We often associate the thyroid gland with metabolism, and when it gets out of balance, we are given medication to correct the imbalance and (hopefully) regain a good metabolism. But treating thyroid imbalance is more than a numbers game. There are 2 questions I always consider when a patient presents with hypothyroid symptoms:
- First, is the thyroid MAKING ENOUGH hormones?
- Second, if there appears to be enough hormone production, but a patient still has hypothyroid symptoms, I think of basic physiology and consider the series of enzymatic reactions required for the body to actually USE thyroid hormones (hint - this involves vitamins/minerals, the gut, the liver, and the adrenal glands).
Let's start with testing....here are some tips when getting your thyroid tested:
1. IT'S BEST TO MEASURE THYROID HORMONES IN THE MORNING. Why? Thyroid hormones have a Circadian rhythm, meaning they are not always present at the same level throughout the day.
2. TSH IS THE "MESSENGER" - IT IS NOT ACTUALLY MADE BY THE THYROID. TSH (thyroid stimulating hormone) is produced by a gland near your brain. TSH communicates with the thyroid and instructs it to produce more or less thyroid hormones. If these messengers are high, it means the thyroid isn't listening (aka, not making enough of the hormone "T4"). TSH is great for screening for potential thyroid issues, but will not be the most accurate for evaluating actual thyroid hormone production.
3. "FREE" OR "TOTAL" - WHAT'S THE DIFFERENCE? Free T3 and free T4 are the thyroid hormones that are produced by the thyroid gland. When they are "free", this means they are not bound to proteins that can inhibit their function. It's best to check the "free" levels.
4. T3 IS THE SUPERHERO HORMONE. The hormone that is actually responsible for regulating metabolism and energy is free T3. Most (80-90%) T3 comes from T4 - only a small amount is directly made by the thyroid gland.
5. AUTO-ANTIBODIES CAN SHOW UP 10-15 YEARS BEFORE CHANGES ARE SEEN IN THYROID LEVELS. There are two main auto-antibodies involved in Hashimoto's hypothyroidisim - TPO and thyroglobulin - but TPO antibodies are most prevalent and cause the most damage to they thyroid. At TMC, we recommend screening for thyroid auto-antibodies yearly, and if these are elevated, find a functional medicine practitioner (or see us, at Texas Metabolic Centers!), who may be able to stop the auto-immunity before it destroys the thyroid gland.
6. DON'T TRUST THE REFERENCE RANGES. Lab ranges listed on labwork are an average range (determined by the lab company)- it does not indicate optimal function (determined by scientific research). For example, TSH may have a reference range of 0.4-4.5, but the "optimal" range is actually 0.5-2.0 (for those who are between the ages of 20 and 60).
7. DON'T FORGET TO LOOK AT THE THYROID GLAND. Anyone with symptoms of thyroid dysfunction - whether labs are normal or not - should have their thyroid evaluated by a healthcare practitioner (via physical exam and palpation), AND via ultrasound. A good physical exam can identify thyroid nodules that may need to be further evaluated. An ultrasound also looks for nodules but also for evidence of thyroid gland breakdown (usually caused by auto-antibodies).
There is a lot to consider when looking at the thyroid! Stay tuned for Part 2 (What is needed to allow the body to use thyroid hormones - both the hormones the body makes and the hormones you get from medication)