In part I of the Thyroid Health Series, we discovered that 1 in 7 Australians suffer from thyroid disorders, with 5 of the 7 being women.

There are common symptoms that MANY women experience everyday that can be attributed to thyroid disorders.  These range from anxiety, stress, debilitating depression to fatigue, heartburn, lack of motivation, and bloating, constipation, increased risk of gallstones, nutrient deficiencies such as B12, zinc, ferritin (iron storage) and even infertility.  

A healthy thyroid helps to keep you at an ideal weight, it keeps you happy and sleeping soundly as well as having a healthy digestion. 

We also discussed that many people are misdiagnosed with conventional thyroid tests not telling the whole story, meaning many go along dealing with symptoms believing it is just in their head.

With such common symptoms that most of us would experience at least some time throughout our lives, how can you know when it is your thyroid and what steps can you take to make sure your diagnosis is accurate?  When does a thyroid condition become an autoimmune condition? And why are thyroid problems so common?

We have much to get through!  Lets get into it.. 

Before we discuss the types of thyroid conditions and why they are misdiagnosed, we need to look a little more closely at the thyroid and its hormones.

The thyroid gland

Meet The Thyroid Family:

I have listed the hormones, antibodies and general pathway that is essential in understanding the impacts of thyroid can have on the body and understanding proper diagnosis.   

If you would like to see a handy little geek map that I put together to help you understand this process, you can go here…  Thyroid Diagram

TRH –thyrotropin releasing hormone.  Produced in hypothalamus.  Acts on pituitary gland, a little pea sized gland at the base of your brain, to produce TSH.

TSH – Thyroid Stimulating Hormone.  Produced by the pituitary gland.  It stimulates the thyroid gland to make T4 and T3.   Think of it like the control centre – when thyroid hormone levels are low, more TSH is produced to signal more thyroid production.  Or when they are high, it down regulates and slows the production of thyroid hormones. 

T4 – Throxine.  The inactive hormone, gets converted into T3 before it can be used by the body.  It can also be converted into reverse T3 (RT3).  The conversion takes place mostly in the gut, liver the thyroid gland.

T3 – Triiodothyronine.  Active big kahuna hormone, is 4 times more powerful than T4.  Its like the accelerator for your engine.    Has the biggest impact on the body, signalling the cells to make energy, with production of approximately 90% T4 and only 10% T3.

RT3 – reverse T3.  T4 gets converted into T3.  Think of it like brakes as opposed to T3 which is like the accelerator.  It blocks T3 from signalling the cell to make energy.

TPOab – Thyroid Peroxidase Antibodies (aka Anti-TPO).  These guys hinder the enzyme that helps T4-to-T3 conversion and can indicate that the immune system is attacking the thyroid gland.

TBG – Thyroid binding globulin.  A protein that transports the thyroid hormones in the blood.  These guys taxi thyroid hormones to the cells, but having too much or too little TBG can cause issues with thyroid levels.

The Thyroid Factory

Producing and balancing thyroid hormones is kind of like baking a cake.  You need the right variables in place to make the perfect cake – temperature, quality ingredients in the right ratios, and time and duration in the oven.  Not enough flour say, or poor quality milk or one too many eggs and your cake won’t come out nicely and will be a disappointing mess. Well the thyroid factory is the same.  

Its all about balance and getting the right nutrients, with the right hormones and enzymes and proteins, to keep processes functioning optimally to create these hormones in the right quantities so you have enough energy in your cells to feel on top of the world.

When things go wrong, even just one variable is missing or is too abundant, you get thyroid hormone imbalances that cause a range of symptoms from hypothyroid (low hormones) to hyperthryoid (too much hormone).  Its finding which process or which variable isn’t working for you that is key to better thyroid health.

Hashimotos

Hypothyroidism is when the thyroid doesn’t produce enough thyroid hormone, it’s the most common thyroid disorder.  Since every cell in the body has receptors for thyroid hormones, the hormones affect the entire body with symptoms from feelings of fatigue to low motivation, weight gain, poor mood, constipation and cold extremities.

Hashimoto’s Thyroiditis is a type of hypothyroidism and it is autoimmune in nature like juvenile diabetes and rheumatoid arthritis.  In fact, 90% of hypothyroid cases autoimmune.  In the case of Hashimoto’s the immune system builds up antibodies to the thyroid which start to attack the thyroid gland which consequently causes problems with thyroid hormone levels.  No one factor causes the the body to attack the thyroid, it can run in the family as well as be caused by an infection viral or bacterial and it can medications and toxins as well as lifestyle, diet and stress can also cause damage to the thyroid.

Having hashimotos can lead to build up of antibodies to other enzymes and tissues as well leading to celiac disease, neurological disorders, anaemia, type 1 diabetes and even anxiety, meaning that you get a double or triple whammy of autoimmune conditions and symptoms.

*We will look more closely at why autoimmune conditions are on the rise next week.

Conventional Thyroid Tests Aren’t Enough

When you head to your GP, presenting with many of the symptoms I have outlined above, your doctor might request a blood test and it will usually include TSH and T4.  but that only gives us part of the story.

Without getting too nerdy on you, its important you understand what CAN potentially go wrong so you can see how complex the process is and why a proper diagnosis is difficult (not to mention how treating it isn’t as simple as it seems).

Its like questioning why your cake didn’t rise properly by only looking at the amount of eggs or milk you put in without taking into consideration the oven temp, the duration, the amount of flour etc.  It doesn’t paint the entire picture.

We need to look at each step, each process, each hormone, the nutrients required to make these hormones, and the factors that hinder the processes (like stress) to be able to ascertain what is going wrong and why as well as how to fix it.  And just to make it eve more complex, every one has a different presentation with varying symptoms, results and therefore treatment plan to support and improve the thyroid.

Thyroid Results

You go to the docs and get your bloods done as you are positively convinced that you have thyroid problems, but your results show up normal.  What the?!  

In terms of hypothyroidism test results, there are 7 patterns that can help to decipher what is going on with the thyroid to help support and treat the thyroid and improve overall health.  

1.  Low TSH

The pituitary gland needs to be functioning properly to be able to produce enough TSH to signal the thyroid to make hormones.  Tests will commonly show low TSH and T4 if pituitary issues are the cause of problems.

2.  T3 low but TSH and T4 normal

As stated above, T4 needs to be converted to the active T3 hormone to be able to be used by the body.  Inflammatory cytokines (molecules that are stimulated as part of inflammation at a cellular level) and stress (cortisol) hinders this conversion process.  

The Thyroid Pathway Geek Map

 Click here for the printable Thyroid Diagram

3.  T3 low, TBG high

If the TBG taxis are in abundance, they hang on tightly to the thyroid hormones making them inactive and they are unable to get into cells to do their job.  

4.  T3 high, TBG low

 Adversely, if TBG is low, too much free thyroid hormone running around in the blood can cause cell receptors to build resistance to thyroid hormones.

5.  Normal levels, but still symptoms

If your levels are all normal, you could potentially still have thyroid issues caused by stress, genetics or high homocysteine causing the receptor of the cell to build up resistance to the hormones, not allowing it in.  

6.  High TSH & TPOab

When high TSH and TPO antibodies are present, you can suspect hashimotos the autoimmune condition is at work having destroyed the thyroid so it can no longer make enough thyroid hormone on its own.  The TSH is knocking at the thyroids door, but the thyroid ain’t listening!

7.  TPOab slightly elevated, TSH normal

This does not necessarily confirm that you have hashimotos as antibodies also aid in removal of dead cells meaning they may increase for reasons other than hashimotos such as an infection or virus.  Its worthwhile having your labs done routinely with a full thyroid panel including Tg and TPOab. 

Note – test results often vary between each test so its important to have more than one.

So as you can see, testing is not that straight forward.  There is always more to the puzzle than a straight forward TSH thyroid test.  If you feel you have thyroid symptoms but your thyroid tests show up normal, don’t give up yet.  You might have to dig a little deeper and I highly suggest seeing an alternative holistic GP to get to the bottom of your condition.  

Stay tuned for next weeks edition as we look at treatment for hypothyroidism, 10 ways to support a healthy thyroid and 10 things you should avoid.