Stop the Thyroid Madness (STTM)

Stop the Thyroid Madness (STTM)–style testing focuses on a broader picture of thyroid and whole-body health. Alongside standard labs like TSH and Free T4, many patients track Free T3, consider reverse T3 (rT3) for context, and check autoimmune antibodies. Because fatigue, brain fog, hair loss, and weight changes can come from more than thyroid alone, STTM-inspired panels often include iron/ferritin, vitamin B12, vitamin D, and cortisol pattern testing to spot common “look-alikes.”

Our stance is proactive and balanced: use comprehensive labs to clarify screening, diagnostic triage, and monitoring—then interpret results with your clinician and current medical guidelines. Major endocrine societies do not use rT3 to diagnose hypothyroidism, and “adrenal fatigue” is not a formal diagnosis. Still, many people find value in tracking Free T3, nutrient status, and HPA-axis context while addressing symptoms. Labs complement, not replace, a clinician’s exam, imaging when needed, and urgent care if warning signs appear.

Signs, Symptoms & Related Situations

• Underactive-leaning clues: fatigue, cold intolerance, weight gain, dry skin, hair loss, constipation, low mood

• Overactive-leaning clues: anxiety, palpitations, heat intolerance, tremor, weight loss, frequent stools

• Autoimmune & gland clues: goiter/neck fullness, hoarseness, trouble swallowing, family history of thyroid/autoimmune disease

• Nutrient & metabolic context: heavy periods or restless legs (iron loss), brain fog/tingling (B12), bone/muscle aches (vitamin D), elevated cholesterol or glucose

• Medication/exposures: high-dose biotin supplements, amiodarone, lithium, iodine contrast, kelp/iodine products

• Seek urgent care now: chest pain, severe shortness of breath, fainting, high fever with confusion, sudden vision changes

Symptoms require evaluation by a qualified clinician.

Why These Tests Matter

What testing can do

• Confirm thyroid status (hypo-, hyper-, or euthyroid) and identify autoimmunity

• Highlight contributors that mimic or worsen thyroid symptoms (iron/B12/vitamin D, glucose, lipids)

• Provide trend data to discuss with your clinician for tailored monitoring

What testing cannot do

• Diagnose nodules or cancer by blood test alone (ultrasound/biopsy are clinical decisions)

• Use rT3 to diagnose hypothyroidism per major guidelines; rT3 is context-only and rises in non-thyroidal illness

• Replace testing for true adrenal disorders (e.g., ACTH stimulation, late-night salivary cortisol for Cushing) or clinician judgment

What These Tests Measure (at a glance)

• TSH: first-line screen; trends for therapy monitoring (may be less reliable in central hypothyroidism or late pregnancy).

• Free T4 and Free T3: unbound hormones that reflect biologic activity; some patients track Free T3 closely.

• Reverse T3 (rT3): context marker that can rise with illness, fasting, or certain medicines; not used by guidelines to diagnose hypothyroidism.

• Thyroid antibodies: TPOAb and TgAb support Hashimoto thyroiditis context; TRAb/TSI support Graves disease.

• Nutrient & general health: Ferritin/iron/TIBC, Vitamin B12 ± MMA, Folate, Vitamin D, A1c/glucose, lipids, CMP, CBC.

• HPA-axis context: 8–9 a.m. serum cortisol ± ACTH; late-night salivary cortisol or 24-hr urinary free cortisolwhen hypercortisolism is suspected.

• Important prep: high-dose biotin can cause falsely low TSH and falsely high T4/T3—pause 24–48 hours before testing if advised.

Quick Build Guide

How the Testing Process Works

1. Pick your starting set: most begin with TSH + Free T4 + Free T3 and antibodies as indicated.

2. Prepare for accuracy: share medicines/supplements; pause high-dose biotin 24–48 hours if advised. Fasting is usually not required.

3. Provide samples: standard blood draw; saliva or 24-hour urine for specific cortisol tests.

4. View secure results: most post within a few days.

5. Plan next steps: interpret results with your clinician; consider imaging for nodules/goiter and guideline-directed endocrine testing when needed.

Interpreting Results (General Guidance)

• High TSH + low Free T4 → overt hypothyroidism; TPOAb supports autoimmunity.

• Low TSH + high Free T4/T3 → hyperthyroidism; TRAb/TSI supports Graves disease.

• Normal TSH, low Free T4 → consider central hypothyroidism (pituitary/hypothalamic); needs clinician workup.

• Elevated rT3 → often reflects non-thyroidal illness, fasting, or certain drugs; not a stand-alone basis to change thyroid therapy.

• Low ferritin, low iron saturation → iron deficiency pattern; discuss repletion strategy with your clinician.

• Abnormal cortisol screens → confirm with formal endocrine tests (e.g., ACTH stimulation or dex suppression) before any decisions.
  Always interpret with a qualified healthcare professional; trends and context matter more than one value.

Choosing Panels vs. Individual Tests

• Core STTM-style panel: TSH • Free T4 • Free T3 • TPOAb • TgAb (± rT3 for context)

• Autoimmune/hyper add-on: TRAb/TSI if Graves is suspected

• Nutrient/metabolic add-ons: Ferritin/iron/TIBC • B12 ± MMA • Folate • Vitamin D • A1c • Lipids • CMP • CBC

• HPA-axis add-ons: AM Cortisol ± ACTH • Late-night Salivary Cortisol (×2) • 24-hr UFC (per clinician)
  Use bundled panels for efficiency; add single markers to answer targeted questions and track progress.

FAQs

What is STTM?
A patient-led framework that emphasizes Free T3, comprehensive antibodies, and nutrient/HPA-axis context. It is nota medical guideline.

Do major guidelines use reverse T3 to diagnose hypothyroidism?
No. rT3 is not recommended for diagnosis. It may rise with illness or certain drugs and is best viewed as context.

Should I stop biotin before testing?
Yes, if advised. High-dose biotin can distort thyroid results.

Can nutrient testing help my thyroid symptoms?
It can reveal iron, B12, or vitamin D gaps that mimic or worsen fatigue, hair loss, and brain fog.

Is salivary cortisol a test for “adrenal fatigue”?
“Adrenal fatigue” is not a formal diagnosis. Salivary/urine cortisol may screen for true hypercortisolism; low cortisol patterns need ACTH stimulation testing.

Can labs alone change my thyroid dose?
No. Combine labs, symptoms, exam, and guidelines with your clinician before adjusting treatment.

Do I need iodine testing?
Not routinely. Consider only when a clinician suspects abnormal intake or exposure.

Related Categories & Key Tests

• Thyroid Tests Hub

• All Thyroid Tests • Hypothyroidism Tests • Hyperthyroidism & Graves Disease Tests • Hashimoto Thyroiditis Tests • Adrenal Stress Tests • Nutrition Tests

• Key Tests: TSH • Free T4 • Free T3 • Reverse T3 • TPO Antibodies • Thyroglobulin Antibodies • TRAb/TSI • Ferritin • Iron/TIBC • Transferrin Saturation • Vitamin B12 • MMA • Folate • Vitamin D • CBC • CMP • A1c • Lipid Panel • AM Cortisol • ACTH • Late-Night Salivary Cortisol • 24-hr Urinary Free Cortisol

References

• American Thyroid Association — Guidelines for Hypothyroidism; Hyperthyroidism and Other Causes of Thyrotoxicosis.
• AACE/ACE — Clinical practice guidelines for hypothyroidism and hyperthyroidism.
• Endocrine Society — Primary Adrenal Insufficiency; Cushing Syndrome diagnostic guidelines.
• AACC/NACB — Laboratory support for thyroid disease; biotin interference advisories.
• NIH Office of Dietary Supplements — Iodine, Selenium, and Vitamin D fact sheets.
• European Thyroid Association — Position statements on thyroid testing and pregnancy.
• Stop the Thyroid Madness — Patient advocacy resource (non-guideline; for context only).

Available Tests & Panels

Your STTM-style Thyroid Tests menu is pre-populated in the Ulta Lab Tests system. Start with a core thyroid panel(TSH, Free T4, Free T3, antibodies). Use filters to add reverse T3 (context), nutrient checks (ferritin/iron, B12, vitamin D), metabolic markers (CMP, A1c, lipids), and cortisol options when clinically appropriate. Follow any prep instructions (including biotin pause if advised) and review results with your clinician to align labs with imaging and a monitoring plan.