Still feel lousy although your doctor tells you that your thyroid is ‘normal’ based on a blood test? But you still have thyroid symptoms?
Many doctors rely solely on the TSH (thyroid stimulating hormone) levels to determine if a patient has a thyroid imbalance. This is a short-sighted practice. Measuring TSH alone does not measure pituitary function, whether the thyroid hormones are actually working normally or whether there is an autoimmune disorder.
If you still have some of these common thyroid symptoms of hypothyroidism (under-active thyroid), you may need a closer look:
- Weight gain despite a low-calorie diet
- Morning headaches that wear off as the day progresses
- Hypersensitivity to cold weather
- Poor circulation in the hands and feet
- Muscle cramps at rest
- Frequent colds and infections and difficulty recovering
- Slow wound healing
- Require an excessive amount of sleep to function properly
- Chronic digestive problems
- Itchy, dry skin
- Dry or brittle hair
- Hair falls out easily
- Low body temperature
- Edema, especially swelling of the face
- Loss of outermost portion of eyebrows
And even further, if you have these symptoms of hyperthyroidsim (over-active thyroid) or Hashimoto’s autoimmune disease, you may need a closer look:
- Heart palpitations
- Inward trembling
- Increased pulse rate
- Feelings of nervousness and emotional distress
- Night sweats
- Difficulty gaining weight
With Hashimoto’s, your symptoms may be all over the map, changing week to week.
It is estimated that over 27 million people in America suffer from thyroid dysfunction and over HALF of them are undiagnosed and HALF have Hashimoto’s, as estimated by the American Association of Clinical Endocrinologists.
Seventy-five percent of Hashimoto’s patients are women. Wow.
Thyroid 101, the Short Version
Here is a quick and dirty explanation of how the thyroid works so you can better understand the importance of complete testing.
- The hypothalamus gland sends out TRH (thyroid releasing hormone) to the pituitary gland when it detects a need for increased metabolism. The hypothalamus communicates between the nervous system and the endocrine system (your glands).
- The pituitary gland then sends out TSH (thyroid stimulating hormone) to the thyroid to tell it to kick it up a notch.
- The thyroid pumps out T4 (thyroxine) and a little bit of T3 (triiodothyronine). T3 is actually the active form of thyroid hormone that the body can use.
- T4 must be converted to T3 in the liver (mostly) and other places (heart, nerves). Some T4 is activated in the digestive system if the proper gut bacteria are present.
- Some T4 is converted into reverse T3 (rT3), which is a form the body cannot use.
- These thyroid hormones hitch a ride through the bloodstream on thyroid-binding proteins and are called ‘bound‘. When they are dropped off at the cells, they are called ‘free‘ hormones.
Something can go wrong anywhere in that process which may or may not affect the TSH level, the marker most physicians use to determine thyroid health. For example, a malfunction in the pituitary can lead to thyroid dysfunction (known as secondary hypothyroidism). No amount of thyroid medication will repair the upstream problem of the pituitary.
Hashimoto’s Autoimmune Disease
Hashimoto’s is an autoimmune condition in which the body attacks and destroys its own thyroid gland.
In the process of making T4 and T3 hormones, an enzyme known as TPO (thyroid peroxidase) is used. If, for some reason, the body makes antibodies (cells that attack a perceived threat) against TPO, Hashimoto’s can occur.
A protein, TBG (thyroid binding globulin), transports thyroid hormones to the cells. Antibodies produced against TBG can also trigger Hashimoto’s. Interestingly, excess estrogen can cause an elevation of TBG.
A single negative test for antibodies may not be enough. Because the immune system fluctuates, repeating the test is advised.
Ask Your Doctor for a Complete Test
If you have several thyroid dysfunction symptoms, ask your doctor for a blood test that includes all of these markers and check your results with these ranges:
- TSH–1.8 to 3.0 mU/L
- Total T4 (TT4)–(measures bound and free T4), 6-12 ug/d
- Free T4 (FT4)–1.0-1.5 ng/dL
- Free T4 Index (FTI)–(measures the activity of free T4), 1.2-4.9 mg/dl
- Free T3–300-450 pg/mL
- Resin T3 uptake–(measures the amount of protein sites that are available for free T3), 28-38 md/dl
- Reverse T3–90-350 pg/ml
- Thyroid Antibodies (TPO Ab and TBG Ab)–used to determine autoimmune Hashimoto’s disorder
- TSH Antibodies (TSH Ab or TSI)–used to determine hyperthyroidsim or Grave’s disease.
The ranges listed above are functional ranges. A functional range is the optimal range for that particular thyroid marker.
Standard lab reference ranges are the ones you see on the lab test results you receive from your doctor’s lab. These are known as ‘disease ranges’. By the time someone’s thyroid levels are outside of the typical ranges the lab provides, their condition is so advanced that taking medication throughout their life may be the only treatment option.
Compare your test results to the functional ranges listed above. For an at-home test of thyroid function, try this test using a thermometer.
Six Primary Patterns of Thyroid Dysfunction
Dr. Datis Kharrazian defines six common patterns of thyroid dysfunction, although he further describes a total of 22 patterns in his book “Why Do I Still Have Thyroid Symptoms”.
- Primary Hypothyroidism is a true dysfunction of the thyroid and the only pattern that can be managed by thyroid replacement hormones. TSH is elevated while the other markers are normal or low.
- Hypothyroidism secondary to pituitary hypofunction is indicated when TSH is very low, T4 is low and the person has symptoms of under-active thyroid. This is caused by stress, inappropriate use of thyroid medication, or post-partum depression.
- Thyroid Under-Conversion is associated with chronic adrenal stress. The body makes plenty of T4 but too much cortisol prevents T4 to T3 conversion. Total T3 and Free T3 will be low.
- Thyroid Over-Conversion is associated with elevated levels of testosterone in women. Too much T4 is converted into T3 and TBG is under-produced. Free T3, Resin T3 and Free T4 will be high.
- Thyroid Binding Globulin Elevation is typically associated with oral contraceptives or estrogen replacement therapy. Free T4, Resin T3 and Free T3 will be low.
- Thyroid Resistance—hormones are not getting in the cells. All thyroid markers will be normal. Support of the adrenal glands is typically required here.
Autoimmune dysfunction is not a dysfunction of the thyroid. It’s an immune system problem that happens to attack the thyroid gland. While autoimmune disease cannot currently be cured, proper treatment and lifestyle changes can suppress the autoimmune dysfunction and avoid the triggers. It is NOT recommended to suppress the entire immune system with a steroid such as prednisone.
The thyroid doesn’t operate in a vacuum. Other systems and organs in the body affect and are affected by the health of the thyroid gland.
Healthy thyroid function is also important in bone health, gastrointestinal function, male reproduction, gallbladder function, growth hormones, fat burning, glucose and insulin metabolism, cholesterol metabolism, brain chemistry, estrogen metabolism, adrenal hormone metabolism, stomach acid production, protein metabolism, body temperature regulation, progesterone production, and B12/folate/iron anemia.
If your test results are out of range, don’t wait until the disease state is irreversible.
Contact your healthcare practitioner and if they won’t help you to come back in balance, find one who can. Integrative medicine doctors, functional medicine doctors, osteopathic doctors and nutritionists can be helpful.
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Joli Tripp and Mind Blowing Wellness are not medical doctors nor licensed medical professionals. No comment or recommendation should be construed as being a medical diagnosis. If you suffer from a medical or pathological condition, you should consult an appropriate healthcare provider.
These statements have not been evaluated by the Food and Drug Administration. The products mentioned are not intended to diagnose, treat, cure, or prevent disease.
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Why Do I Still Have Thyroid Symptoms?, Datis Kharrazian, DC, DHSc, MS, 2010