First we need to establish that the thyroid is an endocrine gland. A gland is an organ in the body that synthesizes a substance for release of another substance, such as hormones into the bloodstream, for circulation and delivery. The thyroid is among many other endocrine glands, including areas in the brain, particularly the pineal gland, the pituitary gland, and the hypothalamus. These are key players in thyroid function and physiology. Among the endocrine glands, we also have parathyroid glands located in the thyroid gland. We have the adrenal glands. The pancreas, ovaries, and many others, including visceral fat, which is indeed an endocrine gland.
With the production of thyroid hormones, just like so many other hormones, it all starts in the brain. When we talk about hormone metabolism, we typically refer to what are called axis. The axis show the trickle effect, or domino sequence, of the hormone production, the thyroid axis begins in a portion of the brain called the hypothalamus; it’s usually called the hypothalamus-pituitary-thyroid axis (or HPT axis).
If we would explain the thyroid analogy simple; it would go something like this:
TSH – Gas Gauge
T4 – The engine
T3 – The pedal
RT3 – Brake of the car
TPO and TGAb (antibodies) – Emergency Flashers
When this gland receives the thyroid-stimulating hormone, or TSH, it stimulates
the release of two hormones: T3 and T4. T4 is the primary thyroid hormone. It needs to be converted into T3, which is the active thyroid hormone. Again, that enzyme, TPO, is involved in the creation of both T4 and T3. Up to about 93% of the hormone produced by the thyroid gland itself is T4. Remember, T4 is inactive until it’s converted to T3. So we may be producing enough T4, but not properly converting it to T3. This is an area where there can be malfunction
that is not properly detected - the conversion; which happens mainly in the liver kidneys and the gut.
When your TSH is elevated, and your free T4 and free T3 are normal, this is called subclinical hypothyroidism. This is a bit vague to clients because the labs are saying your thyroid is fine according to the reference ranges, but your body is telling a different story. You have all the signs and symptoms of hypothyroidism, just not the lab values. In functional medicine; we start treating the body in the subclinical diagnosis. Because we can now treat it and prevent damage to your thyroid gland that may be permanent.
A Functional Medicine Guide To Thyroid Labs
The standard method conventional doctors take to evaluate the thyroid is to test, but the issue with this evaluation is that the reference range for TSH is not accurate; based on the labs range - your thyroid function is normal if your TSH is anywhere between 0.5 to 8. That is a huge range of thyroid function.
A complete thyroid evaluation includes:
TSH (LAB RANGE - 0.40-4.50/ OPTIMAL RANGE - 1-2)
Free T4 (LAB RANGE - 0.80-1.8/ OPTIMAL RANGE - 1.1-1.6)
Free T3 (LAB RANGE - 2.3-4.2/ OPTIMAL RANGE - 3.0-4.2)
Anti-TPO (LAB RANGE - < 9 / OPTIMAL RANGE - < 9)
Anti-TG (LAB RANGE < 1 / OPTIMAL RANGE < 1)
Reverse T3 (LAB RANGE - 8-25/ OPTIMAL RANGE - 8-15)
In addition to these labs specific to thyroid health, functional medicine practitioners are likely to recommend additional tests to investigate further addressing the microbiome, immune system, adrenals and other hormones. There is a direct correlation between liver, gut, adrenal and thyroid function, in order to get the full clear picture of what is going on; lab work is the foundation to finding out what exactly is off balance. This type of thorough investigation we do in out practice can save you from depending on synthetic thyroid medication for the rest of your life.
The 7 Different Types of Underlying Thyroid Problems
It is important to understand which thyroid pattern are you facing so that you can go for the correct and targeted therapeutic approach. When you have thyroid-related symptoms such as fatigue or weight gain, your problem may be more complex than something that can be fixed with a simple thyroid hormone replacement drug. There is no magic pill for fixing the thyroid; the diagnosis "slow thyroid" is very general and unfair for people are struggling with the symptoms; it is worth the investigation and understanding of what exactly is happening in your body.
1. Autoimmune Thyroid (Hashimoto or Grave's disease)
Hashimoto's or Grave's are not a disease of the thyroid, yet they affects the thyroid in a big way, the thyroid is not the source of the problem here, but the victim of a misguided immune system attack, in which your body mistakes your thyroid for a virus.
In functional medicine we tend to treat autoimmune thyroid problems more naturally than mainstream medicine. We look at the issue in an individualized manner taking into consideration that it can be different for each person – since every person has their own unique biochemistry. I recommend starting with healing the gut with the elimination diet and try and tap onto natural compounds such as Biacalin to balance the immune system. You will need to work with a practitioner closely to manage this issue.
Labs to run: TPO and TBG antibodies
2. Thyroid hormone Resistance due to inflammation
This is considered a cell receptor issue rather than a thyroid issue. Every cell of your body depends on thyroid hormones for optimal function, but if your cells receptor sites are taxed because of inflammation or toxins; your body will feel symptoms of hypothyroidism such as fatigue malaise inflammation, despite having adequate hormones but aren’t being used efficiently - your TSH test will be “normal” but you’ll still feel low and imbalanced.
Turmeric, vitamins C and reservatrol are the best natural remedies for inflammation (best in liposomal form). A diet filled with flavonoids and polyphenols.
Labs to run: CRP, homocysteine and reverse T3. I would also test Insulin Resistance
3. Elevated Thyroid-Binding Globulin (TBG)
TBG is produced in the liver and is a circulating protein that reversibly binds thyroid hormones. Elevated TBG is a common scenario when a woman is suffering from estrogen dominance or is using birth control. All hormones get transported throughout the body on protein carriers; and for the thyroid it is the TBG. When TBG levels are elevated, this could cause an increase of protein-bound thyroid hormones, which can’t be used by your body.
In this case we need to support the body's detoxification pathways to help clear excess hormones using glutathione, milk thistle, dandelion and other herbs that support methylation.
Labs to run: TBG, Free T3, and T4. I would also rule out estrogen dominance using the DUTCH test.
4. Hypothyroidism
Your thyroid only does what your brain tells it to do, and if your undergoing chronic stress, frequent infections or low grade inflammation, the hypothalamic-pituitary-thyroid (HPT) axis will malfunction because of the overload on your body. When the pituitary gland (which sits at the base of your brain) isn’t communicating with your thyroid gland due to the overload; then the thyroid may be just fine, but it is not getting the right signals to do it's job
To support the pituitary gland I recommend focusing on de-stressing, eating enough and nutrient dense foods that will pump up the brain-immune communication. Sage leaf, L-lysine, zinc, and vitamin C are also recommended.
Labs to run: Full thyroid panel, Iron, ferritin, and basic nutrition panel (deficiencies can be very stressful on the body), viral infections and possible Epstein-Barr virus is also recommended to rule out. I would also recommend the GI 360 and the DUTCH test for a better view.
5. Hyperthyroidism
This is when the thyroid creates and releases more hormones than you need. Hyperthyroidism is relatively rare. Symptoms can include weight loss, feeling shaky, increased heart rate, tremors, anxiety, bulging of the eyes, muscle weakness, intolerance to heat and excessive sweating.
Medical conditions that can be the cause of a hyper thyroid function include; Graves’ disease; thyroid nodules, thyroiditis, consuming excess iodine from diet or medications.
In these cases I would start with checking the above medical conditions first with your physician, if all is clear - we need to see how our adrenals are working, and make sure sleep is in check. Focus on low iodine foods such as complex carbs, unsalted nuts, egg whites and a variety of fruits and vegetables. Foods high in selenium, iron and B vitamins are also important.
Labs to run: DUTCH test, Organic Comprehensive, microbiome testing (GI 360), and nutrient testing of selenium, B vitamins, and Iron.
6. Thyroid under-conversion (Low T3 Syndrome)
This is a classic manifestation of chronic adrenal stress and its related elevated cortisol. The majority of thyroid hormone comes in the form of T4, which is largely metabolically inactive and has to be converted to T3 for use in the body. It’s estimated that 80 % of thyroid conversion happens in your liver and 20 % in your gut.
In this case we need to manage stress, support the adrenals and understand how our levels of cortisol and DHEA are playing a role in this thyroid under concersion. Gut health and liver function are also crucial to manage and heal this dynamic. Focus on foods rich in selenium, zinc, and magnesium to support a healthy thyroid conversion. Supplement if needed.
Labs to run: Free and total T3, liver enzymes, microbiome testing (GI 360), and nutrient testing of selenium, B vitamins, and zinc.
7. Thyroid Over-Conversion
This thyroid pattern is sometimes found in people with high testosterone levels, insulin resistance, type 2 diabetes, and in women with PCOS. You would think that if the body produces more T3 (the metabolically active form of thyroid hormone) it would be a good thing. However that is not really healthy; more is not more. This dynamic can overwhelm your cell receptors, leading them to become resistant to the T3, so even though you have a lot, you aren’t able to use it, which leaves you with a high free T3.
In addition to eating a clean diet consisting of lots of vegetables, fruits, meats, and healthy fats, I recommend natural supplements to balance blood sugar such as chromium, berberine, and alpha lipoid acid.
Labs to run: Free and total T4 and T3, free and serum testosterone, fasting blood sugar, and HbgA1c. Fasting Insulin and Insulin Resistance (HOMA score)
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