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.
- TSH (thyroid stimulating hormone)
- Free T4
- Free T3
- Reverse T3
- Thyroid Peroxidase (TPO) antibody
- Thyroglobulin (TG) antibody
What thyroid lab values should I aim for? What’s ideal?
- 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).
- 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).
- 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).
- Reverse T3: a value less than 15 (NOTE: this is still within the lab’s reference range for normal)
- TPO antibody: within the reference range of normal
- 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~
Have you recently been diagnosed with Hashimoto’s thyroiditis?
Take a deep breath. Now, do it again.
Let me tell you, it’s going to be OK.
Hashimoto’s is a unique autoimmune condition in that it is not often associated with long term health complications (including COVID 19 risk) and can usually be well managed with a combination of lifestyle change, diet improvements, herbal therapies and often medication. I do not regard my patients with Hashimoto’s as being very sick. It DOES take a lifelong commitment to living a healthier lifestyle, so there’s that, but as long as it is well managed, it is NOT associated with major organ damage or disability as we see with other autoimmune diseases.
What is Hashimoto’s thyroiditis?
Let’s talk about this VERY common (the most common, in fact) cause of hypothyroidism. Hashimoto’s is a condition caused by inflammation of the thyroid gland. It is an autoimmune disease, which means your body forms proteins that attack your own thyroid gland, as if it was foreign tissue. Hashimoto’s actually typically starts as HYPERthyroid function and then, at varying speeds, the gland slows down thyroid hormone production and becomes hypofunctioning.
The term “autoimmune disease” is scary! You probably think of yourself as a healthy person, and now you have a DISEASE? A disease that you’ll have to manage for the rest of your life? This is life changing. How did this happen? What did you do wrong? What does this mean about life moving forward? Am I at greater risk of COVID 19? How do I treat it? What are my options?
Take another deep breath, friend.
Why do I have Hashimoto’s? Where did this come from?
Hashimoto’s, like other autoimmune diseases, seems to run in families. It is most common in middle aged women (hi there!) but we also diagnose it in younger and older women as well as in men and kids, too. According to conventional literature, the underlying cause of the autoimmune process remains unknown
I often see Hashimoto’s diagnosed around times of big life events or stressors like pregnancy, perimenopause and trauma to name a few. There is some interesting info that it can be triggered by chronic infections like Lyme or EBV, by certain dental procedures, like root canals, and even by certain breast implants.
Most physicians don’t put much work into understanding why the autoimmune process has started. I have to admit that I often overlook this, too, as it seems like the important piece is helping women feel their best while managing the condition. In my practice, I may think about the underlying cause when the treatments that should work aren’t working. Admittedly, I should do better.
What tests should I ask for?
Most GP’s and PCP’s run a TSH screening test to diagnose hypothyroidism. Antibodies are rarely run. If the TSH is 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*.
- TSH (thyroid stimulating hormone)
- Free T4
- Free T3
- Reverse T3
- Thyroid Peroxidase (TPO) antibody
- Thyroglobulin (TG) antibody
- Celiac disease antibodies (If you have Hashimoto’s, you have a higher risk of having Celiac disease, the autoimmune disease in which the body attacks the lining of the small intestines whenever the protein, gluten, is eaten. Gluten is found in wheat, rye, barley, spelt, kamut and products made from these. It’s important to know if you have the Celiac disease antibodies before attempting to follow a gluten free diet as blood tests become normal when you stop eating gluten. Many of my patients start this diet on their own prior to meeting with me, and then we have to decide if reintroducing gluten is a good idea. You have to be eating substantial amounts of a gluten-containing product like breads, pastas & crackers DAILY for a minimum of 2 weeks prior to this test in order for it to be accurate. Women often feel improvements in their health from taking out this potentially inflammatory food and the thought of reintroducing it can be down-right scary. Having a Celiac disease test done while you are not eating gluten is NOT going to work; you must be eating gluten when the test is done. Ok, I hope I’ve made my point.)
What thyroid lab values should I aim for? What’s ideal?
This is a recap from a previous post:
- TSH: you want a value between 1-2 uIU/mL. 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).
- Free T4: a value of 1.25 ng/dL or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid). Some lab ranges have a normal of .6 – 1.2; for these labs, I recommend a value of 1.0 or greater.
- Free T3: a value of 3.0 pg/mL or greater (up to the top of the normal range, and not to exceed that or you risk becoming HYPERthyroid).
- Reverse T3: a value less than 15 ng/dL (NOTE: this is still within the lab’s reference range for normal).
- TPO antibody: within the reference range of normal.
- TG antibody: within the reference range of normal.
- Celiac antibodies: all should be within the reference range of normal.
Ok, so in a conventional medical practice, If TSH is abnormal, OCCASIONALLY (but really, rarely) thyroid antibodies are then ordered. If the antibodies are positive, you have Hashimoto’s.
Thyroid peroxidase (TPO) antibody is the most common antibody elevated in Hashimoto’s.
Why wouldn’t doctors want to know if the cause of your hypothyroidism is Hashimoto’s? Conventionally, treatment options do not change. The option you’ll be given is medication and the most common medication recommended is Levothyroxine (generic) or Synthroid (brand).
Next time, we’ll discuss both conventional and naturopathic treatment options for Hashimoto’s thyroiditis, including other medication options (and a hint: we may talk about gluten again…).
hormones, naturally 