guest post by Jill Grunewald, Holistic Nutrition Coach, AADP, Healthful Elements
I wish I had a dollar for every time one of my clients said, “My doctor tested my TSH and he/she said that my thyroid is fine, but after reading your symptoms list, I’m thinking that I still have a thyroid problem.” Really, your doctor said that your thyroid is fine? Then why are you so exhausted and moody? Why is your hair falling out and your estrogen high? Why are you putting on weight? Why are you having a hard time losing weight despite your best efforts? Why are you lethargic, not sleeping well, and so sensitive to cold? Why do you have unexplained soreness and stiffness and have mad cravings? Among other problems?
One of my past client’s doctor dubbed me “parasitic and predatory” when my client showed this doctor the full list of thyroid labs I gave her (listed below) and the doctor emphatically stated that TSH was the only test my client would need. Wow.
Herein lies the big honkin’ problem with conventional thyroid “treatment” and all of the people running around fried, exhausted, and overweight. True, being fried, exhausted, and overweight can be the result of other issues, but often times, it’s a thyroid problem that many doctors are clueless about how to investigate. By using old guidelines and limited thinking, conventional medicine glosses over the millions who suffer with low thyroid function (hypothyroidism).
If the thyroid is our master gland of energy and metabolism, and you’re fatigued and overweight, you owe it to yourself to completely rule out hypothyroidism by getting the full range of labs performed by a doctor who is open-minded, understanding, and well-informed, not myopic and condescending. You can also perform a BBT test at home.
When it comes to thyroid labs, most doctors only check thyroid-stimulating hormone (TSH), which does not give a full picture of how the thyroid is functioning. Its nickname is Thyroid Stimulating Hooey (thanks, Janie Bowthorpe) and many doctors are married to it as the single indictor of thyroid function. TSH tells you how your pituitary gland is talking to your thyroid, but tells you nothing of overall thyroid function. In fact, even the interpretation of this test is incorrect most of the time.
Truth be told, TSH isn’t wholly irrelevant, but it tells only part of the story. TSH increases when thyroid function drops, and decreases when the thyroid is working. So you want low TSH. Many doctors believe that anything over 5.0 or sometimes even 10.0 is worth treating (WTF?). However, according to many functional medicine doctors, anyone with TSH over 3.0 is hypothyroid. Some doctors claim that women tend to feel best with TSH between .3 – 1.0.
But … “normal” or “low” TSH doesn’t necessarily mean that you aren’t hypothyroid. TSH is simply not the end-all-be-all for thyroid testing.
The list below includes the two tests for thyroid antibodies that would indicate the presence of Hashimoto’s, an autoimmune thyroid condition. Getting doctors to recognize a thyroid problem, run the proper tests, know how to interpret those labs, and treat adequately is often challenging in that it may require a change of doctors and a new way of thinking. Add to this the fact that most doctors know little about how to treat an autoimmune condition, including Hashimoto’s, and patients’ hypothyroidism can still be mistreated.
There is no drug, no pharmaceutical for any autoimmune condition. So even if a doctor knows what Hashimoto’s is, many won’t run the tests for it because their course of treatment wouldn’t change. They would do nothing differently for their patients. Most will tell you that autoimmune conditions are lifelong conditions. Not necessarily true. You deserve to know if you have thyroid antibodies, which indicates thyroid tissue attack. If you have Hashimoto’s, and you’re simply trying to mask symptoms with drugs, you’re barking up the wrong tree. Thyroid drugs can replace missing hormone, but they’ll never heal the thyroid.
Sometimes, doctors will run one antibody test without the other. What good does that do? If you end up getting tested for the antibody that you don’t have, it can be interpreted that you don’t have Hashimoto’s, when in fact you might. So it’s critical to have both tested.
“Another reason doctors don’t want to connect thyroid disease with weight gain is that they simply don’t understand very much about nutrition, metabolism, and the thyroid. They know the basic symptom list, they know how to do a thyroid stimulating hormone (TSH) test, and they know how to write prescriptions. But they don’t know about nutrition. You’ve heard the old bromide about how most doctors spend about an hour on nutrition in medical school. Well, in addition to that hour, they spend a couple of hours on thyroid disease, and that completes their education on nutrition and metabolism. The complexities of the endocrine system, the delicate interplay that goes on between hormones, the brain, the stomach, the appetite, and the ability to store and burn fat, are not topics most doctors have studies or even understand.” – Mary Shomon
I’ve placed an asterisk next to the labs I feel reveal the most about thyroid function:
T3 (or Total T3) – This is the “big daddy” of thyroid hormones, affecting almost every physiological process in the body, including heart rate, growth and development, body temperature, and metabolism.
T4 (or Total T4) – Not that important, in my opinion. T4 is nicknamed “the storage closet.”
* Free T3 (or FT3) – Again, T3 is the “big daddy”, and the “free” in front of the T4 and T3 tells you what is available and unbound and therefore usable by the body. Without the “free,” the labs are only measuring the total of what’s there, which tell you nothing about what is available for use.
Free T4 (or FT4)
* Reverse T3 (or RT3) – Can block thyroid receptors and cause patients to be unresponsive to any thyroid hormone.
TSH (thyroid stimulating hormone)
* TPOab and TgAb (Thyroperoxidase antibody and Thyroblobulin antibody) – These are the two thyroid antibodies tests. Positive antibodies confirm autoimmune thyroiditis (Hashimoto’s), although some doctors say that antibodies less than 30 are “indications” of Hashimoto’s and don’t point to a raging case of Hashimoto’s. I still feel that it’s best to treat low levels of antibodies the same as if they were higher so that people aren’t on the slippery slope of increased autoimmunity.
Important: Unfortunately, low or no thyroid antibodies doesn’t necessarily mean that Hashimoto’s isn’t present. Some people’s systems are fatigued to the point that antibodies aren’t circulating in the blood, even though they do have thyroid tissue attack (thyroid autoimmunity). So antibodies tests can provide a false negative.
It’s important to compare lab results with functional reference ranges vs. the old, outdated, conventional reference ranges that so…many…doctors are still using. Here are the functional ranges, as shared with me by Dr. Laura Thompson of the Southern California Institute for Clinicial Nutrition:
Again, I’ve placed an asterisk next to the labs I feel reveal the most about thyroid function:
T3 (or Total T3): 100 – 180 ml/ul
T4 (or Total T4): 6 – 12 ug/d
* Free T3 (or FT3): 2.0 – 3.0 pg/ml
Free T4 (or FT4): 1.0 – 1.5 ng/dl
* Reverse T3 (or RT3): 90 – 350 pg/ml
* TPOab and TgAb (Thyroperoxidase antibody and Thyroblobulin antibody) – A positive antibodes test indicates Hashimoto’s (autoimmune hypothyroidism).
Jill Grunewald is a Minneapolis-based Holistic Nutrition Coach and health and wellness writer. She graduated from the Institute for Integrative Nutrition in 2006 and in 2008, was diagnosed with Hashimoto’s thyroiditis (autoimmune hypothyroidism). Jill is now in unmedicated remission, having incorporated only whole foods nutrition, botanicals, and lifestyle-based therapies to treat herself. Her health coaching practice focuses on teaching women with these same conditions how to emerge from the fog and regain their vitality with sound nutrition and other natural remedies. Learn more about Jill and her services at www.healthfulelements.com. Also, connect with her on Facebook and Twitter.