Thyroid Function & Managing Thyroid Hormone Levels

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Thyroid disorders are quite common. In fact, it is estimated that 1 in 7 Americans suffer from a thyroid disorder, yet nearly 60 percent of those individuals are completely unaware of their condition. Eighty percent of thyroid disorders occur in women and in many cases begin following pregnancy or menopause. Family history of thyroid disorders can increase your risk.

The thyroid impacts so many aspects of everyday function in the body, including regulation of your metabolism, sleep-wake cycles, appetite hormones, and much more. An untreated thyroid issue can significantly impair your wellbeing and keep you from enjoying simple activities, but it can also put you at risk for serious diseases, like heart disease, osteoporosis and certain cancers. If you know—or even suspect—your thyroid is dysfunctional, you need to seek treatment.

Thyroid Function

The thyroid gland, located at the base of the neck, is responsible for secreting a variety of hormones that regulate growth, development, metabolism and body temperature. Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) are the primary hormones released by the thyroid gland.

TSH is released when a signal from the pituitary gland in the brain is sent to the thyroid gland. This signal regulates thyroid hormone levels of T3 and T4. T3 and T4 are highly involved in basal metabolic rate, or the amount of energy your body uses to perform basic functions, such as breathing and temperature regulation, while at rest. Iodine, consumed in the diet, is a key building block for making T3 and T4. In the United States, iodine was added to table salt to reduce or eliminate thyroid diseases commonly observed in developing nations.

Calcitonin is another hormone produced by the thyroid gland. This hormone supports calcium and bone metabolism. This is why a dysfunctional thyroid can lead to severe cases of osteoporosis or contribute to falls and bone breaks later in life.

The hormones of the thyroid gland impact almost every cell in the body. It is no wonder that individuals suffering from thyroid dysfunction experience diminished quality of life.

The Thyroid Hormones

What is thyroid stimulating hormone?

Thyroid-stimulating hormone is the most well-known of the thyroid hormones. As previously noted, it is responsible for regulating the production of T3 and T4—the other vital thyroid hormones. TSH is the thyroid hormone that most physicians test when assessing the function of the thyroid gland. In these cases, function of the thyroid is deemed outside of "normal" if TSH levels are too low (hypothyroidism) or too high (hyperthyroidism). These ranges of normal—which are large and very non-specific—are often based on outdated standards of testing. And, of course, there is the fact that there is a very big difference between "optimal function" and simply "normal."

What is T3 (triiodothyronine)?

The majority of the thyroid hormone produced in the body is T4 (thyroxine). To exert its effect in the body, it needs to be converted to T3 and this occurs mainly in the liver. The amount of T4 produced is controlled by TSH. Low level of T4 trigger the production of TSH by the pituitary gland and high levels of T3 or T4 inhibit the release of TSH. The majority of the thyroid hormone in the bloodstream travels around bound to proteins. The portion of the T3 and T4 that are unbound are the free portions and the free portions of hormones are biologically active. The bound thyroid hormones cannot exert any effect.

If there is too much T3 circulating in the body, the condition is known as thyrotoxicosis. This can occur with hyperthyroidism or Graves' disease or in the setting of a goiter (swelling of the neck due to an enlarged thyroid). An imbalance of T3 is characterized by such symptoms as heat intolerance, unexplained weight loss, irregular menstrual cycles, rapid or irregular heartbeat, fatigue, hair thinning or loss and retraction of the eyelids (bulging eyes).

What is T4 (thyroxine)?

Thyroxine, or T4, is the primary hormone secreted into the bloodstream by the thyroid gland. Most of the hormone released is converted to T3. It is part of the same feedback loop as T3 and TSH. Levels of each hormone maintain the balance of the others. An overactive thyroid may also be producing too much T4, which can result in a higher rate of conversion to T3 and result in the same thyroid diseases and symptoms as an overabundance of T3.

It is important to point out that thyroid function tests that limit their focus to TSH levels are dismissing the role of T3 and T4 in maintaining optimal function of the thyroid gland. As mentioned, these hormones work on a feedback loop—too much or too little of one or the other can result in thyroid disease and uncomfortable symptoms. Because T4 converts to T3, low levels of T3 can be caused by poor production of T4 or it could be that T4 is being produced by not converted properly. Too little of either hormone will increase production of TSH. To ideally correct the issue, it is necessary to know which thyroid hormone is to blame for the imbalance.

What is Reverse T3?

Reverse T3 (rT3) is the inactive metabolite of T4. Therefore, it is unable to deliver oxygen and energy to the cells throughout the body as T3 does. Reverse T3 tends to be produced as a result of high T4 levels without adequate T3 levels. In healthy patients this is a situation that may occur when a patient is prescribed T4 alone, rather than a combination of both T4 and T3 for thyroid hormone therapy.

Signs and Symptoms of Thyroid Issues & Disorders

The signs and symptoms of a dysfunctional thyroid can be easy to miss, especially when symptoms initially appear. Feeling tired or sluggish, losing or gaining weight, and mood swings can easily be written off as side effects of a normal life. When you are busy with works, kids, family, and social obligations, it can be hard to notice when the symptoms stack up. However, when the symptoms extend to greater, more obvious discomforts, like hair loss, heart palpitations or heat/cold intolerance, you may start ask, what is wrong with me? Ignoring these symptoms is risky since untreated thyroid disorders can develop into much more serious diseases, including heart disease, osteoporosis, and thyroid cancers.

Hypothyroidism (Underactive Thyroid)

Low production of thyroid hormone is known as hypothyroidism, or an underactive thyroid gland. Elevated TSH levels are often the warning sign for this condition. Some patients, however, suffer from subclinical hypothyroidism. This presents with only slightly elevated levels of TSH, but normal levels of T3 and T4. This occurs in approximately 8% of people with thyroid disorders.

Hypothyroidism in any case is frequently misdiagnosed or goes undiagnosed all together. This is because stress or nutrient deficiencies can skew test results, if only TSH is the only hormone being tested.

For example, if thyroid hormone levels—T3 and T4—are low, TSH will increase. This is a red flag that there is inadequate thyroid function. However, some things like low selenium, stress and high cortisol levels can suppress TSH. In this case, you could be in a high stress situation and have a poorly functioning thyroid, but your TSH would not increase to signify low thyroid function because it is being suppressed by high cortisol. This is what makes comprehensive thyroid testing so essential to effective treatment of a thyroid disorder.

Symptoms of hypothyroidism include:

  • Trouble sleeping
  • Tiredness and fatigue
  • Difficulty concentrating
  • Dry skin and hair
  • Depression
  • Sensitivity to cold temperature
  • Frequent, heavy periods
  • Joint and muscle pain

Hyperthyroidism (Overactive Thyroid)

Over production of the thyroid hormone, thyroxine, is known as hyperthyroidism, or an overactive thyroid gland. It can be the result of an autoimmune disorder, thyroid nodules, thyroiditis, overconsumption of iodine and excessive doses of synthetic thyroid hormone.

Symptoms of hyperthyroidism include:

  • Being nervous or irritable
  • Mood swings
  • Fatigue or muscle weakness
  • Heat intolerance
  • Trouble sleeping
  • Hand tremors
  • Rapid and irregular heartbeat
  • Frequent bowel movements or diarrhea
  • Weight loss
  • Goiter

Thyroid Function Test

A TSH test is the most common form of thyroid function testing, but just because it is popular, doesn't mean it is the best. Many physicians who do not specialize in thyroid or hormone disorders may not be aware of these common forms of thyroid testing or how vastly complicated thyroid dysfunction can become.

The major problem with focusing exclusively on TSH to diagnose and treat thyroid disorders is that the reference ranges for TSH are suboptimal. When doctors originally determined the reference range for TSH was determine to be between 0.5uU/ml and 5.0uU/ml. Reviews of the study that led to these established standards were reviewed decades later and found to exclude people with borderline low thyroid function. This review led the Society of Endocrinologists to edit the standard for TSH levels.

Physicians, like the doctors of the BodyLogicMD network, who stay up to date on changes and advancements in hormone studies, have taken these updates into consideration when testing patients for thyroid disorders. In fact, most integrative medicine physicians use a range of 2.0uU/ml to 2.5uU/ml as their upper limit of normal when assessing thyroid function to avoid missing subclinical conditions and optimizing function.

What are Normal Thyroid Levels?

"Normal" is one of those ambiguous terms that attempts to classify things without construct or definition. And, when it comes to people, it is well-known that there is really no such thing as normal—everyone is unique in some way. The same is true when examining your thyroid hormone levels. "Normal" levels for one person may be not-so-normal for another. This is why using broad ranges to characterize and diagnose thyroid disorders is a mistake.

The goal with any medical treatment is to restore function. However, if you have a choice between just functional or optimally functional, which would you choose? The choice is easy—you want whichever will work best.

That is why comprehensive lab testing and face-to-face consultations are so imperative to accurate diagnosis and treatment of thyroid disorders. For some patients to feel their best, their doctor must test for TSH, T3, T4, reverse T3 and even look at cortisol levels. He or she must take the time to chat with you about your symptoms and how life has changed for you personally since your symptoms began. Your medical history and lifestyle are also an important factors. The most effective treatment has to ideally fit your needs and not some ill-defined version of "normal." When all of these factors are examined, your physician can develop a treatment strategy that will not just achieve a working thyroid, but one that works optimally for you.

Hormone Therapy for Thyroid Disorders

The most common and well-known form of hormone therapy for the treatment of thyroid disorders is the synthetic version of T4, known as levothyroxine. Most consumers know the drug by its brand names, such as Synthroid, Levoxyl, and Tirosint. Patients taking these drugs do not always express satisfaction with the outcomes. As with other forms of hormone therapy, the problem with using these medications alone is that they are T4. For many patients, T4 may be inadequate therapy for them to feel optimal. Many patients require T3 in addition to T4 therapy to feel their best.

In many cases, prescriptions for synthetic hormones to treat thyroid disorders are inaccurate or ineffective because the lab testing to reach a diagnosis and treatment plan was shortsighted—only testing TSH levels rather than all the hormones involved in thyroid disorder: TSH, T3, T4, reverse, T3, and cortisol.

Choosing BHRT for Treatment of Thyroid Disorders

Bioidentical hormone replacement therapy for thyroid disorders is an effective solution to thyroid issues because unlike synthetic hormones, bioidentical hormones are designed to be an exact replica of the hormones made by the human body. This structural match ensures that the replacement hormones ideally fit on the receptors in your body so that function is optimized.

Optimal function means that your symptoms are reduced or diminished, the systems of your body function as nature intended.

Balancing Thyroid Levels

Bioidentical hormone therapy is not the only therapy used in treatment plans for thyroid disorders. Nutritional supplements and medicinal herbs may also be part of your treatment plan. For example, many people with thyroid disorders are low in selenium. A trace mineral found in certain types of beans and nuts that plays a critical role in thyroid function and metabolism. Selenium supplements or dietary recommendations may be made to improve selenium levels and enhance thyroid function.

Because cortisol can have an influence on the thyroid hormones and thyroid function, other facets of your treatment plan may include meditation, mindfulness exercises, or recommendations for a peaceful night's sleep. Stress triggers the release of cortisol, as does poor quality sleep, too little sleep and being unable to relax.

Restoring hormonal balance when affected by thyroid disorder is no easy task. The thyroid hormones operate on such a dependent feedback loop that pinpointing the precise treatment is highly dependent upon complete and thorough lab testing, as well as time spent with the patient.

That is why the practitioners of the BodyLogicMD network utilize comprehensive lab testing that includes assessment of all the thyroid hormones, plus reverse T3 and cortisol to ensure they can get an accurate picture of what is going on inside the body. The lab results, however, are only part of the journey to a balanced hormones. Your BodyLogicMD physicians will consult with you, discussing your symptoms, reviewing your lab results and medical history, as well as your lifestyle. With a clear understanding of your condition, your practitioner can partner with you to design a treatment plan perfectly to suite to your restore hormonal balance, wellbeing and optimal function (not just some obscure standard of "normal"). By working closely with you, your doctor can create a treatment plan that effectively addressed your medical concerns while also considering what is practical for your lifestyle.

Even the best treatments take time. You cannot expect that you will begin your treatment plan today and feel better tomorrow. However, if you take the first step on your journey today, you can start feeling better much sooner. Thyroid disorders are not medical conditions that should be ignored. Untreated thyroid issues worsen and compile symptoms, as well as increase risk of certain diseases.

If you are ready to stop suffering from low energy, sleepless nights and inexplicable changes to your weight, contact a practitioner of the BodyLogicMD network today. You can begin your journey to feeling better, being healthier, and living the highest quality of life.

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