Let’s Talk Thyroid

Why is everyone talking about thyroid?

Ok, maybe in your world people do not always talk about this important hormone, but in my world it comes up a lot! Let’s review this precious hormone and see why it gets a lot of attention, especially amongst women.

What does my thyroid gland do?

The thyroid gland is one of your main metabolic hormone producers. It makes two hormones called T4 and, to a lesser extent, T3. These hormones energize every cell in your body (woo hoo!), in all of your organs from your brain to your uterus. Being HYPOthyroid means you have less of those energizing hormones being produced (boo). 

What are the symptoms of Hypothyroidism?

Less thyroid hormone means things sssslllllooooowwwww down. Women will often admit to  noticing::

  • Fatigue
  • Lethargy
  • Lack of motivation
  • Depression
  • Easy weight gain
  • Difficulty losing weight
  • Constipation
  • Swelling or puffiness in the face or around the ankles
  • Irregular periods
  • Infertility
  • Miscarriage and/or recurrent pregnancy loss

And this is the SHORT list!

It’s important to know that these common symptoms overlap with MANY other medical issues, so just because you have one or two (or most) of the symptoms on this list does not mean you have thyroid disease. Even though it’s common, hypothyroidism is not always the right answer.  At some point every year, I swear I have a slow thyroid. I get my thyroid panel run and it always looks excellent. This is great news, but I’m always secretly disappointed. I know, that’s weird. It would just be so easy!! Women tell me this a lot. I understand.

Anyhow, there is a tendency to overdiagnose hypothyroidism, especially in the alternative medicine community. This can be dangerous, especially if women are put on thyroid medication unnecessarily. Being overstimulated on thyroid meds can damage the heart and accelerate osteoporosis (bone thinning). 

What are the causes of hypothyroidism?

The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis. That sounds scary. Don’t worry, it’s not. We’ll break that down in the next post. 

Other common causes include genetics (it is very common to see thyroid disease in families, particularly amongst the female line) and big hormone changes like puberty, pregnancy and menopause. Unregulated stress and poor nutrition can decrease your thyroid hormone production and another common cause is simply aging. 

How is hypothyroid diagnosed?

A simple blood test is used to diagnose hypothyroidism. In conventional medicine (this includes most General Practitioners and Primary Care Providers), a TSH is run as a screening test for thyroid dysfunction. 

An elevated TSH is considered abnormal. This is confusing–why would the TSH be HIGH if I have LOW thyroid function? TSH is Thyroid Stimulating Hormone and comes from the brain. It literally stimulates the thyroid (hey, great name!) to make thyroid hormone. I like to think of TSH as a volume control. If the brain and thyroid are communicating in a healthy way, the volume is on the low end. If the thyroid gland is starting to struggle to produce hormone and is slowing down production, the brain turns the volume of TSH up (it stimulates the thyroid MORE) and the TSH goes up. The brain gets louder and louder and sometimes yells for the thyroid to keep up. We detect elevated TSH in these cases.

What tests should I ask for?

As noted, most GP’s and PCP’s run a TSH screening test only. If it’s normal, you will be told that you do not have thyroid issues. 

Many naturopaths, functional medicine practitioners and endocrinologists have a more narrow range of normal and see that many women struggle with LOW thyroid symptoms when the TSH, although within the lab’s reference range of normal, is not ideal. Given normal vs Ideal, I’ll take Ideal functioning every time!

It’s important to know, though, that TSH can be ideal and you could still have Hashimoto’s. It’s important to get the whole picture. Ask for the following labs and find a practitioner who will order these, if your provider will not.

  1. TSH (thyroid stimulating hormone)
  2. Free T4
  3. Free T3
  4. Reverse T3
  5. Thyroid Peroxidase (TPO) antibody
  6. Thyroglobulin (TG) antibody

What thyroid lab values should I aim for? What’s ideal?

  1. TSH: you want a value between 1-2. This varies per person, but you definitely want a value less than 2.5. (NOTE: this is still within the lab’s reference range for normal).
  2. Free T4: a value of 1.25 or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid).
  3. Free T3: a value of 3.0 or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid).
  4. Reverse T3: a value less than 15 (NOTE: this is still within the lab’s reference range for normal)
  5. TPO antibody: within the reference range of normal 
  6. TG antibody: within the reference range of normal

I regularly talk to women who have had hypothyroid symptoms for YEARS, sometimes decades, and their labs have always been “normal”. When we recheck, or I review the labs they just had their GP/PCP run, and tell them they ARE, in fact, hypothyroid, there is a mix of emotions and responses: disbelief, anger at having been dismissed, fear at having a new diagnosis, feeling justified and occasional joy at finally finding the answer to why they’ve felt so crappy for so long.

Ready to have a second opinion about your recent thyroid labs? Need a thyroid panel ordered and reviewed?

Give my office a call! 206-525-8012

I’m offering telemedicine (video or phone) visits for all patients, so distance is not a concern.

(If you’re in Washington state, there’s a good chance your insurance will cover our visit!)


Next time we’ll discuss treatment options for Hypothyroid and it’s most common cause, Hashimoto’s thyroiditis. 

Stay tuned~


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