Thyroid 101: Digging a little deeper

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I frequently hear stories from patients that start with “I had my thyroid tested and everything was normal but I’m still not feeling well” OR “I’m not feeling any better since starting thyroid medication”. Both scenarios are significant clues that we need to dig deeper to figure out what’s going on.

Let’s back up and start with some basics on thyroid disorders and what might make you suspicious of a problem. The thyroid, a butterfly shaped gland located in the middle of your neck, is a major player in metabolism and can create a host of problems when not working well. 

There are two major types of thyroid disease: 

Hypothyroid is when you’re not producing enough thyroid hormone and hyperthyroid (aka Graves’ Disease) is when there is too much hormone. Today the focus is more on hypothyroid which can cause a multitude of symptoms including fatigue, weight gain, hair loss, constipation, dry skin and intolerance to cold but the lab information can potentially apply to both.

Let’s chat about how thyroid function is often assessed vs. the “digging deeper” I prefer. The most commonly ordered lab test is TSH. TSH is a hormone produced by the anterior pituitary in the brain and is the signal that tells the thyroid to produce hormones, T4 and T3. If the thyroid isn’t producing enough hormone, TSH increases because it needs to get louder to try and get the thyroid to respond and eventually can = hypothyroid. If the thyroid is producing too much, TSH production decreases and gets “quiet” which = hyperthyroid. 

TSH is a good place to start but doesn’t always tell the full story. I like to expand testing to include T4 and T3 for a few major reasons: 

  • You can have a normal TSH but low T4
  • There can be a normal TSH AND normal T4 but abnormal T3. This scenario is important because T3 is the active hormone or what I like to call the “work horse” when it comes to thyroid function and metabolism. 
  • There are therapies that don’t necessarily involve thyroid medication that help improve both situations above, but you have to know these issues exist in order to address them. 

No matter the TSH levels, I also like to assess thyroid antibodies, specifically thyroid peroxidase (TPO) and thyroglobulin. These lab markers are a big deal if positive, showing autoimmunity against the thyroid which means the body is attacking itself. This is called Hashimoto’s and ideally should be addressed differently than hypothyroidism from other causes. There are many cases when thyroid antibodies are elevated while hormones levels are normal which provides the ability to treat the autoimmunity and potentially avoid any hormone replacement if caught soon enough. 

Testing doesn’t necessarily end here- there are lots of other areas that can and sometimes should be assessed that indirectly impact thyroid health including adrenal function, sex hormones and GI health. If you’re ready to dig deeper with your hormone health, I’m here to help!