Let's talk about how to evaluate your thyroid... I talk to people all day long all over the country who know or suspect they have a thyroid issue. They check every box on the symptom list for hypothyroidism... Low energy, weight gain, could sleep ALL day, constipated, cold, dry skin, thinning hair, depression. They may be on Thyroid medication and still feel this way. They may have been told everything looks "fine" with their Thyroid... but is it?
I am breaking down the things you need to look at to know if your Thyroid is indeed "fine". If you have labs, get them out and take a look. The video and picture above show more details, but I wrote it all out also for those who like to see it in writing. Let's dive in.
TSH - This stands for Thyroid Stimulating Hormone. It is acutally a pituitary hormone that tells us if the brain and thyroid are communicating properly. The higher this number goes, the more thyroid hormone the brain is telling the thyroid gland to produce. Hopefully the body needs that. You can look at this and know whether the brain and thyroid are on the same page.
If you have a high TSH, you should have low T4 and T3 hormones. If not, you know you have a breakdown in the Hypothalamus, Pituitary Adrenal (HPA) axis. The optimal level for TSH is 1-3 despite the "Reference Range" being .5 - 4.5
Next we look at T4 and T3 levels. It's important to look at both direct and free levels. Why is that you might ask? Direct is the total amount, but most of the hormone is bound to proteins in blood so it's not free or useable. If you check the free levels you will know how much is available. Most of the time, the direct and free levels paint the same picture, but not always. If you have plenty of direct hormone but not enough free hormone, you FEEL like you are low which is the reality you are living, so you need to find out why so much is bound and why it's not available.
We also need to make sure we have plenty of T4, the inactive form of the hormone, AND enough T3, the active form. It's the active form, T3 that does all the good stuff. Helps us burn calories, stay warm, have good hair and skin, etc. The problem is that we don't always convert T4 to T3. Stress, inflammation, liver dysfunction, gut health issues and nutrient deficiencies in things like zinc, selenium, Vitamin D, B vitamins and other nutrients can leave us struggling to convert. So, we look at levels of both T4 and T3 and then conversion ratios. I often see people with plenty of T4 but low T3. All the Thyroid hormone medication in the world won't help that, because the vast majority of those medications are synthetic T4 only.
Another important marker is Reverse T3. If you can't convert T4 to T3, you may be converting to Reverse T3 instead. Think of Reverse T3 as an "Imposter" form of T3. It's not the good T3 that we need. But, if we eat a low calorie diet, a diet that contains gluten, have stress and inflammation, we can favor this pathway. I think it's important to see if this is happening.
Next we look at Thyroid Peroxidase (TPO) and Thyroglobulin (TG) antibodies. Those are markers that let us know if our body is attacking it's own tissues. TPO antibodies indicate a breakdown of the thyroid gland itself and TG antibodies let us know that we are attacking the transport "busses" that carry thryoid hormone to the tissues that need it. If we have elevated levels of either of those, we know we have an autoimmune situation where the thryoid is the TARGET and not the real problem. This is super important and often overlooked because most doctors don't address the root autoimmune cause. They simply wait until the thryoid is damaged enough to need medication or be surgically removed.
This autoimmune flavor of hypothyroidism is referred to as "Hashimoto's" when the TPO or TG antibodies are elevated and the TSH is out of "Range". The problem is that the autoimmune process is often present for YEARS before the TSH goes out of the traditional "Reference Range" so that by the time it's caught, it's late in the game and substantial damage to the thyroid gland has already occured. If caught early, we can address the underlying causes of autoimmunity and save as much of the thyroid as possible! If missed, many people go on to develop other autoimmune conditions like Rheumatoid arthritis, Ulcerative colitis, Multiple Sclerosis, Lupus or one of the other 150 plus autoimmune conditions with fancy names. Then they end up on medications for those as well.
I hope this helps paint a picture of how to evaluate a thyroid gland. If you want to visit about that please feel free to reach out for a short, free call so I can listen, answer questions and offer to help if, and only if, I truly believe I can help. You deserve a thorough evaluation of your thyroid gland!
To your health!
Dr. Jeni
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