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Standard Thyroid Function Labs Don’t Tell the Whole Story ...

Updated: Dec 30, 2022

January is Thyroid Awareness Month, and in my practice, I see many patients who have been told their thyroid labs are “normal” yet they feel anything but normal.

To understand why, you need to understand what the thyroid is and how important it is to your body.

Your thyroid is a small butterfly shaped gland that sits near the base of your throat. It is responsible for the production of thyroid hormones which regulates our metabolic rate.

Thyroid hormones affect nearly every tissue in your body and when the thyroid is functioning improperly the entire chemical balance of the body is upset.

According to the American College of Endocrinology, nearly 30 million American’s are affected by thyroid disorders, but more than half remain undiagnosed and untreated.

Nearly 90% of those affected are women, and 1 in 8 women will experience a thyroid issue in her lifetime.

Understanding what a significant role your thyroid function plays in your overall health, most would assume if they had a problem with their thyroid they would know or it would have been tested. Unfortunately this is not always true.

Many patients struggle for years with fatigue, weight, memory issues, hormonal problems, anxiety and depression feeling dismissed for their concerns before a proper diagnosis is made. The quality of life cost, impact on interpersonal relationships or mistreated mood disorders are incalculable. Undiagnosed thyroid conditions increase risk of infertility, osteoporosis and cardiovascular disease.

How you know if you have a thyroid disorder?

While not all thyroid-like symptoms will turn out to be due to a thyroid condition, proper laboratory testing will diagnose underlying thyroid disorders. Hypothyroidism is the most common thyroid problem, and 90% are autoimmune, mostly due to Hashimoto’s.

Symptoms of Hypothyroidism can include

  • Fatigue

  • Cold sensitivity

  • Constipation

  • Dry skin

  • Unexplained weight gain

  • Puffy face

  • Muscle aches and weakness

  • Elevated cholesterol and triglyceride levels

  • Thinned or partially missing eyebrows

  • Numbness in fingers and tingling in hands and fingers

  • Heavier than normal or irregular menstrual periods

  • Hair loss or Thinning hair

  • Brain Fog & memory problems

  • Depression

The problem with testing is that some providers may be reluctant to do an adequate workup of thyroid function. Most providers are taught to check the TSH and if it is within “normal range” everything is ok and there is no thyroid disorder.

The “normal” lab range for TSH is 0.45-5 mlU/L. This broad range is somewhat controversial as endocrinologists have proposed lowering the upper to 2.5-3 mU/L. It is important to keep in mind as well that “normal” especially in labs with such a broad range, is not always optimal for you individually. This is why you need better lab work.

Bloodwork I typically request for my clients with thyroid concerns:

TSH- thyroid stimulating hormone is released from your pituitary to communicate with your thyroid. If your TSH is high, it is telling your thyroid to work harder. The goal is to aim for what’s optimal-this is individualized to each patient but is typically between 1.5-2.5mlU/l

Free T4 & Free T3

T4 and T3 are the hormones produced by your thyroid gland. T4 is produced in the largest amount and is metabolically inactive and must be converted to T3, which is the active form. Proper conversion of T4 will not occur if there are nutritional vitamin deficiencies or inadequate zinc, iron or tyrosine. Free T4 & Free T3 are the unbound, active forms of the hormones usable by the body.

Reverse T3

This is an inactive, unusable version of T3. Chronic stress, illness, prolonged undernourishment or high cortisol can raise levels of reverse T3. It will divert the active T3 into the inactive from which will result in your reverse T3 being elevated. Instead of your metabolism being optimized, you will be conserving energy.

Thyroid Antibodies

High levels of antibodies diagnose autoimmune thyroid disease. I order a Thyroid Peroxidase (TPO) Antibody and Thyroglobulin Antibody.

If labs return showing that there is hypothyroidism, I may recommend additional testing for micronutrients deficiencies such as selenium, iron, zinc and vitamins including B & D. A complete picture of your health, nutrition, lifestyle, stress and environmental exposures and triggers is important to create the best path moving forward in relieving your symptoms.

If you’d like to chat with me about whether you’d benefit from this type of testing, please schedule a consultation.

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