We get it. You have all the thyroid symptoms, but your doctor told you that your thyroid is normal and you wonder why you still don’t feel well.

Your thyroid was probably assessed by checking only a TSH (thyroid stimulating hormone) as the single lab screen, as is the case for the majority of patients seen in traditional medicine. I know, because I used to be trapped in this one concern, one test model of traditional health care. As MDs, we’re taught that the TSH is a very sensitive test for thyroid problems, that it will catch the vast majority of thyroid issues, and that it’s likely insurance won’t cover additional screening thyroid labs anyway.

However, there are several problems with using only a TSH to assess thyroid function. TSH actually comes from the pituitary gland to “stimulate” production of more thyroid hormone by the thyroid gland if there isn’t enough thyroid hormone circulating. So, a high TSH can mean a low thyroid hormone. The first problem is that TSH is only one player in a multitude of hormones that make up thyroid function.

The next problem is that the range for a normal TSH is quite wide, usually ~0.5 – 4.5, because the studies used to determine this range were not personalized, and didn’t take into account that some people in the study population were already trending towards thyroid disease. In functional medicine we look at optimal ranges over normal ranges, and we look at personalized levels. Our optimal range for TSH is typically between 1.0-2.5.

Using this functional perspective helps us find more thyroid problems and find them earlier, giving us a chance at more effective reversal of the thyroid disease process. Because most thyroid disease is auto-immune, we also screen by looking for antibodies that attack the thyroid so that we can intervene before more damage is done.

Lastly, using TSH only misses the mark because it’s not telling us how well the thyroid hormone is being converted to its active form and how well the tissues are using the thyroid hormone at the cellular level to drive metabolism. At Root, we check for this using a full thyroid panel in an affordable blood test. (We skip the insurance coverage guessing game and offer low direct pricing on essential thyroid tests).

For a full thyroid panel, what thyroid tests do I need?

When we assess thyroid from a functional level we check: TSH, Free T3, free T4, and thyroid antibodies. Because not only do we want a normal functioning thyroid, we want that thyroid hormone to be working optimally in your body. We want the conversion of T4 to T3 (the active form of thyroid hormone) assessed, and we want that T3 to get into the cell where it’s used to drive metabolism.

When do you need a full thyroid panel?

You may need a full thyroid panel if:

Were you told that your thyroid levels are normal but you still have hypothyroid symptoms? Such as:

  • Hormone imbalance (PMS, irregular periods). T3 is needed to make sex hormones.
  • Infertility or Miscarriage
  • Daytime fatigue
  • Anxiety, Depression, or Mood Disorders. T3 works right on the serotonin receptor, helping to un-lock it and accept serotonin.
  • Constipation
  • Hair loss
  • Aches in joints, muscles, hands
  • Difficulty concentrating or remembering things (brain fog)
  • Unexplained weight gain or difficulty with weight loss

Or, you’re already on thyroid medication and your doctor is only checking a TSH.

Where do we go from here?

Not only do we assess the whole picture when it comes to how your thyroid is functioning, if it’s not functionally optimally, we want to know why – what are the root causes of thyroid dysfunction? Some common root causes we check for are: adrenal dysfunction, gut health (important for addressing thyroid antibodies), nutrient deficiencies, inflammation, activity level, sleep and stress, infections, and medication side effects.

Root’s Gut Health bundle

We find root causes of thyroid disorders by listening to your story from birth, by assessing possible causes of your symptoms, and by using advanced testing with functional medicine labs. We put the whole picture together.

So often in healthcare, medicine is artificially separated in silos. If you have a thyroid problem you see an endocrinologist. If you have a heart problem, you see a Cardiologist. Bone problem – osteoporosis specialist, and so on. This leads to often multiple medications for symptom control in each area and no one putting the whole picture together to address root causes and solve the problem at the cause.

With thyroid in particular, who is putting your whole picture together to optimize not only how you feel but the prevention of future problems?

Prevention of related problems:

Nearly all hypothyroidism  (>90%) in the U.S is caused by an auto-immune process (Hashimoto’s). We know that those with one autoimmune disease are more prone to develop another if we do not lower inflammation and address root causes. For example, a large number of patients with Celiac disease will develop Hashimoto’s.

Extra-thyroid symptoms:

Thyroid disease affects nearly every body system. For example, people with thyroid disease or who are on thyroid medication are more at risk for bone loss. Many with thyroid disease also have sleep apnea (and often have sleep apnea with associated thyroid antibodies before being diagnosed with thyroid problems).

Thyroid hormone Affects other body hormones:

Thyroid hormone directly affects our female hormones. In addition, adrenal health and thyroid are inter-related.

Simply replacing the end result (thyroid medication) isn’t enough. It doesn’t reverse disease or fix what got you there in the first place (likely inflammation). Plus, there is evidence that circulating thyroid antibodies don’t just hurt the thyroid. A comprehensive approach to actually treating thyroid problems takes time, a partnership, the availability of the right labs, and nutrition knowledge. Treating the problem is different from simply managing the problem with medication.

Extra-thyroid targets:
Gut Health