More and more new patients are coming into my office seeking advice on what they think may be a problem with their thyroid gland. In most cases, their intuition is correct; they do indeed have a concern with their thyroid. However, a very common phrase I’ll hear from them is, “They say my thyroid is fine because I’ve had the thyroid test and nothing showed up”. This test they are referring to is the TSH test, which is more of a screen for the thyroid as opposed to a definitive test. There really is no such thing as a thyroid test that tells you if your thyroid is working. In this week’s article, we will discuss how the thyroid gland can be evaluated with more thorough and accurate testing.
In my opinion, thyroid symptoms are very meaningful regardless of what any single test says. All doctors are trained to take all the information from several sources and put it together with the patient’s individual characteristics to make a proper assessment. Unfortunately, this does not happen as well as it should in the conventional system in part because there is an overreliance on the TSH test. I’ve had dozens and dozens of patients in the past year with thyroid symptoms only to be told their thyroid gland is fine because the TSH is normal. In many of these cases, I ordered a full thyroid panel of tests and discovered the contrary.
Thyroid Panel
There are at least 4 individual tests that should be performed in order to thoroughly assess the thyroid gland. These include TSH, free T4, free T3, and Thyroperoxidase.
TSH
TSH is a hormonal signal sent from the pituitary gland to the thyroid. The higher the number, the more the pituitary is working to get your thyroid to work. When the number increases it usually indicates a hypothyroid situation. One of the concerns with the TSH test is the range of acceptability. In BC it is considered normal to have a TSH from 0.1 to 5.0. However, many doctors consider a number above 2.5 to be suspicious and worthy of further evaluation, especially if the patient has hypothyroid symptoms.
Free T4
Free T4 is the hormone the thyroid gland makes in most abundance. It is an inactive hormone that floats in the blood until it binds to a receptor in or on a cell membrane. At this point the T4 converts to T3 and the thyroid hormone does its work in the cell. When T4 levels are normal the TSH levels should be normal as well. Unfortunately, this does not mean you will be without thyroid symptoms. If T4 is not converting to T3 properly a person can suffer from hypothyroid symptoms not because of their thyroid gland but because of poor conversion in the rest of the cells in the body.
Free T3
Free T3 is produced in the thyroid gland but represents the minority of thyroid hormone compared to T4. T3 is active and ready to stimulate metabolic activity. As mentioned above, T3 is created from T4 at the binding of receptors in a cell. It’s important to know your T3 levels if you have hypothyroid symptoms because if T3 is low, regardless of what the TSH and T4 levels are, consequences are likely to occur.
Thyroperoxidase
Thryoperoxidasae is an autoimmune marker for the thyroid. When this number is elevated it represents an attack from your own immune system on the thyroid. The most common autoimmune condition producing hypothyroid symptoms is Hashimoto’s thyroiditis. Autoimmune thyroid conditions are likely to result in some randomness with symptoms. This often brings normal periods of time mixed with episodes of fatigue, brain fog, weight gain, sluggish digestion, and loss of hair to name a few.
If you suspect your thyroid gland or thyroid hormones may be contributing to your health concerns I’d recommend you speak with a physician who can order a thorough thyroid evaluation in order to determine to proper diagnosis and treatment plan.
If you have any questions about the thyroid or would like to schedule a consultation with Dr. Barlow please contact his office at 250-448-5610.
