The Thyroid Connection: Part II
By Dr. Alanna Kuhn, ND
Have you been told your thyroid hormones are normal only to have every symptom related to hypothyroidism? This might be because you don't yet need medication. Yay! It's been found early - or is it that you don't fit the definition of primary hypothyroidism? Let's overview the types of thyroid diagnoses and why you might be feeling unheard, frustrated, and falling into the category of people who are undiagnosed.
Primary Hypothyroidism: When TSH (thyroid stimulating hormone) levels are elevated, free T4 levels are low. This is when you would be prescribed thyroid hormone.
Subclinical Hypothyroidism: When TSH is mildly elevated but within the labs reference range, free T4 levels are also within the labs reference range.
Functional Hypothyroidism: When TSH and free T4 are within the labs reference range but not optimal. Evidence over the last 5 years suggests that our current lab reference ranges are outdated and that 95% of people without thyroid disease have TSH levels of below 2.5uIU/mL (*). The American College of Clinical Endocrinologists suggests a new reference range of 0.3-3.0 uIU/mL. Like many other functional healthcare providers, I have found that most people feel best when their TSH is between an even tighter range of 0.5-2.5 uIU/mL; there are many conflicting opinions here. Most importantly, is that we are focussed on the patient in front of us. Only prescribing medication or neutraceuticals based on one or two thyroid tests is short sighted.
If you experience the symptoms of hypothyroidism, a full thyroid panel should be run including: TSH, free T4, free T3, reverse T3, anti TPO antibodies, anti TG antibodies. If you have thyroid nodules, a thyroid ultrasound is also imperative to rule out Hashimoto's thyroiditis (autoimmune thyroid disease) as well as thyroid cancer. Your MD or Nurse Practitioner have the ability to refer for imaging; that is not yet a part of a ND's scope of practice.
Other important things to note here are that thyroid hormone levels mildly fluctuate depending on the time of the day and if you do have Hashimoto's, TSH levels often fluctuate, so they are definitely not the best way to monitor treatment progress; with this you may end up in a pattern of increased/decreased medication/neutraceuticals every few months. It's important to also focus on how you are feeling overall.
Want a second opinion on your hormone health? Let's connect!
Want to learn more? See our post The Thyroid Connection: Part I
Reference:
NH, Papaleontiou M. Biochemical Testing in Thyroid Disorders. Endocrinol Metab Clin North Am. 2017;46(3):631-648. doi:10.1016/j.ecl.2017.04.002
