Thyroid testing – what’s wrong with ‘normal’?

Thyroid testing; what's wrong with normal

When I talk about the importance of thyroid testing if you suspect you may have symptoms, many women tell me they have already been tested and told they were ‘normal'.

This is always a red flag to me – I always want to know more!

Your thyroid hormone is vital for every cell in the body to make the energy required for it to do it’s job – whether that’s making your heart beat, your muscles work or your brain function properly!

So when it's not working as it should, it can make you feel exhausted, cause brain fog, anxiety, depression, weight gain, hair loss, dry itchy skin, PMS, low libido, constipation, & can be a factor in high cholesterol levels.

Women are more at risk of a low functioning thyroid, and the risk goes up as we get older. Especially as we go through peri-menopause and all our hormones are under a bit more stress.

And if you have thyroid issues in the family, there’s a strong genetic element.

So if you have any of these symptoms, it’s important to get proper thyroid testing.

Standard Thyroid Testing

Doctors in general are quite happy to test your thyroid, especially if you have symptoms. You will often only get 2 test results – your TSH, T4. These are important, but they don’t show the whole picture. So you can be told you’re ‘normal’ when you feel anything but.

When your test results come back ‘normal'

A very wide reference range -The reference ranges for thyroid hormones are very wide. That means that you could be ‘normal’ even though you are at the lowest end of the scale. Unless you dip under the threshold you won’t get any treatment. This is known as ‘sub-clinical’ hypothyroidism and is there is much debate about how or even whether it should be treated. Similar to adrenal function, thyroid disease is often only recognized as overt hyperthyroidism and overt hypothyroidism.

If you are producing too much TSH, it indicates that the body doesn’t have enough T4 or T3 and is signalling the pituitary to produce more, so more TSH is released. This is a hypothyroid condition, and is the most common of the two.

There are many differing views on the lowest reference range of TSH. In the US they have lowered it to 3, and anyone above that is put on thyroid hormone replacement. This change was in response to research linking low thyroid (over 4) with heart disease.

However in the UK, lab reference ranges for thyroid testing vary extensively and you could have a TSH of 5 and be diagnosed ‘normal’. Well, it doesn’t you’re your thyroid is optimal – and that’s what we’re aiming for.

Many health practitioners like to see TSH levels below 2.5 for optimal health, corresponding with guidelines for pregnant women.

It’s not the whole picture 

It's important to understand your thyroid pathway. TSH is your Thyroid Stimulating Hormone – this is released from the pituitary gland in the brain to tell the thyroid gland how much T4 hormone to make.

T4 is the inactive hormone that gets converted to T3, your active hormone. T3 is the one that does all the work.

Standard thyroid testing will sometimes only measure TSH and T4. It’s really important to know your free T3 levels but these won’t necessarily be measured if your TSH and/or T4 is ‘normal’. This testing process only looks at a small part of the H-P-T axis and doesn’t take into account what may be happening further down the chain (eg if your T4 is not converting to T3, you have low active hormone).

No interest in the cause?

If you have low thyroid function, it is vital to know what's causing it. Around 80% of thyroid disease cases are auto-immune Hashimotos or Graves disease. Auto-immune thyroid conditions have a different etiology than other thyroid issues, and so require a different protocol of treatment. Many people are just put on Thyroxine, not knowing they have an immune disorder and how to treat it.

But if your immune system is attacking your thyroid, it’s not so much an underactive thyroid issue, it’s an immune system issue – I’d want to know why your immune system is over-reacting – what’s going on in your gut to be causing that. Then we can focus on addressing the root cause rather than just your symptoms.

If you suspect you may have a thyroid issue, make sure you ask your GP for all 4 thyroid measures; TSH, fT4, fT3, and TPO antibodies.

What's the best thyroid test?

If you have symptoms of an over or underactive thyroid, then please get properly tested. You could be at risk of further complications if you leave it unaddressed.

A full thyroid hormone panel is our standard test for our clients. It includes TSH, fT4, fT3 and 2 types of antibodies. We also look at your other hormones to see if they are having an effect.

That way, if there is a problem we can see where in the chain it’s likely to be occurring and put in place the right protocol to address it.

Are you satisfied you've been properly tested?  If not, contact us for more details of how we can help.

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