Whether you’ve had thyroid problems all your life, were diagnosed within the past few years, or are close to someone with a dysfunctioning thyroid, the following will probably resonate.

“My doc says my thyroid lab results look great, which surprises me because I’ve been feeling worse for months. My brain feels like it’s broken and no matter how well I eat or how much sleep I get, I have zero energy...”
“I’m on the verge of crying when she points out the TSH test result and says, ‘See? Your TSH value is still well within the normal range. Whatever you’re going through right now can’t be thyroid-related.”
“This is how I felt when I was diagnosed with hypothyroidism.”
And the doctor just nods and says, “A lot of things can make you feel that way. Since you associate those feelings with your thyroid, it’s hard to see past that, but the numbers don’t lie. It has to be something else.
So, she’s saying I have tunnel vision. But she’s not saying anything about how we’re going to find out what that something is. I wonder just how sick I have to get before she’ll do anything at all.

“The numbers don’t lie” -- but the TSH value is only one number. And it doesn’t say nearly enough.

Speaking Of Tunnel Vision

Conventional endocrinologists often refer to the TSH test as the “gold standard” for diagnosing thyroid problems (1). As of 2017, most clinics will accept as normal any TSH value between 0.5 and 5.0, though some will use the narrower range of 0.4 to 4.0.

Unfortunately, that range still isn’t narrow enough to detect milder -- but still debilitating -- cases of hypothyroidism, where the TSH value is above 2.5 and thyroid hormone levels, specifically T3, are at the low end of “normal.”

For many of us, even a slight variation from optimal levels of thyroid hormone is enough to cause a chain reaction that slows everything down. But conventional medicine’s over-dependence on the TSH test and its overly broad “normal range” allows thousands of deeply fatigued and dysfunctional thyroid patients to go untreated or under-treated.

As Dr. James Norman points out in his post, “Thyroid Gland Function Tests” on EndocrineWeb.com:

“No one single laboratory test is 100% accurate in diagnosing all types of thyroid disease; however, a combination of two or more tests can usually detect even the slightest abnormality of thyroid function.” (2)

It also bears mentioning that it can take months or even years for the TSH value to reflect the real state of someone’s thyroid health (3).

It takes two (or more)

The fuller picture provided by more comprehensive thyroid testing can lead to therapies with life-changing results. So, why isn’t that the standard?

It usually comes down to money. For clinics and hospitals, it costs more to run those extra lab tests and to process the results.

If clinics used a narrower range to ensure optimal thyroid function, it would also result in a dramatic increase in thyroid patients, the treatment for whom would also cost money -- especially if treatment included regular and comprehensive thyroid testing.

What are those extra tests?

T4
T3
Reverse T3
Thyroid antibodies (TPO & Tg)
Ultrasound (to check for nodules).

T4

About 80 percent of the thyroid hormone produced by the thyroid gland is T4 (thyroxine) (4); the “4” represents the number of iodine atoms (5), one of which it loses to become T3, the most biologically active form. A low serum T4 reading, combined with a high TSH reading, points to hypothyroidism.

T3

About 20% of the thyroid hormone produced by the thyroid gland is T3 (triiodothyronine), and T4 converts in the body to supply the rest. T3 is the workhorse of the two, maintaining metabolic processes throughout the body and keeping your organs healthy. For optimal health, your T3 value should be in the top quartile of its normal range (6).

Reverse T3

Emotional, physical, or biological stress can cause your body to convert too much of your T4 to Reverse T3 (RT3) instead of T3, and then your body has less of the active T3 it needs to function properly.

RT3 even tries to stop T3 from doing its job.

Of all the possible causes for overproduction of RT3, the following four are the biggest culprits (7):

High cortisol (from stress)
Moving into low cortisol (adrenal fatigue)
Inadequate iron levels
Lyme disease, chronic inflammation, or other autoimmune conditions

Ideally, the RT3 value should remain in the lower half of its normal range (8). My doctor likes to have RT3 below 10.

Thyroid Antibodies

The most common form of hypothyroidism is caused by an autoimmune condition called Hashimoto’s Thyroiditis. For years, Hashimoto’s patients may fluctuate between low and high thyroid levels, until the thyroid gland is so damaged it can no longer produce enough to sustain the body. Checking for specific thyroid antibodies can help your doctor determine whether Hashimoto’s is at the root of low or high thyroid values.

Antibodies may attack any of the following parts of the thyroid gland (9):
Thyroid peroxidase (TPO)
Thyroglobulin (Tg)
Thyroid-stimulating hormone (TSH) receptors

A positive test for TPO antibodies often points to Hashimoto’s. If, in tandem with the positive TPO antibody test, your doctor can detect (by manual palpation) some swelling or lumpiness in the thyroid gland, an ultrasound is usually the next step.

Ultrasound

An ultrasound can show not only the size of your thyroid gland and its overall appearance but also the presence (or absence) of thyroid nodules, which can be either benign or cancerous.

At-home Thyroid Testing

If your doctor refuses to order more comprehensive thyroid tests, you can still get a clear picture of your own thyroid function by ordering a full thyroid panel testing kit from a trusted source like Everly Well. The labs are certified, accurate, and reliable, and a real physician reviews and explains your results (10).

Armed with physician-reviewed lab results, you’re more likely to obtain the treatment you need, though you still may need to shop around for a primary care physician who will look beyond your TSH value. The search is well-worth the trouble if you find a doctor willing to act on your comprehensive lab results and work with you on finding a treatment that will finally set you on the road to healing.

Final words

Functional medicine doctors tend to be decades ahead of their conventional peers when it comes to big-picture thyroid treatment. They know something that too many doctors -- including endocrinologists -- don’t seem willing to consider:

The TSH test, while it has its uses, should not be the default thyroid test. Because a normal TSH value does not mean everything is okay. And ultimately, we all pay the price for a tunnel-visioned approach to thyroid treatment.

1. https://www.verywellhealth.com/thyroid-testing-what-is-a-normal-tsh-level-3232902
2. https://www.endocrineweb.com/conditions/thyroid/thyroid-gland-function
3. https://stopthethyroidmadness.com/tsh-why-its-useless
4. https://www.endocrineweb.com/conditions/thyroid/how-your-thyroid-works
5. http://t3andt4.com
6. https://www.verywellhealth.com/interpret-your-thyroid-test-results-3231840
7. https://stopthethyroidmadness.com/reverse-t3
8. https://www.verywellhealth.com/interpret-your-thyroid-test-results-3231840
9. https://www.webmd.com/women/women-thyroid-antibodies#1
10. https://www.everlywell.com/products/thyroid-test https://www.endocrineweb.com/conditions/thyroid/thyroid-gland-function

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