Does your doctor know how to diagnose 'Subclinical Hypothyroidism'? In my office, I see patients every day who have loads of hypothyroid (low thyroid) symptoms, but because their blood work is within the 'normal' range they are told they're fine. After reading this article, you'll probably know more than 99% of the doctors. A low level of thyroid hormones can cause:
- Weight Gain
- Cold Hands and Feet
- Thinning Hair and Eyebrows
- High Cholesterol
- A Heavy Menstrual Cycle
The thyroid is a small endocrine gland located below the Adam’s apple on the front of the neck. As an endocrine gland the thyroid secretes hormones into the blood stream. Thyroid hormones are responsible for determining the metabolic rate. If the metabolic rate is healthy, calories are quickly turned into energy and weight is easily maintained. However, if the thyroid does not secrete its hormones in sufficient amounts the metabolic rate will slow down, calories will be burned more slowly and weight will begin to accumulate.
The standard method for determining thyroid function is to measure the amount of Thyroid Stimulating Hormone (TSH) in the blood. TSH is produced by the pituitary gland in the brain and signals the thyroid to manufacture more of the thyroid hormones. TSH is like the voice of a rider that commands the horse to run faster. But if the horse (thyroid) is too tired the rider (pituitary) can yell (TSH) all he or she wants but no change will occur. In this case, the TSH will be elevated, but the thyroid hormones will be lower than optimal. This is called primary hypothyroidism. The TSH has long been considered the gold standard for testing thyroid function. However, times have changed and many physicians have not kept up with their homework. The result is that many patients are told they have “normal” thyroid function despite a laundry list of thyroid symptoms.
If you suffer from many of the hypothyroid symptoms listed above such as weight gain, fatigue, depression, cold hands and feet, thinning hair, high cholesterol, dry skin or a heavy menstrual cycle do NOT accept that you “are getting older” or “there is no explanation for your symptoms” just because your initial blood test was considered normal.
The following are a few of the common pitfalls to getting proper thyroid assessment and treatment:
- TSH, total T4 and total T3 is not a comprehensive thyroid blood panel. TSH, as I mentioned above, is the pituitary hormone that tells the thyroid to get to work. In response, the thyroid gland produces the most abundant thyroid hormone, T4, which is then converted into the active thyroid hormone, T3. Total T4 and total T3 can provide beneficial information, but they are bound to protein molecules that make them inactive. To assess the thyroid hormones that are physiologically active in the body we need to test Free T4 and Free T3. This will give a much more accurate picture of true thyroid hormone levels.
- Blood ranges are based on an unhealthy population! Conventional laboratory blood ranges are screening tests to determine which patients belong in a hospital and which do not. There are no optimal ranges for standard blood work. If you are not in the sickest 5% of the population your scores are considered normal. There is little consideration paid to degrees of severity. The field of Functional Medicine is beginning to change this outdated paradigm. Functional Medicine strives to promote optimal health rather than focusing on crisis management. Functional Medicine practitioners interpret blood work according to a more stringent set of values, which is better suited to treat sub-clinical and non-critical situations. I find that many patients in the lower half of the traditional thyroid hormone blood test ranges are experience typical hypothyroid symptoms and need to be treated accordingly.
- The TSH is no longer the gold standard. Recent research has shown that there are two major modern day problems that skew the TSH value. One is stress and the other is environmental toxins. Both of these ubiquitous problems will lower the TSH, making it appear better than it should be. Therefore, if too much emphasis is put on TSH, many thyroid issues will be missed.
- Thyroid hormone may be in the blood but not in the cells. It is quite common to have enough thyroid hormone in the blood (causing an initial blood test to look normal) but it may not be getting into the cells. In this case the thyroid hormone (particularly Free T3) never actually does its job! Many environmental toxins (xenoestrogens found in weed killers, auto exhaust and plastic out-gassing) bind to the location on cells where thyroid hormone is supposed to bind. This blocks the T3 from working and causes a type of hypothyroidism which is difficult to detect.
- Your thyroid may be stuck in reverse. As the inactive thyroid hormone T4 is converted into T3 about 20% of T4 is converted into a waste product without physiological activity, reverseT3 (rT3). Many factors can increase the creation of rT3 including stress, diabetes/insulin resistance, heavy metal toxicity, chemical toxins, oxidative stress, nutritional deficiencies and a lack of exercise.
- Your belly-ache can affect your thyroid. The digestive system is very metabolically active. The gut is like our very own chemistry lab. One function of the gut is to create much of our T3 hormone. However, if your digestive system is over run by pathogenic organisms (bacteria, fungus, parasites), irritated by food sensitivities or suffering from “leaky gut” the result can be lowered levels of T3 and all the hypothyroid symptoms that lower your quality of life.
- Hypothyroid can be an immune system problem. One of the most common reasons for a thyroid on the fritz is the immune system attacking its own tissues, hormones or enzymes. If your thyroid shifts between low, high and normal function that can be a sign that the immune system is involved. Also, if you or family members have rheumatoid arthritis, Lupus, MS or other autoimmune diseases this should be a red flag and an indicator to test for autoimmune antibodies. Autoimmune diseases are on the rise because of chronic low-grade and undetected infections, burdened detoxification pathways and vitamin D deficiencies. Autoimmune thyroid conditions need to be treated differently from other thyroid conditions and proper testing is a must.
- How to test your true thyroid function. As I mentioned above the traditional thyroid panel including TSH, total T4 and total T3 is inadequate and incomplete. The free T3 is a much more sensitive test for measuring the amount of active thyroid hormone in the blood, but that does not tell us if the free T3 has made its way to the cells and bound to the cell receptor. To determine the true activity level of the thyroid hormone at the cellular level I use the Thyroflex by Nitek Medical. Using the reflexes as an indicator of thyroid function used to be a standard test during physical exams. It is well known in Western medicine that if the reflexes of the knee, ankle, etc. are very weak or completely absent the doctor will order blood work to test the thyroid. Instead of a subjective test that is “eyeballed” Nitek Medical has made this test computerized and more accurate. Nitek’s research has shown that, when accurately measured, the reflexes are the most sensitive indicator of thyroid function.
The thyroid is an extremely important gland and when not functioning properly will greatly impact your quality of life. To precisely determine the problem it is often necessary to run more sensitive and specific blood tests. The Thyroflex is also a great tool for determining optimal thyroid function, not just “normal”. Finally, treatment for the thyroid many involve nutrition, detoxification, healing the digestive system, regulating the immune system, stress relief, exercise or blood sugar balancing. Sometimes patients “just want their thyroid (or other body system) fixed”, but the body is an interconnected whole. The sooner patients and doctors focus on the need for balance, integration and long term solutions the sooner we will have healthcare that promotes optimal health.
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