I’ve been wanting to write about thyroid health for a while. In this post, I summarize symptoms of hypo and hyperthyroidism, common problems with diagnosis, and what you can do to find out what’s causing your symptoms so you can fix it and start feeling better.
Often, my friends, family and patients say:
‘my doctor says my thyroid is fine’
‘my thyroid labs came back fine.’
But they are not feeling fine. Something is off. They don’t feel themselves. Some complain of hair loss. Others of fatigue. Some of constipation. Others of difficulty waking up.
I’m not trying to discredit doctors here and this post is not intended for you to diagnose yourself or for me to diagnose you. The purpose is to provide you with tools, knowledge, so you can ask your doctor further or take measures into your own hand and take charge of your own health.
Why is the thyroid gland important?
Thyroid hormone is THE MOST important hormone in your body. I’m not exaggerating! It affects every physiological pathway in your body. Every cell has a receptor for thyroid hormone, and the cells are waiting for it to get turned on to start their functions. Think of it as the spark that turns on the fire! These pathways include metabolism, fat burning, hair growth, building bone and skin, ability to produce energy, and produce enough heat.
Your thyroid gland is like your car’s gas pedal. If it’s cruising properly, you feel great. If not, you will be moving in slow motion with one foot on the gas and the other on the break pedal, resulting in the many signs and symptoms.
What is thyroid hormone anyways?
Warning! The discussion about thyroid is about to get a bit complicated. Hang in there!
The thyroid gland secretes two hormones: T3 and T4. Triiodothyronine (or T3) is the active thyroid hormone. Thyroxine (T4) is the precursor for T3. Sometimes T4 is referred to as the prohormone.
The thyroid glad makes about 10% T3 and 90% T4. T4 has to be converted to T3 in cell membranes before it can be used because the nuclei of cells has receptors for T3 only. The conversion of T4 to T3 happens mostly in the liver, muscles, and digestive tract.
WHY and HOW does the thyroid start having issues?
There are many reasons why your thyroid starts to give in.
- Nutrient deficiencies: the thyroid gland needs vitamin D, vitamin B12, iodine (deficiency is not too much of an issue anymore), selenium, and iron. Lack of digestive enzymes and digestive capacity can lead to nutrient deficiencies.
- Adrenal insufficiency/fatigue: you have two adrenal glands that sit on top of your kidneys and produce cortisol, the stress hormone. Low adrenal function, due to chronic stress, contributes to and looks like low thyroid function. This is important. If you have symptoms of hypothyroidism and your doctor gives you thyroid hormone, but the true cause of your symptoms is low adrenal, you will not feel better. Or, you may feel better initially but then feel sluggish again. Giving the body too much thyroid when the adrenals are fatigued will exhaust your adrenal further because both glands work in harmony. In this case, you need to support the adrenal first.
- Stress: it’s sort of related to adrenal fatigue and insufficiency but needs to be a point on it own due to the damage it can cause! There’s feedback loop between the adrenals (secrete cortisol), hypothalamus, and pituitary (secretes TSH) that regulates cortisol. Chronic stress will lead to high cortisol levels that will eventually plummet in severely fatigued adrenals). Too high or too low cortisol will force the liver to produce reverse T3 (rT3) instead of active T3. Reverse T3 is another hormone that is the mirror image of T3 but it’s inactive and blocks the T3 from being used in the cells.
- Gut issues: by now, you know that T4 has to be converted to T3 to be used. 20% of this conversion happens in the gut. If your gut health is compromised due to leaky gut, dysbiosis, or infections (such as h pylori), there will be even less T3 available for use. What causes compromised gut health? Chronic antibiotics use, chronic antacids, too much sugar in the diet, lack of fiber in the diet, nutrient deficiencies, inflammation, artificial sweeteners, birth control pills, and infections.
- Food sensitivities: food sensitivities are immune system reactions to food antigens that should be seen as normal and benign. Food sensitivities are linked to compromised gut health, lack of digestive capacity, nutrient deficiencies, and others. If you eat the foods your immune system reacts unknowingly, you will contribute to inflammation which slows down your thyroid.
- Inability to eliminate toxins: the liver converts the highest amount of T4 to T3. If the liver is overworked, under a lot of toxic load, or unable to eliminate toxins, the T4 to T3 conversion will be affected and you will have less T3 available.
- Genetic per-disposition: some people have the genes for auto-immune thyroid diseases Hashimoto’s and grave’s disease. But having the gene doesn’t mean you will develop the disease. Genes can get turned on and off depending on your environment; what you eat and how you live your life.
Symptoms of Hypothyroidism (low thyroid hormone)
- Fatigue, tired, sluggish
- Weight gain despite eating a low-calorie diet
- Morning headaches that wear off as the day progresses
- Need for excessive hours of sleep to function well
- Constipation or difficult bowel movements
- Hypersensitivity to cold weather
- Poor circulation and numbness in hands and feet
- Cold hands and feet/feeling cold all over
- Low auxiliary body temperature, less than 98.6 first thing in the morning (may also be caused by any hormonal imbalance)
- Muscle cramps while at rest
- Increased susceptibility to colds and other viral or bacterial infections and difficulty recovering from them
- Slow wound healing
- Chronic digestive problems, such as lack of stomach acid (hypochlorhydria)
- Itchy, dry skin
- Dry or brittle hair
- Hair falls out easily (scalp, face, or genitals)
- Loss of outmost portion of the eyebrow
- Swelling, especially facial (myxedema)
Symptoms of Hyperthyroidism (high thyroid hormone)
- Heart palpitations
- Inward trembling
- Increased pulse rate, even at rest
- Feelings of nervousness and emotional distress
- Night sweats
- Involuntary weight loss
- Difficulty gaining weight
What about Hashimoto’s Thyroditis and Grave’s Disease
Both are autoimmune conditions that involve the thyroid gland. If you have symptoms that fluctuate between hypo and hyperthyroid, you may have an autoimmune thyroid disease. In general, in Hashimoto’s, the thyroid gland eventually wears out and only hypothyroid symptoms exist. In grave’s, mostly hyperthyroid symptoms exist. Understanding these needs a thorough lab assessment that I will reserve for another time. If you want to learn sooner, contact me.
Problems with Typical Thyroid Tests
Most doctors just measure TSH, which stands for thyroid stimulating hormone. The pituitary gland, which sits at the base of your brain, secretes this hormones when it senses low thyroid hormones (T3 and T4) so as to promote the thyroid to make more of them. When TSH high, it’s supposed to indicate low T3 and T4 and thus, problems with thyroid function.
There are 3 problems with measuring TSH alone and how it’s typically interpreted. I tried to summarize them as clearly as possible!
- What is considered normal TSH varies between labs. Lab ranges are not based on research that shows us what a healthy range should be. The range is the bell curve of values obtained from people who come to the labs for testing. And who goes to get tested? People who are fatigued, can’t lose weight, or with other hypothyroid symptoms. In other words, the labs are creating normal ranges based on thyroid levels of people who might have hypothyroidism. Twisted? Yeap. Useless? Yeap.
- The typical range for healthy TSH is very broad, often from 0.5-4.5. If your TSH level sits in this range, your doctor will tell you that it’s fine, but it might not be. The healthy functional range for TSH is 1.8-3.0. Anything higher than that means that your pituitary is sensing low T3 and/or T4 and that your thyroid is starting to get tired and give in. In conventional medicine, most doctors are trained to wait until TSH is higher than 4.5 to diagnose hypothyroidism, but when it reaches that level, you and your thyroid have been suffering for a long time already.
- High TSH doesn’t tell us whether T4 or the active T3 is low. Remember, there could be a problem with the conversion process. So if you have high TSH because your body can’t make enough T3 from T4 and your doctor prescribes Synthroid or levothyrozine (which is T4 only), you still won’t feel good. More T4 is not the solution. Fixing the root cause of why it’s not converting and maybe adding T3 to your medication will help instead.
- There are many patterns of thyroid issues. If you look at TSH alone (or even TSH and free T4 alone), you might miss the big picture. If you’re suffering from chronic infection, inflammation, high blood sugar, or even pregnancy, the pituitary gland (which secreted TSH) might be fatigued. In this case, it will not produce enough TSH. Your labs might show normal or low TSH and your doctor will not pay attention to it because the standard thought process is that high TSH means hypothyroidism and low/normal TSH means nothing. However, you may be suffering from hypothyroid symptoms and low T4 or T3 and don’t know it. Sometimes, the liver produces more or less thyroid binding globulin (TBG), a protein that carries T3 in the blood, due to hormonal imbalances (estrogen and testosterone). High and low TBG will lead to hypothyroid symptoms even though your TSH might be normal. In this case, giving you more thyroid hormone will not help you feel better but balancing the hormones will.
Ask your doctor to check ALL these labs:
If you really want a full assessment of your thyroid health, as your doctor to check all of these. Make sure he/she does not just order any thyroid panel. Some panels don’t have all the information you need, and you end up paying for useless information. In parenthesis, I provide the functional medicine recommendation for healthy ranges. In other words, these are the ranges for optimal health, which are probably going to be different than the ranges considered normal in your lab report.
- TSH: (1.8-3.0 mlU/L)
- Free T4: (1.0-1.5 ng/dl)
- Free T3: (3.0-4.0 pg/dl) so you can catch under-conversion of T4 to T3 which may be caused by chronic inflammation, chronic stress, and elevated cortisol
- Reverse T3: (90-350 pg/ml) the liver converts T4 to either T3 or reverse T3 (rT3). Under chronic stress and when the body needs to reserve energy, it will produce more rT3. The liver will also produce more rT3 if you have too much T4 as when you’re taking too much thyroid hormone medication made of T4 alone such as Synthroid or levothyroxine. Without rT3, your doctor might think you’re not getting enough T4 and up your dose, which will not help you feel better. Again, it’s a conversion issue, not inadequate TS issue.
- Thyroid antibodies, anti TPO and anti-thyroglobulin: (negative) to detect autoimmune thyroid conditions. Both antibody tests are needed because sometimes one is elevated and the other is not.
If your doctor doesn’t want to test…
If you have symptoms of hypothyroidism, hyperthyroidism, or auto-immune thyroid conditions and your labs come back ‘fine’ according to conventional medicine, or your doctor refuses to order the full thyroid panel, you can take matters into your hands. There are many options to test on your own.
In fact, I realized that I can’t help my patients get results with diet alone if they have an underlying thyroid or adrenal condition. It’s frustrating for me, and them, to see them work hard on changing their diet and lifestyle and not feel any better. That’s why I started offering thyroid and adrenal testing for those patients who aren’t getting the help they need from their physicians.
If you want to know if these may be the root causes of your symptoms, contact me and I’m happy to offer a free 15-minute consultation to figure out what’s the best next step.