Women's Health Series: Hypothyroidism Part 2
How do I know if I have hypothyroidism?
Constipation, fatigue, depression, hair loss, dry skin, weight gain (that is not due to diet or lack of exercise) are all symptoms that can indicate hypothyroidism.
They can also be due to numerous other issues, and usually it is more than one cause. Even if it hypothyroidism is a primary cause, you need to know how you got that way if you truly want to feel well again.
So, how do you determine what, or how much, poor thyroid health contributes to your health issues?
Conventional medicine relies on a simple check of TSH (thyroid-stimulating hormone) to diagnose hypothyroidism.
Your TSH level is inverse to your level of thyroid functioning. So, if you have too little thyroid hormone, your master gland, the pituitary, starts 'screaming' at your thyroid increases the amount of TSH it sends to your thyroid, essentially ‘yelling louder’ at your thyroid to secrete more thyroid hormone.
Too little thyroid hormone? Increased TSH.
This practice of diagnostics and treatment leaves up to 60% of people with hypothyroidism undiagnosed. And even if you are diagnosed, while necessary, hormone replacement doesn’t begin to address the whole picture and leaves underlying drivers of hypothyroidism unchecked.
Autoimmune vs Non-autoimmune Hypothyroidism
If your TSH is high, your doctor may or may not check for the autoimmune form of hypothyroidism, Hashimoto's thyroiditis. In this case, your body has mistakenly started creating immune molecules called antibodies that flag your thyroid for attack. Over time, this prolonged attack will eventually lead to decreased secretion of thyroid hormone.
Your doctor often won't check for thyroid auto-antibodies because they don't treat any differently if they find them. Conventional practice is just to wait until the thyroid has degraded to the point that it can't produce enough thyroid hormone and then give synthetic T4 as either Synthroid or Levothyroxine.
Note that simply having auto-antibodies against your thyroid does not mean you are hypothyroid. It may take some time for the attack to degrade your thyroid to the point that it can no longer secrete enough thyroid hormone. And unfortunately, the conventional approach is to simply wait for this to happen and then prescribe often varying amounts of thyroid hormone to try and make up for it.
Is TSH the best way to diagnose hypothyroidism?
Whereas in conventional practice, hypothyroidism is not diagnosed until TSH is over 4.5, optimal TSH ranges for health lie between 0.5 and 2, or at most, 2.5 mU/mL. As we age, the upper range may increase to between 3.5 - 4 and still be normal.
Ultimately, the amount of thyroid hormone in circulation (as defined by free T4 and free T3) and how you feel are better determinants of your thyroid function and if medication will help you. Merely having an elevated TSH does not always mean you have insufficient amounts of thyroid hormone (yet). Though it is definitely a call to action to start investigating and addressing any possible causes of this.
In practice, if someone has no symptoms or clinical signs of hypothyroidism, I wouldn't recommend hormone replacement therapy when TSH is high. This is however a sign not to wait until thyroid hormone is insufficient and to look for and address underlying drivers of poor thyroid function!
Also, there are forms of hypothyroidism in which the TSH will be normal. Chronic illness, chronic stress, autoimmune disease, and head trauma can all lead to 'central hypothyroidism' (and global ‘central hypopituitarism’). In this case TSH will be normal or even low along with low circulating thyroid hormones. Essentially, the whole system is sort of 'tired' and in conservation mode
How to get a better diagnosis if you are dealing with hypothyroidism symptoms:
There are two main things to do to better understand your thyroid function:
Test additional markers of thyroid function if you are experiencing possible hypothyroid symptoms.
Not just TSH, but total and free T4 and T3, and RT3.
Narrow the ranges of what is considered 'normal' to define health and not the outright disease.
To improve hypothyroid diagnosis, we must better understand where thyroid hormone signaling is being affected and why. If we understand that the body is making these changes for a reason, and look for those reasons, we will be able to alleviate the stressors leading to dysregulated thyroid hormone signaling and give the body a better chance to restore normal functioning.
Many factors control how active your body keeps thyroid signaling and if thyroid hormone’s message is received by its target cells. These include other hormones (estrogen, cortisol, adrenaline), inflammation, nutrients and stress. In our modern world, stress and inflammation lead to broad spread dysregulations in many hormone functions in the body, of which thyroid hormone is just one (though often is felt the most).
Once you know your hypothyroid is not functioning well, it is time to look throughout the body and your life for the causes. Proper hypothyroid diagnosis (and treatment) includes looking at the gut microbiome and other sources of inflammation, lifestyle (stress, sleep, exercise), nutrients and other hormones.
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