Thyroid Function & Testing

   

If you’re having trouble losing weight, feeling low on energy and stamina, have a goiter, have aches and pains (especially in the hands, feet, shoulders and neck areas), vacillating between hot and cold all day, having night sweats or hot flashes… have fat deposits on your body (upper arms or neck area or high back), then your thyroid AND adrenal glands are simply not functioning like they should at optimal levels…. despite what any “normal” or “standard” blood testing is showing when you go to your regular medical doctor!

The classic signs of a sluggish thyroid gland are weight gain, lethargy, poor quality hair and nails, hair loss, dry skin, fatigue, cold hands and feet, and constipation — these symptoms are relatively well known.

However, some of the conditions you might not associate with your thyroid include:

  • High cholesterol
  • Irregular menstruation in women
  • Recurring UTI’s / bladder infections
  • Infertility & Low libido
  • Gum disease
  • Fluid retention
  • Skin conditions such as acne and eczema
  • Memory problems
  • Poor stamina
  • Cardiovascular irregularities (high or low blood pressure)
  • Sinus issues and allergies worsening
  • Diabetes

Most people with any of the above symptoms have either been told by their medical doctor that their thyroid is just fine… or worse… the doctor never looked at the thyroid gland’s production (or lack of production) as the possible CAUSE for any of the above symptoms.

Your thyroid plays a part in nearly every physiological process. When it is out of balance, so are you. This is why it is so important to understand how your thyroid gland works and what can cause it to go wacky.

Every process that goes on inside your body requires ENERGY. When the body doesn’t have enough energy to function properly, each component of the body will malfunction in its own unique way. For example, if the brain has too little energy, thought processes such as memory and focus become impaired. Most “thyroid” people have low body temps. They might run as low as 96.0 or 97.5… Your body operates at an optimum temperature of 98.6 – if your temp goes lower than that, energy is impaired throughout your entire body, even by a few degrees.

FIRST LINE OF DEFENSE:

Your thyroid gland is located in the front of the lower part of the neck. Amazingly all the blood in the body passes through the thyroid gland every 17 minutes. The gland’s secretion of iodine kills weak germs that may have entered the blood through an injury to the skin, the lining of nose or throat or through absorption of food from the digestive tract. Strong, virulent germs are rendered weaker during their passage through the thyroid gland. With each 17 minutes that rolls around they are made still weaker until finally they are killed off IF the gland has its normal supply of iodine! If it does not, it cannot kill harmful germs circulating in the blood as Nature intended it to do! This is why individuals with lower functioning thyroid develop sinus issues that never clear up, have numerous infections, impaired gut function, etc.

HOW THE THYROID WORKS:

The word “THYROID” originally meant “SHIELD”… and it looks like a shield or butterfly at the base of your neck. Your thyroid gland gets its original communication to go to work from the pituitary gland in the brain. It works like this:

The pituitary gland sends out TSH (thyroid stimulating hormone) to “stimulate” the thyroid gland and tell it to go to work. If your TSH is high this means that the pituitary gland is YELLING at the thyroid gland in order to get it to do ITS job! (Kind of like a boss who is yelling at an employee to get them to do their job.)

Once the thyroid is stimulated by the TSH coming from the pituitary it then produces T4 (thyroxine). T4’s job is to convert into two more thyroid hormones:

T3 (Free triiodothyronine) and Reverse T3. 

FREE T3 operates in your body like the accelerator for your car. Reverse T3 operates like your brakes! 20% of the Free circulating T3 in the body comes directly from the thyroid gland… the remaining 80% of T3 in the body comes from the conversion of  T4. (Hmmmmm…. Are you starting to get a clue as to what might be going on in YOUR body?)

60% of the time I see clients who are making too much Reverse T3 and not enough Free T3… they’re braking more than accelerating! The energy of their cells and their entire metabolic rate is put on “SLOW!”

Their T4 is converting into too much Reverse T3!!! This is a key piece of the puzzle. Most medical doctors (including endocrinologists) never look at – much less monitor – the ratio between Free T3 and Reverse T3!

In comparing T4 and T3… I want you to know a few key points… T4 and T3 are the two MAIN hormones… we get that. But… T3 is up to 8+ times as strong as T4, AND it is biologically more active! One doctor explained it like this: T4 is like the food in your refrigerator, while T3 is like the food on your plate ready to eat and Reverse T3 is the food thrown in the disposal!

 HOW DO MEDICAL DOCTORS “TREAT” YOUR THYROID PROBLEM?

If you’ve been taking Levothyroxine or Synthroid… you’re taking T4 only. Your doctor is most probably monitoring your TSH only (in some cases they might monitor T4 along with the TSH). No one is bothering to look at the real true FUNCTION of your thyroid system.  Your doctor is ASSUMING that your body is converting T4 into enough FREE T3 to do the job. (We all know how much trouble we get into when we “ASSUME” anything!!!!)

 “Literally millions of people (men and women alike) suffer months or years with thyroid conditions that could have been easily reversed with proper testing and natural handlings. It’s estimated that 13 million cases of thyroid dysfunction go undiagnosed each year, and inadequate thyroid testing is a big reason for this failure.” – Dr. Marie

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 So why is this happening? Most doctors rely ONLY on the TSH marker to diagnose and manage thyroid disease.

First… This is completely inadequate and just one of the four needed markers to establish a correct interpretation and analysis of your thyroid function. TSH stands for “Thyroid Stimulating Hormone” … it is produced by the pituitary gland (located at the base of your brain). The purpose of this hormone is to leave the pituitary and stimulate the thyroid into action.

Second… Medical doctors use the lab ranges (referred to as “pathological” or disease ranges) that come with the test results, instead of utilizing functional ranges, which have been carefully researched and formulated as better parameters of good thyroid health.

The lab ranges are simply the averages of all the people who have had blood work analyzed by that lab in the last year. They are so called “normal” or “healthy” places to be but are actually statistical averages. Different labs can and do have different reference ranges. It is common to have a test result come back “normal” from one lab and “out of range” for another lab. In truth, if your lab values are within the set reference range, you are within the “average,” and not necessarily healthy.

Like all of your endocrine glands (ovaries, testacies, adrenal glands, pituitary, hypothalamus, etc.) the thyroid does not exist independently of other glands. The thyroid is a part of the HPT axis (hypothalamus, pituitary, thyroid) and as such is under the influence of several hormones and feedback loops. Additionally, the thyroid is linked to the adrenal glands and can be greatly affected by the body’s responses to stress.

As an example of this, it’s well established and known that increased levels of adrenal hormones such as cortisol, can inhibit TSH release by the pituitary, and inhibit the conversion of T4 into T3, which takes place in the liver.

If you go to your local endocrinologist or internist… he or she will most likely ONLY order the TSH (thyroid stimulating hormone) test as they consider this to be the “gold standard” in checking thyroid status. Again, let me state this… TSH is NOT a thyroid hormone!!!! TSH is a pituitary hormone sent out by the pituitary gland to stimulate the thyroid into action. Testing ONLY that would be like the doctor calling your spouse to find out how YOU are doing???? Would you really want your medical doctor to rely solely on what your spouse said about you???? I think NOT!

The key factors in analyzing your full thyroid function or to determine if your current thyroid mediation is even helping you correctly is to check not ONLY the TSH but Free T4, Free T3, Reverse T3, as well as antibodies like TPO (thyroid peroxidase antibodies) to help detect any autoimmune thyroid disease. The TSH, Free T3, Free T4 should all be run as a minimum for follow-up testing and monitoring.

If you don’t test these markers all at the same time, then you and your doctor are running the huge risk of missing the fact that you might be having sub-normal levels of T4 and T3 and /or antibodies that show your thyroid gland is in a self-destruct mode from an autoimmune attack.

If your doctor is monitoring ONLY the TSH he is forcing you into a “reference range” from the lab that is based on a bell curve of other sick people in your area… not based on how YOU are feeling and operating at all!

TSH is considered by most labs and medical doctors to be “in range” and ok if you are anywhere between .35 – 4.5.

First… that is a huge range. And how you feel at .40 is totally different than at 3.9!

Second… we know in the holistic field after looking at hundreds of thousands of people that any level above 2.0 is considered suspicious for “subclinical” hypothyroidism.

Third… if you are taking a desiccated thyroid hormone like Armour or NP thyroid or Naturethroid that contains T3 in it or a compound that contains T3… your TSH may be suppressed to almost zero.

Many doctors assume that if the TSH is low… it means you are being “overdosed” and need to decrease your hormone dosage! That is NOT correct!!!!  Monitoring TSH alone will cause your medical doctor to grossly under-dose you leaving you feeling horrible (high cholesterol, aches and pains, weight gain, anxiety, heart palpitations, etc.).

Again… checking EVERYTHING is vital to monitoring your thyroid function or your thyroid dosage of hormones:

  1. Free T4 (Free Thyroxine)is used to measure the amount of free (active) T4 in the blood. It is high with hyperthyroidism and low with hypothyroidism. The Free T4 test measures the available amount of the T4 storage hormone available to be converted into T3, the active thyroid hormone. While the reference range at many labs runs from .8 to 2.8 ng/dL, integrative physicians and holistic practitioners have found that most patients feel best when their level falls into the top half of the range, at a level of 1.3 or higher.
  2. Free T3 (Free Triiodothyroxine)measures free T3 hormone and is the best marker for measuring active thyroid hormones available to thyroid receptor sites. Free T3 measures are more clinically relevant than Total T3 measures. Decreased FT3 measures are one indicator of low thyroid activity. While the reference range at many labs runs from 2.3 to 4.2 pg/mL, integrative physicians and holistic practitioners have found that most patients feel best when their level falls into the top half of the range, at a level of 3.2 or higher, and in many cases, at 3.7 or higher.
  3. Reverse T3is a measure of the amount of T4 that is converted into a biologically inactive form of the T3 hormone. Integrative physicians have found that elevated levels (above 16) of Reverse T3 may suggest that thyroid hormone is not properly converted from T4 into T3, for use by the cells, and may result in hypothyroidism symptoms despite otherwise “normal” levels of Free T4, Free T3 and/or TSH.

A combination of the serum levels of TSH, free T3, free T4, reverse T3, (and  ideally anti-TPO antibody, antithyroglobulin antibody and SHBG) should be used in combination with paying attention to HOW the client is feeling and functioning in life to most accurately determine the overall thyroid status.

In my opinion simply relying on TSH to determine the thyroid status of a patient or client demonstrates laziness and a lack of understanding of thyroid physiology and is not good evidence-based medicine. Don’t let your medical doctor hold you hostage to an old antiquated way of monitoring your thyroid function. Be responsible and get with a doctor/practitioner who understands this and is willing to support your whole body naturally.

WHAT IS THE DIFFERENCE BETWEEN T4 AND FREE T4 TESTS?

The thyroid gland makes T4 in response to thyroid-stimulating hormone (TSH). TSH is made by the pituitary gland in your brain.

T4 is found in the body in 2 forms: free T4 and bound T4. Free T4 travels into body tissues that use T4. Bound T4 attaches to proteins that prevent it from entering these tissues. More than 99% of T4 is bound. Because T4 is converted into another thyroid hormone called T3 (triiodothyronine), free T4 is the more important hormone to measure. Any changes show up in T4 first.

July 2014: An important paper published in Clinical Endocrinology Journal

Thyroid UK advisors Rudolf Hoermann, John E.M. Midgley and Johannes W. Dietrich published a research paper in the Clinical Endocrinology Journal. Dr John Midgley tells us: “What it proves is that there is no such thing as a TSH range that is suitable for everyone, and that the range is different according to the effect of independent influences such as age, body mass, size of working thyroid volume and whether someone is on T4 or not. The T4 therapy range is very much lower than the “normal” untreated and sits around the 1 or lower mark. The 3-4 upper level that works for the normal person is not satisfactory and can indicate under-treatment. Also we’re finding that people with no thyroid working at all cannot easily regain normal FT3 with T4 alone and that TSH suppression often has to happen, and in some people no amount of T4 will regain normal FT3 levels. Recent reviews by the gurus now admit that some people cannot handle T4 only and regain health. Just thought you’d like to know that the avalanche is beginning.”

WHAT ARE YOUR THYROID HORMONE SUPPLEMENTATION OPTIONS?

Two thyroid hormones — T3 and T4 — are what control the metabolism of every cell in your body. But their delicate balance can be disrupted by nutritional imbalances, toxins, allergens, infections and stress. If your T3 is inadequate, either by insufficient production or not converting properly from T4, your whole system suffers. So which do you take? T4 or T3? Or Both? Let’s take a look.

 Synthroid or Levothyroxin– a totally synthetic version of T4. This is not truly a hormone but a drug. Big difference. It is a SYNTHETIC thyroxine (T4) therefore it is NOT bio-equivalent to the natural hormone your body normally should be producing. This is the 4th most prescribed medication in the United States and in over 90% of the cases it actually worsens a thyroid condition because the synthetic T4 will compete with a body’s natural T4 and create total confusion in the body. Your body also has to try to convert a synthetic T4 into natural T3… how in the heck can something “un-natural” create something natural? It can’t. And no one bothered to ask that before to any doctor!

If a client is on T4 only treatment at least make sure that they are getting the name brand not the generic! We have seen a HUGE difference in how clients feel taking name brand.

It’s also imperative that anyone on T4 also include T3 (Cytomel) into their “treatment plan”. T4 and T3 can also be compounded together at any good reputable compounding pharmacy.

Tirosint is another synthetic option for thyroid clients. This prescription differs from Synthroid in a few ways: Tirosint is in liquid form contained in a capsule so it might be absorbed easier and better than Synthroid since it is NOT affected by gastric acid changes. Tirosint also has no artificial ingredients, gluten nor lactose whereas Synthroid does contain talc, lactose and confectioner’s sugar and color additives. Some clients are unwilling to switch their Synthroid to all natural desiccated hormones like Naturethroid but should consider switching to Tirosint since it has less contaminants and toxins. Tirosint is T4 only and many clients still need to add in a bit of T3 (Cytomel). Ensure you work with a practitioner who understands how to dose and monitor these.

Natural Desiccated Thyroid hormones – like ARMOUR or NP Thyroid or NatureThroid that are a combination of T4, T3 and T2 made from desiccated, or dried, animal thyroid. Desiccated (dried) thyroid is a thyroid hormone replacement drug, prepared from the thyroid gland from pigs or cows that are 100% pasture fed from New Zealand. Some of the brand names including Armour Thyroid, Nature-throid, and Westhroid or NP Thyroid. Desiccated thyroid is a prescription drug, and it’s regulated by the FDA. It has been on the market and safely used for more than 100 years. Until synthetic thyroxine (also known generically as levothyroxine, with brand names including Synthroid, Levoxyl, and Levothroid) was introduced in the 50s, desiccated thyroid was the only thyroid hormone replacement medication. These are virtually identical to the normal human T4 and T3. Studies show that individuals taking NDT (natural desiccated thyroid like Armour or Nature-Throid) showed greater improvements in mood and brain function compared to those on synthetic SYNTHROID (T4 only).

 Thyroid Glandulars – depending on the severity of your situation you might be able to utilize thyroid glandulars from porcine sources that are organic and “hormone” free. You would need to work with a natural practitioner to insure proper usage of this substance. We have seen numerous clients do great with this as an option as a first step prior to utilizing NDT.

 How do you know if you’re on enough thyroid hormone?

Before labs were developed, doctors successfully treated hypothyroid patients by symptom elimination. Today, patients and many wise doctors still find symptom elimination an ideal way to treat.

After starting supplementation of thyroid hormones we look for ALL of the following: the complete removal of our hypothyroid symptoms, an afternoon temp of 98.6F/37C, a morning before-rising temp of 97.8 – 98.2 (held under arm ten minutes with a liquid thermometer if you are imitating what Dr. Broda Barnes did), a good heart rate and blood pressure, lower cholesterol, plenty of energy and more positive signs.

We also discovered over the years that when optimal and feeling pretty good (and in the presence of good cortisol and good iron, which is crucial to get the benefits of NDT), our free T3 is towards the top of the range, and free T4 is midrange.

Note: if your free T3 is at the top of the range and you still feel horrible, or have hyper-like symptoms, time to re-test your iron (with blood) and cortisol levels (via saliva, NOT blood). Problems with either will cause T3 to pool high in your blood and not get to your cells well. Fixing the gut is also important. This means fixing your diet and removing any and all food allergies or food sensitivities. Removing anxiety (stress) in your life might also be called for. So many times, a client feels that their thyroid hormone is causing their anxiety when in fact it’s life in general. Or maybe the client really does need to try a different form of T4 and T3… we certainly have seen clients “allergic” to or “sensitive to” Armour or Naturethroid or Synthroid or a generic form. The bottom line is you need to work with someone who truly understands that will help you find the right form and dosage so that you will be symptom free.

Do I take it once a day? Most do just fine taking their natural thyroid hormone first thing in the morning… but interestingly enough many clients have found it beneficial to divide their dose to at least twice a day in order to spread the energy-giving effect of T3.  Desiccated thyroid contains direct T3, which is short-lived, and which peaks about 2 hours after you take it. An example is taking 2/3 or your natural desiccated thyroid in the morning, and the other 1/3 in the early afternoon. Your own thyroid, if healthy, would have given you what you need throughout the day instead of one dump; thus, multi-dosing is a way to replicate that. Again… you have to find what works for you.

What do you do if your Free T4 looks fine or even a tad low but your Free T3 is high?

This phenomenon is what we call “pooling”. Pooling means your free T3 isn’t making it well to your cells, and instead, is hanging out in your blood, going higher and higher as you raise your T3-containing medication like Cytomel or natural desiccated thyroid (Armour or Naturethroid). You may or may not know it’s happening at first. But sooner than later, pooling ends up promoting excess adrenaline and hyper-like symptoms as a result. It seems to also eventually result in higher RT3 if you keep raising NDT in the presence of low iron or a cortisol problem. It will be VITAL for you to do a saliva hormone test to check your adrenal function and a full fasting iron serum test with Ferritin.

What are symptoms patients experience due to pooling, which pushes excess adrenaline? 

They are individual, but we noticed symptoms such as anxiety, panicky feeling, shakiness, heart palpitations, higher heart rate, higher blood pressure, etc.  Other issues can cause those excess adrenaline symptoms, too, but we do notice them when pooling, too.

What causes pooling?

 For most thyroid clients, it’s caused by: inadequate levels of iron, and/or a cortisol problem, whether too low, or too high. Also accompanying pooling sooner or later, and if you are using Natural Desiccated Thyroid or T4 in your treatment, is rising Reverse T3 (RT3)–the inactive hormone that if in growing amounts, contributes to the “pooling” since it’s competing for the same cell receptors as T3, and blocking the door! T4 in higher amounts converts to RT3 if you have an iron or cortisol problem! Getting both a saliva hormone test and a full iron panel with Ferritin done is important.

Do I HAVE to take my thyroid medication on an empty stomach before breakfast?

Quick answer… NO! You CAN take Natural Desiccated thyroid or T3 with food and many clients have done so for years successfully! You will need to avoid taking your thyroid meds with iron supplements calcium supplements, or estrogen(creams or oral) supplementation. Wait at least 4 hours. So taking your thyroid meds with breakfast and/or afternoon snack or even at bedtime should be just fine!

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