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Integrative Health

The 8 Best Tests To Diagnose A Hormonal Disorder (That Most Docs Don't Order)

Author: Romie Mushtaq, M.D., ABIHM

April 07, 2026

Brain Doctor

By Romie Mushtaq, M.D., ABIHM

Brain Doctor

Romie Mushtaq, MD, ABIHM, is a board-certified physician and USA Today National Best-Selling Author of "The Busy Brain Cure: The 8-Week Plan to Find Focus, Tame Anxiety, & Sleep Again" (Harper Collins 2024). She has over 20 years of thought leadership and research in neurology, integrative medicine, and mindfulness. She uses her unique expertise to bring together Western Medicine and Eastern Wisdom in transforming mental health and workplace cultures. In the last 10 years, she has been the go-to authority on stress management and workplace wellness as a speaker and consultant for Fortune 500 companies, professional athletes, and global organizations.

Image by Katarina Radovic / Stocksy

April 07, 2026

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In the latest epidemiology studies in the U.S., the prevalence of overt hypothyroidism varies from 0.1 to 2% of adults. The prevalence of subclinical hypothyroidism1 is higher, ranging from 4 to 10% of adults, with possibly a higher frequency in older women.

In fact, hypothyroidism is five to eight times2 more common in women than men, and more common in women with small body sizes at birth and during childhood.

Traditional hypothyroid symptoms (low thyroid hormone levels) are associated with weight gain and constipation. (Hair loss is also common and too often dismissed by traditional medicine as a vanity complaint.) But hypothyroidism symptoms can also include anxiety.

In fact, a review published in June 2018 in JAMA Psychiatry (Journal of the American Medical Association) found that people with hypothyroidism are more than twice as likely3 as people without the condition to develop anxiety disorders and that 29.8% of all anxiety disorders are associated with autoimmune thyroid disease.

Is an undiagnosed thyroid disease contributing to your anxiety?

I want to highlight a point on which all the medical literature agrees (both traditional endocrinologists and integrative medicine doctors): Thyroid disease is underdiagnosed4. Could it be affecting you or someone else you know with a "busy brain"? It is estimated that one in eight people have thyroid disease that is getting missed because their symptoms are not obvious. Or they are like me and their TSH levels are in the normal range despite symptoms of thyroid issues.

Thyroid disease can promote the occurrence of other symptoms of a busy brain, including insomnia and ADD/ADHD. Research shows that those with generalized resistance to thyroid hormones are far more likely to have ADHD5 when compared to other family members with healthy thyroid functions. Another large meta-analysis assessed that hyperthyroidism and hypothyroidism have clinical overlap with sleep conditions such as insomnia, restless legs syndrome, and obstructive sleep apnea6. In other words, well-established symptoms of nervousness, anxiety, and insomnia are related to both hyperthyroidism and subclinical hypothyroidism.

Too often, a thyroid disorder is missed by a physician because of vague symptoms given by the patient, and only one laboratory value is checked—the thyroid-stimulating hormone (TSH). As a part of a routine screening, a doctor will see that your TSH is within a broad normal range from 0.4 to 4.0 mIU/L. Without a more comprehensive lab evaluation for your thyroid gland, it cannot be said that "your thyroid function is normal." Too often, key symptoms—such as lack of daytime energy, and anxiety—are dismissed as "stress" without digging deeper to assess if the thyroid gland is the culprit.

In your next lab panel, I recommend that you ask your physician to order a full thyroid panel that includes the following laboratory values:

- Thyroid-stimulating hormone (TSH)

- Total triiodothyronine T3

- Total thyroxine T4

- Free triiodothyronine (fT3)

- Free thyroxine (fT4)

- Reverse T3 (rT3)

- Anti-thyroglobulin antibodies

- Thyroid peroxidase antibodies

Inevitably, your physician may say that not all of these labs were needed. But I believe that without that entire lab panel, the following root causes of a busy brain can be missed:

- Autoimmune thyroiditis

- Subclinical hypothyroidism

- Subclinical hyperthyroidism

So why aren't more people, including myself back in the day, getting their full thyroid panels screened by their physicians? In my clinical days, a thyroid disorder had to show physical symptoms, such as weight gain and constipation, for a doctor to consider treatment. A primary care doctor or endocrinologist did not consider neurological and psychiatric symptoms of ADHD, anxiety, and insomnia as part of a thyroid disorder. Suppose these are the primar