Thyroid Testing

Your thyroid is a small gland located in the front of your neck which is repressible for regulating all metabolic processes in your body.  A malfunctioning thyroid can either be working too much (hyperthyroidism) or not enough (hypothyroidism).  When your thyroid is not functioning optimally, a multitude of symptoms can manifest.  Not only is thyroid disease very common, but it is horribly under diagnosed and misdiagnosed.  

Doctors’ inability to properly order a thyroid panel may be the most frustrating diagnosis error I see.  This is just normal lab testing too, no specialty lab required.  Thyroid health is a perfect example of functional medicine, where the hormones act on each other in a cascading pathway (for the most part).  Therefore, functional medicine testing should be fairly straight forward; just start at the top of the pathway and work down.  This is how most doctors are trained to think.  The problem is that something can go wrong at any point in the pathway and not affect the other components.  


Most doctors, suspicious of thyroid disease, will order a TSH (thyroid stimulating hormone) test without fuss.  If that test comes back normal they say you do not have thyroid issue and that’s that, end of discussion.  The problem is that there could be an issue downstream that is affecting your thyroid health and not affecting your levels of TSH.  If your doctor doesn’t believe this they are doing you a disservice because thyroid illness is severely under diagnosed for this reason.  I see this all the time and it is infuriating.  Those doctors are treating the labs and not treating the person, you.  


The next issue is that when TSH comes back abnormal doctors are quick to treat you for hyper or hypothyroidism just based on that result.  This is how thyroid disease is so often misdiagnosed.  We need to know all the details in order to make a proper diagnosis and render an effective treatment.  


Lastly, or at least for this discussion, is that doctors aren’t testing antibodies to make sure your thyroid issue is not an autoimmune issue.  No matter how much you take, conventional treatment for say hypothyroidism will not work for autoimmune Hashimoto’s thyroiditis.  

Now, take a look at my med school drawing, which still holds true today, to learn more about your thyroid and its hormones.

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  1. The journey begins in the hypothalamus in your brain which receives a stimulus such as a change in temperature​

  2. The hypothalamus releases thyroid releasing hormone (TRH) which travels to the pituitary gland also in your brain

  3. The pituitary gland then releases thyroid stimulating hormone (TSH) which travels to your thyroid gland in your neck to produce more thyroid hormone

  4. Your thyroid, with the help of thyroid peroxidase (TPO) to produce a whole bunch of T4 (inactive thyroid hormone) and a little bit of T3 (active thyroid hormone)

  5. T4 is taken to the liver where it is either converted to more active T3, reverse T3 (rT3) which is mainly made in times of stress to slow down metabolism, and T3 sulfate & T3 acetic acid (these are taken to your intestines to be converted to T3 by your gut microbiome

  6. Thyroid binding globulin (TBG), a protein that transports T3 around your body, takes T3 to the target cell to do its job

If you suspect you have thyroid problems or your current treatment is not working, it is time to get proper testing and a proper set of eyes on it.  If your doctor says that more testing is not needed because your TSH was normal, you need a new doctor.  A proper thyroid panel should consist of TSH, T3+T4 (free and total), rT3, TBG, TPO, and antibodies.  No, this is not overkill, this is proper patient centered care. 


The test can be ordered for you anywhere in the country.  All you have to do is take the order to a blood draw site near you for collection and the rest is taken care of!