We see a lot of people in the clinic who present with some type of thyroid dysfunction. Most are women; however, it does affect men also. Sadly, most of these patients have been dismissed by a general practitioner as being ‘fine’ when the individual knows that’s not the case. Why does this happen? Because standard thyroid testing gives an incomplete picture of thyroid health and in most cases it’s completely inaccurate. Hence why we are calling it ‘thyroid madness’ because the system is letting people down.
First, let’s look at the basics of thyroid hormones and the importance of proper testing.
Thyroid hormones 101
Here is a basic guide to your thyroid hormones, what they do and why we need to test them.
Thyroid stimulating hormone (TSH)
According to the general practitioner, this is the gold standard for testing. Sadly though, it’s the most unreliable marker when it comes to the health of your thyroid.
TSH is a signalling hormone that tells your thyroid to produce T4 (see below). If T4 is low, feedback mechanisms will tell the hypothalamus and the pituitary gland that we need more T4 so TSH gets up-regulated. If T4 is high, those same mechanisms work to dial down TSH.
In theory, if you have high TSH, you have low thyroid function (or hypothyroidism) and if your TSH is low then you have an overactive thyroid (hyperthyroidism).
T4 is your storage form of your thyroid hormones. It does not exert any metabolic effects when it is in this form.
If you are taking thyroxine, you are getting T4 only.
Perhaps one of the most important markers of thyroid function, T3 is your active thyroid hormone. It is responsible for the beneficial effects on health and metabolism. We need to maintain good levels of T3 and yet this is rarely tested. If your body has issues converting T4 to T3, then you are going to feel lousy.
Some patients take T3 as prescribed by a general practitioner, but this is typically the exception and not the rule.
Reverse T3 (rT3)
Reverse T3 is effectively rendered useless by one small structural change to active T3. This can happen when your adrenals are working overtime pumping out cortisol to help you deal with stress, for example. Unfortunately, your body still recognises it as active T3 and this can distort your TSH levels dramatically, hence why the TSH marker is unreliable.
Reverse T3 is never tested by a general practitioner. You can pay an additional fee to have this added to your thyroid panel if you want it checked.
TIP: If you do have it checked, you need to ensure it is taken from the same blood sample as the rest of your thyroid panel, otherwise the result on its own is largely meaningless.
If you have elevated antibodies, this could be a sign of an autoimmune disease e.g. Hashimoto’s (hypothyroid) or Graves’ (hyperthyroid). This is the result of an overactive immune response against your body’s cells, in this case, the thyroid.
Your general practitioner often won’t test for these antibodies because it won’t change their treatment (thyroxine).
Thyroid testing 101
If your general practitioner orders a test for your thyroid, it is typically only TSH. Sometimes T4 may also be tested but this is rare. This means you are only getting a small part of the thyroid picture and could be why most thyroid issues are missed.
General practitioners have restrictions on what they can do and generally it is only when TSH is way out of the range that they will dig deeper and look at other markers such as T4, maybe T3 and occasionally antibodies, but never rT3. Largely they are looking for overt disease which they can then treat with a drug.
The take home message here is that if your TSH is ‘normal’, it doesn’t necessarily mean you don’t have thyroid problems.
The classic situation involves low or normal TSH (with low T4 if that has been tested). When you dig a bit deeper, results can often show high levels of rT3 which is reducing our T3 (active hormone and the one we want) and throwing the feedback loop out of line.
If you have been taking thyroxine for a while and your general practitioner is advising your TSH (and maybe T4) is in range but you still feel terrible, you need to undertake further investigation.
So what can you do?
As qualified naturopaths, we can check to see how well your body is converting T4 to T3 and what impact rT3 and antibodies are having on your thyroid. We can determine whether a full thyroid panel is warranted and also address other contributing factors to thyroid dysfunction such as nutrient deficiency, particularly iron, selenium and iodine.
Don’t put up with thyroid madness. You deserve to feel good!
Written by Denise Berry
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