22 Nov The GP says my thyroid is fine – then why do I feel so crap?
“I’ve had my thyroid tested and it’s fine.”
I hear this over and over in my practice, usually when dealing with tired, stressed out women who are showing signs of a sluggish thyroid. They usually tick off several of the following signs and symptoms:
- Dry skin
- Digestive issues
- Weight gain
- Cold hands and feet
- Joint or muscles pain
- Hair loss
- Brain fog
- Difficulty sleeping
- Anxiety, depression or poor response to stress
When I ask to see their pathology results, it turns out they’ve only had their TSH done, which came back “normal.”
But here’s the problem: TSH is only one of several markers of thyroid health (and in my experience, not the most accurate one).
TSH is actually produced by the pituitary gland – it’s not a thyroid hormone at all – it’s a thyroid stimulating hormone. It tells the thyroid what to do. But it doesn’t always tell us exactly what your thyroid is up to. Instead, to find this out, we need to look at levels of T3 and T4.
T3 and T4 are your thyroid hormones. Your thyroid makes T4 first (a type of inactive thyroid hormone), and then converts it to T3 – the active form. This is the one that does the good work, and it needs to be present in the right amounts to prevent the symptoms listed above.
Now, back to TSH…
TSH should fluctuate in line with what the thyroid is doing. If the body sees that thyroid hormone levels are high, it makes reduced levels of TSH, to send a message to the thyroid to make less hormones. On the flipside of that, if thyroid levels are low, TSH should increase, to send a message to your thyroid to start making more hormones. It’s kind of like nature’s see-saw.
However… I see countless cases in clinic where their TSH is within normal range… and T4 or T3 is too high or too low. Which means that your TSH test results will look “fine” but you’ll still feel unwell. Remember – T3 is the most important marker to look at, because this is the active one. If T4 levels are high, but T3 levels are low, there are follow up tests we can do to look at the cofactors needed for conversion, like selenium iodine and tyrosine.
But wait, there’s more.
If you’re stressed or unwell, there’s another potential issue. Instead of converting T4 to T3, your body might convert it to something called Reverse T3, which is an inactive form of T3. If this happens, then you are likely to see a reduction in T3 levels, as the body prioritises the making of Reverse T3. If you see an issue with elevated Reverse T3 on a test result, you know that you need to focus on reducing stress and supporting the adrenals.
Finally – when testing, I also look for anti-thyroid antibodies. A huge percentage of hypothyroid (sluggish thyroid) cases are autoimmune – a condition known as Hashimotos Thyroiditis (or “Hashis”). Many people with low thyroid levels aren’t even aware that they’ve got this. As far as I can see, the reason that many GPs don’t test the autoimmune antibodies is because it doesn’t change their course of action – their only tool, whether the sluggish thyroid is of autoimmune origin or not, is to give Thyroxine – a synthetic version of T4. (And remember – you still need to take that T4 and convert it to T3!).
But a naturopath will look at Hashimotos (or all autoimmune conditions for that matter) very differently. If someone is autoimmune I usually go in much harder with gut healing and anti-inflammatory protocols, in order to bring the body into balance. In our profession, it’s vital information.
This is why I order a full thyroid panel with my naturopathic clients, including T3, T4, Reverse T3 and anti-thyroid antibodies. Only then can we truly say that your thyroid is fine. Until then, we only know a very small part of the picture.