How Does The Thyroid Gland Function
The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. To exert its effects, T4 is converted to triiodothyronine by the removal of an iodine atom. This occurs mainly in the liver and in certain tissues where T3 acts, such as in the brain. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone . The amount of TSH that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees. If the pituitary sees very little T4, then it produces more TSH to tell the thyroid gland to produce more T4. Once the T4 in the bloodstream goes above a certain level, the pituitarys production of TSH is shut off. In fact, the thyroid and pituitary act in many ways like a heater and a thermostat. When the heater is off and it becomes cold, the thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. This is illustrated in the figure below.
Thyroid Function Blood Test
A GP may arrange for you to have a blood test to check your thyroid hormone levels. This is known as a thyroid function test.
The test checks the levels of:
- thyroid-stimulating hormone a hormone produced by the pituitary gland which controls the production of thyroid hormones
- triiodothyronine one of the main thyroid hormones
- thyroxine another of the main thyroid hormones
Your thyroid hormone levels will be compared to what’s normal for a healthy person of your age. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid.
Doctors may refer to these measurements as “free” T3 and T4 .
What’s considered normal varies depending on things such as your age and the exact testing technique used by the laboratory.
Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism
The Thyroid Federation International estimates there are up to 300 million people worldwide suffering from thyroid dysfunction yet over half are presumed to be unaware of their condition. Hypothyroidism, an underactive thyroid, is one of the most undiagnosed, misdiagnosed, and unrecognized health problems in the world. It is an epidemic that is sweeping the globe yet doctors are failing to recognize and diagnose hypothyroidism. Hypothyroid patients are falling through the cracks of mainstream medicine, left to suffer debilitating and even life-threatening symptoms. What is going on?
What Imaging Tests Do Doctors Use To Diagnose And Find The Cause Of Thyroid Disease
Your health care professional may order one or more imaging tests to diagnose and find the cause of thyroid disease. A trained technician usually does these tests in your doctors office, outpatient center, or hospital. A radiologist, a doctor who specializes in medical imaging, reviews the images and sends a report for your health care professional to discuss with you.
Your Personal Cholesterol Levels Are Up
One of the reasons people don’t always know that they should ask to get their thyroid checked is the fact that so many of the symptoms can also indicate some other issue besides too-high or too-low thyroid hormonal levels. You don’t think of a high cholesterol level as indicative of a thyroid problem, but it can be. The Mayo Clinic says to watch out for an “elevated blood cholesterol level” as a symptom of hypothyroidism. The American Thyroid Association explains why this is. “When thyroid hormone levels are low and TSH levels are increased , cholesterol levels are increased,” the organization says. So treatment for the condition may also help to lower cholesterol levels.
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Can I Check My Thyroid At Home
You can do a quick and easy self-exam of your thyroid at home. The only tools you need to do this self-exam are a mirror and a glass of water.
To do the thyroid self-exam, follow these steps:
- Start by identifying where your thyroid is located. Generally, youll find the thyroid on the front of your neck, between your collar bone and Adams apple. In men, the Adams apple is much easier to see. For women, its usually easiest to look from the collar bone up.
- Tip your head back while looking in a mirror. Look at your neck and try to hone in on the space you will be looking once you start the exam.
- Once youre ready, take a drink of water while your head is tilted back. Watch your thyroid as you swallow. During this test, youre looking for lumps or bumps. You may be able to see them when you swallow the water.
Repeat this test a few times to get a good look at your thyroid. If you see any lumps or bumps, reach out to your healthcare provider.
Tests For Thyroid Cancer
Thyroid cancer may be diagnosed after a person goes to a doctor because of symptoms, or it might be found during a routine physical exam or other tests. If there is a reason to suspect you might have thyroid cancer, your doctor will use one or more tests to confirm the diagnosis. If cancer is found, other tests might be done to find out more about the cancer.
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What Is Thyroid Function Testing
A number of blood tests may be used to learn if your thyroid gland is working normally. These thyroid function tests reveal if your thyroid is producing the right amount of thyroid hormones. Thyroid blood tests may be ordered:
- To check for thyroid disease before it causes symptoms, especially in newborns
- To diagnose an underactive or overactive thyroid
- To determine if an underlying disorder, such as Hashimotos thyroiditis, Graves disease, or thyroid inflammation, may be causing an underactive or overactive thyroid
- To evaluate a lump on the thyroid gland, called a thyroid nodule
- To evaluate an enlargement of the thyroid gland, called a goiter
- To monitor treatment for thyroid disorders
Understanding how your thyroid is functioning enables your doctor to treat a thyroid disorder if one is present.
What Do My Thyroid Test Results Mean
The two most common types of thyroid function tests are the T4 and TSH test. Typically, these two tests are ordered together.
The T4 testmore commonly known as the thyroxine testis used to determine if your thyroid is overactive. If this is the case, you will be diagnosed with hyperthyroidism.
Symptoms of hyperthyroidism include unplanned weight loss, tremors, diarrhea and anxiety.
The TSH test will reveal how much thyroid-stimulating hormone is in your blood. Normal levels range from 0.4 to 4.0 milli-international units of hormone per liter of blood.
If youve been diagnosed with hyperthyroidism and your TSH levels are above 2.0 mIU/L, you are at a heightened risk of developing hypothyroidism, which can result in weight gain, fatigue, depression and weak hair and nails.
If your doctor believes you have hyperthyroidism, he or she may order a T3 test to check for levels of the hormone triiodothyronine.
This hormone level should be within 100-200 nanograms of hormone per deciliter of blood. If your levels are abnormally high, it is possible that you are suffering from an autoimmune disorder called Graves disease.
The final thyroid function test your doctor may order is the T3 resin uptake test. Also known as a T3RU, this blood test will measure the binding capacity of a hormone called thyroxin-binding globulin.
Your doctors office should reach out to you within a matter of days to walk you through the results of your thyroid test.
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Why You May Need A Thyroid Test
Women of all ages are more likely than men to have low thyroid hormone levels. However, many of their symptoms are attributed to other conditions or written off as a consequence of aging.
A blood test for levels of TSH is the most sensitive test for determining whether you have hypothyroidism. Most laboratories use 0.45 5.00 mIU/L as a normal reference range for TSH. People with TSH between 5.00 and 9.99 mIU/L often have no symptoms , but some do. Another test called T4 will be done if your TSH is in this range. A low level of T4 usually means you will benefit from thyroid hormone replacement.
Many people with hypothyroidism or subclinical hypothyroidism aren’t aware anything is wrong because they haven’t been tested. The U.S. Preventive Services Task Force doesn’t recommend thyroid screening because it hasn’t found sufficient evidence that testing thyroid hormone levels in large groups of people without symptoms is cost-effective. Dr. Garber agrees, and suggests a different approachtesting asymptomatic people who are most likely to develop thyroid disease and benefit from treatment.
Treating subclinical hypothyroidism with synthetic thyroid hormone may reduce the risk of developing more serious problems like cardiovascular disease. They note that low thyroid hormone can cause a high cholesterol level and treatment with thyroid hormone may make statin therapy unnecessary.
Outdated Tsh Lab Ranges
TSH alone does not provide a complete picture. If doctors are going to rely on TSH alone, however, they should at least give consideration to the controversy over the TSH normal reference range and consider this when diagnosing patients. Mainstream medicine relies on a normal TSH range from 0.5 to 5.0 with variations depending on the laboratory. However thyroid advocates and many integrative physicians are fighting to narrow that range to close to 1.0.
Many traditional doctors rely strictly on the TSH range of 0.5 to 5.0 despite the patients obvious symptoms. Then, there are other doctors who will only diagnose hypothyroidism once TSH is above 10.0! WHAT? By then your symptoms can be so debilitating you are struggling to live through each day!
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Let’s Look At Testosterone
Next on the list is testosterone.
And for this section, I’m going to focus mainly on men, even though the same logic applies to women.
When a man goes into the doctor’s office to test his testosterone level how do you think it’s done?
It’s done by testing DIRECTLY for serum testosterone levels .
It’s NOT done by testing for the LH or FSH .
In addition, once a man is being treated for low testosterone his dosed is titrated based off of the absolute concentration of testosterone in his blood, not the LH or FSH.
If we applied this logic to your thyroid then we would care a lot more about your absolute thyroid hormone concentration and a lot less about your pituitary pro-hormone TSH.
And, much like estrogen and progesterone therapy, the FSH and LH in men taking testosterone are extremely suppressed.
In fact, even low to moderate doses are enough to shut down the HPA system and reduce FSH and LH to undetectable levels.
It appears that while the pituitary system is great for managing your sex hormones, thyroid, and cortisol on its own, it’s exquisitely sensitive to outside forces or hormones.
We can and should use this information when we look at your thyroid.
Benefits And Limitation Of The Self
An at-home self-exam known as the “neck check” can help you find thyroid lumps or enlargements on your own thyroid gland. These growths may point to any number of thyroid conditions from nodules and goiters to thyroid cancer.
Lumps in the neck can be caused by thyroid disease, and they can also be caused by a variety of other conditions, such as lymph node enlargement, lymphoma, an infectious abscess, or a traumatic injury.
In general, a neck check is not considered the most accurate or reliable way to identify thyroid disease. You can have serious thyroid disease if you have a completely normal neck check. On the other hand, a major growth can often be a sign of an easily treatable condition, such as an iodine deficiency.
In the end, there are limitations as to what a neck check can tell you. A 2017 report from the U.S. Preventive Services Task Force concluded that neck palpation was able to detect thyroid nodules in only 11.6% of cases. Ultrasound, an imaging procedure using sound waves, was five times more accurate in detecting abnormal growths.
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Thyroid Testing And The Tsh
This isn’t necessarily a problem by itself, but it should cause some alarm bells to go off once people start realizing that this treatment doesn’t always deliver the results people are looking for.
What do I mean?
When I first started training I found out fairly quickly that thyroid patients tend to be very difficult to treat.
From a conventional standpoint, they don’t ever seem to get better! .
They would come into my office complaining of fatigue or just not feeling like themselves and I would quickly diagnose them with hypothyroidism when their TSH came back as “high”.
The only problem?
The symptoms wouldn’t go away once they were “treated” and their TSH was lowered back to normal.
This didn’t sit well with me from a logical standpoint.
I knew that fatigue was one of the major side effects of hypothyroidism, so wouldn’t it make sense that this fatigue should resolve once the main problem was treated?
It’s always possible that their fatigue could be from some other cause, but I started to second guess my personal bias in regards to treating when I saw this trend happening over and over.
It caused me to reflect on the TSH as a marker of thyroid function and compare that to how we look at other hormone systems in the body .
And I realized that we treat the thyroid differently than other hormone systems in the body.
It’s actually very easy to understand so let me explain.
This is how it works:
Do you see the pattern here?
But we don’t.
Thyroid Lab Tests Every Patient Should Insist On
So, you just got back your thyroid labs and all they say is: TSH and Total T4. Your doctor might have even told you that you do not have a thyroid problem even though you are ticking every symptom of hypothyroidism
If you are lucky, the doctor would have also tested you for Total T3. If you are really lucky, the doctor would have ordered the Free T4 and maybe Free T3.
Why is it important to know if you want to manage your thyroid health? Here are a few reasons.
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Undetected Low Levels Of Thyroid Hormone May Underlie Subtle Changes That Can Increase Your Risk Of Cardiovascular Disease
For a gland only two inches in size, the thyroid has a huge influence on our health. It produces a hormone that is carried in the bloodstream to all parts of the body. Thyroid hormone plays a major role in regulating metabolismthe process by which body cells convert nutrients into energyand thereby helps regulate body temperature, , and even brain function. So when thyroid hormone levels fall, the body slows.
You’re probably aware of the common symptoms of low thyroid hormonefatigue, fuzzy-headedness, weight gain, cold hands, and dry skin. But if you’re like most of us, you’re likely to blame your diet and exercise regimen instead of your thyroid if your cholesterol levels and weight are creeping up, especially if you don’t have any of the other symptoms of low thyroid. “Symptoms are often nonspecific, and since women over 60 generally have more of these nonspecific symptoms, their doctors may not think to test for hypothyroidism,” says endocrinologist Dr. Jeffrey Garber, associate professor of medicine at Harvard Medical School and author of The Harvard Medical School Guide to Overcoming Thyroid Problems.
Failure To Do Full Thyroid Blood Testing
How can doctors diagnose and treat thyroid disorders without doing a full investigation? How can they hope to understand the complexity of their patients issue while relying on TSH alone or even a combination of TSH and T4? They are missing critical pieces of the puzzle. Patients are falling through the cracks left suffering debilitating symptoms all because of an outdated medical protocol.
When the pituitary gland in the brain releases TSH, TSH stimulates the butterfly-shaped thyroid gland at the base of our necks to produce the thyroid hormones T4 and T3. The majority of thyroid hormones produced by the thyroid are T4, however T3 is the most active useable form of thyroid hormone that can be used in the cells of the body. The conversion of T4 to T3 is a critical element in this puzzle. By testing TSH and T4 alone, doctors are assuming that our bodies are properly converting the T4 to active T3.
Hashimotos disease is an auto-immune disease where the body has turned on itself and attacks and destroys its own thyroid gland. It is a leading cause of hypothyroidism, yet mainstream medicine fails to test patients for thyroid antibodies. You cant imagine how many followers here at Hypothyroid Mom have let me know after years of struggling with hypothyroidism they were finally diagnosed with Hashimotos after insisting on these two thyroid antibody tests Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies .
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Thyroid And Basal Body Temperature
One of the major clinical signs of hypothyroidism is low body temperature. Analyzing the bodys basal body temperature through axillary testing is a fantastic way to assess your thyroid function in a low-cost, non-invasive way.
This test was popularized by Dr Broda Barnes MD, and has been used by many medical and natural health care practitioners over the years . Some research has been doing on BBT, showing that it is highly correlated with low thyroid activity
While most people are aware that the standard body temperature is 98.6 degrees F, the normal underarm temperature is 97.8-98.2 deg F or 36.6-37 deg C. If your temperature is consistently under 97.4 deg F or 36.5 deg C, then you most likely have under functioning thyroid activity. If the temperature is consistently above 99 degrees than you may have hyperactive thyroid activity.