Most Indian doctors test only TSH and call it thyroid screening. If your TSH comes back between 0.5 and 4.5, they tell you your thyroid is fine. But this misses millions of cases. You could have early autoimmune thyroid disease (high Anti-TPO, normal TSH). You could have subclinical hypothyroidism (TSH 2.5-4.5 with debilitating symptoms). You could have normal TSH but poor T4-to-T3 conversion — meaning your body isn't producing active thyroid hormone efficiently. A single TSH number doesn't tell you any of this.
India has the highest prevalence of thyroid disease in the world. 42 million Indians are affected. The majority are women. And the majority are undiagnosed because doctors rely on TSH alone.
42 million Indians have thyroid disease. Most don't know it. The reasons are multiple:
Iodine status: While India no longer has widespread iodine deficiency (thanks to salt iodization), iodine intake varies by region and diet. Iodine is essential for thyroid hormone synthesis.
Autoimmune prevalence: Hashimoto's thyroiditis (autoimmune hypothyroidism) is the most common cause of hypothyroidism worldwide. Women are 5-10x more likely to develop it. Pregnancy and postpartum are high-risk periods.
Stress and lifestyle: Chronic stress, poor sleep, and sedentary lifestyles increase thyroid antibodies and suppress thyroid function.
Nutrient deficiencies: Selenium, iron, zinc, and vitamin D are critical for thyroid health. Deficiency is common in India.
Gut dysbiosis: 70% of immune function lives in the gut. Poor gut health (from antibiotics, processed foods, low fiber) worsens autoimmune thyroid disease.
Under-testing: TSH-only screening misses 30-40% of thyroid disease cases. Most Indian doctors don't order Full panels as standard.
These are often dismissed as stress, depression, or PCOS:
A woman walks into a doctor's office with these symptoms and leaves with a prescription for antidepressants or PCOS management. Her real problem — hypothyroidism — goes untreated.
TSH (thyroid-stimulating hormone) is produced by your pituitary gland. It signals your thyroid to produce T3 and T4 hormones. When you have enough T3 and T4, TSH drops. When levels are low, TSH rises — a feedback loop.
The problem: TSH is a secondary marker, not a direct measure of thyroid function. It tells you what your pituitary thinks your thyroid should be doing, not what's actually happening in your body.
Normal range: 0.5-4.5 mIU/L (or 0.4-2.5 depending on lab)
The pituitary hormone that tells your thyroid to produce hormones. Elevated TSH suggests your pituitary is working hard to stimulate an underactive thyroid. Low TSH suggests overactive thyroid or over-replacement. TSH alone doesn't tell the full story — but it's the starting point for screening.
Normal range: 0.8-1.8 ng/dL (or 10-23 pmol/L)
The main hormone your thyroid produces. It's mostly inactive; your body converts it to T3 when needed. Low Free T4 = hypothyroidism. Normal Free T4 doesn't mean you're fine — your conversion to active T3 might be impaired. This is why Free T4 without Free T3 is incomplete.
Normal range: 2.3-4.2 pg/mL (or 3.5-6.5 pmol/L)
The active hormone your cells actually use. Your body converts T4 to T3 in liver, gut, and other tissues. If conversion is poor (due to selenium deficiency, stress, poor sleep, or gut dysbiosis), Free T3 drops and you feel hypothyroid despite 'normal' TSH and Free T4. This is why Free T3 is critical — it explains why you're fatigued despite appearing normal.
Normal: Less than 35 IU/mL
The most sensitive marker for autoimmune thyroid disease. Elevated Anti-TPO means your immune system is attacking your thyroid gland. This is the hallmark of Hashimoto's thyroiditis. Critically: Anti-TPO can be elevated for 5+ YEARS before TSH rises. Early detection allows you to address root causes (stress, nutrient deficiencies, gut dysbiosis) and slow disease progression. If you're female with fatigue, hair loss, and family history of autoimmune disease, Anti-TPO should be tested. One positive result changes management entirely.
Normal: Less than 40 IU/mL
Another marker of autoimmune thyroiditis. Like Anti-TPO, it indicates your immune system is attacking thyroid tissue. Present in 40-60% of patients with Hashimoto's. Less specific than Anti-TPO, but useful for confirming autoimmune etiology. High Anti-Tg + high Anti-TPO = confirmed Hashimoto's.
Normal range: 9.2-24.4 pg/mL (or 14-37 pmol/L)
An inactive form of T3 your body produces as a buffer during stress, fasting, or chronic illness. High Reverse T3 (especially with normal TSH and Free T4) means your T4 is being shunted into an inactive form. Result: you're effectively hypothyroid but standard tests appear normal. Root causes include chronic stress, inadequate sleep, poor nutrition, or prolonged illness. Treatment addresses the cause: stress reduction, sleep, nutrient repletion, gut healing.
Less useful than Free T3 and Free T4 because they measure all forms (bound and unbound). Free versions are more clinically relevant. Some labs include them; arq. prioritizes Free T3 and Free T4.
A less common marker that directly measures thyroid peroxidase (the enzyme your immune system targets). Useful in research; less common in clinical practice than Anti-TPO antibodies.
This is where most Indian patients are harmed by TSH-only testing.
Subclinical hypothyroidism: TSH is elevated (typically 2.5-4.5), but Free T4 is still in the "normal" range. You have symptoms — fatigue, weight gain, cold intolerance, brain fog, hair loss. Your doctor says "your TSH is slightly elevated, but your thyroid hormones are normal. Let's just monitor." Six months later, you're still symptomatic. Still told to wait.
The problem: studies show that treating TSH above 2.5 when you're symptomatic improves outcomes. Waiting for TSH to reach 5+ (overtly hypothyroid) means years of suffering. And yes, TSH between 2.5-4.5 is technically "normal," but normal labs don't equal normal symptoms.
arq.'s approach: If you have TSH 2.5-4.5 with clear symptoms (fatigue, weight gain, hair loss), AND your Free T3 and Free T4 are on the lower end of normal, treatment is discussed. Your symptoms matter as much as your labs. This is clinical medicine, not algorithm-based medicine.
Hypothyroidism and depression are clinically indistinguishable. Both cause fatigue, low mood, poor concentration, weight gain, and loss of interest. A woman presents to her doctor with these symptoms, and without thyroid testing, she's labeled depressed and prescribed sertraline (SSRI).
But SSRIs don't fix thyroid disease. Six months later, she's still depressed, still fatigued, still gaining weight — now also with sexual side effects from the SSRI.
The fix: thyroid panel (TSH, Free T3, Free T4, Anti-TPO) before diagnosing depression. If thyroid is the cause, treatment is levothyroxine, not antidepressants. Depression resolves as thyroid hormones stabilize.
Similarly, hypothyroidism presents as PCOS:
A woman gets an ultrasound showing ovarian cysts (which are common and often asymptomatic) and is told she has PCOS. She's prescribed metformin and told to lose weight. But her real problem is hypothyroidism, which is being ignored. Thyroid treatment fixes the irregular periods and enables weight loss. PCOS diagnosis was a red herring.
Again: full thyroid panel before assuming PCOS. If both are present, both are treated.
arq. doesn't test TSH alone. Every thyroid patient gets:
Your physician then reviews all markers together with your symptoms. If Anti-TPO is elevated with normal TSH, autoimmune disease is detected early — before it progresses to overt hypothyroidism. Aggressive management (stress reduction, selenium supplementation, gut healing, eventual thyroid hormone replacement as disease progresses) is started immediately.
If Free T3 is low with normal TSH and Free T4, conversion is the problem — selenium, sleep, stress management, gut health become the focus.
If Reverse T3 is high, chronic stress or poor nutrition is the culprit — again, addressing the root cause matters more than levothyroxine alone.
The point: your full picture matters. Isolated lab values mean little. Clinical context — your symptoms, your history, your bloodwork together — guides treatment.
The first-line treatment for hypothyroidism. Standard dosing is 1.6 mcg per kg body weight, adjusted based on TSH response. In India, available as Eltroxin, ThyroXL, and generic formulations. Most people respond well — their converted T3 normalizes and symptoms improve.
Levothyroxine is taken on an empty stomach (30 min before food) for optimal absorption. Iron, calcium, and certain medications interfere with absorption.
An older formulation derived from porcine (pig) thyroid glands. Contains both T4 and T3 in physiologic ratios. Some patients feel better on NDT because they get T3 directly rather than relying on conversion. However, NDT dosing is less precise (potency varies batch-to-batch), and it's generally considered second-line. If you trial NDT, regular monitoring is essential.
For patients on levothyroxine who remain symptomatic despite normal TSH, adding T3 (liothyronine) can help. This is individualized and requires careful monitoring.
Selenium: Essential for thyroid peroxidase function and T4-to-T3 conversion. 200 mcg daily is standard. Found in Brazil nuts, fish, eggs.
Iodine: Required for thyroid hormone synthesis. 150 mcg daily (from iodized salt or supplementation). Excess iodine can worsen autoimmune thyroiditis, so balance is key.
Iron: Critical for thyroid peroxidase function. Ferritin should be 50+ ng/mL for optimal thyroid health. Iron supplementation if deficient.
Vitamin D: Immune regulation. Deficiency worsens autoimmune thyroiditis. Target 30-100 ng/mL. Most Indians are deficient; supplementation is usually needed.
Stress reduction: Chronic stress elevates cortisol, which suppresses T4-to-T3 conversion and elevates Reverse T3. Meditation, yoga, adequate sleep, regular movement matter enormously.
Gut healing: 70% of immune tolerance originates in the gut. Dysbiosis worsens autoimmune thyroiditis. Dietary improvements (reduce processed foods, increase fiber, probiotics), address food intolerances (gluten sensitivity is common in thyroid disease).
Tired, gaining weight, or losing hair? Get the full thyroid panel. Talk to an arq. physician who tests beyond TSH →
Once on thyroid replacement, monitoring is ongoing:
Symptoms typically improve within 4-8 weeks of starting appropriate replacement. If you're on levothyroxine but still fatigued, depressed, or gaining weight after 3 months at stable dose, something is wrong — poor absorption, inadequate dose, conversion issues, or concurrent problems (iron deficiency, B12 deficiency, sleep apnea). Further investigation is needed.
A thyroid "test" at most labs means TSH only. That misses Free T3, Free T4, TPO antibodies, anti-thyroglobulin, and reverse T3. TSH alone fails to detect Hashimoto's, T4-to-T3 conversion issues, and stress-driven thyroid suppression. Complete panel costs ₹1,500-3,000 — worth every rupee.
| Test Type | Markers Included | What It Catches | What It Misses | Cost (India) |
|---|---|---|---|---|
| TSH Only | TSH | Overt hypothyroidism/hyperthyroidism | Subclinical disease, T4→T3 conversion issues, Hashimoto's, central thyroid disease, stress-suppressed TSH | ₹200–400 |
| Basic Panel | TSH, Free T4 | Overt and mild hypothyroidism, hyperthyroidism | T3 deficiency, Hashimoto's (no antibodies), T4→T3 conversion problems, early autoimmune thyroid | ₹600–1,000 |
| Comprehensive Panel | TSH, Free T3, Free T4, Anti-TPO, Anti-Tg, Reverse T3 | Hashimoto's (early), T4→T3 conversion issues, autoimmune thyroid disease, secondary hypothyroidism, iodine status | Nothing critical; captures 99% of thyroid pathology | ₹1,500–3,000 |
| Functional Panel | Comprehensive + TPO peroxidase, Free T3/T4 ratio | All above + functional conversion capacity assessment | Nothing; most complete test available | ₹2,500–4,000 |
No AI chat. No templates. A specialist reads your panel against South Asian-calibrated ranges and writes the protocol on a 15–20 minute video consult — inside 7 days of your home draw.