Increased platelets may be seen with atherosclerosis.
• Lymphocytes are a type of white blood cell. Decreased levels are often seen in a chronic viral infection and oxidative stress. It may also indicate a fatigued immune response, especially with a low Total WBC count. An increase is usually a sign of a viral infection but can also be a sign of increased toxicity in the body or inflammation.
• Monocytes are white blood cells that are the body’s second line of defence against infection. They remove dead cells, microorganisms, and particulate matter from circulating blood. Levels tend to rise at the recovery phase of an infection or with chronic infection.
• Neutrophils are the white blood cells used by the body to combat bacterial infections. Levels will be increased in bacterial infections.
• Eosinophils are a type of White Blood Cell, which are often increased in people that are suffering from intestinal parasites or food or environmental sensitivities/allergies.
• Basophils are a type of White Blood Cell, which will often be increased with tissue inflammation and is often seen with cases of intestinal parasites, which can be a source of inflammation in the gut.

Liver, Kidney, and Gallbladder Function Tests

Because toxins are usually a root cause in the development of Hashimoto's, it's important to assess the status of the body's detoxification system.

• Alkaline phosphatase (ALP). Elevated levels of can occur with any liver dysfunction and can indicate any type of obstruction in the biliary tract. The degree of ALP elevation is in direct correlation to the severity of the obstruction. Low levels of ALP may also suggest a zinc deficiency.
• Gamma Glutamyl Transferase (GGT) is an enzyme that is present in the liver, kidney, prostate, and pancreas and in the epithelial cells of the biliary tract. GGT increases following cell damage or destruction and/or biliary obstruction.
• ALT is an enzyme present in the liver, skeletal muscle, the heart, and kidney. ALT increases following cell damage or destruction. It can be caused by exposure to chemicals and viruses (viral hepatitis, mononucleosis, cytomegalovirus, Epstein Barr, etc.). The most common non-infectious cause of an increased ALT is a condition called steatosis (fatty liver).
• The total bilirubin is composed of two forms of bilirubin: Indirect or unconjugated bilirubin, which circulates in the blood on its way to the liver and direct or conjugated bilirubin, which is the form of bilirubin made water-soluble before it is excreted in the bile. An increase in total bilirubin is associated with dysfunction or blockage in the liver, gallbladder, or biliary tree, or red blood cell destruction.
• Albumin is one of the major blood proteins. Produced primarily in the liver, it plays a major role in water distribution and serves as a transport protein for hormones and various drugs. It’s levels are affected by digestive dysfunction and a decreased albumin can be an indication of malnutrition, digestive dysfunction due to low stomach acid, or liver dysfunction. Malnutrition leads to a decreased albumin level in the serum primarily from lack of available essential amino acids. Decreased albumin can also be a strong indicator of oxidative stress and excess free radical activity
• Creatinine is produced primarily from the contraction of muscle and is removed by the kidneys. Decreased levels are associated with muscle loss.
• A BUN (blood, urea, nitrogen) test measures the amount of urea nitrogen that's in your blood.

Blood Sugar Regulation Tests

Poor blood sugar regulation often results in inflammation and is a precursor to metabolic syndrome and diabetes.  It is also common in people with autoimmune disorders and may exacerbate symptoms or be a driver of the immune response.

• HbA1C measures the amount of glucose that combines with hemoglobin to form glycohemoglobin during the normal lifespan of a red blood cell, which is about 120 days. Elevated levels of HbA1C are associated with elevated blood glucose in the past 120 days. It is used primarily to monitor long-term blood glucose control and to help determine therapeutic options for treatment and management.
• Fasting glucose test measures the amount of glucose in your blood when it should be at its lowest. That happens in the morning and when you haven’t had anything to eat or drink for a while.
• Fasting insulin test measures the amount of insulin in the body. It is also used to monitor the treatment of abnormal insulin levels and to monitor insulin resistance.  It's more accurate than HbA1c.
• Cholesterol is a steroid found in every cell of the body and in the plasma. It is essential in maintaining cell membrane integrity and is also important for hormone production. Cholesterol is made in the body by the liver and other organs and from dietary sources. The liver, the intestines, and the skin produce between 60-80% of the body’s cholesterol. The remainder comes from the diet. Increased cholesterol is one of many risk factors for cardiovascular disease. It is also associated with metabolic syndrome, hypothyroidism, biliary stasis, and fatty liver.
• Triglycerides are composed of fatty acid molecules that enter the bloodstream either from the liver or from the diet. Levels may be decreased in liver dysfunction, a diet deficient in fat, and inflammatory processes.
• HDL transports cholesterol from within the body to the liver for processing and metabolism into bile salts. Increased HDL is considered protective for the formation of fatty plaques in the artery.
•  LDL transports cholesterol and other fatty acids from the liver to other parts of the body for use by the cells. An increased LDL cholesterol is a risk factor for cardiovascular disease. It is also associated with metabolic syndrome, oxidative stress, and fatty liver.

Other Tests

The following tests are also useful in identifying the causes of symptoms and tracking progress.

• Nutrient status.  This can include RBC and/or serum tests for levels of magnesium, Vit B12, folate, Vit D, zinc, copper, selenium, Vit B6.
• C-Reactive Protein is a blood marker that can help indicate the level of inflammation in the body. 
• Total serum protein is composed of albumin and total globulin. Conditions that affect albumin and total globulin readings will impact the total protein value. A decreased total protein can be an indication of malnutrition, digestive dysfunction due to stomach acid need, or liver dysfunction.

If you're interested in finding out more about Hashimoto's and blood tests, check out my other post Hashimoto's and Blood Tests - How to Be Sure They are Correct.