Many people get a standard thyroid blood test (TSH) as part of their annual physical, and are told that their thyroid is fine. But they don’t feel fine. Sound familiar? Maybe you have struggled with weight for years, trying every diet, losing a bit and then regaining even more. Over and over again. Perhaps like many people you have tortured yourself with excessive exercise routines in an attempt to stop the ever increasing weight gain. Or perhaps you have been put on anti-depressant or sleep medication or told your problems are all in your head.
The standard thyroid test “normal” range is open to interpretation and under debate, and you really need a fuller test to determine if you are really getting all the thyroid hormone your body needs to function at its best. I will talk about the tests you need to see if your thyroid is really up to par in a bit, but first let’s look at some low thyroid symptoms.
A misbehaving thyroid affects many other hormones in the body and produces a wide range of symptoms, including depression. In her book, The Diet Cure, Julia Ross has compiled an impressive list of symptoms:
Most Common Symptoms and Risk Factors of Low Thyroid Symptoms
- Uncomfortably heavy since childhood
- Family history of thyroid problems
- As a child, played quietly, rather than vigorously
- Weight gain began when you got your period, had a miscarriage, gave birth or began menopause
- Low energy, fatigue, lethargy, need lots of sleep (more than 8 hours), trouble getting going in the morning
- Tendency to feel cold, particularly in hands and feet
- Tendency towards excessive weight gain, or inability to lose weight
- Hoarseness, gravelly voice
- Depression (including postpartum)
- Low blood pressure/heart rate
- Menstrual problems, including excessive bleeding, severe cramping, irregular periods, severe PMS, scanty flow; early or late onset of first period; premature cessation of menstruation (amenorrhea)
- Reduced sexual drive
- Poor concentration and memory
- Swollen eyelids and face, general water retention
- Thinning or loss of outside of eyelids
- Tend to have a low temperature (under 97.8)
- Headaches (including migraines)
- High cholesterol
- Lump in throat, trouble swallowing (e.g., pills)
Other Common Symptoms of Low Thyroid
- Goiter; enlarged, swollen, or lumpy thyroid (look at the base of your throat, below your Adam’s apple)
- Coarse, dry hair
- Hair loss
- Infertility, impotence
- Weak, brittle nails
- Anemia, low red-cell count
- Dry, course, or thick skin
- Overuse of caffeine or other stimulant drugs
In addition, low thyroid function may cause these symptoms, which may be more common in older women:
- Pale skin
- Hair loss
- Labored, difficult breathing
- Swollen feet
- Nervousness, anxiety, panic
- Enlarged heart
- Premature graying
- Gallbladder pain
- Pain in joints
- Heart palpitation, irregular heartbeat
- Muscle weakness
- Strong-smelling urine
- Tongue feels thick
- Vision and eye problems
- Excess ear wax
What triggers a Slow Thyroid?
There are several different things that may trigger the onset of declining thyroid function. One of the most common is genetics. It tends to run in families.
Nowadays, a very common trigger is low calorie dieting. You have probably been told that the best way to lose weight is to eat less. Within hours of cutting calories, the thyroid slows down your metabolism in order to help your body hold on to what it has. It should speed up again when you eat more, but this doesn’t always happen. In fact, for many people who have dieted or restricted food intake for fear of becoming obese, over a long period of time or dieted multiple times, the thyroid gets permanently stuck in low gear, which leads to a rebound weight gain as soon as the diet ends. Depending upon height and frame size, most women should be eating 1,700 to 2,300 calories a day. Many, if not most, women I work with eat far under what they should be able to eat, and need to eat, in order to get enough nutrients. So many of them are down around 1200 calories a day or even less. If the thyroid stays in low gear, the only solution is hormone replacement. Sometimes, if a person has been on a Paleo style diet with very low carbohydrate intake, reintroducing more carbohydrates can speed things up and kick start the thyroid again. Conversely, if someone has been on more of a Standard American Diet, which is high carbohydrate, low in healthy fats, and nutrient poor, adding some high quality fats, particularly coconut oil, can help nourish the thyroid.
Nutrient Depletion is another trigger. Nutrients needed for your body to make enough thyroid hormone include iron, selenium, iodine, and the amino acid tyrosine, which comes from protein. Vegan diets can be lacking in both sufficient protein and iron. Vegetarian diets which include either dairy or eggs are mainly low in iron.
Hormonal changes is another big trigger. The beginning of adolescence is often when problems first begin, and many girls begin dieting for the first time to stop excessive weight gain. Later on a miscarriage, pregnancy, or menopause. So often I hear “I could never lose the baby weight, and I just kept gaining” or “I was fine until menopause, and then I started gaining weight even though I am active and didn’t change the way I ate.”
Injury or illness is another possibility. Head injuries may trigger a loss of thyroid function. Richard Shames, MD, author of Thyroid Power and Thyroid Mind Power, says that whiplash injury often affects the thyroid. A serious or prolonged illness may also result in suboptimal thyroid.
Food intolerances, may cause a particular type of low thyroid which is autoimmune in nature and your body begins attacking your own thyroid. One of the most common food intolerances which triggers this condition is gluten intolerance. Gluten is found in wheat, rye and barley, but is also in many flavorings added to processed foods. Blood tests which measure the number of antibodies to the thyroid typically go down within 6 months once gluten is eliminated from the diet. There could be other foods which cross react and can also be a problem.
Another issue is what we call competing halogens – if you took high school chemistry and remember that row on the periodic table. It is a family of very similar elements which include chlorine, fluorine, bromine, iodine and astatine. So what you say? Well, the thyroid hormone itself is made up of one amino acid, tyrosine, and either four or three iodine molecules. T3 has three iodine molecules, and T4 has four. Iodine deficiency used to be a serious issue worldwide, which is why salt was iodized. Wheat flour also used to iodized. Now flours are brominated. Chlorine and fluorine are both added to drinking water for purification and also some gets absorbed through the skin in showers or by swimming in pools. So what happens is, when there is a lot of bromine, chlorine and fluorine in your system, sometimes they replace the iodine on the thyroid hormone, but then that thyroid hormone won’t work properly. The solution is to limit your exposure to these competing halogens and ensure that you get sufficient iodine, but not too much iodine. Some people overdo iodine supplementation and this can actually trigger thyroiditis, or thyroid overproduction. Some symptoms of this condition include being tired and wired, insomnia, rashes and palpitations. If you are using sea salt, you will most likely need another source of iodine in your diet. I personally cook with sea salt and then use Maine Coast Sea Salt with Sea Vegetables at the table. Sea vegetables naturally contain iodine. So, if you eat a lot of sushi with the nori wraps or you like the seaweed snacks that will most likely be sufficient iodine. You can also take a multiple vitamin which contains the daily requirement of 150 micrograms.
The Adrenal – Thyroid Connection
A routine part of my initial health evaluation involves an assessment of different body systems including digestion, blood sugar handling, cardiovascular, hormonal, and others, and more often than not, I see that adrenal system and the thyroid system travel together. I have found that clients do best when I support both systems, and that I can’t permanently re-balance one without rebalancing the other. And you might notice that some of the symptoms of low thyroid are also symptoms of adrenal fatigue. For more information on the stages of adrenal fatigue and what to do about it, see my blog “Is Adrenal Burnout at the Basis of your Irritability?” Chronic stress, meaning 3 weeks or longer, is enough to reduce adrenal function and this adrenal malfunction is enough to reduce thyroid function. First off, if the adrenals go into overdrive as an initial response to stress, the thyroid slows down to calm the system down. The adrenals produce cortisol, which regulates the immune system to some extent, and is anti-inflammatory. If cortisol levels are off, too high or too low, the immune system will be affected, and thyroiditis may result. When the thyroid is malfunctioning, the adrenals can get overworked trying to make up for it. So, if you have been treated for either low thyroid or adrenal fatigue and aren’t satisfied with your weight, energy level or health, chances are you need some help with the other.
Tests that Measure Thyroid Function
If you have looked over the list of symptoms and considered your family history and think you might have low thyroid function, it is time to gather more information and determine if you really do have low thyroid function regardless of what you have been told by your physician in the past. There are both blood tests and functional tests that can tell you how your thyroid is doing.
TSH or Thyroid Stimulating Hormone – Optimal value 1-2
This is the most common blood test routinely run. It measures the amount of thyroid stimulating hormone sent by the pituitary gland in your brain to the thyroid. TSH signals your thyroid gland to release T4 and T3. About 85% of the thyroid hormone generated is T4, which is the less active form. A small amount of T4 gets converted to T3, but selenium is needed for this reaction to occur. This T3 then gets converted to either free T3 (FT3) or Reverse T3 (RT3).
The ideal range for TSH according to many functional medicine doctors and thyroid specialists is between one and two. TSH levels greater than two indicate that the body needs more thyroid hormone, although the normal range on the test goes up to five and a half. The big issue though, is that TSH alone is not the best indicator of thyroid function. This measurement needs to be looked at in a broader context along with other thyroid blood tests, functional tests including the ankle reflex and basal body temperature, and low thyroid symptoms. Otherwise, your doctor can treat you with Synthroid which replaces T4 and tells your pituitary all is well, so that TSH then goes back into a normal range. The problem then might be that as far as your doctor is concerned you are treated, so if you have any symptoms, they are in your head, or you aren’t trying hard enough to lose weight.
So, if you have thyroid symptoms but your TSH is within the normal range, regardless of whether you are already taking thyroid medication or not, you need to demand these other tests:
Free T4 (FT4) – Optimal value is over 1.1
Free T3 (FT3) – Optimal value is over 3.3
This is important because this is the form that can attach to a cell receptor and have an effect upon your physiology. It determines how your body uses energy, controls body heat, maintains bowel movements, and keeps other hormones at their proper levels.
Reverse T3 RT3) – Optimal value – less than a 10:1 ratio of RT3:FT3
This is a metabolite of T4 that differs from the active free T3 in that the iodine molecules are in a different place. It can bind to the cell receptors for T3 and block the active form from doing its job. Reverse T3t goes up under stress, starvation, anorexia, burns, surgery, severe infections and illnesses and may be an attempt by the body to conserve energy needed for recovery. If the adrenals are producing a lot of cortisol under stress, this will cause the formation of too much of the RT3.
Thyroid Peroxidase Antibodies (TPOAB) – Optimal range less than 4 or negative
This is the most common antibody to the thyroid found in about 95% of people with Hashimoto’s thyroiditis. Elevated antibodies are connected with feelings of anxiety, depression, panic or distress.
Thyroglobulin Antibodies (TGAB) – Optimal range less than 4 or negative
This is the other antibody that can be high in Hashimoto’s thyroiditis.
Testing the Achilles Tendon Reflex
Your foot should bounce when your Achilles tendon is tapped. If there is a slow or inactive movement, then that is an indication that your thyroid is low. Your foot should have a nice bounce.
Basal Body Temperature
Ask your health care provider for the instructions for measuring your basal body temperature as methods and timing vary depending upon whether you are a man or woman and whether a women is in her reproductive years or post-menopausal.