Thyroid labs explained
Have you ever suspected you had a thyroid issue, made an appointment with your primary care?
You went in explained your symptoms such as declined energy, weight gain, hair loss, brittle nails and so on… your practitioner agreed to check your thyroid.
A few days … or let’s be honest, WEEKS later they call you and tell you - that your “labs were normal”?
They leave you with no suggestions and just tell you some blanket advice to come back if you're not doing better or symptoms persist in X number of months.
Low thyroid function called hypothyroidism OR below optimal thyroid function is grossly under diagnosed.
For starters, because most practitioners are checking the wrong labs! Yes, that’s right! Often providers are only checking Thyroid Stimulating Hormone called (TSH) as a screening either that reflexes to T4 total, if TSH is above a certain value or they’ll add the T4 in.
Problem with this methodology - TSH is actually a pituitary signal to the thyroid, so often it’s not the best indicator of true thyroid function and active, available hormone levels.
Thyroid hormone production begins in the hypothalmus where it produces thyrotropin releasing hormone (TRH) to the anterior pituitary that then secretes Thyroid Stimulating Hormone (TSH).
The thyroid converts thyroglobulin (a protein) to thyroxine (T4) which then cascades to other thyroid hormones, T3,reverse T3, T2, and T1. In a healthy person, these thyroid hormones stay stable and are produced in adequate amounts. T4 makes up 80% of the hormones thyroid produced. It then converts to T3 which is actually 5 times more active than T4 which is why I dubbed in the “money maker'' of all thyroid hormones because it best reflects symptoms.
You can have all the T4 but if it never makes it to T3 you’ll feel like you have hypothyroidism all day,every day.
Most thyroid hormone is bound to protein, like 99% of it. Assessing the T4 and T3 (total) tests in lab works looks at the bound levels. But really, it’s the 1% of FREE hormone, especially free T3 affecting your weight, energy, mood, hair, skin, body temperature, menstrual regulation and more.
To get the most accurate picture of what’s going on with the thyroid we recommend checking;
TSH
Free T4
Free T3
Reverse T3 (either initially or at follow-up for FT3 found to be below optimal)
Thyroid Peroxidase antibodies (TPO)
Thyroglobulin antibodies.
The second big reason low or suboptimal thyroid function is missed is because in medical school, providers are taught to follow lab reference ranges that only show a statistic of what’s average instead of what’s optimal or the point where symptoms are relieved. Reference ranges are formulated based on a 95% median. So out of 1000 lab samples the low 2.5% (25 labs in this example) are considered low abnormal and the high 2.5% considered high abnormal. Leaving a whopping 950 patients considered “normal.” I’m sure you can already see the problem with this methodology. The powers at be that determine these reference ranges are not comparing symptoms or health status with numbers. The lab reference ranges have absolutely NOTHING to do with symptoms!
So basically when you tell your provider you have low thyroid symptoms yet your labs come back in a general reference range…. It doesn’t mean you don’t have below optimal levels for YOU. It just means, you’re in the 95% median range, your’e a broad average. I don’t know about you but I want to be above average in every healthy way possible!
Low or Below Optimal Thyroid Symptoms:
Fatigue/ Tiredness
Sensitivity to cold such as cold hands/feet or not tolerating cooler temperatures.
Weight Gain or Difficulty losing weight
Dry Skin
Constipation
Hair thinning or hair loss
Eyebrow thinning (Outer 1/3rd of the eyebrow)
Water retention or puffy face
In significant cases sometimes hoarseness or difficulty swallowing due to enlarged thyroid
Slowed Heart Rate
Muscle Weakness
Muscle aches
Joint stiffness
Impaired memory- often patients describe as “brain fog” which can also be connected to cortisol levels
Depression
Heavier than normal menses
Irregular menstrual cycles
Brain fog
And high blood cholesterol
If any combination of these symptoms sounds familiar you need to have your lab work properly tested and interpreted…. Even, if you’ve been told it’s “normal”.
In this video I give a patient example of suboptimal thyroid, explain optimal thyroid levels and review possible causes for the thyroid which give real clues as to how we can best treat the condition.
Thyroid reference ranges vs optimal ranges
Labs For Hypothyroidism vs Subclinical or Below optimal thyroid
Treatments
So you find out you’ve got hypothyroidism or suboptimal thyroid… now what?!
What I’ve seen work best in treating hypothyroidism or suboptimal thyroid is to find the root cause and treat it whenever possible. But I do believe medications to be helpful and they certainly can also make a world of difference in a patient's life when needed.
Here’s my 3 basic rules to treating low thyroid
Rule #1 Get to the root whenever possible meaning correct the reason for the specific hormone deficiencies whenever possible is always the best and most holistic route. Medications absolutely have a place, but if we can get to the root of the issue we can maximize results while minimizing, if not eliminating the need for thyroid medications.
Sometimes getting to the root is easier said than done but most of the cases I treat it proves to be well worth it- not just for the thyroid but for overall health!
Rule #2 Get the RIGHT medication if needed - Levothyroxine (brand name -Synthroid) which is synthetic T4 alone rarely relieves symptoms.
Now in some cases I’ll use it, particularly in the presence of Hashimoto’s with adding T3 or liothyronine (brand name Cytomel) if indicated which in some cases works really well.
A natural desiccated thyroid (NDT) such as Armour, Nature thyroid, Westhroid, or NP thyroid (brand names) usually does the trick in relieving symptoms! Of course, symptoms and labs need to be monitored and adjustments made as necessary.
Rule #3 Understand that T3 is the money maker…. You can have all the T4 in the world but if it never makes it to FT3 then you still have symptoms. So fix the conversion or replace the T3 to create a better FT3 to RT3 ratio.
In cases of poor conversion of Free T4 to Free T3 where there’s optimal or borderline optimal Free T4 (FT4) but LOW Free T3 (FT3) there’s what we would call a FT4 to FT3 conversion. This is where checking a RT3 level can be helpful to get a ratio of FT3 to RT3 levels. Once you have those lab values you can use a calculator to determine that ratio here https://stopthethyroidmadness.com/rt3-ratio/. An optimal ratio of FT3 to RT3 is 20 or more.
Root causes of Low thyroid
Thyroid medications can be helpful but if we can correct the root cause issues of your symptoms and lab, you’ll experience the best and longest lasting results. Some people are able to reduce or in some cases, wean off completely off of thyroid medications if they’ll put in some ground work to correct these possible root causes. Not only will your thyroid be better for it but so will your overall health!
From the Institute of Functional Medicine, 2014
The primary root causes of proper thyroid function or hormone levels include:
Stress
Infection, Trauma, Radiation, medications including BIRTH CONTROL or Synthetic Hormones-- - Hello, ladies!Fluoride which fights against iodine, an essential thyroid mineral.
Toxins including pesticides, mercury, cadmium, and lead to name a few.
Infections including Epstein Barr Virus (aka Mononucleosis) history
Autoimmune disease including Celiac can contribute. Overtime what can start as an attack on the thyroid by presence of thyroid antibodies (Hashimoto’s thyroiditis) causes low thyroid function.
Root Causes of poor thyroid conversion ( Trending low FT3 levels or poor FT3:RT3 ratio )
In cases where there’s a FT4 to FT3 conversion issue the most common causes are:
1.Low Iodine, Selenium, zinc
2 High stress (physical or emotional) where the adrenal glands are ‘stealing’ from the thyroid hormones to produce more cortisol
3 .And again toxins!
If you're experiencing low thyroid symptoms and haven’t gotten the help you needed, then look no further. We would love to partner with you on your path to restore your health from the inside out. You can learn more about our program here.
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