Abnormal functioning of the thyroid hormones (yes, thyroid hormones. More than one. Several as a matter of fact) tends to be such a driver of chronic disease. Almost any symptom under the sun could be thyroid related. Identifying and optimizing thyroid hormones is it integral part of feeling better and reversing disease. It is vitally important in reversing autoimmune disease (AD) or preventing it in the first place.
It is quite important to optimize thyroid function during pregnancy. If done well, the developing child is so much better off and will tend to be healthier their whole life. This is epigenetics. The ability to optimally set our DNA’s gene expression early in life will help protect the child from chronic diseases their whole life.
Some people believe that up to 40% of Americans have an undiagnosed low thyroid issue. The reason for this was discussed in detail in the previous blog post.
Unfortunately, a big reason why people have undiagnosed thyroid problems is because of inadequate blood work testing being done and/or misinterpretation of the results.
So what tests should be run and how do you interpret the data in order to identify and treat a low thyroid problem when one exists? Thus, being in a position to turn multiple chronic health issues around all at the same time, prevent new health issues and more specifically, prevent and reverse AD.
Let’s talk first about the tests that are usually run. Often times, there is only one screening test run if a low thyroid issue is suspected. Maybe your physician is thinking there might be a thyroid issue. Or maybe you push your doctor to test your thyroid because you’ve read up on thyroid and it seems like you have so many symptoms that seem thyroid related.
The test typically run is called TSH. Thyroid stimulating hormone. TSH is just a marker molecule. It’s not one of the thyroid hormones per se. TSH is not a very good test in general. It was only invented as a test back in the late 1970s. TSH basically tells you how you’re doing with a thyroid hormone that doesn’t do anything. A hormone that is relatively inactive. This hormone is called T4.
The reason T4 has the number 4 in its’ name is that it has 4 iodine atoms in the T4 molecule. T4 is made by the thyroid gland. But it really doesn’t do much of anything. It is a relatively weak thyroid hormone. What it does do is get released from the thyroid into the bloodstream. It then goes to the liver, kidneys, the good bacteria in our gastrointestinal system and some other tissues. It is here that the T4 gets turned into a hormone called free T3. Free T3 is the active, usable thyroid hormone that does so much for our health.
The reason free T3 has the number 3 in it’s name is because it has 3 iodine atoms in the T3 molecule. One of the 4 iodine atoms in T4 has been removed. Free T3 is the active, usable, powerful thyroid hormone. Very few doctors, other than Functional Medicine physicians or Integrative Medicine physicians, will test for free T3 in the blood. TSH levels may look good but all this really says is you are doing OK with your T4. T4 may look good but all this really says is you are doing OK with a hormone that doesn’t do much of anything.
If TSH is off, you know something is wrong. If T4 is off you know something is wrong. But it still doesn’t give you the information necessary to optimally deal with the thyroid issue. Free T3 must be tested for as well. But there is one more test that truly never gets run unless you’re seeing those few physicians that specialize in Functional or Integrative Medicine. That thyroid hormone is called reverse T3.
Reverse T3 is the inactive, unusable form of T3. Just like free T3, reverse T3 is produced when T4 loses one of its’ iodine atoms. The thing is, the iodine atom lost to make reverse T3 is in a different position on the T4 molecule than the one lost to make free T3. Free T3 and reverse T3 have exactly the same atoms making up the molecule. The only difference is one iodine atom is in a different spot. All the same atoms in the molecules but just one iodine atom in a different spot.
The body is so smart. If the iodine atom is in one position, then free T3 is made to do all the great work you want thyroid to do in the body. If the iodine atom is in a different position, then reverse T3 is made and it does absolutely no work. You can’t get much different than that despite having all the same atoms in a molecule! The body is so smart.
Free T3 and reverse T3 fight each other for space on the T3 receptors on the surface of every cell in our body. When free T3 hits the thyroid receptors you feel great. But when reverse T3 hits the receptors nothing happens.
You need enough free T3 to do the work that thyroid should do. The problem is, even if you have enough free T3, you may have too much reverse T3 getting in the way. Thus, the free T3 does not have the ability to help make you feel great because all the reverse T3 is getting in the way of T3 receptors. Nowadays, even some more traditional, allopathic physicians are testing for free T3. Either because they know about it being the active thyroid hormone or because patients are specifically requesting it to be tested after they’ve read about it. But despite this, reverse T3 is almost never tested.
If free T4 levels are low, a person has become a “poor thyroid producer.” The thyroid has stopped making enough T4 hormone. If free T4 levels are great, then a person is still a “good thyroid producer.” If TSH levels are higher than they should be, this tends to suggest the body has become a poor thyroid producer as well.
Ofter times, when someone has been identified as a poor thyroid producer, they are offered a T4 medicine. T4 once again being the inactive, doesn’t do much of anything thyroid hormone. Common names for these medicines include “Synthroid” and “levothyroxine”. In the past, if a high enough dose of these medicines were used, typically a person would feel great. Typical doses used to achieve maximum benefit prior to the development of the TSH test were 200-300 micrograms.
Doctors in the past treating patients with T4 medicines would start at a lower dose and slowly go up on the dose until the person felt so much better. But when TSH was invented as a test in the late 1970s, something big changed. It was then that doctors started treating based on TSH levels, not how the person felt. Because of using TSH levels to guide dosing decisions, typical maximum doses of the T4 medicines became only 100-150 micrograms!!! Basing treatment on TSH levels tends to underestimate how much T4 medicine a person truly needs.
In the last 20 or 30 years though, something even newer and even more problematic has started to happen. It’s not just whether you have enough T4 to make yourself feel great anymore. No. People not only can become “poor thyroid producers” but now they also can become “poor thyroid converters”. Poor thyroid convertors have a difficult time converting the free T4 made by our thyroid into the free T3 needed to do all the thyroid work in the body. Instead, they are turning free T4 into too much reverse T3 which gets in the way of the free T3.
What makes somebody a “poor thyroid convertor”? Stress will make you a poor thyroid converter. The “stress hormone” cortisol being off will make you a bad thyroid converter. Vitamin deficiencies will make you a bad thyroid converter. Toxicity will make you a bad thyroid converter. Eating too many carbs and not enough protein will make you a poor thyroid converter. The standard american diet or the “SAD” diet. Too many carbs and not enough protein.
Everyone is stressed. We live in such a stressful world.
Everyone is nutrient depleted. Foods don’t have the nutrient content they used to. Even if people are eating high-quality, whole foods that are organic and non-GMO, they are often times still not getting the nutrients from the food well. This is because, we as Americans, tend to have messed up guts. Everyone is using medicines for diarrhea, constipation, gassiness, bloating, heartburn. The gut just can’t do a good job of digesting foods and getting the nutrients out. All the acid blocking medicines will make it really difficult to get any nutrients out of the food a person eats. Disrupted digestion and absorption.
Everyone is toxic. We live in a very toxic world. Heavy metals, pesticides, herbicides, plastics and flame retardants just to name a few. All children are born with lots of environmental toxins already in their systems.
This is just “life in the 21st century”!!! Everyone is stressed. Everyone is nutrient depleted. Everyone is toxic. Everyone eats too many carbs and not enough protein.
Being a poor thyroid converter is so common. Even if your thyroid is making enough T4, people can still be “hypothyroid” because of being a poor thyroid converter.
I hope this Part 1 answers the question for you that so many people end up asking which is “Why do I feel so poorly when my thyroid lab tests say I’m fine?” All the correct tests are not being run and in Part 2 we will discuss why the interpretation of the results is not ideal.
