You’re tired & cold all the time. You feel exhausted no matter how much sleep you get. You have to drag yourself out of bed every morning or you seem to get every cold going around. Your hair seems to be falling out more and more and just looking at food seems to be enough to gain weight. Worst of all, you’re frustrated. You know something is not right, but every time you go to the doctor they tell you your TSH is normal, so it just can’t be your thyroid. And yet, whenever you search on the web for what may be causing your symptoms, or talk to a friend about them, that is exactly what seems to be problem. How do you get help? How do you get someone to listen to you, to believe you?
First let me start by saying, you are not alone and you are not crazy. You really can have all the signs and symptoms of hypothyroidism while still having a perfectly normal TSH level. In this article, I’m going to explain exactly how and why. It’s going to a get a little technical in spots, but just hang in there. At the end, we’ll talk about what tests you can ask for to confirm hypothyroidism and where you can get help if your doctor doesn’t seem to know what to do.
First the technical stuff….
TSH stands for Thyroid Stimulating Hormone and it is a hormone actually secreted by the pituitary gland in the brain. Its job is to stimulate the thyroid gland, so when thyroid output is low, TSH increases to give it a kick in the pants, so to speak. Increased TSH is classically how hypothyroidism is determined.
But this isn’t the only way to determine hypothyroidism. This is because there are several factors that determine the ability to make thyroid hormone and distribute it to each individual cell.
- TPO Antibodies– Presence of these antibodies indicates an autoimmune mechanism- Hashimoto’s autoimmune thyroid. Since TPO is the enzyme that sticks iodine atoms on the tyrosine molecule, thereby making T4, the antibodies can inhibit the ability of the thyroid gland to make T4. Hashimoto’s autoimmune thyroid is the most common cause of hypothyroidism in the U.S.
- T4 to T3 conversion– Even though close to 85% of the thyroid’s production is T4, the active form of thyroid hormone is T3. So in order for the cells to get enough thyroid hormone, it has to be converted to T3. This conversion process is mediated by bacteria in the gut, so leaky gut and gut dysbiosis can stymy the conversion. In this case, TSH and even T4 levels may be perfectly normal on a blood test.
- Thyroid-binding globulins– Globulins are types of proteins in the body. Thyroid binding globulins are proteins that carry thyroid hormone from the thyroid gland to cells of the body. If these globulins hold on to too much thyroid hormone or hold it too tightly, it can’t get off at the cell, where it needs to have its effect. This can be measured via T3 uptake. It’s also important to know that relative levels of estrogen and testosterone can affect the amounts of thyroid-binding globulin. If there is estrogen dominance or testosterone deficiency, too much thyroid hormone can stay bound to thyroid-binding globulins and not have any effect on the cell.
- SNPs in thyroid receptors– SNPs, pronounced “snips,” stands for single nucleotide polymorphisms. Basically, these are small changes in the DNA code for a protein that forms a receptor. Receptor proteins on a cell surface are like a lock in your door- they need a key with the correct shape to open the lock- and thereby the door. Thyroid hormone will act like a ‘key’ when it binds to its receptor. However, some people may inherit SNPs that change their lock, making the thyroid hormone ‘key’ useless. Thyroid hormone then cannot get into the cell where it directs metabolism.
So what is a full thyroid panel?
Given the scenarios outlined above, we can have several different mechanisms that lead to the signs and symptoms of hypothyroidism, without seeing an increase in TSH levels. In other words, you can have hypothyroidism even with a ‘normal’ TSH level. In order to determine where the actual problem is coming from then, its important to have a FULL thyroid panel done. What does a full thyroid panel include? Well, at the very minimum, it should include:
- T4 (total and/or free)
- T3 (total and/or free)
- T3 Uptake
- TPO Antibodies
If you think you are struggling with hypothyroidism, its best to work with a trained functional medicine practitioner who understands the different mechanisms outlined above. The good news is that with diet changes and smart supplementation, many of the symptoms of hypothyroidism can be managed. You can get your life back!
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