Blood tests for thyroid function are an important part of the process for diagnosing thyroid disease. This video will help you understand the impact on the diagnosis and management of your thyroid condition. You can then delve into some of the root causes and gain a better understanding of what it all means.
Hey everybody Dr Hagmeyer here and today I wanted to spend some time talking about the TSH test and why when ordered by itself or in conjunction with free T4 is incredible misleading.
I realized after shooting my last video titled “12 symptoms of Low thyroid that indicate the need for a full Complete Thyroid panel” that there was just to much information that I didn’t get a chance to talk about
So, in today’s video I wanted to dive into some of these areas. There are 4 main things I want to review with you today.
Why you can’t rely on TSH for Thryoid Health (and explain the shortcomings of the TSH test)
The specific markers that make up a Complete thyroid panel and Where the ranges for those markers should fall (we call these functional Thyroid lab ranges),
Some of the additional lab bio markers while not part of a thyroid panel, should be run because these markers if out of range will affect your thyroid.
Some of the common causes or conditions where the TSH is less than the reference range but a person is still hypothyroid.
So, lets get started. One of the most widely used lab tests to evaluated thyroid function is the TSH. However it is also one of the most misleading Thyroid tests done when it comes to ruling in or ruling out a thyroid problem. I review patients testing every single day and I am amazed at how many patients when they submit blood testing for my review have all the symptoms of thyroid disease but the only test that was ever run was the TSH-
TSH stands for Thyroid Stimulating Hormone. It is made in the brain and the purpose of this hormone is to instruct your thyroid to make …………you guessed it……thyroid hormones.
Unfortunately, doctors have continued to put too much emphasis on its importance in ruling in and ruling out thyroid disease.
If you are a person who has been noticing increasing fatigue, weight gain, some anxiety or depression, brain fog, perhaps even hair loss, then chances are your last visit to your primary care doctor resulted in you getting a TSH and perhaps a Free T4 test run.
What If I told you that there is much more to the thyroid story than just TSH and Free T4. What If I told you that your normal TSH may not be so normal?
As you can imagine, it can be quite confusing. Having all of these symptoms and being told your have a normal TSH.
What many doctors find even more confusing is when a patients is diagnosed with low thyroid or hypothyroidism- receives thyroid replacement such as synthroid or levothyroxine, Armour or Cytomel, but still experiences all the symptoms.
As you can see from this study published in the indianl journal of endocrinology- titled “Why are our Hypothyroid patients unhappy”
The journal goes on to say- “A large number of hypothyroid patients, receiving adequate doses of Thyroxine supplementation, continue to complain of dissatisfaction and varied symptoms.”
I don’t think any doctor or patient in the United States would argue with this conclusion.
So as you can see those who receive thyroid replacement often don’t feel better and continue to suffer with symptoms and those patients who have symptoms are being told they are normal.
I think you can see the dilemma, We have a pretty messed up situation for most people who just want to feel better..
Let jump into why this is happening and what you need to do to get on solid ground.
In order for us to understand if our thyroid levels are normal, there are few things we first need to understand.
To Start With- You Cannot Have An Intelligent Conversation About Your Thyroid If You Don’t Have a Complete Thyroid panel.
So step #1 get a complete thyroid panel– only after you have had a complete thyroid panel can we now begin the conversation of Why do I have a Thyroid problem in the first place. I should say that having a thyroid blood test showing you have low thyroid still does not tell us WHY your thyroid Is not producing enough T4 or T3. So keep this in mind.
Having A Thyroid Blood Test that shows low Thyroid Hormone Production Does Not Tell Us Why Production Is Low.
These thyroid blood tests show us if you have low Thyroid levels like low T3, or low T4 or High Reverse T3,or if you are not converting T4 into T3, but they Don’t Tell us WHY- for this you need to work with a doctor who practices Functional medicine and one who can do further investigation.
Keep in mind that restoring function back to the thyroid gland is more than just giving T4 or T3 replacement. That doesn’t fix the Thyroid gland even though it may alleviate some of your low thyroid symptoms.
The goal of any treatment should be to support and revitalize the gland with the hopes that those efforts will allow the gland to produce sufficient hormones on its own. That’s what Functional Medicine is all about.
Allopathic medicine is just looking at what levels are low or high and then giving you a hormone to raise those levels or to lower those levels. In the long run- you are still sick and getting sicker. Important that you know that.
So what is this Complete Thyroid Panel and what are the thyroid ranges and some of the reasons why the TSH can misleading.
So let’s say you are convinced that something is wrong with your thyroid but every doctor you have seen says its normal- and they are just not listening.
Understanding Your Thyroid Lab levels -What tests do you need and How Do You Interpret The Results?
#1 Free T3: I like to see these levels between 3-4 (very often people who are prescribed Liothyronine, Cytomel or some combination of T4/T3 will have elevations in Free T3 levels.
This sudden rise in T3 will initially make you feel good if your levels were low, but very quickly the good feelings are followed up with anxiety, insomnia, heart palpitations, heart racing, inward trembling, racing thoughts, hot flashes and even some weight loss (many of the so called hyperthyroid symptoms)
But in the long run- when your T3 or Free T3 levels remain elevated, it will suppress your pituitary glands release of TSH. (Both T3 and T4 can do this) and now your back to low thyroid symptoms again- fatigue brain fog, weight gain, depression, hair loss, etc
This is what I call the Thyroid roller coaster. This is the scenario where every time you go to your doctor or endocrinologist, your TSH is up and then it’s down and your doctor is increasing or decreasing your medication.
#2 Reverse T3: Should be < 15 (without exception), if your Free T3 is high and your reverse T3 is also high then a couple of scenarios could be happening
- Your being overdosed with Thyroid Hormone- (if you are taking thyroid replacement),
- High Physical, Chemical or emotional stress in your life-(Thyroid/Stress connection)
- You are inflamed- See other bio-markers at the end of this article.
- High cortisol levels
- High levels of oxidative stress or you may be dealing with
- insulin resistance
If you visit my website you can use my T3/Reverse T3 calculator that will help you understand the importance of the T3/Rt3 ratio and some of its causes.
2- Total T3: I like to see these levels, and I find most patients feel their best, when levels are between 110 and 150
Over 150- I am asking my patient about things like anxiety, heart palpitation, insomnia, feeling hot all the time, feeling on edge, etc. Too much T3 will cause symptoms similar to Hyperthyroidism.
My advice to you is that when you have your blood bio markers done- you should be looking at your T3 levels, Free T3 levels and on your blood work report- write down your symptoms and how you are feeling.
Everybody’s T3 needs are different. One person might feel terrible with a T3 level of 130 and another person might be feeling the best they ever have- so it is very individualistic. So again write down your symptoms and how you feel.
3- Free T4: This is a test that is sometimes run with the TSH by your primary doctor. Synthroid/Levothyroxin or any other replacement that contains T4 or a combination of T4/T3 can cause these levels to rise.
I like to see these ranges between 1-1.5. A low Free T4 without being medicated indicates what you would expect- your Thyroid is not producing enough thyroid hormones.
The problem with this test is that if you have high T3 levels (let’s say because you are overmedicated or you have insulin resistance) it can lower your T4 levels.
4- TSH: Should be between 1.8-3.0. When combined with a complete Thyroid panel, anything higher indicates hypothyroidism this is where things can get tricky.
Many patients can have a TSH less than 1.0 (.4, .5, .6, .7, .8 and still be a sign of hypothyroidism. When TSH numbers are this low I am also thinking about autoimmune Hashimoto’s disease.
It’s also important to remember that BOTH T3 and T4 will cause your TSH to decrease. In fact T3 thyroid hormone is 3x more potent at decreasing your TSH than T4 thyroid hormone, so If you have a low TSH taking a T3 replacement Liothyronine, Cytomel, T4 Thryoid replacement such Synthroid and Levothyroxines or any medication it can lower your TSH.
One thing I like to tell patients is that if they have a high TSH that when they start T3 or T4 replacement their TSH should drop.
#5 and #6 Thyroid antibodies:
(Thyroid Peroxidase and Thyroglobulin antibodies) what you will notice here is that some labs for the TPO antibodies go from 0-12 and some have a range that go from 0 up to 30. The point worth noting is the zero part. You don’t want antibodies to show up. EVER.
One thing to keep in mind regarding autoimmune Thyroid disease is this. When we talk about the immune system- there is what we call humoral immunity and cell mediated immunity. TH1 and TH2 immunity. TH1 is cell mediated immunity and Th2 is humoral immunity.
Even if your test show nonexistent levels of antibody production-keep in mind that you can have normal antibodies and still have autoimmune thyroid disease due to cell mediated immunity.
Let’s talk a bit about some of the other lab biomarkers that are important to have done alongside a Complete Thyroid Hormone Panel.
There Are 6 Additional Lab Bio Markers That I like to Run With Patients.
#1 Sex hormone binding globulin- (SHBG) In women it should be in the 70-80 range and can be helpful for determining tissue levels of thyroid hormone (can’t be used if a woman is on birth control medication or oral forms of hormone replacement therapy)
#2,#3,#4 and #5 are #6
HS-CRP, ESR, Ferritin, Fibrinogen, Homocystein
Elevations in these markers indicates inflammation and are known as acute phase reactants. The CRP and ESR should be as low as possible, However Fibrinogen and Ferritin will often shoot up in cases of infection and inflammation (as they increase, so too will the reverse T3) and your Homocysteine levels should be less than 7.0.
Ok…. the last thing we need to cover today are several conditions where the TSH can be so called “normal” but the patient can still be hypothyroid. When you look at your blood work reference ranges, you will notice that it’s a pretty big range it goes from .5-5.0 or even up to 6.0 on some labs.
Some of the common scenarios where the TSH is less .5 or slightly above include:
- Low T3 Syndrome
- Partial or complete Thyroidectomy
- Hashimoto’s or autoimmune thyroiditis
- Cases of dysglycemia/Insulin and/or Leptin resistance
- Cases of Chronic inflammation (including chronic pain, fibromyalgia and/or chronic fatigue syndrome)
Unfortunately, patients who fall into any of these categories tend to get misdiagnosed and/or mismanaged for years by providers who rely solely on TSH levels for diagnosis.
As you can seem, testing for hypothyroidism is far more complex than just testing the TSH (and maybe a free T4).
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