Hypothyroidism
The primary symptoms of hypothyroidism are many yet many of them can be due to other issues related to poor digestion, adrenal fatigue, imbalanced sex hormones, low cholesterol, blood sugar dysregulation, low vitamin D, parasites, and low-grade chronic bacterial and mold infections.
It is common for people to believe their symptoms are due to low thyroid hormones and that a thyroid prescription will resolve their symptoms.
If you decide to see a physician specializing in thyroid hormones, beware.
Lab Testing and More
The only way to assess hypothyroidism or suboptimal thyroid hormone levels is through blood testing.
If you want to know about thyroid hormone tests and how thyroid cells make thyroid hormones, read on. If not, then skip this section.
Here is a list of thyroid labs which should be ordered; TSH (Thyroid Stimulating Hormone), T4, Free T4 and Free T3.
I will explain what each of these are.
The pituitary gland in the brain monitors the levels of thyroid hormones in the blood. If thyroid hormones are low, it will secrete TSH. If thyroid hormones are high, it will decrease the secretion of TSH.
TSH travels through the bloodstream to the thyroid. There are TSH receptors on the membranes of thyroid cells and when TSH binds to these receptors it signals the thyroid cell to secrete primarily one thyroid hormone called thyroxine or T4 because it has four atoms of iodine. Outside the cell, T4 will be partially converted to T3, with three iodine atoms.
TSH also opens channels on the membrane of thyroid cells to allow iodide to enter. This is converted to iodine which is needed to make T4. This conversion of iodide to iodine requires hydrogen peroxide produced inside thyroid cells.
In the bloodstream T4 and T3 are either coupled to a carrier called Thyroid Binding Globulin (TBG) or they are detached and referred to as free and available, meaning they can leave the bloodstream and interact with cells.
For lab testing, to have a complete overview, we need to know the levels of TSH, Total T4 which is the bound and the free, Free T4 and Free T3.
Primary and Secondary Hypothyroidism
Hypothyroidism simply means that the T4 and T3 are below the lab’s reference range. There are two reasons for this.
Remember that TSH signals the release of T4 from thyroid cells.
When TSH is elevated and T4 and T3 are low, this is referred to as primary Hypothyroidism. Most of the time this is due to a lack of the nutrients thyroid cells require to make thyroid hormones. These essential nutrients are iodide, selenium, zinc and sometimes copper.
Secondary Hypothyroidism relates to low TSH, a pituitary issue. If thyroid cells do not receive the TSH signal, then of course thyroid hormone levels will decline. Sometimes taking iodine and iodide can signal the pituitary to secrete more TSH.
Please remember that with blood testing every thyroid hormone including TSH is given a lab reference range. Only when the results for T4 and T3 are below this reference range will the diagnosis be Hypothyroidism. Yet many people experience hypothyroid symptoms when thyroid results fall within the lower end of this reference range.
In these cases, there are two choices, provide the nutrients thyroid cells require or try a thyroid prescription. In some cases, both can be used.
Types of Thyroid Prescriptions
There are two types of thyroid prescriptions. One is synthetic and the other is considered ‘natural.’
There are a couple of synthetics, Levothyroxine and Tirosint, which are T4. The dose is primarily determined by weight. Some of this T4 will convert to T3. Usually after a month of taking this medication thyroid labs should be run.
If the Total T4 and Free T4 are in the middle of the reference range (optimal) then the person is taking the correct dose of Levothyroxine but if the Free T3 is low or suboptimal, the person is not converting T4 to T3 well, and another synthetic thyroid hormone called Liothyronine (T3) would be added.
- One ‘natural’ thyroid prescription is NP Thyroid which is made from the thyroid gland of a pig. This type of medication has been around for about a century. Inside this glandular tablet there are thousands of thyroid cells with their lipid membrane intact. When swallowed and dissolved by stomach acid, both T4 and T3 are released and absorbed through the gut. This prescription is also determined by the person’s weight.
- With the autoimmune condition called Hashimoto’s, the prescription should always be the synthetic. This is another topic.
- With both the synthetic and the ‘natural’ prescriptions, blood tests for thyroid hormones should be done monthly until the optimal dose is determined.
Caution with Physicians
We have mentioned those thyroid hormones which should be tested yet many physicians still follow the guidelines they learned in medical school.
The thyroid test they often run is ‘TSH with reflex to Free T4.’ This means if TSH falls within the lab’s reference range then Free T4 will not be tested. The lab order is not really checking thyroid hormones since TSH is not a thyroid hormone.
Free T3 is seldom checked even though this is the more important of the two hormones for energy and overall health.
Conclusion
Hypothyroidism and suboptimal thyroid hormone levels are rampant primarily because of nutrient deficiencies, especially iodide. In the past, one of the primary sources was iodized salt containing potassium iodide and was formulated in the 1920s because of the high incidence of thyroid goiter due to the lack of iodide in foods. Now most people use sea salt and others which do contain iodide but not enough.