Still Struggling with Thyroid Symptoms?
by Darcy A. Ries, ND
“My doctor tested my thyroid and it was fine…but I still have low thyroid symptoms.” Sound familiar?
What most people don’t know is that there’s a wide range between “normal” and diagnosable disease. This wide range of “in between” can include a myriad of symptoms that make it clear you’re not feeling your best, yet your doctor tells you all is “normal.” How can this be the case, when you feel foggy-headed, tired, depressed and chilly, maybe with some hair loss, and perhaps with your waist continuing to expand for seemingly no reason?
The answer, at least in part, may have to do with how medicine views standard lab ranges. It doesn’t recognize any significance in the wide range between “normal” and overt pathology. Did you know that most large scale private labs as well as hospital labs state a “normal” thyroid stimulating hormone (TSH) as 0.35 – 5.0 mIU/l? This, by the way, is an incredibly wide chasm of so-called normal. This is because the range is determined based on what is typical for a given patient base tested at that particular facility. Hospitals tend to see sicker individuals, so their lab ranges tend to be wider.
But dysfunction can be present even when results fall into “normal”. After all, we know many symptoms that are common and “typical” (poor sleep in the working professional, cognitive decline with aging, or monthly PMS, to name a few) but this does not mean they are necessarily “normal” or reflective of good health.
Functional medicine doctors keep this in mind and aim for much tighter lab ranges – a range that supports optimal function. Exact numbers depend on functional medicine training and background, but for TSH this typically is a tight range that only varies by 1-2 units. In such a range, this stimulatory signal from the brain to the thyroid is not too soft, and not too loud, but the goldilocks volume that tells your systems to keep humming along at equilibrium. If you have low or high thyroid symptoms, but your labs are reportedly “all fine” you likely fall into this chasm outside optimal but in between normal and not-quite-diagnosable-abnormal.
In the realm of functional medicine, we actually do something about that.
First, a little thyroid hormones 101:
Thyroid stimulating hormone, or TSH, is still considered the gold standard of thyroid assessment and the only lab marker initially tested by most physicians when investigating thyroid health. In reality, it is not an output of the thyroid at all, but a signal from the brain further upstream. The pituitary gland releases TSH as a signal down to the thyroid gland, either telling it loudly to make more thyroid hormone (as in the case of higher TSH), or telling the thyroid it can chill out and curb production (as in the case of lower TSH).
If the thyroid receives an increased TSH signal, the message it receives is there is not enough thyroid hormone – and it needs to make more! – and thus more T4, the inactive thyroid hormone, is produced. A much smaller amount of T3, active thyroid hormone, is produced alongside it.
T4 production requires a number of nutrients, including vitamins B2, B3, B6, C, D, E, tyrosine, zinc, and iron. T3, active thyroid hormone, is better utilized by the body, and must be first converted from T4, a process that requires good liver and gut health, as well as co-nutrients like selenium and iodine.
A functional medicine assessment of thyroid health would include at minimum a TSH level along with T4 and T3 in both their free and bound forms, to get an accurate look at both signaling pathways and actual output from the gland itself. This of course takes into account functional ranges versus the conventionally wider lab ranges. It would also include a look at nutritional status, stress and exercise levels, as well as a plan to specifically optimize liver and gut health – because while seemingly separate, this is just one example of how our body systems work together intricately, affecting our overall health.
There are a number of patterns possible in which thyroid health is suboptimal but still outside the lines of overt disease, leaving conventional doctors scratching their heads. If you fall into this category, consider seeking out a functional-medicine trained doctor.
Knowing functional lab ranges is only part of the picture. Seeing the body as a whole and how suboptimal thyroid health manifests in the first place – through stress, infection, trauma, auto-immune disease, toxins, medications, gut or liver dysfunction – is critical to correcting course and seeing symptom improvement.
Dr. Ries offers naturopathic consultations to individuals seeking alternative solutions to their health concerns. If you’ve failed to see results with conventional care, it may be time to think outside the box. Schedule a free 15 min. Discovery Call to learn more.
