At least once each year, most adults have — or should have — a blood test to evaluate thyroid health and function. For most people, these tests come back normal. That’s good news. It’s usually a sign that the thyroid is doing its job properly.
When everything is working well, the thyroid helps to regulate body functions. These functions include metabolism, which is the process of converting food into energy. Too little thyroid hormone causes weight gain; excessive thyroid hormone causes weight loss.
Heart rate and blood pressure also rely on proper functioning of the thyroid. A lack of thyroid hormone (hypothyroidism) can cause fatigue, depression, brain fog, muscle cramps, cold intolerance, weight gain, or dry skin. Too much thyroid hormone (hyperthyroidism) can result in rapid heart rate, excessive sweating, nervousness/agitation, anxiety, weight loss, restless sleep, headaches, or chronic fatigue.
A Challenging Diagnosis
More than half the people with normal thyroid function will display some of the symptoms associated with thyroid dysfunction, and this can make it difficult to accurately diagnose the problem. What’s required is a closer look at blood tests, symptoms, medical and family history, and any previous diagnoses and treatments.
Some form of thyroid disease is apparent in about 6 percent of the population, with the majority of those cases showing low levels of the thyroid hormone (hypothyroid).
At BioDesign Wellness Clinic, a Tampa functional medicine clinic, I often see patients who are looking for a second opinion when it comes to thyroid health. In some cases, these patients have already visited their primary care physician (PCP), or they’ve visited an endocrinologist who specializes in thyroid disease.
Regardless of the scenario, the outcome is either a diagnosis of thyroid disease and a prescription for thyroid hormone, or no diagnosis at all, which can leave patients feeling frustrated because they still don’t feel well.
To relieve symptoms, patients are often provided with an antidepressant or anxiety medication that can help temporarily but doesn’t address the underlying causes. And while this temporary solution can work for a time, it will ultimately backfire as the patient’s fatigue and weight gain (or inability to lose weight) persist. This leaves patients bewildered and frustrated.
The Most Common Mistakes Doctors Make
I want to share with you the two common mistakes I see in medicine that often result in patients receiving an inadequate diagnosis, treatment, or both.
The first mistake many doctors make is that they fail to order all the lab tests needed to perform an accurate diagnosis. Testing only the level of thyroid stimulating hormone (TSH) or only the levels of TSH and thyroxine (T4), which is common practice, isn’t sufficient to determine the absence or presence of thyroid disease.
Comprehensive testing requires the following:
- TSH: The TSH level tells you how your brain is signaling the thyroid gland.
- T4, T3: These are the hormones that the thyroid gland produces.
- Free T4, Free T3: Unbound by protein, Free T4 and T3 enable your body to use thyroid hormones in the free state.
- Thyroid antibody testing: The two main thyroid antibodies are thyroid peroxidase and antithyroglobulin. Checking levels of these antibodies provides insight into any autoimmune thyroid condition such as Hashimoto’s thyroiditis, which is the most common cause of hypothyroid. Patients may not be aware that they have an autoimmune condition. With this simple blood test, it can be confirmed. And if the test proves positive, it can be followed up with a sonogram or ultrasound of the thyroid to check for nodules.
Two other tests can provide deeper insight into what’s going on:
- Reverse T3: Your T3 level reveals the amount of thyroid hormone your body is purposefully wasting. If your other labs are all normal, but you’re still feeling bad, this lab can help you understand why. It’s possible, in the presence of inflammation, for your body to excrete excess unused thyroid hormone.
- Selenium and iodine levels: These minerals are critical for optimal thyroid function and thyroid hormone production.
The second mistake doctors often make is to stop short in the diagnostic process. As a result, they often overlook hormonal imbalances that provide valuable clues as to what’s going on beneath the surface.
The only imbalance that’s many conventional practitioners look at involves TSH and T4. TSH is a chemical messenger that tells the thyroid to start producing thyroid hormone. Elevated TSH with low T4 indicates that the brain is shouting at the thyroid to produce more T4, but the thyroid simply cannot produce enough of it.
However, even when doctors examine the TSH-to-T4 ratio, they often stop there, without taking a deeper dive into why that is happening, which is very useful to know. Are you eating too much sugar? Is there a stressful life situation you’ve been dealing with over the last few months or years? I’ve addressed this issue in previous posts, including Hashimoto’s Thyroiditis – Yes, but what’s the cause?
Another possibility is that the TSH can be elevated even while T4 levels remain normal. The thyroid is releasing enough thyroid hormone to make the lab test appear normal, but it’s needing too much TSH to make that happen, which can cause problems down the road.
Another scenario? The TSH is normal, but T3 is low. T3 is the active form of thyroid hormone and is important for metabolism, hair growth, and energy. It’s quite common for me to see a patient who has been on thyroid hormone for many years but still has low-thyroid symptoms. Their endocrinologist or PCP is providing synthetic thyroid hormone, which is a T4 derivative. These patients often benefit from the addition of T3 in a synthetic or natural form.
Schedule a Thorough Thyroid Exam
If you have not had your thyroid properly checked, and you continue to experience symptoms of thyroid dysfunction or inflammation, here’s a brief list of my process:
- Start with a functional medicine analysis to uncover hidden causes of low thyroid and the symptoms you are currently experiencing.
- Proceed with a one-hour consultation to discuss your concerns in depth and create a plan of action.
- Complete thyroid labs with a detailed review to determine the best course of treatment.
If you’re ready for a thyroid test, or you haven’t had one in a while, and you’re in the Tampa area, click to schedule an appointment.
= = = = = = = = = = =
About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.