This is Part 2 of the series on hypothyroidism.
The focus of this article will be on the diagnosis of hypothyroidism.
So, you’re feeling depressed, like you’ve lost your mojo. Maybe you’ve gained a few pounds… Some extra weight that, no matter what you do, just won’t come off. Perhaps your libido has gone AWOL, and you can’t ever seem to get warm. You’re tired all the time. Your brain is foggy – it’s hard to remember things, and so difficult to maintain your focus. These concerns are often associated with menopause…
But guess which hormone is most likely the cause?
If you said thyroid, you’re right on.
Have you been told that your thyroid tests are normal, but you still don’t feel well? Hypothyroidism often goes undetected.
What is Subclinical Hypothyroidism?
Subclinical hypothyroidism occurs when your lab tests haven’t yet fallen into a PATHOLOGICAL range, but your numbers aren’t OPTIMAL either. This is why you don’t feel well – and it’s like being in a frustrating state of limbo. In order to discover if your thyroid really is functioning optimally, you need to have the right tests, and those tests must be looked at through the right lens.
Take a look at the graphic below. If you have the standard thyroid screening tests, TSH and T4 (more details on these later in this post), and your levels fall into the Yellow Zone, you’ll likely be told that there’s nothing wrong, and that there’s nothing that can be done except wait until your levels move into the pathological range. Once your thyroid has become underactive enough for your TSH to go HIGH, and for T4 to drop LOW (Red Zone), then thyroid medication will be prescribed.
When you’re in the Yellow Zone, you don’t feel good. Just because the lab says your levels are normal… Well, you know better. Everything is NOT fine. Most of the women I see typically have a multitude of signs and symptoms: fatigue, struggles with weight, feeling cold, no libido, thinning hair… These all point directly to hypothyroidism.
These women don’t want to wait to feel worse before taking action. They also want to understand the underlying cause of EVERY health condition they have, so they can take proactive steps to create wellbeing, to live vibrantly, and to age well… To move into the Green Zone.
In Part 1 of this series, the focus was primarily on the concern that so many women have: “Why am I so TIRED all the time?” The women I work with want to know if their exhaustion is due to menopause, or due to “just getting older” (and it’s rarely caused by either of those!).
If you didn’t get a chance to read Part 1 of this series, we covered the following:
1. Hypothyroidism is one of the most common causes of FATIGUE in women
2. Hypothyroidism can also cause these signs and symptoms:
- Depressed mood, unmotivated, lost your “mojo”
- Unexplained weight gain, difficulty losing weight or maintaining your ideal weight
- Impaired memory, brain fog (my article)
- Loss of libido
- Feeling cold all the time, especially hands and feet
- Elevated blood cholesterol level
- Increased sensitivity to cold, especially hands and feet
- Constipation, less than one bowel movement per day
- Dry skin
- Thinning hair or hair falling out
- Puffy face
- Thin eyebrows, especially the outer edge
- Muscle weakness, muscle aches, and pain
- Joint pain and/or swelling
- Exercise intolerance, less stamina, don’t recover well
- Headaches, especially in the morning
3. We answered the question, “Why is hypothyroidism so often missed in women over 50?”
So, now it’s time to dig deeper into the topic for this article: diagnosing hypothyroidism.
Do You Suspect You Have a Sluggish Thyroid?
It never surprises me when a woman I work with has a suspicion about what’s out of balance in her body… And we find out she’s absolutely, 100%, right on target – even if her doctor has told her otherwise. When you pay attention to your body’s signals, when you have an intuitive sense that something just isn’t right, don’t let anyone tell you otherwise. So, if you think you may have hypothyroidism, read on. I’ll explain what you’ll need to know, so you can form an action plan and get your mojo back.
Debbie’s story is an example of a woman who listened to her body’s signals, questioned what her doctor was telling her, and diligently kept searching for a solution that would address the true, underlying cause of her issues. She finally found her answers.
Debbie had been on Synthroid for 3 years.
In 2001, I met Debbie. She came to my Evergreen, Colorado clinic after being referred by her sister. Frustration had set in. She’d gained 15 pounds, but she wasn’t doing anything, in terms of her eating and exercise, that was any different than what she and always done. She made healthy choices and ate small portions. With moderate exercise, she maintained an ideal weight for her entire life – until 3 years ago. She also reported that she was cold most of the time, and was constantly turning up the thermostat in the house. Even during in the summer months, she wore jeans and long sleeve shirts – when her girlfriends were in shorts and tank tops. Her hair was slowly (but noticeably) getting thinner. “Could this be due to an underactive thyroid?” She wondered.
Lab tests revealed hypothyroidism, but the medication never seemed to help.
During the first six months after she began taking Synthroid, her doctor made one adjustment, increasing her dose slightly. Then he recommended annual retesting. Because her TSH and T4 levels were normal (according to the lab and her doctor), for the past 2 years, she remained on Synthroid at the same dose. Unfortunately, none of her health concerns improved… On each annual visit to her doctor, she reminded him that her weight still wouldn’t come off, that she was still cold all the time, and about her thinning hair – the thing that bothered her the most.
Her doctor reminded her that her lab tests showed that her thyroid was in a normal range. Her TSH was 3.95, and her free T4 was 0.9. As you’ll see in the chart below, these values placed her in the Yellow Zone. You’ll also discover that only testing TSH and T4 never provides a complete picture of how the thyroid is functioning.
So, since Debbie’s doctor couldn’t increase her dose of Synthroid, he said there was nothing he could do for her. He talked to her about bioidentical hormone replacement therapy (BHRT). Since she was 49, he felt her issues could be attributed to menopause, but as we discussed in Part 1, symptoms that can appear to be due to menopause are often a result of a sluggish thyroid.
Thyroid Balance During Menopause is Crucial
My experience has shown me that the key to an enjoyable transition through menopause necessitates addressing any imbalances in your thyroid and adrenals. Once these glands are functioning optimally, most women (myself included) breeze through menopause in a state of hormonal harmony. Adrenals can be supported and rebalanced most often with lifestyle changes and supplements. What needs to be done for the thyroid will vary… On some occasions, medication is necessary. In either case – taking thyroid hormone or not – you’ll want to support your gland with proper nutrition, stress management, quality sleep, and joyful movement of your body.
Will You Need to Take Thyroid Hormones for the Rest of Your Life?
Dr. Datis Kharrazian has identified six patterns of hypothyroidism, but only one of these hypothyroid patterns them can be addressed with medication. In Part 4, I’ll be revealing all the treatment options available, so you can choose the best course of action for your unique needs.
Debbie’s Quest to Create Hormonal Harmony
The first part of her journey began with getting appropriate thyroid testing. I sent Debbie to the lab for a comprehensive thyroid panel. The five components I test are listed below. The findings did not surprise me. I’ll be revealing the details of the protocol we implemented in Part 4. With a partnership between Debbie, myself, and a top-notch endocrinologist, she was eventually able to get to the root of her hormonal imbalances.
You’ll find out that there’s more to resolving hypothyroidism than just treating the thyroid. My approach always addresses each woman holistically. So, giving close consideration to gut function, detoxification pathways, food sensitivities, emotional stressors, sleep quality, and joyful movement is part of each woman’s individual healing journey. For Debbie, the ultimate result: ideal weight, shorts and tank tops, and luscious hair.
Two Ways Conventional Lab Testing Falls Short:
- You may not have had a comprehensive thyroid panel. There are five components needed to accurately assess what’s going on with your thyroid. The majority of women I work with have only had two of these components tested, TSH and T4, which don’t give the complete view of how your thyroid is functioning.
- You may be in a normal range according to the lab, but you may not be the OPTIMAL range (Green Zone). If you discover your values fall in the Yellow Zone, there are many strategies available to improve your thyroid’s function – and you may find that working with a healthcare practitioner trained in Functional Medicine can be quite helpful. Don’t accept not feeling your best. Don’t wait until you end up in the Red Zone.
**At the end of the article I have included a chart with the functional ranges for Practitioners.
The following are the six components you need to have tested:
- Thyroid Stimulating Hormone (TSH) – produced by the pituitary gland.
- Free T4 (fT4) – Thyroxine
- Free T3 (fT3) – Triiodothyronine
- Thyroid Peroxidase Antibodies (TPO)
- Thyroglobulin Antibodies (TG)
- Reverse T3
If your doctor won’t order these tests, you have options:
- Explain that you don’t mind paying out of pocket if your insurance doesn’t cover the comprehensive testing. Sometimes that’s why doctors are hesitant to include all 5 components.
- Find a doctor who will listen and work with you. Look for one trained in Integrative and/or Functional Medicine.
- Have your blood work done yourself. Google “direct to consumer lab testing” to see the options in your area. Any Lab Test Now is one that people in our area use frequently. Once you receive your results, you can bring them to the practitioner you are going to be working with.
Here’s what’s still to come:
In Part 3, I’ll cover the most common cause of hypothyroidism, Hashimoto’s Thyroiditis, which is actually an autoimmune condition (this is the type I have, and I’ll be sharing my personal journey with you). Maybe you’ve already been diagnosed with hypothyroidism, but haven’t been tested for Hashimoto’s. I’ll be explaining why you absolutely must find out if you have Hashimoto’s, and what you need to do about it.
In Part 4, I’ll share all of the various options for treatment of hypothyroidism. You may require thyroid medication – some people do. I’ll cover the various types of thyroid hormones available, and how to determine which one is the best choice for you. Good news! There are more and more doctors that have the clinical acumen to find the best medication, properly monitor your hormone levels, and then adjust the dosage. It shouldn’t be difficult to find one that can help you.
Please remember: This information is not intended to treat, diagnose, cure, or prevent any disease. This article is provided for educational purposes only. Always seek the advice of your physician or other qualified health care practitioner with any questions you have regarding your medical condition or concerns.
***For Practitioners: Thyroid Functional Ranges.
|Functional Range (green)||Quest’s Range (the lab I use) RED|
|TSH||1.8 – 3.0||0.4 – 4.5 mIU/L|
|fT4||1.0 – 1.5||0.8 – 1.8 ng/dL|
|fT3||3.0 – 4.0||2.3 – 4.2 pg/mL|
|TPO Antibodies||*none should be present||less than 1 IU/mL|
|TG Antibodies||*none should be present||less than 9 IU/mL|
In my opinion, if your patient’s immune system is working properly, there should be NO measurable antibodies present.
Functional Ranges for the optional components:
|Functional Range (green)||Quest’s Range (the lab I use) RED|
|Rev. T3||25 – 30||8 – 25 ng/dL|
|T3 Uptake||28 – 38||22 – 35 %|