Thyroid – key facts and tests to run

Did you know that…?

One in eight women will develop thyroid disease during her lifetime.

Women are more prone to thyroid dysfunction than man and most women are diagnosed when they are between 30 and 50 years old. With such prevalence, it’s very important to understand its causes as well as how you can effectively prevent or treat this common condition.

How your thyroid gland works?

Let’s start by briefly explaining how your thyroid work and why its so important for overall health. Feel free to skip that part if you know the basics already:)

Your thyroid is part of the endocrine system. The thyroid produces hormones that are released into the blood. The thyroid produces the T4 hormones using iodine and tyrosine (amino acid) making those two critical to the health of your thyroid. Then T4 is being converted to active form T3. More than 99 percent of thyroid hormones hormones are bound to blood proteins known as TBG. This renders them inactive. Only free T3 and T4 hormones have any effect on your body. It’s vital that your body maintains the right levels of free T3 and free T4 hormones, and the job of retaining this balance is performed by the hypothalamus and the pituitary gland.

TSH is not a hormone but your signalling molecule…

When your levels of these hormones are too high or low, the hypothalamus produces the Thyroid Releasing Hormone (TRH). This hormone signals the pituitary, which increases or decreases the levels of another hormone called the thyroid stimulating hormone (TSH). When TSH levels are rising it means that there is not enough hormones available and your pituitary is screaming to your thyroid “hey can you produce more hormones as they are needed here and there”. If your thyroid is functioning well it will produce as much hormones as its currently needed and all your blood levels will be normal. However if there is a problem we speak about under or over production of thyroid hormones

HYPOTHYROIDISM = under active thyroid (low thyroid hormone production)

HYPERTHYROIDISM = over reactive thyroid (excess hormone production)

When on the top of that your thyroid becomes inflammed we talk about autoimmune conditions like Hashimoto’s or Graves’ disease which I explain more in detail in a bit:)

What your thyroid is responsible for?

Thyroid is a tiny gland but yet so powerful and also very sensitive. Thyroid hormones control basically thousands processes in your body including:

  • Metabolism and weight control
  • Cognitive functions like mental clarity, focus and memory
  • Regulating your sleep, menstrual cycle and body temperature.
  • Digestion, absorption and energy use
  • Maintaining hormonal balance, bone mass and muscle strength.
  • Heart function and keeping cholesterol in a healthy range and much more

What is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis commonly known as just Hashimoto’s. It’s an autoimmune condition that affects thyroid but is related to immune system dysfunction. It develops over time, usually it takes 3 to 10 years for the symptoms to show.  

Does Hashimoto’s lead to under active thyroid?

Yes – Hashimoto’s is an autoimmune condition where your body is attacking your own thyroid gland, gradually leading to thyroid damage. As a result, your thyroid will slow down and become less efficient at producing thyroid hormones. That’s why many people with Hashimoto’s also experience variety of symptoms related to under-active thyroid or so-called hypothyroidism.

However, you can have hypothyroidism or sub-clinical hypothyroidism without Hashimoto’s

Hashimoto’s and under active thyroid signs and symptoms:

If your thyroid become sluggish or inflamed, you may experience range of symptoms. The most common is fatigue (especially on waking up in the morning), weight gain (no matter how much or how little you eat), hair loss and low mood.

This is by no means an exhaustive list, but it gives a good overview of how vast (and nonspecific) the symptoms can be.

  • Weight gain
  • Fatigue and tiredness even with sufficient sleep
  • Indigestion, constipation, bloating 
  • Hair loss & thinning eyebrows
  • Feeling cold
  • Having cold hands and feet
  • Cognitive changes, “brain fog”, memory problems, difficulties to focus or concentrare, forgetfulness.
  • Feeling low and depressed
  • Dry skin and hair
  • Skin problems like eczema, acne
  • PMS, Irregular or heavy periods
  • Low sex drive
  • Muscle weakness, stiff and tender joints particularly in the hands, feet and knees.
  • Infertility or miscarriage
  • Reduced exercise or activity tolerance
  • High cholesterol
  • More frequent cold
  • Fluid retention
  • Goiter, or swelling of the neck

What can cause low thyroid function?

Usually, it’s a combination of multiple factors, the most common are:

  • Iodine and other nutrient deficiencies
  • Excess of soy and goitrogenic raw vegetables like spinach, kale, broccoli etc
  • Chronic stress
  • Adrenal exhaustion
  • Gut dysbiosis 
  • Toxic and heavy metals overload (from food, beauty and cleaning products, tap water and environment)
  • Excessive and intense exercise
  • Menopause
  • Pregnancy
  • Certain medications, especially used to treat cancer, psychiatric conditions and heart problems.
  • Pituitary gland or hypothalamus disorder

close up of woman in home wear sitting with cup

How to diagnose Hashimoto’s?

The most common diagnostic tests for Hashimoto’s are thyroid antibodies markers: thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TGB Ab). However, to get better picture of your thyroid health in general, it’s worth running a full thyroid panel that includes: TSH, Total T4, Free T4, Free T3, Reverse T3 and Thyroid Antibodies. 

Why thyroid conditions are so commonly under diagnosed?

Under active thyroid is quite often misdiagnosed or diagnosed too late. Similar with Hashimoto’s. Symptoms of Hashimoto’s are nonspecific and can seem unrelated at the beginning.

The standard practice among GPs to screen for thyroid health is very limited and includes only TSH and Free T4 blood test. That unfortunately doesn’t give you full picture and it doesn’t even show your free T3 levels which is the active thyroid hormone – the most important one responsible for your metabolism and wellbeing. Additionally standard GP lab range is very wide and will show you that something is abnormal when the disease process is already very advanced. TSH standard lab range is between 0.3 and 4.2. The problem is that for optimal health and thyroid function it should be between 1 and 2.

That’s why many people are sent back home with “normal” blood results while feeling unwell with range of symptoms. The earlier thyroid dysfunction is detected the quicker you can fix it. Ask your doctor to run full thyroid panel or do it privately on your own and always look at the functional medicine reference ranges – they will give you optimal levels necessary to feel good:)

What thyroid blood tests to run to detect Hashimoto’s and early thyroid dysfunction?

A full thyroid panel can give you an insight into your current state of thyroid health and a clearer picture of what’s happening in your body. 

TSHthyroid stimulating hormone is produced by the pituitary to instruct your thyroid gland to produce thyroid hormones. 
Free T4T4 and T3 are your body’s main thyroid hormones. Free T4 measures the bioavailable (unbound) hormone produced by the thyroid gland. Low T4 is a marker of low thyroid function.
Free T3T4 is converted to T3 in the peripheral tissues like your gut and liver. Free T3 is also known as the “gas” that fuels all the processes performed in your body. It’s the active form of your thyroid hormones that you need the most at the end of the day. A low level of T3 can indicate low thyroid function, or just a problem with conversion
Reverse T3less known but useful if everything else looks “normal” and you still feeling unwell. Reverse T3 is also known as the “breaks” and it inactivates your active free T3. High levels of reverse T3 can be responsible for symptoms of hypothyroidism, since it competes with free T3 for cell receptor sites. This is an additional marker to help determine what’s going on and indicate the root cause of your thyroid problems
Thyroid Peroxidase (TPO) and Thyroglobulin (TG) antibodiesThese are two markers that will help you determine if you have autoimmune condition or not. The thing is that you don’t have to have abnormal basic thyroid markers to have Hashimoto’s. You may start seeing TSH, FT3 and FT4 outside the range once there is more severe thyroid damage. That’s why in my opinion it’s important to run full thyroid panel in terms of early detection and also prevention

Click here to get a cheat sheet with functional medicine optimal ranges and how to interpret your results


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