Hey, people!
Today’s health tip concerns blood tests.
As I’m sure many of you have experienced, a lot of doctors rely heavily on test results.
The most commonly ordered are TSH and T4.
Some doctors won’t order anything other than TSH.
And many labs now do what is called a TSH cascade, which means they only test more than TSH if TSH is out of range.
Which it isn’t, a lot of the time. Regardless of how lousy you feel.
What this practice amounts to is simply managing TSH.
Managing TSH is not the same as managing Hashimoto’s.
Lately, several people have posted questions regarding their lab values.
In most cases, I can’t give a good answer.
I’m not trying to be a jerk, it’s because lab tests are flawed.
They are not the be all and end all.
They do not provide answers by themselves.
With Hashimoto’s, what you feel, the symptoms you have, are clinically significant and diagnostically important.
And here’s why this is especially true of TSH.
TSH is thyroid stimulating hormone.
It is released by the pituitary gland to signal the thyroid to release thyroid hormone.
And research has found that the pituitary does not absorb thyroid hormone
in the same way that the rest of the cells in the body do.
A study published in the British Medical Journal, Meir et al looked into the question of whether or not TSH and the amount of thyroid hormone in the cells of the body were directly correlated.
It was shown that the TSH level had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose.
The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure.”
“… We found no correlations between the different parameters of target tissues and serum TSH.”
“…no correlations…” means these 2 things aren’t connected.
Do want to know what your test results mean?
Look at them in the context of how you feel.
A thorough assessment of your signs and symptoms is, by far, the best way to understand how you feel.
Trust your body.
It will tell you whether or not what you are doing is working.
And if you feel like crap, what you are doing is not working.
It’s time to change course.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143526/
Edit:
I conducted a poll on my Facebook page the other day (http://facebook.com/HashimotosHealing) asking whether anyone who had normal lab results were still experiencing symptoms. These graphs below illustrate the results from that poll:
A new study published in the Journal of Thyroid Research explores the difference between the theory of T4 (thyroxine) and TSH (thyroid stimulating hormone) interactions and the actual data found in populations.
The conclusion of researchers is that “The population curve is consistent with the physiological studies of the TSH response to T4 and implies a greater interindividual variation in the positive thyroid T4 response to TSH than in the central inhibitory TSH response to T4.”
In other words, TSH responds to T4 therapy, but there is greater variation between individuals’ response to how TSH affects T4 levels than to how TSH is affected by T4 (More T4 is supposed to make TSH levels go down).
This is a really important finding and something I have written about on several occasions.
This matters because so many doctors determine everything they do on lab results and the most common lab tests, by far, that are ordered are TSH and T4.
And what this study tells us is that this is not always the best way to practice because everyone is not the same and everyone does not respond the same way to T4 only treatment.
Let me explain how this all works in your body.
TSH is thyroid stimulating hormone. This is released by the pituitary gland to stimulate the thyroid so that more thyroid peroxidase (an enzyme) is made.
This enzyme combines with iodine to make thyroid hormone, T4 and T3. About 97% is T4 and 3% is T3.
The body can’t really use T4, so it has to convert this into T3 which is the form that the cells of the body can use to do stuff. 60% of T4 is converted by cells in the liver, another 20% by cells in the gut and the remaining 20 or so % is converted by cells in the peripheral tissues of the body (muscles, fat, etc.)
And this is the basic premise of thyroid replacement hormones like Synthroid. It’s synthetic T4. The theory is that you just give it to the patient and tell them to call you in 6 months. An everything should be hunky dory.
(Only in real life, it sometimes isn’t. Here’s a detailed post I wrote on this.)
And the reason it doesn’t work is that thyroid hormone must be converted from T4 into T3 in order for the body to utilize it. This conversion happens differently in different parts of the body.
The problem with TSH only testing to determine thyroid hormone levels in the entire body is that the pituitary, which releases TSH, converts thyroid hormone differently than the rest of the body.
This is why you often see normal TSH with lots of hypothyroid symptoms.
Many doctors, somehow, are ignorant of this fact and instead of truly understanding what is happening physiologically, blame the patient for having symptoms when their lab tests say that they should be fine.
Another thing that this study points out is “The pituitary, though ultimately responsive to T3, is more responsive to T3 generated in the pituitary from circulating T4 by type 2 deiodinase than to circulating T3, and TSH levels are more consistently related to levels of T4 than T3. There are physiological advantages of this preference.”
Another very important observation. Here’s how this happens.
How Does T4 get Converted to T3?
There is an enzyme that is largely responsible for thyroid hormone conversion. It is called 5′ deodinase. And it actually comes in 3 forms: deodinase type I (D1), deodinase type II (D2)and deodinase type III (D3).
D1 and D2 Don’t Behave the Same Way
D1 converts inactive T4 to active T3 throughout the body. In the pituitary, D2 controls this conversion. These two forms behave very differently and are affected by different things.
D1 is suppressed and down-regulated (which means it decreases T4 to T3 conversion and increases reverse T3 levels) in response to stress (both physiologic and emotional), depression, dieting, weight gain and leptin resistance, insulin resistance, obesity and diabetes, inflammation from autoimmune disease or systemic illness, chronic fatigue syndrome and fibromyalgia, chronic pain, and exposure to toxins and plastics.
What did we just describe? Your average Hashimoto’s patient living in the modern world!
Most people with Hashimoto’s have the majority of conditions mentioned above.
In addition, D1 activity is also lower in females, making women more prone to tissue or functional hypothyroidism.
Sound familiar? Normal lab results but hypothyroidism at the cellular level.
And when you have these conditions, there are reduced tissue levels of active thyroid hormone in all tissues except the pituitary because D2 does not behave like this, at all.
D2 is 1,000 times more efficient at converting T4 to T3 than D1 in the rest of the body. And it isn’t suppressed and down regulated by any of the things we mentioned.
So TSH is within normal range because the pituitary is getting plenty of thyroid hormone, but the rest of the body is hurtin’ for certain.
T4 has a long half life, so pituitary responses to it must be slow or you’d have very little TSH signaling.
A large portion of thyroxine (T4) binds reversibly to plasma proteins. Only a small free fraction (0.02% to 0.03%) is available for conversion to T3 and transport to cytoplasm.
T3 is formed from T4 by 5′ deiodination at the outer ring by type 1 deiodinase predominantly in liver, kidney, and thyroid.
Type 2 deiodinase mediates intracellular deiodination in glial cells, pituitary, brown adipose tissue, skeletal muscle, and placenta.
These higher levels of Type 2 deiodinase in the pituitary help keep the body balance and help keep feedback loops working.
In theory.
But real life is not theory and it is very common to have normal test results and still not feel normal, or even feel really lousy. The reason for this is that there is so much variability in how T4 behaves in the body.
There a few simple things that you can do.
#1. Understand that how you feel is diagnostically important and clinically relevant. If you have normal test results, but you feel like crap, something is not working.
Don’t just accept that this is how things are going to be. They don’t have to be, but you will have to look elsewhere for solutions.
#2. Get your doctor to order other tests: free T3, free T4 and reverse T3 all provide meaningful information on how well thyroid hormone is being utilized in your body.
#3. Do everything you can to improve thyroid hormone conversion. There’s a lot you can do. Begin by reading this post where I explain how to improve conversion in depth.
#4. Make reducing inflammation your top priority. Inflammation is the root of all evil. It is a primary reason why thyroid hormone doesn’t work in your body.
Take natural anti-inflammatories and understand that stress is very inflammatory. You need to take it very seriously.
#5. Keep circadian rhythms. TSH is released in a pulse with your body’s natural circadian rhythm. (I’ll be exploring how to do this in an upcoming post.)
#6 Consider treatments that involve adding T3. Natural desiccated hormone therapy like Naturethroid or Armour contains more T3 and there are synthetic T3 treatments like Cytomel. Check out this post for a detailed discussion on thyroid replacement hormone.
http://press.endocrine.org/doi/10.1210/er.2008-0019
https://www.hindawi.com/journals/jtr/2016/6351473/
https://www.hashimotoshealing.com/5-keys-improving-thyroid-hormone-conversion/
https://www.hindawi.com/journals/jtr/2012/351864/
https://www.hashimotoshealing.com/hashimotos-why-do-i-feel-like-crap-on-synthroid/
Thyroid Levels Impact Dementia Risk
A new study published in the journal Neurology has found that high and high-normal thyroid levels are linked to greater risk of developing dementia, but not vascular brain disease.
This is a very interesting finding because (as this previous post illustrates) cognitive decline has been linked with hypothyroidism and high TSH.
This study shows that having too low TSH can also be risk factor (we’ll explore why this might be in a moment). What this also shows us is just how important balance is. There may be a “Goldilocks” zone of TSH and free T4 that’s “just right”.
In this study, researchers led by Layal Chaker, MD, MSc, of Erasmus University Rotterdam, the Netherlands investigated the role of thyroid function in dementia, cognitive decline, and vascular brain disease.
They examined a subgroup of 9446 people (mean age 65) enrolled into this Rotterdam Study. Researchers looked into the link between thyroid-stimulating hormone (TSH) and free thyroxine (free T4) and incidents of dementia.
Here’s what they found: Over the course of follow-up (mean 8 years), 601 patients developed dementia (Alzheimer’s dementia n=487). Higher levels of TSH were found to be associated with lower dementia risk for both the full and normal ranges of thyroid function, independent of cardiovascular risk factors (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.83–0.98; and HR 0.76, 95% CI 0.64–0.91, respectively).
Participants with higher levels of free thyroxine were found to have greater dementia risk (HR 1.04, 95% CI 1.01–1.07).
Higher levels of TSH were associated with better cognitive scores (P =.021), and in older women, a 5% decrease in absolute 10-year dementia risk. Notably, thyroid function was not found to be associated with subclinical vascular brain disease.
The results, the authors concluded, suggest that thyroid hormone impacts dementia risk through nonvascular pathways.
The researchers offered a couple of other ideas about why this might be including the possibility that excess free thyroxine may affect the way that genes are expressed in important pathways in the brain or that destruction to nerves my be caused by oxidative stress which can cause destruction of brain tissue (which, frankly, makes a lot of sense to me – more on this in a moment).
Also, participants with early signs of dementia may have changes in behavior, like diet, which may alter thyroid function. (As we know diet and behavior are extremely important for maintaining a healthy brain).
“In other words, we may not be observing a true effect of thyroid hormone on dementia risk but rather the opposite,” the authors concluded.
This is one of those instances when looking at research can make you crazy. Too high TSH and hypothyroidism is clearly a potential problem and too low TSH may also be a potential problem.
Age is another factor to consider when trying to wind yourself through this maze. Thyroid hormone is absolutely essential for the developing brain, so if your are pregnant or if you are an infant or young child, it may be more important to have your TSH a little lower (In fact, the American Endocrine Society has recommendations for TSH in each trimester and they can be found in this post.)
As we age, the brain becomes becomes more vulnerable to certain processes and, I think, the chief concern here may be the role of oxidative stress on the mitochondria in the brain.
In thyrotoxicosis (excessively low TSH or a hyperthyroid state), glucose uptake and utilization by muscle is increased as is the breakdown of glycogen (glycogenolysis) and glycogen (a substance that stores carbohydrates) depletion is seen in muscle biopsy samples.
Also, mitochondrial oxidation is increased and lipid oxidation, protein and purine breakdown all occur and this results in lower ATP (our cells energy sources).
And being naturally a little hypothyroid might actually protect your brain from this (but, it can also cause it’s own problems – damned if you do and damned if you don’t!)
And mitochondria are smack dab in the middle of this whole process because they are involved in both energy production and cell death.
Mitochondria are unique in that they both produce energy and make free radicals. They do this in order to monitor cellular health and to make a rapid decision (if necessary) to initiate programmed cell death.
When this process goes haywire in the brain, it can have devastating impacts on nerve cells. And too much free T4 can be one of the factors that drives this.
From http://www.sciencedirect.com/science/article/pii/S0925443909002427
Ironically, mitochondria in the brain are really of victims of their own amazing abilities.
If the amount of free radical species produced by them overwhelms the neurons in the brain’s ability to neutralize them, oxidative stress occurs, followed by mitochondrial dysfunction and neuronal damage.
Reactive species generated by mitochondria have several cellular targets including mitochondrial components themselves (lipids, proteins, and DNA). The lack of histones in mitochondrial DNA (mtDNA) and the diminished capacity for DNA repair render the mitochondria an easy target to oxidative stress events.
So, they are especially vulnerable to their own attacks. (There has to be a lesson there. 🙂 )
All of this can translate into destruction of brain tissue due to this oxidation which produces free radicals. (In fact, many symptoms of aging are due to these free radicals).
Basically, this all comes down to electrons. These reactive oxygen species are untethered electrons flying around breaking up cells, and wreaking havoc (think bullet in a tin can).
And really, at the end of the day, this mitochondrial dysfunction is a causal link between neurodegeneration caused by both hypo and hyperthyroidism.
So, obviously, this begs the question, How do we preserve and heal the mitochondria in our brains (and the rest of our bodies?)
Stay tuned. We’ll be exploring this in a future post in considerable depth.
Want to Banish Brain Fog and Heal Your Brain? Check out Dr. Datis Kharrazian’s Banish Brain Fog Program ($50 off if you purchase before 10/3/2016).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923401/ Endocrine Risk factors for Cognitive Impairment
https://www.ncbi.nlm.nih.gov/pubmed/17353866 Hypothyroidism and reversible cognitive decline
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496329/ Review of 23 studies on subclinical hyperthyroidism and cognitive decline
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872098/ Role of Thyroid Hormone in Oxidative Stress and Neurodegeneration
http://joe.endocrinology-journals.org/content/176/3/321.full.pdf Hypothyroidism alters mitochondria
http://www.sciencedirect.com/science/article/pii/S0925443909002427 Mitochondria Dysfunction and Alzheimer’s
Low Carb Diet Lowers Thyroid Antibodies
Hey people! I’m always astonished when people share with me that their doctor said, “Diet doesn’t matter, there’s nothing you can do except take thyroid hormone.”
I have literally heard variations of that one sentence over 500 times. I really don’t understand it because in my (and many of my colleagues) clinical experience this is the single most important factor in achieving long term success.
In today’s post I want to share a new research study that suggests otherwise. This was published in the Drug Design, Development and Therapy Journal, Volume 10, 2016.
This study, entitled, Effects of low-carbohydrate diet therapy in overweight subject with autoimmune thyroiditis: possible synergism with ChREBP , looked at “…a total of 180 patients, 84 males and 96 females, aged 30–45 years. All the subjects did not present celiac disease, but Hashimoto’s disease was detected. Moreover, each patient showed others autoimmune symptoms, they are typical Hashimoto’s disease.”
(This isn’t huge cohort, but it’s certainly enough people to give us some decent data.)
All patients had elevated antibodies.
TSH, free T3, free T4 and levels of anti-microsomal, anti-thyroglobulin, and anti-peroxidase Abs were measured. (Which is interesting since anti-microsomal and anti-TPO antibodies are essentially the same ).
They were put on the following: a diet program based on the following proportions: carbohydrates 12%–15%, proteins 50%–60%, and lipids 25%–30%. These patients were instructed to eat large leafy and other types of vegetables and only lean parts of red and white meat, avoiding goitrogenic food. The following items were also excluded from the diet: eggs, legumes, dairy products, bread, pasta, fruits, and rice.
This protein-rich diet plan was implemented for 3 weeks, at the end of which bioimpedance tests, bodyweight measurements, and blood tests (TPO Ab, anti-microsomal Ab, thyroglobulin [TG] Ab, and thyroid hormones) were performed.
There was also a control group that didn’t make any dietary changes and were also tested.
Initial (pre-diet) levels of FT3, FT4, and TSH were not significantly different between the two groups.
In just 3 weeks, these were the results: patients treated as above showed a significant reduction of antithyroid (-40%,P<0.013), anti-microsomal (-57%, P<0.003), and anti-peroxidase (-44%, P<0,029) Abs. Untreated patients had a significant increase in antithyroid (+9%, P<0.017) and anti-microsomal (+30%,P<0.028) Abs. Even the level of anti-peroxidase Abs increased without reaching statistical significance (+16%, P>0064).
In other words, there was a 40% reduction in anti-thyroid, a 57% anti-microsomal and a 44% ant-TPO antibodies. While people in the control group who made no changes showed an in crease of 9% anti-thyroid, 30% anti-microsomal and 16% increase in anti-TPO antibodies.
There was also some weight loss noted about a 5% reduction and a 4% reduction in BMI.
Those antibody reduction numbers are HUGE differences. If they were develop a drug that could do that, it would be a multi-billion dollar discovery.
So, I think it’s safe to say that this type of diet is, at least, worth trying.
I also think there are few things that came up in this study that interesting and worth pointing out. These researchers had the dieters remove goitrogenic vegetables. I have looked into the research on this and I don’t think they have the impact that we have been led to believe.
In my opinion, as long as you steam or blanch or cook them in some way, most of those properties are not an issue. Here’s a good discussion on this.
Basically, with the exception of soy, these vegetables have far more health benefits than problems.
The other thing I thought was fascinating about this study was the discussion of why this may be (I’m a geek when it comes to this and I’m forever curious to learn WHY?)
First thing the researchers note is that “… the aim of this type of diet is to reduce the overall inflammatory state and consequently inflammation of the thyroid gland.” This is an anti-inflammatory diet and test results confirm that.
Also, they note that these results may be “related to the role of the thyroid hormone receptor-α (TRα), found mainly in the liver and white adipose tissues.”
This receptor is involved in fat metabolism and balance. It causes certain genes to be expressed ( such as ChREBP or Carbohydrate-responsive element-binding protein which interacts with carbohydrate expression in DNA.)
In addition, they note “It has also been suggested that TRα could be involved in the transcriptional regulation of lipogenesis in the liver. Activation of these genes determines an increase in the expression of anti-microsomal Abs, which occurs mainly in the REL of hepatocytes, and it has a fundamental role in inflammatory processes.”
In other words, this receptor is involved in fat production in the liver (which is the result of sugar and carbohydrate consumption) AND it increases anti-microsomal antibodies AND it is is important in inflammation.
I have often noted how important blood sugar regulation is for Hashimoto’s patients and I frequently express this to my patients and we work diligently to balance their blood sugar. And this is why it is so important!
They also note” that 83% of patients with a high level of autoantibodies are breath test positive to lactase with a lactase deficit higher than 50%…” This is one of the reasons dairy can be problematic for Hashimoto’s patients as well.
And one final point that was really interesting and which emphasizes the importance of making sure your liver is functioning properly is that “Chronic inflammation of the thyroid gland can also be due to the presence of environmental contaminants that are suspected to disturb activity against the endocrine system, known as endocrine disrupting chemicals.”
These chemicals like PCBs are known endocrine disruptors and have been shown to disrupt thyroid function. These researchers suggest that a rise in anti-microsomal antibodies may be a way for our bodies to defend the thyroid and prevent it from being further destroyed.
What these chemicals do is to disrupt the thyroid receptor that we looked at earlier. And this all happens in the liver. What this study makes us more curious about is how the thyroid gland is involved in lipid metabolism (yes, those of you who know me may see the light going off in my brain- more blog posts to come!).
Bottom Line? A diet based on the reduction of carbohydrate content leads not only to a weight loss, but also a decrease in fat mass and a significant drop of autoantibodies in Hashimoto’s thyroiditis.
So, dear doctor, DIET DOES MATTER!!!!!
Try it people.
Have a great day, unless you have other plans!
Edit:
I recently conducted an informal survey on my Facebook page (http://facebook.com/hashimotoshealing)
I asked people about what worked for them the most in treating their Hashimoto’s symptoms.
The results were rather telling and, I feel, are relevant to this post. Many of them talked about dietary changes being one of the most significant factors in helping to alleviate their symptom.
Here’s a graph of the results:
Hey, people!
Today’s health tip concerns blood tests.
As I’m sure many of you have experienced, most doctors and even some alternative care practitioners rely heavily on test results.
The most commonly ordered are TSH and T4. Some doctors won’t order anything other than TSH. And many labs now do what is called a TSH cascade, which means they only test more than TSH if TSH is out of range.
Which it isn’t, a lot of the time. Regardless of how lousy you feel.
Lately, several people have posted questions regarding their lab values.
In most cases, I can’t give a good answer.
I’m not trying to be a jerk, it’s because lab tests are flawed. They are not the be all and end all.
They do not provide answers by themselves.
With Hashimoto’s, what you feel, the symptoms you have, are clinically significant and diagnostically important.
And here’s why this is especially true of TSH.
TSH is thyroid stimulating hormone. It is released by the pituitary gland to signal the thyroid to release thyroid hormone.
And research has found that the pituitary does not absorb thyroid hormone in the same way that the rest of the cells in the body do.
A recent study published by the European Thyroid Association looked into the question of whether or not TSH and the amount of thyroid hormone in the cells of the body were directly correlated and why T4 was sometimes poorly absorbed.
Another study from the British Medical Journal showed that TSH levels had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose.
The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.”
Do want to know what your test results mean? Look at them in the context of how you feel. A thorough assessment of your signs and symptoms is, by far, the best way to understand how you feel.
Trust your body. It will tell you whether or not what you are doing is working.
Some of the most common questions that I get from people who reach out to me are about antibodies.
There seems to be a good deal of confusion about them and also a good deal of emotion and expectation attached to these numbers going up or down.
In this post, we examine thyroid antibodies and, hopefully, dispel some of the myths around them.
First of all, what are antibodies, exactly? I like to use military analogies when describing the immune system. And antibodies are like military intelligence (hold the oxymoron jokes).
They are the part of the immune system that gathers information on the bad guys (bacteria, viruses, fungus, parasites, etc.) and then they label those bad guys. Kind of like putting a red flag on them.
The invader is called an antigen. Antibodies bind to these antigens like a lock and a key. Every cell has antigens and these are what the immune system recognizes. And every cell in our body has a self-antigen which are supposed to let the immune system know that our own tissue isn’t a bad guy.
Once the bad guys have been labeled, other parts of the immune system are signaled and they attack and, in most cases, kill the bad guys. In some cases these antibodies can neutralize the bad guys all by themselves and not have to wait for reinforcements.
With autoimmune disease these antigen signals get confused and the immune system ends up attacking our own tissue.
Over the last 50 years there has been a lot of research in this area.
There is a region on cells located on some of our genes called the HLA (or Human Leucocyte Antigen) System. Many of these are located on chromosome 6 (for those of you keeping count).
Mutations or defects of HLA has been linked to many different autoimmune diseases. Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.
There is a specific class of HLA (class II) that has been linked to autoimmune thyroid diseases like Hashimoto’s and there are also specific antibodies that are important in the disease.
There are 2 autoantibodies that are important:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
In Hashimoto’s, TPOAbs are present in nearly all (>90 %) patients, while TgAbs can be seen in approximately 80%.
Antibodies against TPO (TPOAbs) and Tg (TgAbs) are of immunoglobulin G class, (IgG) and both are really good buddies with their antigens.
For TPO, it is for the enzyme thyroid peroxidase, which frees iodine and helps in the production of T4 and T3.
And for TgAb it is for Thyroglobulin, which is also used by the thyroid to produce T3 and T4.
When these 2 things get destroyed, over time, the body can’t make enough thyroid hormone.
This results in hypothyroidism and all the familiar problems of Hashimoto’s: fatigue, constipation, depression, hair loss, cold hands and feet, brain fog, memory issues and lots more.
Unlike TgAbs, TPOAbs can activate certain parts of the immune system (complement) and are able to cause damage to thyroid cells.
However, there isn’t much evidence that both antibodies have a major role in the formation of Hashimoto’s or in the destruction of thyroid cells.
It seems a lot more likely that other parts of the immune system are signaled and that they bring in the Navy Seals of the immune system which attack and kill thyroid cells.
TPO and TgAb antibodies, however, are considered the definitive test for whether or not you have Hashimoto’s. Basically, if either one or both of these are found to be above the lab range values, then you are positive for the disease.
Most labs have the high end at about 25 to 35. Numbers vary considerably, but it is not unusual for people who have been diagnosed to have antibodies above 1,000.
As I stated above, in most cases these antibodies, themselves, do not attack and kill thyroid cells.
What’s also important to understand is that there are various stages of autoimmune disease and depending on where you are in the progression, you will have different degrees of thyroid tissue destruction and, therefore, different symptoms.
According to Dr. Datis Kharrazian, there are 3 stages of autoimmune disease. While these stages are not recognized by conventional doctors, they are very useful in determining exactly where you are in the progression of the disease.
And realizing that there are stages and that the stages get worse and worse, is also helpful for motivating you to do as much as you can to stop the progression. (Hopefully!)
You can read more about these stages here.
The antibodies are really involved in signaling the immune system and in setting off a series of events that results in the attack and destruction of the thyroid.
I have written extensively about what happens in this previous post.
The important thing to understand here is that the amount of antibodies don’t necessarily directly correspond to how severe the Hashimoto’s is.
There are many reasons for this, but one simple way to look at it is this: The amount of destruction that is done by the army (the immune system) depends on the strength and number of the soldiers.
As I said earlier, the antibodies are really like the CIA or some intelligence gathering part of the army. The front line soldiers are the killers. If you have lots of soldiers and they are all revved up and ready to dance, then you get more destruction.
If your army is weak and there aren’t that many soldiers, then the CIA tells them to kill, kill, kill, but they can only do so much damage.
On the other hand, even if there are only a few CIA agents and there is a large, aggressive army, you will still have massive destruction (and loss of thyroid function).
Where am I going with all this? The amount of destruction, which really is the cause of how crappy you feel, depends on the strength and number of soldiers, not on the number of CIA agents in the field.
This is why antibodies are not a good measure of progress and often don’t correspond with how well people feel.
Antibody numbers don’t correspond, directly, with tissue destruction. As I mentioned above, in some cases TPO antibodies have been linked to tissue destruction, but more often, this is not the case.
Many patients and doctors or practitioners track these numbers and use them as a measure of whether or not what they are doing is working. And many times, they will find that there is no correspondence.
Obviously, getting antibody numbers to drop is not a bad thing. But it is also not necessarily such a good thing, because it may not be an indication that the destruction or the progression of the disease has slowed.
In conventional lab testing there really aren’t tests that are done to look at this. One theory with Hashimoto’s is that the ratio between the CIA and the soldiers is important.
The soldiers are also known as the TH-1 system, the cytokines or immune proteins associated with this part of the immune system are the killers.
The CIA is known as the TH-2 part of the immune system and you can test for ratios between TH-1 and TH-2 cytokines.
If there is a lot more of the soldiers than CIA agents, then the prognosis is not good and the disease tends to be more severe.
With Hashimoto’s there is a tendency towards more TH-1 than Th-2, but this is not always the case.
On the other hand if the CIA is more numerous or more balanced and the control and command part of the immune system (TH-3 or the regulatory part of the immune system- what we can call the General) is also strong, then, usually the prognosis is better and you can calm the attack and slow or stop the progression of the disease.
In reality, the immune system isn’t linear and this is an oversimplification. Testing is available to look at the cytokines that represent these different parts of the immune system, but there are many other factors that make current tests for this unreliable and not that helpful.
However, you can use these ideas to help figure out what you need to do in order to calm the attack, slow the progression of the disease and, most importantly, feel better.
The major cause of thyroid tissue destruction is something called apoptosis. This is programmed cell death.
Lots of crazy things happen on a molecular level (like cytoskeletal disruption, cell shrinkage, chromatin condensation, nuclear fragmentation, membrane blebbing, and DNA fragmentation – membrane blebbing, people!) to make this happen, but the easiest way to grok the root of it is to understand that it is initiated by inflammation.
The best way to slow the progression and minimize destruction is to do everything you can to stop inflammation and to strengthen the regulatory part of the immune system.
2 important anti-inflammatory agents are: Vitamin D and glutathione. These supplements strengthen the regulatory part of the immune system (TH-3 or the General).
(One important thing to note is that some people with Hashimoto’s have a defect with vitamin D receptors and may need to take more than is usually required by normal individuals.)
These are important anti-inflammatories.
Another player in the complicated drama of Hashimoto’s is TH-17. This is like a rouge agent that when numerous and aggressive can do major damage. TH-17 is highly inflammatory.
Natural supplements that reduce TH-17 include Turmeric and Resveratrol. Some Chinese herbs that have been shown to reduce TH-17 are Chang Shan or dichroa root and Huang Lian and Huang Qin whose active compound is berberine.
Also, it is very important to reduce the causes of inflammation in your diet. The three most inflammatory foods in our diet are gluten, dairy and soy.
Gluten has been extensively hybridized and deamidated and has been linked to the initiation and progression of thyroid autoimmunity.
Dairy products when commercially produced are full of antibiotics, hormones and god knows what else. They have also been linked to the initiation of various autoimmune diseases.
Soy is one of the most heavily genetically modified foods in our diet and is also quite difficult to digest.
Some research has indicated that thyroid replacement hormone can reduce TPO antibodies, though there is also some indication that natural desiccated hormone can raise antibodies in some individuals (it seems to be those who have a particularly severe immune reactivity – i.e., they have lots of inflammation).
Selenium has been found to reduce TPO antibodies in a number of studies.
Thyroid antibodies are important for determining whether or not you have Hashimoto’s but are not always a good indicator of how well what you are doing is working.
Do not get too excited if antibody numbers go up or down. It’s not the antibodies that are the problem as much as the other parts of the immune system that are attacking and destroying the thyroid.
Get excited about reducing inflammation. That should be your daily obsession. Really, its that important.
Thyroid replacement hormone and selenium have been shown to reduce TPO antibodies, but this may not work for everyone.
Hashimoto’s is complicated. It is a multi-system disorder that requires a multi-system approach. That’s why created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. Click here to learn more.
References:
http://en.wikipedia.org/wiki/Apoptosis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555850/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/– Technichal, but great info on what happens in Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/15307940
http://www.ncbi.nlm.nih.gov/pubmed/7878464
http://www.ncbi.nlm.nih.gov/pubmed/20477110
http://www.medicalnewstoday.com/releases/241571.php
http://www.jimmunol.org/content/185/3/1855.full
http://www.cambridgemedicine.org/news/1299069648
http://jcem.endojournals.org/content/87/4/1687.long
Hashimoto’s is one of the most common autoimmune disease in the United States, yet is is also one of the most poorly managed. One of the most common questions I get is, what tests should I ask my doctor to order?
Because Hashimoto’s is a thyroid disorder and an autoimmune disease there are a number of additional lab tests that are important but are not, specifically, tests for the thyroid. In this post I will discuss them all and explain why it is important to order them, as well.
There are some people out there on the internet, who, out of frustration, believe that you should forget about asking a doctor to order tests for you and just order them for yourself.
In their defense, many doctors do not order the appropriate tests to do proper management of thyroid patients. There is too much emphasis put on some tests, and not enough on others that can give a great deal of information about how you are doing and how your medication is working.
However, here’s my take on that:
If you bought a luxury car, say a Tesla or a Lamborghini, you’d want to make sure it was kept in tip top shape. Would you do the diagnostics yourself? Think about how long it would take you to master the proper care of those vehicles.
It’s kind of the same thing with your body and lab testing. Hashimoto’s has so many moving parts. You are better off finding a doctor who you can have a partnership with who can give you his years of clinical expertise and help you to make sense of it all.
And if your doctor can’t or won’t do that? Well, find a doctor who will and work together to do a proper history, evaluation and diagnostic testing so that you can optimize your body and your health.
For myself, my health and my body are worth way more than a luxury car. I want to do everything I can to make sure it is kept in the best possible running order. And ordering your own lab tests can be very expensive, especially if you don’t have insurance. I give my patients lab tests at my cost. We can get them at a substantial discount and we are able to pass the savings onto them.
When interpreting Hashimoto’s lab tests you are always given 2 sets of numbers. Your test results and the laboratory range. The laboratory range is an average that is calculated based on the number of people who go to the lab in a given geographic area for a fixed amount of time.
These averages are influenced by many things: the health of that general population, the medication that is popular and prescribed during that period of time and by what general diseases those people have.
All of these factors skew the numbers. Have you been to a lab lately in your area? Spend a day there and ask yourself if those people represent the quality of life and general state of health that you want.
In many areas, in the US in particular, the general population has not gotten any healthier over the last 20 years. Look at the statistics. You probably don’t want to be among that average group. What I am getting at is, the laboratory range is not really a measure of good health. This is particularly true when it comes to the thyroid.
Millions and millions of Americans have thyroid disease and are on thyroid medication. This skews the numbers. Practitioners of functional medicine, like myself, use an additional set of numbers when we evaluate people’s health.
This is called the functional range and different specialists in various fields have identified these ranges as being where optimal health is.
So, when you are looking at laboratory results make sure you ask about functional ranges as well as laboratory ranges. Many doctors do not look at functional ranges, so be aware that asking about this may elicit a confused or dismissive response. (In this post we are focusing on lab tests alone, in a future post I will discuss how to interpret these tests.)
Hashimoto’s is an autoimmune disease and a thyroid disorder, so we must evaluate many things not just the thyroid. Here’s a list of what any good workup should include:
* Thyroid tests: TSH, free T3 (fT3), free T4 (fT4), Reverse T3, (rT3)
* Blood Sugar Analysis: Fasting glucose, HgA1C, Triglycerides, Cholesterol, LDL, and HDL
* Iron: Serum iron, TIBC, Transferrin and Ferritin
* Vitamin D3
* Vitamin B12 and B6
* Red and White Blood Cell Count: Complete CBC
* Tests to determine Adrenal Gland Health: BUN, Creatinine, Sodium and Potassium, Special test(s)
* Electrolytes: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous
* Markers that Evaluate the Health of the Intestines: Protein and Globulin, Special tests
* Hormone Testing: Saliva tests
* Immune Cell Testing: Special tests
…and maybe more, depending on what is found in a good thorough history. Let’s take a look at each of these briefly to give you a good sense of what we are looking for.
Thyroid Testing
TSH – Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function. But it is not the be all and end all in thyroid testing, the way that so many doctors and practitioners make it.
In addition, many laboratories have do what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. That doesn’t help you and there not much agreement on what the normal range should be.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid-pituitary communication, about T3 to T4 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid.
One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Free T3 – measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions. May also be high in thyroid toxicosis.
Free T4 – used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Reverse T3 – Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
This may also be high if your iron is low.
Thyroid Antibodies
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state.
They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
For a complete overview of all thyroid tests to order, you can read my previous post here.
Blood Sugar
Measuring blood sugar is critically important for Hashimoto’s patients because if you have issues with your blood sugar (too high or too low) it can undermine everything else you are trying to do.
Fasting Glucose: A snapshot of how your blood sugar is at the time of the test.
HbA1C (Hemaglobin A1C): This test is a long term sugar marker and commonly used to assess type II diabetes and metabolic syndrome. (It’s optional, but should be ordered if you are overweight and have a history of high triglycerides and fat around your waist.)
Triglycerides: These are sugars stored in the fat in the liver.
Cholesterol, LDL, HDL: Most people have been brainwashed into thinking cholesterol is about fat. Don’t be misled. Its about sugar and sugar consumption and statin drugs do nothing to fix this.
Iron:
Iron is another “deal breaker”. If you have low iron it will undermine everything you are trying to do and make it unsuccessful. Hashimoto’s folks, especially women, often have issues with their iron levels. Most iron panels contain all of the following tests:
Serum Iron – Iron is necessary for making hemoglobin which carries oxygen on red blood cells. Decreased iron levels must be correlated with RBC, HGB, and HCT to rule out anemia (more on what those mean in a moment).
TIBC – Total iron binding capacity. this will be elevated in iron deficiency because this increases the cells’ potential to bind to iron. TIBC is high before anemia develops and, therefore, can be a good way to find iron deficiency early.
Transferrin – Regulates iron absorption. Increased with iron anemia.
Ferritin – A good marker for total body iron levels and reflects how much iron the body has stored. It also called an “acute phase reactant” and can be a good marker of inflammation.
Vitamin D:
Test for Vitamin D3 (25-hydroxyvitamin D). Vitamin D is hugely important for people with Hashimoto’s because it strengthens the regulatory part of the immune system and we often have difficulty absorbing it.
Vitamin B12, B6 and Folate
These tests can be expensive and B12 and B6 can be tested by reading a CBC (Complete Blood Count) properly, a test that is available for under $20. (I’ll explain how to do this in a future post.)
CBC
A complete blood count that includes: Red Blood Cell counts: Red Blood Cells (RBC), Hemoglobin (HGb), Hematcrit (HCT), MCV, MCH, MCHC
and White Blood cell counts: White Blood Cell Count (WBC), Lymphocytes, Neutrophils, Basophils, Monocytes, Eosinophils.
There is a ton of information that you can gather from this very inexpensive test, including information about various anemias, autoimmunity, and possible infections that may be affecting your progress. (More on how to interpret this in a future post).
Electrolytes: These tests are usually part of what is called a “metabolic panel” and can be helpful in finding mineral deficiencies and electrolyte imbalances. These include: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous. The metabolic panel will also include Serum Protein, Albumin and Globulin.
Adrenal Health:
On a simple blood test, you can test the adrenals by ordering a Renal panel (BUN, Uric Acid, Creatinine) and by evaluating electrolytes, Potassium and Sodium.
The gold standard for measuring adrenal health is a saliva test that tests cortisol levels throughout the day. This can tell you a lot about how adversely stress may be affecting your health and your thyroid.
Special Tests:
These are all tests that can be very important for Hashimoto’s patients, but they are complicated and should be ordered by someone who knows what to do with the information that they provide.
Intestinal Health:
Healing the intestines is job #1 for many Hashimoto’s patients because the gut is where the immune system lives and if you want to modulate and calm your immune system, you must go there it lives. In a common blood test, Serum protein, and globulin levels can give clues to intestinal issues.
There are test on the market for intestinal permeability (leaky gut), gluten sensitivity and intolerance, and cross reactive foods that may be causing immune flare ups. The best Lab for this is Cyrex labs.
Hormone Testing:
There are various hormones that can be tested including, estrogen, progesterone and testosterone. This is involved and deserves a blog post of its own (which I will, humbly provide, in due time).
Depending on what you want to accomplish, the best of these to determine fertility and possible defects throughout a woman’s cycle are saliva tests gathered at intervals throughout the entire month.
Immune System Testing:
There are various ways to test the different aspects of the immune system from Cytokine testing, to TH-1 and TH-2 challenges. This is also quite complicated and involved and must be done with someone who understands what to do with this data.
Bottom Line:
As you can see, this can get pretty complicated, pretty quick. The best thing to do is inform yourself and then work with someone who is experienced in reading and evaluating these kinds of tests and who knows what to do with the data that is gathered.
That is what I offer here at Hashimotoshealing.com and why I created my program, Healing Hashimoto’s: the 5 Elements of Thyroid Health. In this 6 week intensive you will learn how to interpret your blood tests and, more importantly, learn what to do with that information in order to create an effective strategy for Healing your Hashimoto’s.
Thyroid lab tests are the general standard for measuring function and to determine what is or is not working. While these tests can be very effective in helping you discover where the problem might be, they are not perfect. And for those people with Hashimoto’s they can be misleading.
This is simply because all your thyroid numbers may look fine, but you still feel may like crap. Laboratory tests of thyroid function do not account for flare ups and do not really tell you anything about how your immune system is functioning. In a future post, we will take a look at how to better assess your immune system.
The way the thyroid works in the body is kind of like a bucket brigade. Hormones pass the tiny bucket from the brain, to the pituitary gland, to the thyroid gland, to the liver, and finally to the cells of the body.
The body sends a message to the brain and says “Let’s pick it up!” or “Slow your roll!” (speed up or slow down the metabolism). The part of the body that receives this message is the hypothalamus. The hypothalamus delivers the message to the pituitary gland using thyrotropin releasing hormone (TRH). The brain secretes thyroid stimulating hormone (TSH) which tells the thyroid to make and secrete T4 and T3.
The body can only use T3 and only 7% of it comes from the thyroid gland. The body has to convert the rest from T4. This happens in the liver, the gastrointestinal tract, and in other parts of the body like muscles, the heart, and nerve cells.
So, if your liver isn’t working properly or you have gastrointestinal issues like leaky gut or unhealthy gut flora (bacteria), or your pituitary gland is tired, or you have too many thyroid binding proteins in your blood from too much estrogen or you have an immune problem, you can wind up feeling lousy. It is not uncommon for people to have more than one of these issues at the same time.
And your test results might look perfect. In my last post I discussed how systems of the body are affected by the thyroid. Here you can see how the opposite is also true. All of these systems affect how the thyroid works.
With Hashimoto’s, a lot of what may be causing your symptoms is an autoimmune attack on different tissues of your body. Often, people with autoimmune disease have multiple tissues being attacked and this has less to do with the thyroid than with the immune system.
Typical Lab range: (see below)
Functional range: 1.8 -3.0 mU/L
Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function.
Many laboratories have now taken to doing what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. The problem is, there isn’t a lot of agreement about what the “normal range” is.
Since 2003, the American Association of Clinical Endocrinologists has recommended that the normal range run from 0.3 to 3.0, versus the older range of 0.5 to 5.5. So, according to the new standards, levels above 3.0 are evidence of possible hypothyroidism, and levels below 0.3 are evidence of possible hyperthyroidism. However, there is disagreement among practitioners, and some follow the older range, others use the newer range.
An important thing to understand about TSH is that it is an inverse number when thinking about thyroid function. The higher it is, the more sluggish, under achieving and, generally, slow your thyroid is. The lower it is, the more hyperactive, overachieving and, generally doing too much your thyroid is. Put another way: High TSH = hypothyroid, Low TSH = hyperthyroid.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid pituitary communication, about T4 to T3 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid. One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Laboratory range is somewhere between 0.3 (to 3.0) and (0.5 to) 5.5. That is a huge range and borders on the ridiculous. The lab range values are made based on the general population that goes to the lab.
Most people who go to the lab are taking thyroid hormones or are poorly managed or completely undiagnosed (or all of the above) so this is not really a good measure of optimal thyroid health. Practitioners of functional medicine (like yours truly) look at a narrower range that we and some endocrinologists believe is a much better range for assessing a healthy thyroid.
This range is: 1.8 to 3.0. Notice it is higher on the low end and equal to or lower on the high end. Less is more, people, when comes to monitoring a healthy thyroid.
Typical lab range: 5.4 – 11.5 ug/d
Functional range: 6-12 ug/d
The TT4 test measures both bound and unbound thyroxine levels and is not a good marker for T4 activity when measured alone. Total T4 is increased with lower TSH and is decreased with higher TSH. It is decreased with low TSH when the pituitary gland is not functioning properly (pituitary hypofunction).
Many drugs can alter total T4 levels. In my book Roadmap to Remission I explore these interactions.
Typical lab range: 0.7 – 1.53 ng/dl
Functional range: 1.0 – 1.5 ng/dl
Free T4 is used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Typical lab range: 4.6 – 10.9 mg/dl
Functional range: 1.2 – 4.9 mg/dl
On its own, this test is pretty useless. Total T4 and T3 Uptake are both used to calculate this marker (TT4 x T3 Uptake = FTI). Prescription drugs often affect T4 and resin T3 uptake levels in opposite ways (if T4 goes up resin T3 uptake goes down and visa versa). Many of these drugs affect thyroid hormone binding sites on cells. FTI is increased in thyroid hyperfunction and decreased in thyroid hypofunction and when your body needs selenium.
Typical lab range: 60-181 ng/dl
Functional range: 100 – 180 ng/dl
Total T3 gives you the total concentration of T3 in the blood. It is the preferred test for thyrotoxicosis (hyperthyroid condition, like Graves disease). Total T3 can also be useful in identifying problems of conversion from T4 to T3 in body tissue involving the enzyme 5′-deodinase.
This enzyme both converts T4 to T3 and stops T4 from working in the body.
Typical lab range: 24 – 39 md/dl
Functional range: 28 – 38 md/dl
This test measures the amount of sites for unbound T3 to bind on thyroxine-binding proteins. Many medications can cause high or low resin T3 uptake. In my program Healing Hashimoto’s: The 5 Elements of Thyroid Health we explore these interactions. Elevated testosterone or testosterone replacement therapy can reduce the number of these binding sites.
This causes a low T4 measurement because it leaves very few binding sites for thyroid hormone to attach to. In contrast, anything that raises the number of binding sites, like estrogen or birth control pills will cause a pattern of high total T4 and low T3 uptake.
To summarize, T3 uptake is increased with hyperthyroid and with high testosterone. T3 uptake is decreased with hypothyroid and high estrogen levels.
Free Triiodothyronine (fT3)
Typical lab range: 2.30 – 4.20 pg/ml
Functional range: 3.0 – 4.0 pg/ml
This test measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions.
Typical lab range: 90 – 350 pg/ml
Functional range: 90 – 350 pg/ml
This test measures the amount of reverse T3 that is produced (duh!). Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
Thyroid-Binding Globulin (TBG)
Typical lab range: 15 – 30 ug/dl
Functional range: 18 – 27 ug/dl
Thyroid-binding globulin binds thyroid hormones that are circulating throughout the body. It is the main protein for carrying both T4 and T3 in the blood. This test may help determine thyroid problems from things not directly related to the thyroid like drugs, liver disease, infection, stress from surgery, etc.
Many drugs can alter TBG levels. In my book Roadmap to Remission I explore these interactions.
Typical lab range for all antibodies: Above the laboratory range
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state. They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production. TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
Once you have tested antibodies and they are high, you have established that you have Hashimoto’s. Of course, these should be looked at in the context of other tests to determine how your thyroid is functioning.
Testing antibodies again is not that helpful for patients with Hashimoto’s because antibody levels can change throughout the day and may rise and fall without giving you any real relevant information about how well you are managing your disease.
They are also not a god indication of how your immune system is doing.
Antibody levels getting higher is not necessarily a bad thing, it can be an indication that treatment has stimulated a certain aspect of your immune system.
And antibody levels going down is not automatically a good thing, it may not lead to any improvement in symptoms.
The reality of having Hashimoto’s is that, in many cases, you have to take matters into your own hands to get proper care. This condition is one of the most poorly managed conditions in healthcare today. This is certainly true with lab tests.
The best thing to do is to work with a practitioner who knows what they are doing and who can order tests to properly assess you thyroid. This way and you can know if what you are doing is working or not.
Be prepared that you may have to come out of pocket to pay for these tests yourself if your doctor or your insurance company don’t deem them medically necessary.
The good news is that laboratory tests have become much more affordable and some functional medicine practitioners, like myself, pass this savings onto their patients because we believe you shouldn’t go broke to get better.
Interested in learning more? Check out this post for a more complete overview of lab tests fro Hashimoto’s.
Hashimoto’s is a thyroid condition and an autoimmune condition, both issues must be addressed to successfully manage this condition. Please let me know your thoughts and questions, I’d love to hear from you.
Resources:
Mastering the Thyroid, 2011, Kharrazian, Datis, DC
http://www.netplaces.com/thyroid-disease/hypothyroidism/blood-tests.htm