Dr. Hagmeyer clinic director at DrHagmeyer.com explains How Poor Thyroid Conversion is overlooked by many practitioners who only look at TSH and T4 blood tests.
This pattern of Hypothyroidism often shows up with “Normal” Thyroid Labs With SymptomsHypothyroidism – The Thyroid Underconversion Problem
A very common problem that we see in our office everyday is Thyroid Underconversion. It is now widely accepted that there are 6 major patterns of thyroid dysfunction and only 1 of these patterns responds well to thyroid replacement. For the purpose of this post, I will discuss one of the more common patterns called Thyroid underconversion. Patients with Thyroid problems often suffer terrible with a laundry list of thyroid symptoms, but when the basic thyroid panel comes back the two main markers(TSH,T4) for hypothyroidism are normal. Why does this happen? If you read on, you will understand
Let me explain.
There is two forms of thyroid hormone. Thyroxine, commonly called T4, and triiodothyroxine, commonly called T3. T4 is the inactive form of thyroid hormone, meaning it does not have the ability to bind to cells and create a metabolic response. T3 is the active form of thyroid hormone, responsible for binding to cells and creating metabolic responses.
Your thyroid gland produces predominantly inactive T4. This means that we must convert T4 to T3, called thyroid conversion, in order to have normal thyroid responses. This conversion takes place primarily in the liver and by the bacteria living in the gut mucosa.
The negative feedback loop between the thyroid and the pituitary gland is with TSH and inactive T4. When T4 levels drop then TSH is elevated to tell the thyroid to produce more hormone. If T4 is elevated then TSH is suppressed. It works both ways.
So if T4 and TSH look normal on the lab panels, the true problem may never be investigated and the person may go on suffering indefinitely.
When there is under conversion of T4 to T3 we can’t have normal thyroid responses. T4 does us no good if we can’t get it into an active form. This thyroid under conversion issue is one of the many reasons why patients with hypothyroid symptoms go un diagnosed and mismanaged.
When our thyroid gland produces thyroid hormone, it is produced in the form of T4 which is not a very strong form of thyroid hormone. In order for the thyroid hormone to properly do its job, we have to convert the T4 into a more active form called T3. Much of the conversion occurs in the liver. If the liver is not working well due to toxicity, insulin resistance or some other liver disorder, then the conversion will not occur correctly. Much of the conversion is also carried out in the digestive tract. Gut Dysbiosis and other issues causing poor digestion can lead to poor thyroid conversion. Low cortisol adrenal fatigue from chronic stress is another possible culprit when it comes to conversion because cortisol is crucial for the conversion of T4 into the active T3.
Conversion issues also include the conversion of T4 into an inactive hormone called reverse T3. Although inactive, reverse T3 will bind to your cell and block active T3 from doing its job or decrease the clearing of thyroid hormones.
Other factors that affect the conversion of T4 to T3 which must be addressed include:
- Selenium deficiency
- Zinc deficiency
- Vitamin D deficiency
- Chronic illness
- Decreased antioxidant levels
- Increased levels of adrenaline
I see patients every day that have histories that scream of a thyroid problem, yet they continue to suffer because no one ever looked at the whole picture. T3 levels are rarely ever used in thyroid screening panels, so the T4 to T3 under conversion pattern is often missed.
When it is found, proper testing to determine the source of the under conversion is not investigated. It’s a big problem, since this is such a common thyroid dysfunctional pattern.
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