Kelly Brogan MD – Holistic Women’s Health Psychiatry
Have you been told that your mental illness is a chronic condition?
Have you been diagnosed with an ‘incurable’ disease like depression? Were you told that your only hope is to manage your symptoms by taking lifelong medications? What if you could eliminate this diagnosis by simply fixing nutrient deficiencies or correcting physiologic imbalances? As such, proper blood tests can highlight these vulnerabilities and guide healing protocols.
Some recommend running as many tests as possible, which can get expensive and confusing. Years of clinical practice and a deeper understanding of common symptoms have led me away from running dozens of lab tests. For example, I no longer order salivary cortisol testing, as the results confirm what we already know: we’re enduring unprecedented levels of stress. I’m happy to share with you the five most common and helpful blood tests that I still use with my patients.
1. Thyroid function testsThese tests show how well your thyroid gland is working. As the thyroid is the master regulator of metabolism, people with weight problems, depression, brain fog, anxiety, and constipation often have impaired thyroid function. Thyroid function tests give information about how well your brain is sensing hormone levels. Furthermore, these tests show how your immune system is interacting with your thyroid. I’ll skip the complexities of thyroid hormone production and regulation, which are covered comprehensively in this article. The key takeaway is that your brain and thyroid gland produce hormones called Thyroid Stimulating Hormone (TSH), T3, and T4. T3 is the active form of thyroid hormone, and it can exist as either free T3 (FT3) or reverse T3 (RT3). To screen for problems, most conventional doctors test only for TSH and possibly T4. However, as T3 is one of the body’s master molecules, it’s important to know free (unbound) T3 levels. For example, T3 helps regulate digestion, energy use, and hormonal balance. An autoimmune disease called Hashimoto’s thyroiditis is the most common cause of hypothyroidism in women. I am living proof that this type of thyroid autoimmunity can be reversed, even if you’ve been on a synthetic replacement (like Synthroid) for years. Dessicated thyroid replacement, a natural form of thyroid hormone, can sometimes be the first step to feeling better. Importantly, lifestyle factors, especially nutrition, are essential for long-term optimal health and true, lasting healing. To screen for thyroid autoimmunity, I order a panel to measure thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb). Years of clinical practice and learning from experts have taught me the optimal values for thyroid health, which I’ll share with you now: Optimal values:
- TSH: less than 2 μU/mL
- Free T4: ideally over 1.1 ng/dL
- Free T3 (FT3): ideally over 3.0 pg/mL
- Reverse T3 (RT3): less than a 10:1 ratio RT3:FT3
- TPOAb: less than 4 IU/mL (or negative according to lab range)
- TgAb: less than 4 IU/mL (or negative according to lab range)
- Hemoglobin A1C: 4.8 - 5.2%
- Fasting glucose: 70 - 85 mg/dL
- Fasting insulin: below 6 μIU/mL
What if your doctor won't order these tests?You can choose to engage a comprehensive healing effort to see whether your symptoms can completely resolve within one to two months before pursuing these diagnostics. But if you have worked through a program and are still stuck, these blood tests are a great way to begin to learn more about your physiology. Some doctors are hesitant to order these tests. They may tell you that they’re unnecessary. A naturopath or functional medicine doctor is more likely to understand these tests and order them for you. If you feel that you have unresolved symptoms, you must advocate for yourself and demand this baseline assessment. Many of these tests are covered by insurance or are not terribly expensive. Don’t be afraid to push back if your doctor is dismissive. The moments of awkwardness are worth understanding what’s happening in your body. You may need to go elsewhere for these blood tests - or even order them on your own. Information revealed in these tests will help identify the best support for your healing. References:
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