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Why are so many people misdiagnosed or completely missed when screened for Hypothyroidism?

Did you know that thyroid disease affects more than 13 million Americans, yet more than half remain undiagnosed? More and more patients are coming in with symptoms of hypothyroidism (underactive thyroid) so this month we are setting out to explain it in detail and bring you all the facts that you need to know because it is very likely that either you or someone you know may be affected by it.

Does this sound familiar?

You went to the doctor because you were having symptoms that can be associated with a slow thyroid but after running a blood test, they said your thyroid is just fine! Lets take a look at the different thyroid parameters and why this often happens even though the thyroid may not be “fine” at all.

The importance of a good functioning thyroid

It is important to know that thyroid hormone is used by every cell in the body. Let us repeat that.. “every single cell in the body”, which means that when the thyroid gland is not optimal, the effects can be seen in ALL areas of the body.

The thyroid is most notably known for regulating body temperature, energy, metabolism and sleep, but that is just the beginning. Below are a few of its other very important functions:

1. Manufacturing and storing calcitonin – regulating calcium for bone absorption and use

2. Keeps stomach acid at a beneficial level. Low stomach acid has the following implications:

  • Hinder absorption of key nutrients (B12, IRON, CALCIUM)
  • Allows for the growth of harmful bacteria in the GI causing symptoms such as gas, bloating and a weaker   immune system
  • Slow transit time i.e. constipation

3. Liver and thyroid have a give-and-take relationship. A well functioning thyroid gland is necessary to keep liver excreting toxins it accumulates. The liver is the location where 60% of thyroid hormone conversion takes place, so a sluggish liver can then lead back to low thyroid output in a vicious cycle. 

4. Egg quality along with achieving and maintaining pregnancy. Once the fetus is formed, it does not start producing thyroid hormones until the 2nd trimester and thus is dependent on the mother’s thyroid hormones.

Symptoms of an underactive thyroid are very vast and include the following:

  • Fatigue, sluggishness or weakness
  • Dry skin
  • Brittle nails
  • Hair loss and/or course and dry hair
  • Increased sensitivity to cold
  • Constipation
  • Memory problems or having trouble thinking clearly
  • Heavy or irregular menstrual periods
  • An enlarged thyroid gland (goiter)
  • Weight gain
  • Swelling of the arms, hands, legs, and feet, and facial puffiness, particularly around the eyes
  • Hoarseness of the voice
  • Muscle aches and cramps
  • Low blood pressure
  • Elevated blood cholesterol level
  • Infertility
  • Sleep irregularities

There also appears to be a strong genetic component to thyroid conditions

Why are so many people misdiagnosed or completely missed when screened for Hypothyroidism?

To understand this question, we have to look at the various definitions of hypothyroidism, as well as basic thyroid physiology (don’t worry, in layman’s terms) and in a few short paragraphs, you will understand exactly why this happens and how you can see if your thyroid may have an issue too.

The definition of hypothyroidism is medical condition where the thyroid gland makes insufficient thyroid hormones.

How does your doctor define “hypothyroidism”?

The most popular method is to directly check thyroid output with a blood test, measuring TSH (Thyroid Stimulating Hormone). If this falls outside of your physician’s range, only then you will be considered for medication or other support. The problem is that there are various discrepancies between lab ranges and doctor opinion.

In 2002, The AACE (The American Academy of Clinical Endocrinologists) redefined “normal range” of TSH to be between 0.3-3.0, however most labs still use a reference between 0.5-5.0 as the suggested “normal” for doctors. This means that a level of 3.5 is considered “normal” by your doctor while tons of research for over 10 years found that you would benefit from thyroid assistance.

What is subclinical hypothyroidism?

Many people experiencing the common symptoms of hypothyroidism have been told that despite their symptoms, they do not have an under active thyroid gland because their thyroid blood test results were within the normal range. Some may have even been told that their symptoms are part of the “normal” ageing process.

Such symptomatic individuals may actually have a condition known as subclinical hypothyroidism. In this condition, a patient may have all the symptoms of hypothyroid, and yet the hormones tested via blood do not suggest a problem. In subclinical hypothyroidism, there is a partial decrease in the thyroid glands ability to produce enough hormones to make the body’s metabolism work at 100% efficiency; hence an individual will be symptomatic.

Why are these results not matching the symptoms? The first problem is the “normal range” for TSH which we just discussed. The second problem is that TSH is just the beginning and only shows part of the thyroid picture. It has not yet become common practice for many doctors to run ALL the thyroid hormones (we really don’t know why that is not happening when it really should be).Without running multiple hormones in a pathway, effectiveness is assumed rather than proven. Luckily, there is a specific reason for each pathway breach so comparing the levels relative to one another is not only very informative but necessary in defining the problem area.

What are the other thyroid hormones and how do they work together?

The process actually starts in the brain where your hypothalamus sends a signal to your pituitary gland via a hormone called TRH. Once the pituitary receives it, it sends a signal to your thyroid via a hormone called TSH. As we discussed above, TSH is the most common marker used in conventional lab testing to measure thyroid function and you will soon see in just as second more reasons why this is seldom sufficient.

Once the pituitary sends a message to the thyroid via the TSH, the thyroid produces 2 substances, T4 and T3. T3 is the active hormone that is needed by the body and can be absorbed and used by your cells while T4 is called a pro hormone which has to be converted to T3 in order to be used. The body is very smart and produces about 93% T4 and only 7% T3 because the if T3 was produced by the thyroid at once, it would be used by the cells in the thyroid and never get a chance to get around to the rest of the body where it is also needed. Remember, the thyroid hormone is needed for every cell in the body.

Once the hormones are produced, they don’t usually hang out on their own, but will quickly get bound to different proteins. A good way to visualize this is thinking of the hormones getting on a truck which will drive them to where they need to go. Once the T3 and T4 hop on the truck, the truck takes them to the liver where most of the conversion takes place and T3 is created. In order for this to happen, good liver function is mandatory and since the liver works like a filter, it needs to be cleaned periodically to prevent an accumulation of toxins. Furthermore, the enzyme that converts T4 to T3 is selenium dependent which is why adequate levels of this mineral are so important. About 60% of the T4 is converted to the active T3, but 20% or even more (if there are issues) can be converted to something called Reverse T3 which acts as an opposite of T3 and prevents the T3 from doing its job. The last 20% of T4 gets converted in the gut and good intestinal function and bacteria balance is needed for that to take place properly.

Once converted, T3 gets bound to proteins (jumps back on the truck) and the truck “drives” around the body looking for cells that need thyroid hormone (T3). When the hormones are on the truck and are bound, they are called Total T4 and Total T3, however when they jump off the truck to become available to the cells, they are called Free T4 and Free T3. When the truck gets to a cell, the T3 jumps off the truck (becomes Free T3), knocks on the door (cell receptor) and absorbs in. There are various things that can affect receptor sensitivity, one of the more common being high cortisol levels due to stress and/or inflammation.

As you can see from the above, there is quite a process that happens from the beginning of thyroid hormone production to the end result of the hormone getting into the cell where it belongs. Looking at this, it is crystal clear why measuring TSH alone can often be misleading and various problems are often missed leaving as many as 50% of patients misdiagnosed.

It is essential that we look at all the hormones down the line to see what else can be off. Any regular lab such a Quest or Labcorp have the ability to measure the rest of the hormones so we can see if there are breaks in the pathway.

When visiting your doctor or lab, insist that the following are measured:

  • TSH
  • Total T4
  • Total T3
  • Free T4
  • Free T3
  • T3UPTAKE
  • REVERSE T3
  • Thyroid Antibodies (more on this in the next article)

We want to look at total Total T4 to see what the thyroid gland is producing and Free T4 to see the amount that is not bound (off the truck). We also want to measure Total T3 to see how the liver is converting it as well as Reverse T3 to see how much opposition we have. Finally, an incredibly important and often missed level is for the Free T3 which is the active hormone that goes into the cell as without this number, we really don’t get a full picture. By looking at all these numbers, we can see if there is an issue with the pituitary signaling the thyroid, the thyroid producing hormones, converting hormones or accepting hormones. It’s pretty amazing what we can tell from all these numbers even if the TSH is “in range”.

Also, it is important to remember that just as TSH has an “optimal range”, so do all the other hormones so just because nothing of highlighted in the blood test as out or range, it does not mean everything is necessarily ok. In our practice, we specialize in analyzing blood tests (especially thyroid panels) and can walk you through what we see and what needs to be fixed. Once the imbalances are identified, there are various ways that we can fix the roadblocks that we see with nutrition, supplements, herbs and glandulars customized specifically for your results.

Hormone analysis is often complicated because the body is always regulating itself and these hormonal messengers are constantly responding to signals coming from all ends of the body. If you have any of the above symptoms, ruling out thyroid dysfunction is imperative.  It is likely that you will also see symptoms associated with parallel hormone systems because it is rare that thyroid hormones are “off” on their own as they relate to so many different functions. Taking a whole body approach is the best way to analyze the root cause of dysfunction and get you back to your old self.

If you have any questions, please don’t hesitate to email or call us, we are here to help!

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