In part 1 of this series, I explained what the thyroid is and how it functions within the body. As you now know, there is a whole cascade of events that must occur from your brain to each cell before your body recognizes that your thyroid is functioning well.
So, now of course the question is: Is your thyroid messing with you?
That’s an excellent question because it can seem like your thyroid is the problem based on your symptoms, but it may not be your thyroid that’s the root cause of the problem! After all, lots of symptoms are non-specific and the hormones in the body work in an interconnected web and constantly influence each other. Here’s a very simplified view of what I mean (note: this is not intended to be complete!):
As you can see from part 1 and the diagram above, an entire volume could be dedicated to explaining how the thyroid works and how it interacts with the other systems in the body. There’s no way I can do all of that in a few blogs and no way that you want to read it even if I could!
Instead of attempting what many others have already very successfully done, I’m going to give you the abridged version. I promise it’s enough information to at least get you pointed in the right direction.
How can you tell if you have a thyroid problem?
As with many chronic problems, there is no specific set of symptoms that will definitively indicate that you have thyroid dysfunction. However, we can get lots of clues from our bodies.
These are the common signs and symptoms of hypothyroidism:
- Sluggish Achilles tendon reflex
- Dry, pale or cracked skin
- Coarse, dry and/or thinning hair on your head
- Thinning of hair on the rest of your body, especially the outer third of your eyebrow
- Low body temperature (you feel cold regularly, especially when others don’t) and/or cold hands and feet
- Decreased sweating
- Dry eyes
- Enlarged tongue
- Slow or irregular heartbeat
- Unexplained weight gain (i.e., you aren’t pregnant and haven’t been on an month-long eating binge), especially around your middle that you’re having trouble losing
- Decreased digestion and absorption and generally slowing of the GI tract which may lead to constipation
- Muscle and joint aches and pain
- Numbness and tingling in your fingers and toes
- Thin, brittle fingernails
- Edema / water retention, especially around the eyes and in the ankles
- Menstrual irregularities or heavy periods
- Infertility or poor pregnancy outcomes, like miscarriage or pre-term birth
- Low libido
- Fatigue (mental and physical), especially in the morning, which may be caused by poor mitochondrial function
- Sluggish movement, even of eyelids, or diminished reaction time
- Depression or moodiness
- Lethargy or lack of motivation
- Difficulty concentrating or memory loss
- Sensitivity and susceptibility to toxins, due to decreased phase 2 detoxification capability
These are the common signs and symptoms of hyperthyroidism:
- Inability to gain weight or unexplained weight loss
- Plummer’s nails (separation of the nail from the nail bed at the top of the finger, especially for the ring finger and pinkie)
- Exopthalmos (eyes that sort of bulge out from the eye sockets)
- Intolerance for heat
- Excessive sweating
- Excessive bowel movements, which may seem a bit like diarrhea
- Osteoporosis and increased risk of bone fracture
- Tremors or inward trembling
To determine if your symptoms indicate a thyroid issue, go down each list and count up the number of symptoms that you have. If you have 4 or more symptoms in either the hypo or the hyper list, it is worth exploring further to determine if your thyroid is the root cause.
What labs are available to confirm thyroid performance?
As you saw from the diagram in part 1, a full thyroid lab panel is required in order to determine if your thyroid is functioning properly from beginning to end. These labs include:
- Free T4 (a better indicator than Total T4, although the ratio between the two can be helpful)
- Free T3 (a better indicator than Total T3, although the ratio between the two can be helpful)
- Reverse T3
- Antibodies (Ab) if Hashimoto’s is suspected: Thyroperoxidase (TPO) Ab, Thyroglobulin (TG) Ab
- Antibodies (Ab) if Graves disease is suspected: Thyroperoxidase (TPO) Ab, Thyroid stimulating hormone receptor (TSHR) Ab, Thyrotropin receptor (TR) Ab
If you see a conventional doctor or endocrinologist, it is highly likely that he or she will only test the TSH and maybe the T4 levels in your blood. Essentially they are checking that your pituitary is sending the right message to the thyroid and that the thyroid is producing enough of the inactive hormone.
Important note: Having normal TSH and T4 levels does not mean that your cells are receiving enough T3 and, therefore, you may still have symptoms of low thyroid function.
As well, there may be external forces working on your thyroid like stress or antibodies from your adaptive immune system that may keep your TSH and T4 levels looking normal in this moment, but may be masking subclinical hypothyroidism.
In this state, your thyroid is struggling to keep up, but it’s not easily identifiable through simple blood results. At least it’s not at this point with only the TSH and T4 numbers; it is highly likely that the problem will get worse if an intervention doesn’t occur.
Some examples of other factors are a high amount of thyroid binding globulin (TBG) being produced by the liver, which will prevent the T4 and T3 from being free and available for the cells. Antibodies against your thyroid that are still low level, but are picking away at your thyroid and usually increase in number over time. In fact, an average of 7 years will pass from the first time thyroid antibodies appear in a person’s body to the time that they have destroyed the thyroid enough that a conventional doctor will intervene by giving you hormones to take. Also, the T3 receptors on your cells may not be accepting the T3 hormone that is available.
If you have lots of symptoms that point to your thyroid, but all your thyroid labs are in the optimal range, we can look at other labs also.
Labs not directly related to the thyroid that may suggest that your thyroid is under-performing:
- Low serum B12
- High blood lipids such as LDL, total cholesterol, and triglycerides
- White blood cell differential that suggests chronic inflammation
- High blood pressure
- Low fasting glucose
- Anemia as designated by high MCV and MCH
- Imbalance in blood ions such as high phosphorus and low sodium
- Low iron
Additional labs that may suggest that your thyroid is over-performing:
- High calcium
- High fasting glucose, hemoglobin A1c and/or insulin
- High ferritin
- High liver function enzymes such as alkaline phosphatase and gamma-glutamyl transpeptidase
- Low blood pressure
- Low blood lipids such as total cholesterol and HDL
- Anemia as designated by low hemoglobin and hematocrit
- Low white blood cell count
Important note: As with all lab tests, we are ultimately looking for these numbers to be in an optimal range, not within a “normal” range as designated by the lab. For more on this, check out this video post and this newsletter.
How do I know if it’s actually my thyroid that’s the problem and not something else?
If your TSH and T4 levels are in the optimal range, you do not have any antibodies against your thyroid, and you are not taking any hormone via pill or cream, then your thyroid is performing perfectly (although there may be other problems downstream).
On the other hand, if your TSH levels are too high or too low, then your pituitary gland thinks your thyroid is under- or over-performing.
If your T4 level is too high or too low, then your thyroid is over- or under-performing for some reason. Additionally, if you are taking T4 hormone (ex: levothyroxine), then your thyroid is technically under-performing because you need external help to replace the hormone that the thyroid should be producing. In some situations, the thyroid can be healed to the point that the amount of hormone required is reduced. However, if the thyroid has already been severely damaged, it is possible a person will have to take the hormone for the rest of their lives. In this situation, we work to be sure the rest of the pathway, all the way to the cells, is functioning well.
If your T3 levels are too low and/or your reverse T3 levels are too high, then your liver, gut, muscles, brain, etc. are not doing a good job of converting the T4 to the active hormone. Also, if you are taking a T3 hormone (ex: liothyronine), this means your body is not doing a good job of converting T4 to T3, whether that T4 is being made by your thyroid or you are taking T4 hormone. In this situation, we work to figure out why your body is not converting T4 to T3 and to restore that function.
On the flip side, if your T3 levels are too high, that’s an indicator of hyperthyroidism as it is likely a downstream effect from high T4.
If all your numbers are in the optimal range, but you still have symptoms associated with hypothyroidism, then your cells may not be taking in and using the active hormone. In this situation, we work on ensuring your cells have what they need to take in the hormone and that reverse T3 isn’t getting in the way.
Okay, so I think my thyroid is messing with me. What do I do now?
Well, bummer, we got to this point and you think your thyroid isn’t performing at its best. That stinks since we all want our bodies to work amazingly well. :-/
As I mentioned at the beginning, there are lots of things you can do to get your thyroid back on track… or at least to get the rest of the system performing well, if the thyroid is past repair. So I hope you will hold onto that hope and move forward with the necessary steps to feed your intention to feel amazing!
Here are my suggestions to do that:
- Find a doctor who will work with you to test the entire pathway and help you figure out exactly where the system is breaking down.
- Check out my next blog post that will tell you the things that can cause an imbalance in each step along the pathway and give you some suggestions on how you can correct the imbalances.
- Hire a healthcare practitioner (like me!) who can help you solve the puzzle by helping you figure out what is happening in your body and giving you personalized suggestions on how to fix it.
Image via Unsplash.
— Allen S. Optimal Thyroid Health. In IFMNT Level II. Webinar.
— Berndston K. Hypothyroidism. In onebodymind. Whitepaper.
— Evans J. An Integrative and Functional Nutrition Approach to Adrenal, Thyroid and Hormone Dysfunction. In IFNA Track 2. Webinar.
— Gottfried S. The Hormone Cure.