Beyond the Baseline: which thyroid and hormone tests to add, and when to draw them

Chapters

• 0:00 Welcome and the plan for Part 2
• 1:22 Sarah's three open questions from Part 1
• 4:51 Choosing the next test after a Baseline
• 8:25 Why TSH alone isn't enough
• 9:33 Thyroid antibodies and reverse T3
• 11:00 Four thyroid patterns and what to do next
• 13:32 Poor conversion, under-eating and thyroid co-nutrients
• 14:42 Sarah's ferritin, and timing the thyroid draw
• 15:51 Biotin, consistent labs and when to retest
• 17:02 Sarah's thyroid results
• 18:47 Cycle timing: Day 2 to 5 and the progesterone draw
• 20:09 Irregular cycles, the pill and HRT
• 22:32 Reading Sarah's progesterone against the timing
• 23:49 How hormones change through perimenopause
• 25:08 Perimenopause over 45 is a clinical diagnosis
• 26:41 Perimenopause and metabolism
• 27:58 Sarah's metabolic trend and perimenopause results
• 30:39 Q&A: when the GP isn't on board
• 34:40 Q&A: referred clients stay yours
• 35:54 Setting your own optimal ranges in the platform
• 38:19 Q&A: patient education resources
• 41:56 Wrap up and the next session

This is Part 2 of the Vively Practitioner Masterclass, recorded on 21 October 2026. Dr Michelle Woolhouse, integrative GP and Vively's Founding Medical Director, picks up Sarah's case from Part 1 and works through which tests to add after a Baseline, when to draw them and how to read them.

Cheat sheet: download the one-page Part 2 cheat sheet (PDF), with test timing, the four thyroid patterns and the GP red flags.

What you will take from this session

• Choose each extra test to answer one clear question. If a result won't change your plan, leave that test for now.
• TSH is a starting point. Free T4, free T3 and thyroid antibodies show where in the system a problem sits.
• Four thyroid patterns cover most results, and two of them go straight back to the GP.
• Thyroid hormone depends on iron, selenium, iodine and zinc. Fix low ferritin before looking for a thyroid answer.
• Timing decides whether a hormone result means anything: Day 2 to 5 for FSH, LH and oestradiol, and 7 days before the next period for progesterone.
• Over 45 with symptoms, perimenopause is a clinical diagnosis. FSH swings too much from cycle to cycle to confirm or rule it out.
• Perimenopause shifts metabolism too. Insulin sensitivity falls, and LDL and triglycerides tend to rise.

Sarah's three questions

Sarah is an example client, not a real person.

Sarah is 44, tired by mid-afternoon, foggy and gaining weight around the middle. In Part 1 her Baseline showed early metabolic dysfunction, likely fatty liver, falling iron stores, and a TSH drifting up while free T4 drifted down. Every result sat inside the laboratory range. That left three questions: is she perimenopausal, what stress is she carrying, and where is her thyroid heading?

Choosing the next test

1. Hear the symptoms, including the ones the client has come to see as normal, along with her cycle, medications, life stage and stress.
2. Check what the Baseline already shows, and which way it is moving.
3. Form one question the next test could answer.
4. Choose the markers, and draw them on the right day under the right conditions.

The Baseline includes TSH but not free T4 or free T3. On the Vively platform, practitioners most often add thyroid markers to a Baseline, followed by testosterone, DHEA-S and the cycle hormones.

Thyroid: why TSH alone isn't enough

TSH comes from the pituitary and asks the thyroid to make T4. T4 is converted to T3, the active hormone, in the liver, gut and tissues. So TSH shows the request, free T4 shows the output and free T3 shows what the cells receive. TPO and thyroglobulin antibodies show the immune system attacking the gland, often years before TSH moves. Reverse T3 rises with illness, fasting and stress. Michelle treats it as optional, because its value is debated in mainstream practice.

More detail, with ranges and the co-nutrients, is in Thyroid function test interpretation.

Getting an accurate thyroid result

• On thyroxine: don't stop it. Draw blood in the morning before that day's dose, then take it. Free T4 rises for a few hours after a dose.
• Biotin: common in hair, skin and nail formulas and many B complexes, it can falsely raise free T4 and lower TSH. Pause it for 3 to 5 days before the test.
• Same laboratory, morning draw: TSH runs higher earlier in the day, so keep the laboratory and the time of draw consistent when you are tracking a trend.
• Wait 6 to 8 weeks after a change: a new dose, a new supplement or an acute illness. TSH takes that long to settle.

Sarah's thyroid

Every thyroid value is still inside the laboratory range, and all of them are moving the same way. Her ferritin is 22 and falling, so Michelle wants her iron fixed, and the reason it is falling found, before looking for a thyroid explanation for her fatigue. The open question is whether the thyroid picture is autoimmune. Thyroid antibodies would answer it. They can be added in the platform, or her GP can request them.

Timing sex hormones in the cycle

• Draw 1, Day 2 to 5 (ideally Day 3): FSH, LH and oestradiol, plus testosterone, SHBG and DHEA-S if you need them. Day 1 is the first day of full bleeding.
• Draw 2, 7 days before the next period: progesterone. That is Day 21 of a 28-day cycle, Day 23 of a 30-day cycle and Day 17 of a 24-day cycle. Confirm the cycle length once the period arrives, and read the result against it.

With irregular cycles, draw on Day 2 to 5 of whichever period comes, and repeat the progesterone if the timing turned out to be off. On the combined pill, results reflect the pill rather than her own cycle, and SHBG rises. On HRT, symptoms guide dosing far more than blood levels do. The full table is in the hormone test timing guide.

Sarah's progesterone

Sarah's cycles have shortened to about 25 days, so her second draw was on Day 18. Her progesterone came back at 14 nmol/L. The laboratory printed a range of 0.3 to 90 nmol/L, which has to cover every day of the cycle, so almost any value reads normal. Read against the timing, a level above about 30 nmol/L 7 days before a period is consistent with ovulation. At 14, she may not have ovulated that cycle. One cycle doesn't define her, so the test is repeated.

Clients who log their periods in the Vively app show their phases and predicted next period, which makes both draw dates easy to pick.

Perimenopause

In early perimenopause, progesterone falls first as more cycles fail to ovulate, and oestrogen swings from cycle to cycle, sometimes higher than ever before. FSH starts to rise but bounces around too. Over 45, with symptoms and a changing cycle, perimenopause is a clinical diagnosis, and Australasian Menopause Society guidance advises against using FSH to make it. Blood tests still earn their place: under 45 or when the picture is unclear, to see whether she is still ovulating, and to check thyroid, iron, insulin and prolactin.

Perimenopause changes metabolism as well. Insulin sensitivity falls, weight moves to the middle, LDL and triglycerides tend to rise and HDL can fall. Hot flushes and broken sleep make insulin resistance worse again. Michelle's advice is to believe a woman who says her weight has changed without anything else changing.

Sarah's perimenopause results

With 25-day cycles at 44, the picture is consistent with early perimenopause. The next steps are to repeat the progesterone next cycle, share the results with her GP, and ask about heavier periods, which could also explain her falling ferritin. The metabolic plan from Part 1 stays at the centre, and it matters more in these years.

Results that go straight back to the GP

• TSH above 5 or below 1 mIU/L, or free T4 outside the laboratory range.
• Prolactin above the range, especially with headaches, vision changes or nipple discharge.
• Testosterone well above the range in a woman, or rapid new hair growth or a deepening voice.
• Low testosterone in a man, confirmed on a repeat test. The GP confirms it, looks for a cause and decides on treatment.
• Periods stopping before 40, or a raised FSH at that age, to rule out premature ovarian insufficiency.
• Bleeding that doesn't fit: very heavy, between periods, after sex or after menopause.
• Very low morning cortisol with fatigue, weight loss or dizziness.
• No pregnancy after 12 months of trying, or after 6 months if she is 35 or older.

The Part 1 list still applies, including low haemoglobin, an HbA1c of 6.5% or more, and abnormal liver tests with fever, pain or jaundice.

Sections Michelle ran out of time for

The live session stopped after perimenopause. PMOS (the new name for PCOS), fertility foundations, male testosterone and the stress hormones DHEA-S and cortisol were not covered. The timing for each is in the hormone test timing guide, and the one-page cheat sheet covers them too.

Where each topic goes deeper

• Thyroid: TSH, free T4, free T3, reverse T3 and the Thyroid Function Test, with the patterns in Thyroid function test interpretation.
• Cycle hormones: FSH, LH, oestradiol, progesterone, testosterone and SHBG, with timing in the hormone test timing guide.
• Thyroid co-nutrients: ferritin, selenium and zinc, and the iron studies guide.
• Metabolic markers: fasting insulin and HOMA-IR, covered in Part 1.

Adding these tests for your clients

From a client's record in the Vively practitioner platform, choose Refer something, then Catalogue. Hormone options include the Perimenopause Test, built around the two draws, the Male Hormone Health Test, and hormone markers added to a Baseline. Clients get timing guidance with their request, and when results come back both draws sit in one record, with the draw date on every result. You need to be a verified practitioner to refer these tests.

Request practitioner access, or email Jaimee to book a one to one walkthrough of the platform and your first referral.

The next session is a case clinic, from blood results to a plan, on Thursday 29 October at 1pm AEDT.

• British Thyroid Foundation. Thyroid antibodies explained.
• American Thyroid Association. Biotin and thyroid function tests.
• National Institute for Health and Care Excellence. Menopause: identification and management (NG23).
• Australasian Menopause Society. Perimenopause and diagnosis of menopause.
• Prior JC. Perimenopause: the complex endocrinology of the menopausal transition. Endocrine Reviews 1998.
• GPnotebook. Progesterone and the luteal phase.