thyroid disease

Top 5 Thyroid Tests to Ask For and Why

Are you a questioner? Do you like to know the why behind things? Do you feel like you need more information before you buy in? Sometimes I do and sometimes I don’t but when it comes to my health, I definitely do! I need the what, when, how and why! Getting more information through thyroid lab testing is a great example of how we can answer some of the “why’s” you might be asking. Why do I continue to have symptoms even though my TSH is normal? Why does my doctor refuse to run any additional lab tests? Why do I continue to feel like this when I am being treated for my condition? Why do I continue to feel like it’s a thyroid problem but my doctor keeps dismissing me? Why, why, why? 

One of the biggest challenges in determining what is actually happening with the thyroid gland and other systems involved with thyroid hormones is the ability to get the proper labs completed. Thyroid health is an area where we really need to look at the big picture and how all of the little pieces work together. Research shows that about 5% of the US population has thyroid dysfunction and about another 5% are undiagnosed. That is 5 of every 100 people that don’t know they have a thyroid problem. 

Many conventional doctors, where most of us go for routine visits, base a thyroid diagnosis on a TSH level and sometimes also a total T4. These labs are how they diagnose and decide on treatment with medications, typically Synthroid, a T4 only med. Let’s be fair, though, it is what they know and how they were trained and we can’t expect them to be thyroid experts. Oh, and they also use outdated conventional reference ranges for the labs. It’s no wonder why so many of us are misdiagnosed or undiagnosed and dismissed with continued nagging symptoms. We need to be our own advocates and keep asking “why?” I typically recommend working with a functional medicine practitioner if you can as they take a different approach to your health. They will want to do additional testing and use functional ranges to get more information on why you continue to have problems. 

I’ll share with you a client story. A recent client, let’s call her Lucy, came to me with Hashimoto’s and hypothyroidism. Lucy’s symptoms include fatigue, weight loss resistance, irregular and painful periods, low libido and anxiety. Symptoms that have not improved even though she is being treated for her condition under a physician’s care. The previous labs she sent included a TSH and a free T4 and she is on Synthroid, a T4 only hormone medication. Her TSH is functionally low at <0.5 and her Free T4 is slightly high most likely due to too much Synthroid. What we don’t know is her Free T3, which is the active thyroid hormone that is going to help control all the things that cause her symptoms. Does she have enough T3? Is T4 appropriately being converted to T3? Is too much T4 converting to reverse T3 causing a halt in thyroid hormone function? What are her antibodies? Is her immune system attacking her thyroid? Holy unanswered questions Batman! This is why I want to see the full panel. You get me? 

Knowing these answers will help me help Lucy. If we are looking at an immune system issue, I want to work through diet and lifestyle factors that can make a difference with autoimmune thyroid disease. If there is a problem converting T4 to T3, we can look at ways to optimize it and things that can be hindering the conversion. Do we need to go back to the doctor to try a T3 hormone supplement as well? 

In this blog post, we will talk about how the thyroid works, who should be tested for thyroid disorders, why you should get a thyroid panel run, and the tests in a thyroid panel including functional ranges.

How Does the Thyroid Gland Work? 

The thyroid gland is a butterfly-shaped gland located at the front of the neck below the Adam’s apple. It works in a feedback loop with the hypothalamus and pituitary gland to produce thyroid hormones. The hypothalamus produces TRH, or thyrotropin-releasing hormone, which stimulates the pituitary gland to produce TSH, or thyroid-stimulating hormone, which stimulates the thyroid gland to produce T4, T3, and calcitonin. 

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T4, or thyroxine, and T3, or triiodothyronine, are thyroid hormones produced by the thyroid gland. They are what control the body’s metabolism, body temperature, and many other functions. T4 is produced in about 4x the amount of T3 but T3 is about 10x as active in the body as T4. Most of our T3 needs to be converted from T4 primarily in the liver and kidney. 

Here is how the thyroid should work: when there is too much thyroid hormone (T4 and T3) circulating in the body, TSH is decreased and thyroid function decreases in order to stop producing hormones. When there is too little thyroid hormone circulating in the body, TSH is increased in order to increase thyroid function and produce more hormones. There should always be adequate amounts of hormones circulating to be used by cells in the body. 

Who should be tested for thyroid disorders?

According to the American Thyroid Association, anyone age 35 and over should be tested for thyroid disorders and then retested every 5 years after that if within normal ranges. I would absolutely argue that women need to be tested before age 35 and at least every year. The age really depends on symptoms, if you’re having trouble conceiving, and other factors. Thyroid disorders don’t discriminate based on age. You should absolutely be tested if you have multiple symptoms of a thyroid disorder or a family history. Symptoms of hypothyroidism and Hashimoto’s include:

  • Fatigue

  • Weight gain

  • Dry, brittle hair

  • Constipation

  • Depression 

  • Anxiety

  • Puffy face

  • Dry skin

  • Sensitivity to cold

  • Brain fog

  • Irregular menstrual cycles

  • Muscle fatigue and weakness

If you are experiencing 2 or more of these symptoms and aren’t sure if they could be thyroid related, I would encourage you to get tested. Otherwise, you might be treated for the individual symptom(s) that may not improve if it’s related to your thyroid but the thyroid is not addressed. 

Why Run a Thyroid Panel

More information can be very helpful when looking at the thyroid and the typical symptoms of a thyroid problem. Remember that we want to know why! Thyroid testing is a controversial subject where some don’t believe that running a full thyroid panel is useful in the treatment of thyroid disorders. I disagree. I believe in running the full thyroid panel as it can show that problems don’t always just come from the thyroid. The tests can provide information on where there is a break in the chain of events that leads to adequate thyroid hormones being produced and used appropriately. A break in that chain can equal symptoms that won’t go away. Testing only a TSH and T4 can lead to misdiagnosis when we can’t see the other pieces of the chain. 

I also believe in testing thyroid antibodies as over 90% of hypothyroid cases are due to the autoimmune disease, Hashimoto’s. It is important to know if you have an autoimmune disease because if you have one you are at a much higher risk of having another and some autoimmune diseases can go hand in hand. You better believe I would want to know if I am at a higher risk of my body continuing to attack itself in different ways and if there is something I can do to prevent that! Doctors don’t often run them because it doesn’t change their treatment plan. Do you need to run antibodies every time you do thyroid labs? No. Antibodies don’t typically change quickly, but having them tested occasionally is a good idea, especially if you are working on supporting your immune system and bringing them down. Then, you will know if your efforts are paying off or if you need to try something different. 

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Click here to access this free guide to thyroid testing.

Tests included in a Thyroid Panel

TSH (1-2 mU/L) - Thyroid-stimulating hormone, produced by the pituitary gland, stimulates the thyroid to produce more hormones when there aren’t enough circulating in the body. TSH is increased when there aren’t enough thyroid hormones circulating as it is trying to signal the thyroid to produce more. It is suppressed when there is too much hormone circulating as it doesn’t need to stimulate the thyroid to produce more hormone at that time. This is the most common thyroid lab tested and often what diagnosis and treatment is based on. A TSH alone is not an adequate marker of thyroid function. 

Free T4 (1.1-1.8 ng/dL) - T4, or thyroxine, is a hormone produced by the thyroid gland. The thyroid gland produces T4 and T3 but T4 is produced in a much greater amount. Free T4 is not bound to a protein and is able to be used in the body. T4 must be converted to T3, the more active thyroid hormone, so it is important to know if the thyroid is producing enough T4. 

Free T3 (3.2-4.2 pg/mL)- T3, or triiodothyronine, is a hormone produced by the thyroid gland. There is a very small amount produced by the thyroid and the rest needs to be converted from T4 in the liver and gut. T3 is the main active hormone and free T3 is not bound to a protein and able to be used in the body. If the T3 level is inadequate, there will still be thyroid symptoms. 

Reverse T3 (10-15 ug/dl or <10:1 ratio of RT3:FT3)- This is the opposite of free T3. Reverse T3 is the inactive thyroid hormone that blocks thyroid receptors and can put the brakes on thyroid hormone functions. Some T4 can be converted to reverse T3 in the liver. This is often seen with illness, increased stress and cortisol, and fasting. 

TPO and Tg antibodies (<4 or negative) - when antibodies are present, this can suggest an autoimmune thyroid disease (discuss with your physician). Antibodies are proteins produced by the immune system to attack against what it thinks are invaders. This blog post will give you more information about testing for antibodies. Many doctors won’t test as it doesn’t change their treatment plan. 

I hope this helps to clear up the importance of getting a full thyroid panel run in order to see all components involved in thyroid health. You don’t have to continue to live with life-affecting symptoms because you aren’t getting the care and treatment you need and deserve. I always recommend discussing these labs with your doctor. You can check with them and your insurance about the cost. Also, don’t be afraid to get a 2nd opinion if your doctor won’t work with you. Be sure to scroll back up and get my free thyroid testing guide, if you didn’t already, to have access to information about these labs and the functional ranges.

In health,

Lin










Thyroid Antibodies: Why Test?

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Thyroid antibody lab tests are tests often overlooked by physicians when checking for thyroid disease. This is unfortunate because when caught early, the amount and length of time the thyroid is being attacked could be decreased. If you are interested in learning more about thyroid health, click here for my last post. Hang with me here and we will talk about why thyroid antibody tests are important and if you should have yours checked.

What are Antibodies?

An antibody is a protein made by plasma cells in response to an antigen, or a substance the body thinks is a “bad guy”. Each antibody can bind to only 1 antigen in order for the immune system to attack and destroy that antigen. So, obviously, thyroid antibodies set up an attack on the thyroid gland, each one in a different way.

Anti-thyroperoxidase (TPO) antibodies are the most common and are associated with Hashimoto’s Thyroiditis along with anti-thyroglobulin (Anti-Tg) antibodies. Thyroid Stimulating Hormone (TSH) Receptor (TSHR-Ab) antibodies are associated with Graves’ Disease.

Did you know that thyroid antibodies can be present before other thyroid hormones are out of “normal” range?  

So, if I ask you if you’ve had your thyroid labs check and you are like, “yep, my doctor says my thyroid is good”, it is usually only a TSH level that is checked. This lab test can only give us a small picture of what is going on with the thyroid or maybe not tell us anything at all. Antibodies can be present for years before we see a change in the TSH level. This is super frustrating because if antibodies are present, they can slowly destroy the thyroid over time. This will eventually cause the thyroid to not be able to produce hormone efficiently, then causing the change in TSH.

Thyroid antibodies can produce symptoms even when there is no hypothyroidism detected. Symptoms can include fatigue, anxiety, depression, weight gain, general poor feeling and potential for miscarriage. So no, you are not crazy when you tell your doctor you think there is something else going on even though your labs don’t show it.

Thyroid antibodies with a normal TSH can be an early warning sign of Hashimoto’s Thyroiditis, an autoimmune disease. It is estimated that 90% or more of those with hypothyroidism have Hashimoto’s disease. But, not all of those with Hashimoto’s will have elevated antibodies and will need a thyroid ultrasound if symptoms persist. I am one of the few with hypothyroidism and not Hashimoto’s. If there are antibodies present and an elevated TSH, Hashimoto’s is likely in the later stages.

Why are doctors not testing antibodies?

After reading the information above, you may be asking this same question. Right? Many general medicine practitioners don’t think that an autoimmune disease can be treated and reversed. Therefore, there is no need to know if antibodies are present because it doesn’t change their treatment plan. The root cause doesn’t really matter. They will treat the thyroid if the labs show that it makes sense. Or, if they are aware of autoimmunity, they want to suppress the immune system causing more problems and side effects.  

If I have antibodies will I always have antibodies?

There is no cure for autoimmune disease. Once autoimmunity is present, there is always a potential for your immune system to attack your own cells causing problems. There is, however, a way to support the immune system, reverse or decrease autoimmunity and prevent further attack on the body. Nutrition and lifestyle play a large role in supporting the immune system and this topic deserves multiple blog posts! And, just so you know, I care about the root cause and it does matter!

Antibody levels will change in response to underlying causes, like stress, food sensitivities and infections. It is important to also look at the big picture of how you are feeling. If you have antibodies, it is great to have them checked occasionally with your other labs because it can tell you if your interventions are working or if you are maybe having a flare up and need to try something different.

Who should have thyroid antibodies tested?

If your doctor is already doing blood work to check your thyroid health, I recommend asking for a full thyroid panel, which will include antibody tests. It is great to get these labs done and see the full picture from the start. If this isn’t being done, here are some reasons you may want to ask for thyroid antibody tests:  

  • You have another autoimmune disease like celiac disease, multiple sclerosis, Sjogren’s, etc. Once you have an autoimmune disease, you are 3x more likely to develop another one.

  • You have classic symptoms of a thyroid issue but your TSH continues to come back in the “normal” range.

  • You have a close family member with an autoimmune disease, especially Hashimoto’s or Graves’ disease.

  • You’ve been diagnosed with hypothyroidism or hyperthyroidism but have not had antibody tests done.

Antibodies can be an important piece of information when we are looking at thyroid health and thyroid diseases. They do matter and they can be decreased with immune system support. Antibodies can be present long before the thyroid is showing signs of attack and decreased function. As always, be aware of symptoms and be diligent in finding a doctor who will listen to you.

In health,

Lin

Thyroid Awareness Month: What You Should Know

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January is Thyroid Awareness Month so I wanted to bring a little more awareness to this growing group of diseases and overall thyroid health throughout this month. Have you ever heard of thyroid disease? Do you know what your thyroid is and what it does? Did you know that Hashimoto’s Thyroiditis is one of the most prevalent autoimmune diseases? In this post I’ll talk more about the thyroid gland, thyroid diseases, thyroid testing and and why it is all important.

I wish I had known way more about thyroid health much sooner than when I was diagnosed with hypothyroidism. The more I’ve learned and read about hypothyroidism, the more I’m convinced it started after my pregnancy, which was 8 years prior to my diagnosis. I dealt with postpartum depression as well as some other bouts of depression, anxiety, stubborn weight that doesn’t come off easily, thinning and dry hair, and mood issues. I still deal with some of these occasionally but it’s so much better than it was. You can read more about my story in this post. Determination to figure out how to feel better is what drove me toward integrative and functional nutrition, especially working with others with thyroid disease.

According to The American Thyroid Association, more than 12% of the American population will develop a thyroid condition at some time in their life. That is about 1 out of every 8 Americans, with women being 5 to 8 times more likely to develop thyroid disease. But, they say that up to 60% of those with thyroid disease are unaware of their condition. That is a very large percentage! Undiagnosed thyroid disease can lead to many health problems including cardiovascular disease, osteoporosis and infertility. That is why thyroid awareness is so important!

What is the Thyroid Gland?

The thyroid is a butterfly-shaped gland in the middle of the neck that produces hormones. It plays a major role in metabolism and growth and development. It controls our body temperature, how efficiently our body burns energy, and our menstrual cycles just to name a few. Basically, thyroid hormones affect every cell and organ in the body.

The thyroid gland produces thyroid hormones T3 (triiodothyronine) and T4 (thyroxine or tetraiodothyronine). The body needs more T3, the active form, but produces more T4, which must be converted into T3. There is a potential of underlying causes not allowing proper conversion of T4 to T3, which can cause hypothyroid symptoms.

Then there is thyroid stimulating hormone, or TSH, which is produced by the pituitary gland. Its job is to signal the thyroid to release hormones, which will depend on the amount of hormones already circulating in the blood. It all needs to work together properly for optimal thyroid function.

What is Thyroid Disease?

There are different types of thyroid diseases where too little or too much thyroid hormone is produced. There are also autoimmune thyroid diseases that attack the thyroid gland. I’ll briefly discuss hypothyroidism, hyperthyroidism, Hashimoto’s Thyroiditis and Graves’ Disease.

Hypothyroidism is where the thyroid gland does not produce enough thyroid hormone, or is underactive. It is much more common than hyperthyroidism. Symptoms of hypothyroidism include weight gain, sensitivity to cold, fatigue, brain fog, anxiety, depression, constipation, dry and brittle fingernails, loss or thinning of hair, irregular menstrual cycles, edema and puffiness, joint aches, and trouble sleeping. I suffer(ed) from many of these symptoms and didn’t realize they were all related.

Hyperthyroidism is an overactive thyroid or where the thyroid produces too much hormone. Symptoms include unexplained weight loss, rapid heart rate, excess sweating, irritability, and shaky hands.

Hashimoto’s thyroiditis is an autoimmune disease, meaning the immune system attacks its own healthy cells. With Hashimoto’s, the immune system attacks the thyroid gland and produces antibodies against the thyroid eventually causing the thyroid to not produce hormone properly. It is estimated that around 90% of those with hypothyroidism have Hashimoto’s.

Graves’ Disease is also an autoimmune disease, where the immune system attacks the thyroid gland. The antibodies produced in Graves’ Disease cause the thyroid gland to grow and produce too much thyroid hormone. It can also cause problems with the eyes, called Graves’ Ophthalmopathy.

What Tests Detect Thyroid Disease?

TSH (thyroid stimulating hormone) - This is the most common thyroid test run when checking for thyroid function. The lab range is controversial. Most functional medicine doctors looking for a lower number than conventional medicine ranges for optimal symptom improvement.

Free T3 - the amount of T3 hormone circulating in the bloodstream

Free T4 - the amount of T3 hormone circulating in the bloodstream

Reverse T3 - produced from T4 but blocks the action of free T3 so it can not be used.

The following antibody tests are used to diagnose autoimmune thyroid disease.

TPOAb - thyroid peroxidase antibody

TgAb - thyroglobulin antibody

A full thyroid panel should include all of these tests. The reverse T3 may be an add-on test and not included in the panel.

Takeaways

With as many as 60% of Americans unaware that they have a thyroid disease, it is important to be aware of symptoms and to have a regular screening done by your physician. Many women present to their doctor with symptoms of a thyroid disorder but are referred to other specialists or are treated for their individual symptoms rather than looking at the thyroid. If you are like me, you don’t even realize that the thyroid can be to blame.

If you aren’t sure if your doctor is checking any thyroid labs when you do blood work, ask. If you aren’t sure if your doctor is running all of the appropriate thyroid labs, ask. If your doctor is dismissing your symptoms or prescribing medications for your individual symptoms, find a second opinion and someone who will listen. Know your body, know your symptoms and take control of your health.

Comment below on anything you’d like to know more about with thyroid health. Want to learn more about what I do? Schedule a free call here.

In health,

Lin