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Navigating Thyroid Health: Are You Thyroid Sick or Hypothyroid?

When you glance at the title of this blog post, you might think, “They both sound terrible.” However, upon closer examination, it’s implied that one is less severe than the other—only on paper though. Let me explain.

You can have a checkup at your general practitioner’s office, undergo the standard blood workup covering basic health information like cholesterol, iron levels, vitamin D levels, kidney function, liver function, fasting glucose, and more. But when it comes to thyroid function, the results might show you’re within the normal range, even if you’re not feeling 100%. You may be experiencing symptoms like hair loss, anxiety, fatigue, and more.

To add fuel to the fire, your doctor may dismiss your concerns or, worse yet, recommend an antidepressant—often not the right answer.

Symptoms of low thyroid hormone: 

  • Hair loss or thinning on head
  • Eyebrows may curve straight down on outer edges
  • Hair missing on outer edges of eyebrows
  • Lower eyelashes missing or sparse
  • Cystic acne around mouth or chin due to hormonal imbalance
  • Darkness on the inside corner  of the eye due to adrenal fatigue
  • Dry skin
  • Apathy
  • Anxiety
  • Cold hands and feet
  • Concentration difficulties
  • Constipation 
  • Depression
  • Disturbed sleep patterns and / or insomnia
  • Fatigue or weakness
  • Joint pain
  • Low body temperature
  • Memory problems
  • Migraine
  • Muscle pain
  • Pale skin
  • Reduced ability to sweat
  • Shortness of breath while little exertion
  • Water retention 
  • Weight gain or difficulty losing weight


The basics of how your thyroid works

Now, let’s dive into the basics of how your thyroid works. Picture your thyroid gland as your body’s thermostat, situated in the lower part of your neck, just above the collarbone, often covered by the “V” of your clothing neckline. It’s a small, butterfly-shaped gland playing a vital role in regulating metabolism, the process by which your body converts food into energy.

The thyroid produces two main hormones, thyroxine (T4) and triiodothyronine (T3). These hormones act as messengers, traveling through your bloodstream to affect almost every cell in your body. They control how your cells use energy, influence your body temperature, and even impact your heart rate. The delicate balance is regulated by the pituitary gland, a tiny gland at the base of your brain, releasing thyroid-stimulating hormone (TSH) to signal the thyroid when more T3 and T4 are needed.

Thyroid Sick

Being thyroid sick is when your thyroid gland is healthy but isn’t effectively delivering thyroid hormone to the trillions of cells in your body. Tissues and organs are starving for thyroid hormone, and this dynamic is increasingly prevalent, particularly among women.

If you take away anything from this post, remember this: when measuring the thyroid component in a standard blood work checkup, you’re typically just assessing TSH. TSH falls within normal limits and doesn’t necessarily rule out being thyroid sick, despite shared symptoms with hypothyroidism. Understanding this can empower you to communicate effectively with your doctor and advocate for your health.


A deeper dive into thyroid function

Now, let’s delve deeper into thyroid function. The hypothalamus in your brain produces TRH (thyrotropin releasing hormone), signaling the pituitary gland to release TSH. This TSH prompts your thyroid gland to release T4 (thyroxine), a hormone that plays a role in methylation and detoxification. The conversion to active T3 hormone is crucial for waking us up, but when T4 converts to Reverse T3 (rT3), it blocks T3 from working effectively, leading to hypothyroidism. 

What is methylation and why does T4 need it to turn into the active form of  T3? 

Methylation is a crucial biochemical process that plays a role in various functions in the body, including thyroid function. Let’s break it down:

Imagine methylation as a series of tiny, intricate reactions happening inside your cells, kind of like a mini-factory. In this factory, a process called methylation involves adding a “methyl group” to different molecules. Now, what’s a methyl group? It’s a simple structure made of one carbon atom bonded to three hydrogen atoms (CH3).

Here’s where it gets interesting in the context of your thyroid: Methylation is involved in the activation of certain hormones, including your thyroid hormones. Let’s focus on thyroxine (T4), one of the main hormones produced by the thyroid.

When your thyroid gland releases T4, it’s not the active form. It needs to undergo a transformation into triiodothyronine (T3), the active hormone that really gets things moving in your body. This conversion is where methylation steps in.

The thyroxine (T4) needs to be methylated to become active T3. The addition of a methyl group helps in this conversion process. Think of it like a key turning in a lock to unleash the full potential of the hormone.

Now, why is this so important? T3 is the thyroid hormone that influences your metabolism, energy levels, and overall vitality. Proper methylation ensures that you’re efficiently converting T4 into the active T3, keeping your thyroid function in balance.

But, here’s the catch: If methylation is not happening optimally, it can lead to issues. For example, if the methylation process is impaired, you might end up with an excess of reverse T3 (rT3) instead of the active T3. This situation can essentially act as a roadblock, hindering the beneficial effects of thyroid hormones.

In essence, methylation is like the behind-the-scenes worker ensuring that your thyroid hormones are activated and doing their job effectively. It’s a critical player in the symphony of biochemical processes that keep your body functioning optimally.

An abnormal TSH reading – Hypothyroidism

An abnormal TSH reading indicating hypothyroidism takes time to develop. Relying solely on the standard TSH test may mean missing early signs that can be addressed through lifestyle changes, diet, and supplementation. It’s crucial to consider various factors, from environmental exposure to stress, in maintaining thyroid health.

Testing protocols

So if you suspect that your thyroid may not be working at 100% capacity, what can you do? You can start by knowing which tests to take that will provide a more accurate picture of what’s happening inside and have a road map to improving your thyroid health. . 

Here are several recommended tests to check your thyroid

Keep in mind that the “suggested levels” you are about to read are based on “optimum measurements” and not the “standard of care normals.” The “standard of care normals” for lab tests is typically established based on a reference range derived from a large population of individuals. However, it’s important to note that these reference ranges may include both healthy individuals and those with certain health conditions.

The goal is to capture a broad representation of the population to establish a baseline. This means that the reference range may include values from people who are perfectly healthy as well as those with various health conditions. Therefore, the term “normal” in the reference range doesn’t necessarily mean optimal or ideal for everyone.

In some cases, practitioners may consider narrower or more specific reference ranges for certain populations, such as age or gender-specific ranges. It’s also worth noting that individual variations and factors like age, sex, and other health conditions can influence what’s considered normal for a specific person.

Ultrasound Test

An ultrasound scan is non-invasive and it creates images of your thyroid gland by bouncing sound waves off it. This can detect enlargement or inflammation of the gland but doctor’s don’t generally use this method as often and should. 







Free T4 or Free Thyroxine

Suggested level 0.8 – 1.8 ng/dl (nanograms per deciliter)

Think of the Free T4 test as a measure of the active thyroid hormone available in your body. It’s like checking the levels of workers (T4 hormone) ready to contribute to the job of keeping your metabolism in check.

When you get a Free T4 test, it assesses the amount of unbound (free) thyroxine in your blood. This is important because it’s the unbound T4 that can enter your cells and do its metabolic magic. The test helps to determine if your thyroid is producing an adequate amount of this essential hormone.

In simpler terms, it’s like checking how many workers are available and ready to roll up their sleeves for the job. If the levels are too low, it might signal an issue with your thyroid function, and if they’re too high, it could suggest an overactive thyroid.

Understanding Free T4 levels can provide valuable insights into your thyroid health and help guide any necessary interventions.

Total T4 or Total Thyroxine 

Suggested level 140 – 175 ng/dl

The Total T4 or Total Thyroxine test is like looking at the overall workforce of thyroid hormones in your body. Instead of focusing on the free workers, it considers both the free and the bound ones, providing a comprehensive view.

In this analogy, the total workforce includes both active workers (free T4) and those already assigned to specific tasks (bound T4). The test measures the total amount of thyroxine circulating in your bloodstream, giving a broader picture of your thyroid function.

When the total T4 levels are checked, healthcare professionals can assess if your thyroid is producing an adequate amount of hormone overall. It’s like taking into account all workers, whether they are currently on duty or ready to jump into action.

This test is useful in diagnosing thyroid disorders and understanding the overall capacity of your thyroid gland.

Free T3 or Free Triiodothyroine

Suggested level 3.5 to 4.3 pg/ml (picograms per milliliter) 

The Free T3 test is like checking the availability of the most active thyroid hormone in your body. If Free T4 is the workforce waiting to get the job done, Free T3 is the energetic team leader making things happen.

In simple terms, Free T3 measures the amount of unbound (free) triiodothyronine, which is the thyroid hormone that has the most impact on your cells and metabolism. It’s the one that really gets things moving and ensures that your body is functioning at the right speed.

Imagine Free T3 as the captain of the team, directing and coordinating the metabolic processes. This test is crucial because it gives insight into whether there’s enough of this active hormone available to keep your body running smoothly.

Checking Free T3 levels helps assess the effectiveness of your thyroid in producing the hormone that actively influences your energy levels, temperature regulation, and overall well-being

Reverse T3 or rT3

Suggested level < 15 ng/dl (also expressed as < 150)

This test may not be covered by some health insurance providers but is very important nevertheless. 

Think of Reverse T3 as a sort of “brake” in your thyroid system. While Free T3 is the energetic team leader, Reverse T3 is like the supervisor ensuring things don’t get too hectic.

In this analogy, sometimes when the body needs to slow down the metabolism for various reasons, it converts some of the active Free T3 into Reverse T3. It’s a way of saying, “Okay, let’s take it easy for a bit.” This process can happen in response to stress or illness, among other factors.

So, checking Reverse T3 levels helps understand if there’s an appropriate balance between the active form (Free T3) and the slowdown mechanism (Reverse T3). If there’s an imbalance, it might indicate that the body is trying to adapt to stress or other challenges.

Understanding Reverse T3 can provide insights into the regulatory mechanisms of the thyroid and how the body manages its energy resources.

Free T3 to rT3 Ratio

Suggested level > 2

The Free T3 to Reverse T3 (rT3) ratio is like evaluating the balance between the energetic team leader and the supervisor in your thyroid system.

In simpler terms, it’s a comparison between the active thyroid hormone (Free T3) and the one that acts as a sort of “brake” on metabolism (rT3). Imagine Free T3 as the go-getter team leader driving your metabolism, and rT3 as the supervisor tapping the brakes to ensure things stay in balance.

When you calculate the ratio between Free T3 and rT3, you’re essentially assessing whether the team leader (Free T3) is in the right proportion to the supervisor (rT3). If the ratio is off, it could suggest that the body is dealing with stress or other challenges, and the balance between activation and slowdown may be disrupted.

This ratio provides valuable insights into how well your thyroid system is managing energy resources and responding to various factors.

Thyroid Antibody Test

Thyroid antibody tests offer a unique lens into your thyroid’s well-being. Unlike standard tests, they reveal if your immune system is targeting your thyroid—early signs of potential trouble. Acting as an early warning system, these tests can detect autoimmune thyroid conditions in their infancy, allowing for tailored solutions and proactive steps in your thyroid wellness journey.

Thyroflex Thyroid Test

The Thyroflex thyroid test is a non-invasive and quick assessment designed to evaluate the function of the thyroid gland. It involves a technology known as neuromuscular response testing.

Here’s a simplified breakdown:

  • Neuromuscular Response: The Thyroflex test assesses the neuromuscular response of certain muscles, particularly those associated with thyroid function.
  • Muscle Reflexes: During the test, a healthcare professional typically uses a small device to tap or stimulate specific reflex points on your hand or another part of your body. These reflex points are linked to the thyroid gland.
  • Thyroid Function Evaluation: The response of your muscles to these taps is observed and analyzed. The idea is that the neuromuscular response can provide insights into the function of the thyroid gland.
  • Quick Results: One of the advantages of Thyroflex is its speed. The test is often completed within a short period, providing rapid feedback.

Basal body temperature test

Using basal body temperature (BBT) is a method that some people employ to gain insights into their thyroid health. Here’s a simplified explanation:

  • Basal Body Temperature (BBT): This involves measuring your body temperature at rest, typically first thing in the morning before you get out of bed. This is known as your basal body temperature. Place the basal thermometer under your armpit. 
  • Thyroid Connection: The idea is that your basal body temperature can be influenced by thyroid function. The thyroid hormones play a role in regulating your body’s metabolism, and as a result, they can affect your body temperature.
  • How to Measure: To use BBT for thyroid health, you would need to consistently measure your temperature at the same time every morning, ideally using a basal body thermometer for accuracy. The readings are then recorded over a period, and patterns or trends are observed.
  • Thyroid Imbalance: Some believe that consistently low or fluctuating basal body temperatures might indicate an underactive thyroid (hypothyroidism), while consistently high temperatures might suggest an overactive thyroid (hyperthyroidism).
  • If your temperature measures less than 97.8, that’s a heads up that your thyroid is not working efficiently and indicates hypothyroidism. 

The tests that I listed here in this blog post will give you a good idea of whether your thyroid is functioning properly. Especially the blood tests. The Thyroflex thyroid test and basal body temperature are extras to add on if you want to go the extra mile. 

I know this was a super long blog post, as there’s so much to say about the thyroid and the right testing. When you’re going through menopause or are post menopause, it’s even more important to have a basic understanding of this tiny and incredible gland. By empowering yourself with knowledge, you will avoid the pitfalls of being misdiagnosed, know what questions to ask of your doctor and improve your thyroid health. 

Look, Feel and Be Kuhle!


Thyroid Healthy: Lose weight, look beautiful and live the life you imagine by Suzy Cohen RPh


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