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The Thyroid, Part Three
In the first two parts of this series about the thyroid gland, we covered how the thyroid works, the relationship between the thyroid, the pituitary gland and the hypothalamus and the most common types of thyroid problems. In this issue we will look at the tests that are used to detect thyroid problems and some of the treatments recommended if there is a thyroid problem.
While there is considerable agreement on how the thyroid works, on how thyroid problems develop and even on many thyroid treatment plans, there is a not as much agreement on the tests needed and the interpretation of the tests.
THYROID STIMULATING HORMONE TEST (TSH)
It has happened to many of us. We begin to feel tired all the time and maybe are having trouble getting sleep. After a while we realize that the condition is not improving, so we make an appointment to see a doctor. If this is a typical doctor, he will ask a few questions and then order lab tests. One of these tests is the TSH test because the doctor is finding out if you have a thyroid problem.
The TSH test is normally stated in milliunits per liter of blood. A unit is a standard of measurement and a milliunit is one-thousandth of a unit. A liter is a measure of volume that is a little bigger than a quart.
The pituitary gland releases TSH if it senses that the thyroid is not producing sufficient thyroid hormones. If the pituitary gland senses there are sufficient thyroid hormones in the blood, then no TSH is released. The TSH test measures the amount of thyroid stimulating hormone that is released by the pituitary gland into the blood.
In theory, the TSH test should be reliable. If the TSH amount is low, this is an indicator of hyperthyroidism (overactive thyroid). If the TSH amount is too high, this is an indicator of hypothyroidism (underactive thyroid). However, many doctors disagree on what level is too low and what is too high.
For example, many doctors believe that the “normal” TSH reference scale is between 0.5 to 5.0. However, the American Association of Clinical Endocrinologists (“AACE”) states that the correct range is 0.3 to 3.0. AACE states, …In the future, it is likely that the upper limit … will be reduced to 2.5 mIU/L because >95% of rigorously screened normal euthyroid (normal thyroid) volunteers have serum TSH values between 0.4 and 2.5 mIU/L….”
One of the problems with most labs that do the TSH tests is that they often just send a report that the thyroid is “normal.” However, they may use a reference range of 1.0 to 6.0. This is why you should always insist on seeing the actual results.
As you can see, if your TSH level was 0.4 and your doctor used the AACE reference range, then the TSH would be considered normal. However, if the doctor used a lab reference range of 1.0 to 6.0, then the TSH test would indicate that your thyroid is hyperactive. Doctors who understand that the TSH test may not be conclusive are unwilling to trust only the TSH test.
The following are the main tests now being used.
As we discussed in the prior two parts of this series, T4 is produced by the thyroid gland, enters the bloodstream and some of the T4 is absorbed into the cells. It is found in the blood in two forms:
T4 that binds to proteins (believed to be 99% of the T4 produced by the thyroid).
Free T4 (T4 not bound to proteins) which is the only form of T4 that can be absorbed into the cells.
There is a total T4 test which measures the protein-bound T4 and the free T4. Then there is the free T4 test which is called the Free T4 (“FT4”) and the Free T4 Index (“FT4I or FTI”). Generally, individuals who have hyperthyroidism will have an elevated FT4 or FTI and individuals with hypothyroidism will have a low level of FT4 or FTI.
As we discussed in the first article, T3 is much more powerful than T4, and most of the T3 used by the cells occurs when T4 in the cell is converted into T3. Normally, individuals who are hyperthyroid will have an elevated T3 level. In some individuals with a low TSH, only the T3 is elevated and the FT4 or FTI is normal.
REVERSE T3 TESTS
Many of us experience stress and find that we have problems with our adrenal glands producing too much cortisol. Cortisol affects the conversion of T4 to T3 and this results in the creation of what is called reverse T3. It does not have the characteristics of T3 but it will bind to the T3 receptors in the cells and prevent T3 from activating the receptors. In fact some doctors now believe that the T3/rT3 ratio is currently one of the best indicators of hypothyroidism.
THYROID ANTIBODY TESTS
In last week’s newsletter we discussed autoimmune disorders. Rather than attacking foreign substances like bacteria and viruses, autoimmune disorders cause the body to produce antibodies that attack the organs of the body. Antibodies that attack the thyroid can either stimulate the activities of the thyroid or they can damage the thyroid gland. Thyroid peroxidase and thyroglobulin are the two common antibodies that cause thyroid problems. In cases where the other tests are not conclusive, measuring the levels of these two thyroid antibodies may help diagnose the cause of the thyroid problems.
RADIOACTIVE IODINE UPTAKE
T4 contains iodine. This means that the thyroid gland must absorb iodine from the blood stream to enable it to make the appropriate amount of T4. In this test, the individual swallows a small amount of radioactive iodine. The radioactive iodine can be tracked and the amount of the radioactive iodine taken into the thyroid gland can be measured. This measure is called radioactive iodine uptake (“RAIU”). A very high RAIU level is associated with hyperthyroidism and a low RAIU is associated with hypothyroidism.
Whether high or low, an abnormal TSH indicates an excess or deficiency in the amount of thyroid hormone available to the body, but it does not indicate the reason why. An abnormal TSH test result is usually followed by additional testing to investigate the cause of the increase or decrease.
INTERPRETING THE TESTS
The following table was put together by Lab Tests Online and summarizes test results and their potential meaning.
(Sub-Clinical means that it is not yet detected but statistically it is likely to happen.)
(All of the thyroid tests can be affected by birth control pills, hormone therapy, seizure medication, blood pressure drugs, cholesterol drugs, vitamin and mineral deficiencies and chronic diseases.)
THYROID TREATMENT PROCEDURES
While there is a growing argument among doctors about the types of tests and their interpretations, here is some information on the most common treatments for hypothyroidism and hyperthyroidism.
In cases of hypothyroidism, most doctors prescribe synthetic T4 to replace the natural T4 not being produced by your thyroid. Some of these synthetic replacements are:
Cytomel (T3 replacement)
NATURAL THYROID REPLACEMENT
While most medical doctors do not agree, many people believe that thyroid supplements should be natural. They recommend thyroid supplements derived from the thyroid gland of pigs or cows. Examples of these natural replacements are:
NATURAL THYROID CORRECTION
Whether it is synthetic or natural thyroid replacement, the basic fact is that it is “replacing” the thyroid hormones but are not intended to actually address the cause of the thyroid problem. There is more and more medical literature published by Integrative Medicine doctors indicating that many thyroid problems can be corrected through changes to diet and proper diagnosis and treatment of vitamin and mineral problems. Once corrected, the thyroid will function properly and the person will no longer be required to take thyroid pills.
In this three part series, we have discussed how the thyroid works, the most common types of thyroid problems and the tests used and the treatments often prescribed. We have spent this much time on the thyroid because of the number of undiagnosed thyroid problems experienced by our patients. The more you understand about the thyroid, the more you will be able to ensure that you get proper treatment.
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