Thyroid Disfunction & Testing

Your thyroid is one of the largest endocrine glands.  It influences almost every cell in your body.  Not only does it regulate metabolism and weight, thyroid hormone are required for the growth and development in children, and every Physiological process in your body.  

So when your thyroid hormone are out of balance, your whole immune system is affected.   When your thyroid produces too much or too little hormones it affects your overall health and well-being.  

Research shows that around 10-40% of people in the United States have suboptimal thyroid function.  

It is important to understand how your thyroid works and what causes it to go off balance in order to maintain a healthy and balanced thyroid function.  The thyroid hormones interact with all of your other hormones, insulin, cortisol, and sex hormones like estrogen, progesterone, and testosterone.   

• The major thyroid hormone secreted by the thyroid gland is T4.
  T4 contains 4 iodine atoms.
• T4 is converted into Triiodothyroxine(T3) by the removal of an iodine atom.
• This occurs mainly in the liver and certain tissues where T3 acts, for example the brain.
• The amount of T4 produced by the thyroid gland is controlled by the Thyroid Stimulating Hormone(TSH, which is produced in the pituitary gland.
• The amount of TSH that is sent into the blood stream by the Pituitary gland depends on how much T4 is in the blood stream.
• T4 and T3 circulate almost entirely bound to specific transport proteins.
• There are certain situations where these proteins could change the level of T4 & T3, for example pregnancy and birth control pills.

Poor thyroid function has been linked to serious health conditions.

1.  Hyperthyroidism - 

• Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine
• It can accelerate your body’s metabolism significantly, causing sudden weight loss, rapid or irregular heartbeat, sweating, nervousness or irritability, anxiety, sleep problems, among other symptoms.  

2.  Hypothyroidism - 

• Hypothyroidism results when the thyroid gland falls to produce enough hormones.
• Hypothyroidism may be due to a number of factors, including: Autoimmune disease.
• Those who develop Hashimoto’s thyroiditis have the most common cause of hypothyroidism.

3.  Graves Disease - (Hyperthyroidism)

• Graves disease is an immune system disorder that results in the overproduction of thyroid hormones.
• Your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs.
• It is the most common cause of hyperthyroidism in the United States.
• Some symptoms include rapid heartbeat, insomnia, hand tremors, enlarged thyroid, brittle hair, irritability, muscle weakness.  

4.  Hashimoto’s Thyroiditis - (Hypothyroidism)

• Also known as chronic lymphocytic thyroiditis, often leads to an under-active thyroid gland.
• It is an autoimmune disease where the immune system turns against the body’s own tissues.  Antibodies are directed against the thyroid gland which then lead to chronic inflammation. 
• Some symptoms include fatigue, depression, sensitivity to cold, weight gain, muscle weakness, dry or brittle hair, constipation, difficulty swallowing, a lump in the neck(goiter).

6.  Thyroid Goiter -

• A goiter can occur in a gland that is producing too much hormone(hyperthyroidism), too little hormone(hypothyroidism), or the correct amount of hormone (euthyroidism).
• A goiter indicates there is a condition present which is causing the thyroid to grow abnormally.
• It commonly develops as a result of iodine deficiency or inflammation of the thyroid gland.  It can be frequently seen in areas around the world where there is a lack of iodine rich foods.  
• Not all goiters cause symptoms.  Some symptoms associated with a goiter is swelling, cough, throat tightness, trouble breathing.  

7.  Thyroid Nodules - 

• It is an abnormal growth of thyroid cells that form a lump within the thyroid gland.
• The majority of thyroid nodules are benign, a small portion do contain thyroid cancer.
• These abnormal growths do not produce any symptoms.

Diseases such as Fibromyalgia, Irritable Bowel Disorder, Acne, Eczema, Gum Disease, Infertility and other Autoimmune diseases can be linked to thyroid dysfunction.  

So what do all those fancy thyroid tests mean? Lets take a moment to break each of them down one at a time.  

TSH Test

• A high TSH level indicates that the thyroid is failing because of a problem that is directly affecting the thyroid(primary hypothyroidism).
• When TSH levels are low, usually it indicates that the person has an overactive thyroid that is producing too much thyroid hormone(hyperthyroidism).
• Occasionally a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid(secondary hyperthyroidism).
• TSH levels above 2.5 are considered to be suspicious for subclinical hypothyroidism by many integrative practitioners.

T4 Tests

• T4 avoids any change the proteins could have, going a more accurate value for the t4 level.
• T4 is bound to proteins that prevent the T4 from entering the various tissues that need thyroid hormone.

Free T4

• Free T4 (Free Thyroxine) is used to measure the amount of free (active)T4 in the blood.
• Individuals who have hyperthyroidism will have an elevated Free T4.
• Individuals who have hypothyroidism will have a low level of Free T4.
• While the reference range at many labs runs from .8 to 2.8ng/dL, integrative practitioners have found that most patients feel best when their levels falls into the top half of that range; at a level of 1.3 or higher.  

It is important to note that combining the TSH test with the Free T4 test can accurately determine how the thyroid gland is functioning.  

If it is found that the TSH is elevated and the Free T4 is low, this could indicate primary hypothyroidism due to disease in the thyroid gland.

If the TSH is low and the Free T4 is low, this could indicate hypothyroidism due to a problem involving the pituitary gland. 

If  the TSH is low with an elevated Free T4; this is commonly found in individuals who have hyperthyroidism.

T3 Tests

• Individuals with an elevated T3 level are generally hyperthyroid.
• There are some situations where severely hypothyroid individuals will have a high TSH and a low FT4; but will have a normal T3.
• During pregnancy or while taking birth control pills, high levels of T4 and T3 can exist.  This is because the estrogens increase the level of binding proteins.  In these situations we recommend running a TSH and a free T4 for thyroid evaluation.  

Free T3

• Free T3(Free Triiodothyroxine) measures free T3 hormone and is the best marker for measuring active thyroid hormones available to thyroid receptor sites. 
• Free T3 measures are more clinically relevant than Total T3 measures.
• Decreased FT3 measures are one indicator of low Thyroid activity.
• While the reference range at many labs runs from 2.3 to 4.2 ng/mL; integrative practitioners have found that most patients feel best when their levels falls into the top half of the rang; at a level of 3.2 or higher, and in many cases, at a 3.7 or higher.  

Reverse T3

• Reverse T3 is a measure of the amount of T4 that is converted into a biologically inactive form of the T3 hormone.
• Integrative practitioners have found that elevated levels of Reverse T3 may suggest that thyroid hormone is not properly converted from T4 into T3, for use by the cells, and may result in hypothyroidism symptoms despite otherwise “normal” levels of Free T4, Free T3 and/or TSH.

Thyroid antibody Tests

• Our immune system normally protects us from foreign invaders such as bacteria and viruses by destroying these invaders with antibodies produced by blood cells known as lymphocytes.  
• In individuals with hypothyroidism or hyperthyroidism, lymphocytes make antibodies against their thyroid that can either stimulate or damage the Thyroid gland.  
• Two common antibodies that cause thyroid problems are Thyroid peroxidase and Thyroglobulin.
• Thyroid Peroxidase (TPO) - 
• TPO is an enzyme made in the thyroid gland that is important in the production of thyroid hormone.  
• TPO is found in thyroid follicle cells where it converts the thyroid hormone T4 to T3.  
• A TPO test detects antibodies against TPO in the blood.
• Thyroglobulin(Tg) -
• Tg is a protein produced by normal thyroid cells and also thyroid cancer cells.
• It is NOT a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. 
• Traditionally used in patients that have had surgery for thyroid cancer to monitor after treatment. 
• Positive anti-thyroid peroxidase and /or anti-thyroglobulin antibodies in an individual with hypothyroidism make a diagnosis of Hashimoto’s thyroiditis.
• If the antibodies are positive in a hyperthyroid patient, the most likely diagnosis is autoimmune thyroid disease. 

For the most accurate Thyroid health determination a combination of the serum levels of TSH, free T3, free T4, reverse T3 and anti-TPO antibody, anti-thyroglobulin antibody and SHBG should be used.  

Other helpful testing you may consider:

• Estrogen levels - Excess estrogen can suppress thyroid function.  Which can lead to fat around your waistline.
• Cortisol levels - Cortisol is a stress hormone produced by your adrenal glands.  High cortisol levels are both inflammatory and catabolic, which can contribute to thyroid and metabolic disorders, cognitive decline, depression, anxiety, immune suppression, altered glucose metabolism, elevated blood pressure, altered sleep patterns and hormonal imbalances.   
• Ferritin levels - Ferritin levels show the amount of iron that is stored in your body.  Individuals with hypothyroid may  have difficulty absorbing iron.  Low iron levels can have common hypothyroid symptoms such as fatigue, cold hands and feet, low sex drive, foggy mind and more.   

Using Thermography for Thyroid Health

Thermography can be used to monitor thyroid health.  It can be the first step in determining thyroid dysfunction.   

• Thermography estimates functional cellular activity.
• Energization of the biochemical processes in cells increases a temperature in them.  You may see yellow and orange colors on the thermogram.
• Functional intensity’s decrease in cells leads to the temperature decrease.  You may see blue and violet colors in the thermogram.
• Thermography allows finding out functional condition of the thyroid structure.
• Nodular formations in the thyroid gland may be in different functional condition.
• Normal hormonal level — is not always evidence of health.

Thermography is non-invasive, involves no pain, uses no radiation, is low cost and results are back within a week.  Thermography is a great tool to use in monitoring breast health annually, and other areas of interest.   It’s affordable and many Integrative Practitioners will use the results to help you achieve your health and wellness goals.