Low Thyroid Symptoms and What You Need to Do about It!
By Dr. Justin Marchegiani
Did you know there are almost 30 million people (mostly women) that have an undiagnosed thyroid disorder (i.e., low thyroid symptoms)? Synthroid or levothyroxine (synthetic thyroid medication) is the 4th best-selling drug on the market, yet with more thyroid medication being prescribed, the problem doesn’t seem to be getting better. Here’s why!
Many people have the following symptoms of hypothyroidism even though their doctor tells them they are fine:
Difficulty losing weight
Cold all the time
Chronic fatigue syndrome
Diffuse hair loss or dry hair
Shortness of breath
Heavy menstrual flow
Muscle or joint aches
If you have two or more of the above low thyroid symptoms and your doctor is telling you you’re fine,Â then this article is for you!
Why Running Your TSH Level Isn’t Enough!
The typical thyroid test your doctor is running is not a good indicator of your thyroid function. Most of the time, the conventional thyroid tests are only looking at TSH (a pituitary hormone) and T4 (inactive thyroid hormone). TSH, time and time again, is shown to be a poor measure of overall thyroid function.
“TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure”Â (1).
Yet nearly every doctor relies on this marker to treat his or her patients. So if your TSH comes back normal, but intuitively you know something isn’t right, what’s your next step? Your next step is to get a comprehensive thyroid assessment so you can see exactly where your imbalances are occurring. Your thyroid can dysfunction in many different ways. Below is a picture depicting all the different things that can affect thyroid function all the way from the brain to the gut.
If you are struggling with a thyroid imbalance and/or need help looking over your lab tests, feel free and reach out byÂ clicking here.
The problem with typical thyroid testingÂ is, the majority of treatment is dictated around TSH levels. Your TSH is a pituitary hormone, not a thyroid hormone. Research has shown that essentially the brain is more sensitive to thyroxine (T4) than the rest of the peripheral tissues are, so it’s possible TSH can drop to a normal level while at the same time, the surrounding tissues have not received their proper fill of T4 yet.
“The serum concentration of thyroid stimulation hormone is unsatisfactory as the thyrotrophs in the anterior pituitary are more sensitive to changes in the concentration of thyroxine in the circulation than other tissuesâ€¦It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement” (2).
The question begs to be asked, “Are we treating a lab test or the patient?” The more we use a series of lab tests with other subjective and objective markers in the care plan, it’s my belief the patient will start getting better faster.
Lab Tests That Are Essential to Properly Evaluate Thyroid Function
I also recommend running total and free T4, total and free T3, thyroglobulin, reverse T3, and T3 uptake. Itâ€™s important to assess the bodyâ€™s ability to convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone). Any time we see a normal level of T4 followed by a low level of T3, we know there is a conversion issue. On a conventional thyroid test, T3 would never be assessed, and you would probably slip through the cracks of the medical system with an undiagnosed hypothyroid.
It is important to assess the levels of free fractions of thyroid hormones because those are the only hormones available to the receptor sites. Only 2% of hormones are free, meaning that they are bound to a protein carrier and are, therefore, free to bind to a receptor site and create a metabolic response. About 98% of thyroid hormone is protein bound, so running both free and total thyroid hormone gives you a better perspective into the gland’s overall strength, the ability to convert T4 to T3, as well as the ability for thyroid hormone to bind to receptor sites.
Euthyroid patients receiving thyroxine (T4) replacement have higher serum thyroxine and free thyroxine concentrations than normal euthyroid subjects. This is not so for serum triiodothyronine and free triiodothyronine (T3) concentrations (2).
As you can see above, even patients that are given thyroid hormone replacement are not guaranteed to convert T4 thyroid hormone (inactive) to T3 thyroid hormone (active). Having adequate levels of T4 can make your TSH levels drop, but it may not be enough to ensure your metabolically active thyroid hormone (T3) is adequate.
Did you know 90% of all thyroid conditions stem from an underlying cause of auto-immunityÂ (3)? Essentially, the immune system produces various antibodies that attack the thyroid tissue. Thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) are produced in Hashimoto’s thyroiditis, which is an autoimmune condition that causes hypothyroid function over time.
Thyroid-stimulating immunoglobulin (TSI) antibodies or thyrotropin receptor (TSHR) antibodiesÂ are produced in Graves disease, an autoimmune condition that causes hyperthyroid function.
At a minimum it’s important to ask your doctor to run TPO and TG antibodies to see if your thyroid condition is autoimmune in nature. Most medical doctors resist running these antibodies because it doesn’t change conventional protocol.
From a functional-medicine paradigm, itâ€™s important to know if you are autoimmune because it changes the overall approach to how the thyroid is treated. Any time any autoimmune condition is present, the focus needs to more on the immune system and the gut and less on the thyroid or injured gland.
Most Important Lab Tests
TSH: Pituitary hormone that signals the thyroid to make T4, a poor marker of thyroid status unless elevated.
Total T4: 98% of T4Â thyroid hormone that isÂ inactive and protein bound.
Free T4: 2% of T4Â thyroid hormone that isÂ active and freely bound.
Total T3:Â 98% of T3 thyroid hormone that is inactive and protein bound.
Free T3:Â 2% of T3Â thyroid hormone that isÂ active and freely bound.
Reverse T3: Sign of a stressed physiology and a slower metabolism.
Thyroglobulin: Increases with BCPs (birth control pills) and higher levels of estrogen, decreases with elevation in testosterone like in polycystic ovary syndrome (PCOS).
T3 Uptake: How much active thyroid hormone is taken up by the receptor site. Elevated uptake can be a sign of higher levels of testosterone, commonly cause by PCOS in females. Low uptake can be caused by elevations in estrogen primarily seen by BCPs.
TPO antibody: 70% of autoimmune patients are positive for TPO.
TBG antibody: Less likely positive but should still be tested to rule out autoimmunity.
TSI antibody/thyrotropin receptor antibodies: Autoimmune condition that causes hyperthyroidism or Graves disease.
There are some excellent calculated ratios that you can perform that can provide additional data points to assess your overall thyroid function.
Most Important Calculated Ratios (4)
TT3/rT3 Ratio: 10â€“14
rT3/free T3: Ratio 20â€“30
â€œThe T3/rT3 ratio is the most useful marker for tissue hypothyroidism and as a marker of diminished celÂlular functioningâ€ (4).
If you would like to schedule a brief complimentary consultation to review your options and order the above lab tests, appointments can be made online by clicking here.
1. British Medical JournalÂ PMC143526.
2.Â British Medical Journal PMC1341585
4. The Journal of Clinical Endocrinology & Metabolism 2005; 90(12):6403â€“6409