Hypothyroidism is the most common thyroid problem, and Hashimoto’s disease, an autoimmune form of hypothyroidism, is the most common form of all. Women are much more likely than men to have thyroid problems. Hypothyroidism can appear at anytime but is especially common after childbirth and is prevalent in woman during their 40s and 50s.

Yet so many doctors seem reluctant to do an adequate work-up of thyroid function. Some will only order TSH levels and refuse to order some of the more telling markers like Free T3 and Free T4 or the antibodies TPO and TG because knowing this info wont change the way they treat.  If this is the case then you need to find a new Doctor!  There have been many updates in treating Hashimoto’s or Sub-Clinical Hypothyroidism with nutritional approaches and fixing other underlying issues like Leaky Gut, GI Pathogens or stress related hormone dysregulation.  A functional approach to Thyroid health not only helps to address the real issues, but often restores optimal thyroid function without long term medication use.

What is the Thyroid?

The thyroid is a butterfly-shaped gland that sits at front of your neck and sets your entire metabolic rate. Thus it controls your weight, whether you feel sluggish or energetic, mentally crisp or foggy, cheerful or blue, and is involved in the control of everything from your cholesterol to your female hormones.

When your thyroid is not functioning optimally, you can feel dull, tired, constipated, gain weight, your skin gets dry, your hair can become dry and even fall out, your muscles and joints might ache, your periods become irregular, you might have fertility problems, brain fog, sugar and carb cravings (because your body is desperate for energy!), high cholesterol even if your diet is amazing, and a host of other large and small symptoms.

What is Hypothyroidism?

Hypopthyroidism is a term used to describe a decreased metabolic state that is due to inadequate amounts of – or functioning of – thyroid hormone. Ninety-five percent of all cases are due to what is called “primary hypothyroidism.” This means that the thyroid gland is acting sluggish – or sometimes barely responding at all. This can be due to a number of reasons ranging from leaky gut to autoimmune disease.

Alternatively, we can be producing thyroid hormones effectively, but we can have “thyroid hormone resistance” similar to the way we can have insulin resistance. Our cells are not picking up and effectively using the active thyroid hormone we are making. We can also be making enough of the inactive form of thyroid hormone but not be effectively converting it to the active form.

While hypothyroidism can also be due to more serious problems in the hypothalamus and pituitary, this is rare. However, chronic or substantial stress can suppress the pituitary gland enough to interfere with thyroid hormone production.

Symptoms of hypothyroidism include:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Unexplained weight gain
  • Cravings for sugar and carbohydrates
  • Puffy face
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness and stiffness
  • Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Impaired memory (“Brain fog”)

Key Thyroid Tests

There are key tests that can unlock the mystery of your thyroid function and are what we should be looking at to assess Thyroid function.

First we will run just 3 tests (TSH, Free T3 and Free T4) and if these come back borderline or positive for thyroid or thyroid hormone problems, I will then add in the remainder of the tests. At times I also recheck test results for TSH, FT3, and FT4, if normal in a newly symptomatic client, in 6-12 weeks.  I do this because initial testing can be normal while only a short time later the tests come back confirming the problem.

Thyroid Stimulating Hormone (TSH)

Thyroid Stimulating Hormone (TSH) is produced in a part of your brain called the pituitary gland. The job of TSH is to tell the thyroid gland that it’s time to get busy producing more thyroid hormone. When the healthy thyroid gets this chemical message, it produces two hormones: triiodothyronine (T3) and thyroxine (T4),

As a functional practitioner I believe that the upper end of normal is 2.5-3 mU/L. Many integrative and functional medicine doctors find that their patients feel their best at an upper limit of 1.5-2 mU/L.  So this is the first assessment we look at to determine Thyroid function.

In most cases hypothyroidism occurs because the thyroid gland is sluggish – that is, it is having trouble producing T3 and T4. This can be due to a variety of reasons ranging from nutritional deficiencies to autoimmunity. So TSH gets pumped out in a higher amount to try harder to stimulate the thyroid gland into action. However, TSH can be normal in the presence of hypothyroidism in some cases, and you can still be having the symptoms of low thyroid when TSH is normal because of poor conversion of T4 to T3 (see below) or because of thyroid hormone resistance at the level of your cells.

When stress (mental/emotional, physical or biochemical stress can all impact this) is suppressing the pituitary gland enough to interfere with producing TSH, you might see low or normal TSH levels in the presence of low thyroid hormone production (T3 or T4), and hypothyroid symptoms.

Thyroid Hormones (T3 and T4)

Triiodothyronine (T3) and thyroxine (T4) are the hormones produced by your thyroid gland. T4 is produced in a much larger amount and is then converted to T3, the active form of the hormone, as needed to up-regulate metabolic functions. T3 and T4 are sent out into your bloodstream where they are responsible for the thyroid’s actual work of controlling your metabolism. Free T3 (FT3) and Free T4 (FT4) are called this because they are not bound to proteins in your blood, making them free to perform their work in your cells – keeping your metabolism appropriately revved up for your optimal health.

Measuring FT3 and FT4 is important because they are the indicators of thyroxine and triiodothyronine activities in the body. A high TSH and low FT4 and FT3 indicate hypothyroidism. A normal TSH, normal FT4, and low FT3 can indicate T4 to T3 conversion problems, and a normal or high TSH, normal FT4 and high FT3 can indicate cellular resistance to FT3 which can still lead to hypothyroid symptoms because the active hormone can’t get to the cell to do its job.

Thyroid Antibodies

Thyroid antibody testing is ordered to diagnose autoimmune thyroid disease and distinguish it from other forms of thyroid dysfunction.

The two thyroid antibody tests that I order are Thyroid peroxidase antibody (TPOAb) and Thyroglobulin antibody (TgAb). Some people do have an autoimmune thyroid condition but don’t initially test positive. If positive, antibody testing can be repeated every six months to trend improvement while you are working with an integrative physician to address possible underlying causes.

Additional Testing

If labs return showing that there is hypothyroidism, then also looking for deficiencies of selenium, iron, and zinc would be important next steps, while also looking for environmental factors that interfere with iodine utilization.  Fluoride and bromide exposures from water and flame-retardant products respectively would be initial starting points.  If we haven’t already addressed other underlying causes like, gluten intolerance, heavy metal exposure, and other environmental triggers we would explore these areas now as well.

Next Steps

If any of this information is resonating with you, go ahead and contact me thru the “work with me” tab and we can take a comprehensive functional approach to uncovering what’s going on with your Thyroid and overall health.