Table of Contents
ToggleIntroduction To Thyroid
How Does it Work?
- T4 or thyroxine that has 4 iodide atoms and makes up 95% of your total thyroid hormone in the blood.
- T3 or Triiodothyronine has 3 iodide atoms and makes up 5% of the total circulating thyroid hormone in the blood.
- Calcitonin is another important hormone that plays a vital role in calcium and phosphate metabolism.
What are the Key Functions of Thyroid Hormone in the Body?
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- Most of the thyroid in the blood is T4 (almost 95%) – while T3 only makes up 5% of the circulating thyroid hormones. This knowledge comes in handy when you are interpreting your thyroid function test results.
- To perform its functions, your T4 hormone must be converted into T3 with the help of enzymes. In simple words, your thyroid gland releases mainly T4, which is transported by the blood to destination tissues where its activity is needed. Once T4 reaches destination tissue, T4 loses 1 Iodide to become what? No tricks here, one Iodide is gone, and what we are left with is T3 – a more active and powerful form of thyroid hormone that helps the tissues by creating different enzymes and proteins.
- Maintaining your body weight (that is right, if your body is not producing sufficient thyroid, you would gain weight with minimal calorie intake or if your body is producing too much thyroid, you would lose weight).
- Maintaining your bone health
- Regulation of your body temperature (when I was hypothyroid, I was cold all the time)
- Development of brain so you stay mentally alert & sharp (yes, brain fog and memory issues are very common in thyroid disorders)
- Regulation of cholesterol
- Reproduction (women who have unhealthy thyroid often have trouble in becoming pregnant)
Feedback Regulation of Thyroid Hormones
When it Doesn’t Work Right
Sadly, regardless of this beautiful, synchronous feedback system, thyroid disorders are very common, especially in women. According to research, Thyroid diseases are 5-8 times more common among women as compared to males – so if you are a woman who is suddenly feeling fatigued all the time, with no energy, motivation, or stamina, you could be suffering from thyroid disease.
It has been reported that thyroid diseases are more common after pregnancy and menopause (1). In my case, I developed thyroid issues after the birth of my second child (My healing journey)
Diagnosing Thyroid-Related Disorders:
- Are you gaining weight with almost no appetite?
- Do you find it difficult to get out of bed every day after a good night’s sleep?
- Do you feel depressed or emotional all the time?
Did you know that over 60% cases of thyroid disorders remain undiagnosed?
- A positive family history of thyroid illness
- Advanced age (especially elderly women)
- Intake of high doses of Iodine (or drugs high in Iodine such as Amiodarone)
- If you have a history of autoimmune disorders such as Celiac disease
Why do Traditional Healthcare Practitioners Request TSH and T4 to Evaluate the Thyroid?
Before we dive deep, understand that the results of these tests are not black & white or standard to interpret. Your tests may appear normal or near-normal but that can still mean that your thyroid is sick.
What is the TSH Test and why is it important?
TSH is one of the most important tests advised by healthcare providers during the assessment of thyroid disease.
TSH or Thyroid Stimulating Hormone is an anterior pituitary hormone that serves as the feedback control center for thyroid release. TSH is often considered as an ideal indicator of thyroid function as most often abnormalities in TSH levels appear long before the actual changes in the serum levels of thyroid hormone.
TSH levels have an inverse relationship with Thyroid hormone levels. In other words, if your test shows high TSH levels, it means that the thyroid hormone production is inadequate (or hypothyroidism). Likewise, if your test shows low TSH levels, it indicates that your thyroid hormone production is higher than normal (hyperthyroidism).
In some cases, low thyroid levels are a result of pituitary failure (or inadequate production of TSH) in which cases both TSH and thyroid levels are low, and the condition is referred to as central hypothyroidism.
There is a popular misconception that TSH levels alone can depict a fairly good picture of your thyroid gland status. This is not true! Reason being:
- The normal reference range for TSH levels is fairly broad – and does not necessarily correlate with the optimal range (where you feel your best).
- The normal reference range for someone on thyroid treatment is different from someone who is not on thyroid treatment.
Thyroid Hormone Function Tests
Thyroid tests calculate T4, Total T4, Free T3, Total T3, and rT3
Total T4: includes both T4 that is bonded with protein and T4 which is not bonded with protein in the blood.
Free T4: it is an active form of thyroxin and is not bonded to protein. As explained previously, more than 95% of T4 is bound to proteins, and thus is not available to enter the cells or tissues. On the other hand, FREE T4 can be readily absorbed by tissues to exert a variety of metabolic functions. You are probably wondering why even bother running a TSH test if T4 levels can tell you about FREE and BOUND T4 levels?
So how does elevated Thyroid-Binding Globulin or Decreased Thyroid-Binding Globulin affect the thyroid?
The answer is simple, high TBG in the blood reduces the bioavailable (or Free T4) in the blood and may cause mild hypothyroidism, likewise if TBG decreases, more thyroid hormone becomes available for uptake by tissues and may result in mild hyperthyroidism.
What Should be the Optimal Range you Should have to Feel Well?
Why Do I Still Feel Awful If My TSH, T4, and T3 Tests Are In The Normal Range?
- So the reference range listed above is ideal for normal healthy adults. But if you are suffering from pituitary disease or thyroid cancer or if you are on certain medications, the normal balance among different hormones would be altered. Likewise, the normal range when you should feel healthy will also be different. In fact, even in some physiological conditions such as pregnancy or old age, the optimal effective range of thyroid hormones is different from the reference range listed above.
- The normal range of thyroid hormones is fairly wide. In other words, theoretically 0.5 mIU/L and 5.0 mIU/L are both normal for TSH, but you may not feel optimal at 5.0 mIU/L. This is especially true for people who are on thyroid supplements.
Why are T3, Free T3, T4, Free T4, RT3 Tests so Important in the Diagnosis, Evaluation, And Treatment of Thyroid Disease?
For example, sometimes people have normal TSH levels and normal T4 levels, but still feel awful. Now if you or your healthcare provider is only looking at T4 and TSH, you will definitely get misled or misdiagnosed as it happened to me.
As I mentioned, T4 and T3 are interchangeable forms of thyroid hormone – but in some cases, T4 is converted into rT3 (or reverse T3) which is an inert or inactive form of T3. If your body has excess rT3, you will experience symptoms of hypothyroidism with otherwise normal lab results.
Healthcare providers therefore access a complete thyroid profile every 3-5 weeks in the first few months of starting the replacement or treatment therapy. Once desired serum levels are achieved with a certain dose, your doctor may require your thyroid function tests assessed every 6-12 months.
It is an active form of thyroid hormone. Around 20% of Triiodothyronine is generated directly by the thyroid gland in the bloodstream; the remaining 80% is generated by the transformation of thyroxin by different organs such as the kidney and liver. There are three tests that analyze different aspects of T3.
- Total T3: the total amount of Triiodothyronine in blood which includes both bonded and not bonded with protein.
- Free T3: the active form of Triiodothyronine which is not bonded with protein.
- Reverse T3: it is an inactive form of thyroid hormone.
So Is That all? Are there Other Tests That Can Help In The Diagnosis of Thyroid Disease
Thyroid Antithyroglobulin antibody (ATA):
This test detects antibodies in the blood that may suggest the presence of an autoimmune disease. High ATA titer in the body suggests Grave’s disease or Hashimoto’s thyroiditis. In some cases, you may have high ATA titers in the body without any noticeable thyroid symptoms.
Thyroid peroxidase antibody (TPO):
This is another test that detects the presence of autoimmune disease. The enzyme Thyroid peroxidase (TPO) plays a vital role in the production of thyroid hormones.
Diseases & Disorders of Thyroid Gland
The thyroid gland is unable to produce enough thyroid hormone required by our body to work efficiently. The major cause of hypothyroidism in the United States is an autoimmune condition known as Hashimoto’s disease – a condition in which our body’s immune system starts attacking the thyroid producing tissues resulting in inflammation; thereby limiting the production or release of thyroid hormone. Hashimoto’s disease (also referred to as Hashimoto’s thyroiditis) is more common in women as compared to men.
Other causes of primary hypothyroidism include:
- Partial or complete surgical removal of thyroid gland
- Radiation therapy
- Thyroiditis i.e. thyroid inflammation
- About 1 in 4000 babies in the United States are born with congenital hypothyroidism (a rare but serious condition.
Classic symptoms of Hypothyroidism include:
- Fatigue
- Poor metabolism
- Weight gain
- Depression
- Dry skin
- Hair thinning
- Generalized swelling
- Constipation
- Menstruation problems in women etc.
Hyperthyroidism refers to hyper or excessive secretion of thyroid hormone. The most common cause of hyperthyroidism is an autoimmune condition known as Graves’ disease, a disorder in which the immune system attacks thyroid gland resulting in overproduction of thyroid hormone. It is often genetic and tends to occur more in women than men. Other cause of hyperthyroidism includes:
- Overactive thyroid,
- Thyroiditis
- Excess use of any hormone drug
- Excessive intake of iodine levels
Hyperthyroidism affects 1.2% of the US population (2)
Hashimoto's Disease
Hashimoto’s disease, also known as autoimmune thyroiditis, chronic lymphocytic thyroiditis, and Hashimoto’s thyroiditis, damages the thyroid gland, which produces hormones that regulate nearly every aspect of the body’s metabolism and keep it operating regularly.
In Hashimoto’s thyroiditis, the thyroid is attacked by the immune system because it doesn’t recognize it as being your own. In the United States, five out of every 100 individuals have Hashimoto’s disease.
Furthermore, it frequently runs in families (it is hereditary). People with other autoimmune disorders, such as autoimmune hepatitis, B12 insufficiency, gluten sensitivity, rheumatoid arthritis, type 1 diabetes, lupus, and Addison’s disease, are more susceptible to developing Hashimoto’s syndrome.
The initial symptom of Hashimoto’s syndrome is frequently a goiter. Although a goiter is not painful, it can give you a feeling of having your throat full and make the front of your neck appear enlarged. Other Hashimoto’s disease signs and symptoms that appear gradually include:
- Weight gain
- Â Tiredness
- Â Feeling coldÂ
- Muscle pain or joint stiffness
- Â Constipation
Although to treat hypothyroidism, Hashimoto’s disease patients typically use medication given for hypothyroidism- Levothyroxine, the synthetic hormone that functions similarly to the hormone T4 hormone.
It is important to determine what is the underlying cause of your health condition and work with the cause.
It could be the deficiency in selenium, zinc, magnesium, iodine, or exposure to heavy metals and toxins. Get a complete thyroid panel first and don’t forget to have your labwork done frequently.
Compounded thyroid replacement medication may provide a more individualized approach to treat hypothyroidism which could help to address some of the drawbacks of conventional laboratories offering their thyroid medicines without wheat starch that has gluten, lactose, sugars, and dyes.
Thyroid medication dosage will be determined by your healthcare professional based on your age, weight, level of thyroid production, other medical conditions, and other considerations. About 6 to 10 weeks later, your doctor will recheck your thyroid hormone levels and, if required, change the dosage.
You will continue to take the drug once a day once the ideal dosage has been established.Â
Your doctor will choose the right dosage based on your age, weight, level of thyroid production, underlying medical conditions, and other considerations.
A doctor may also give a synthetic T-3 hormone (Cytomel) or a synthetic T-4 and T-3 combination to treat symptoms of hypothyroidism or resolve by taking only T4 medicine. The T3 medication dose should be adjusted gradually to avoid symptoms like anxiety, sleeplessness, and a fast heartbeat.
Grave’s Disease
An autoimmune condition called Graves’ disease can result in hyperthyroidism or an overactive thyroid. When you have Graves’ disease, your thyroid produces excessive thyroid hormones as a result of an immune system attack on the gland.Â
Women and people over the age of 30 are more likely to get Graves’ illness.
If you use nicotine products, have other autoimmune diseases, including vitiligo, autoimmune gastritis, type 1 diabetes, or Graves’ or Hashimoto’s disease in your family, or if you have any of these conditions, you are more likely to acquire the disease.
Graves’ disease, if left untreated, can result in serious health issues, such as an erratic and rapid heartbeat that increases the risk of blood clots, stroke, heart failure, and other heart-related issues; thinning bones, osteoporosis, and muscle problems; issues with the menstrual cycle, fertility, and pregnancy; and Thyroid Eye Disease.
Stopping the generation of thyroid hormones and blocking their impact on the body are the main goals of treatment for Graves’ disease.
Some remedies consist of the following:
L-carnitine
To assist manage the signs and symptoms of hyperthyroidism, l-carnitine is advised. Lysine and methionine, two amino acids, are used to create it in the liver. Additionally, the kidneys and the brain produce some carnitine.
It can also be found in some of the foods we eat, including dairy items, organic pork, grass-fed beef, fish, and poultry. L-carnitine, which is generally taken in dietary supplements, is merely carnitine’s mirror counterpart. Because it inhibits thyroid hormone, it can aid in treating hyperthyroidism.
As a result, it can assist with the cardiac symptoms linked to these illnesses, such as the elevated heart rate and/or palpitations that are frequently experienced by patients with hyperthyroid problems.
Radiation Treatment With Iodine
You consume radioactive iodine (also known as radioiodine) orally throughout this therapy. The thyroid absorbs radioiodine into the thyroid cells because it needs iodine to make hormones, and the radiation gradually kills the hyperactive thyroid cells. Your thyroid gland shrinks as a result, and symptoms gradually go better over several weeks to months.
Antibiotics For The Thyroid
Antithyroid drugs prevent the thyroid from using iodine to make hormones. These prescription drugs include methimazole and propylthiouracil (Tapazole).
Methimazole
Methimazole is the drug of preference when prescribed by doctors because propylthiouracil carries a higher risk of liver illness.
However, due to the minor risk of birth abnormalities associated with methimazole in the first trimester, propylthiouracil is the preferred antithyroid medication. After the first trimester, pregnant women usually resume using methimazole.
A return of hyperthyroidism may happen down the road if these two medications are used in isolation without further therapies. Long-term outcomes for any medication may be improved by using it for a period longer than a year. Additionally, antithyroid medications may be taken before or following radioiodine therapy.
Beta-blockers
These drugs block the effects of hormones on the body but do not prevent the generation of thyroid hormones. They might offer comparatively quick relief from symptoms including weak muscles, sweating, diarrhea, heat intolerance, tremors, anxiety, or irritation.
Surgery
Another option for treating Graves’ illness is thyroidectomy or partial thyroidectomy surgery, which involves removing all or part of your thyroid. You’ll probably require treatment to provide your body with the correct amount of thyroid hormones after the operation.
Nodules
Thyroid nodules are swelling and abnormal tissue growth in the thyroid gland. The nodules can be single or many, or solid/ fluid filled. Generally, these nodules are not dangerous and don’t cause any symptoms but sometimes they increase thyroid production and result in hyperthyroidism, only a small percentage of these nodules turn out to be cancerous.
Nodules on the thyroid are extremely prevalent. As much as one-third of women and one-fifth of men have tiny thyroid nodules when tested with ultrasound imaging.
Most cases of enlargement of the thyroid are caused by one of the following issues:
- Ineffective thyroid hormone production.
- Thyroid inflammation.
- Â Postpartum thyroiditis.
- Infections.
- Some drugs
- Thyroid tumors, and other conditions that can result in thyroid inflammation.
Goiter
Goiter is swelling and enlargement of the thyroid gland. Goiter is generally a painless condition, however; sometimes it causes swelling in the neck which may result in discomfort, difficulty in breathing, hoarseness, and trouble in swallowing. The primary cause of goiter is iodine deficiency.
This post is the continuation of Diagnosed with Thyroid disease? (Part I)
Thyroid cancer
A rare kind of cancer that affects the thyroid gland is thyroid cancer. People in their 30s and older suffer from it the most frequently. Women are two to three times as likely as males to develop it.
Although it can occasionally return after therapy, thyroid cancer is typically treatable and, in many cases, entirely curable.
A swelling or a painless lump in the front of the neck, enlarged neck glands, unexplained hoarseness that does not go away within a few weeks, difficulty swallowing, and only 1 in 20 neck lumps are cancer are all symptoms of thyroid gland cancer.
There are four types of thyroid cancer:
- Papillary carcinoma
- Follicular carcinoma
- Medullary thyroid carcinoma
- Anaplastic thyroid carcinoma
Both types of thyroid cancer and its stage will determine how they should be treated.
The primary therapies include:
- Surgery
- Radioactive iodine treatment
- External radiotherapy
- Chemotherapy and targeted therapies
To make the decision that best suits your needs, it’s crucial to talk to your family and treatment team about all of your treatment options and any potential adverse effects. Ask to get anything explained if you don’t understand.
Your capacity to have children later in life may be impacted by some thyroid cancer therapies. Before choosing a course of treatment, discuss this with your doctor if you think it might be an issue for you. It is frequently wise to get a second opinion if time permits.
References:
- https://www.thyroid.org/media-main/press-room/#:~:text=More%20than%2012%20percent%20of,are%20unaware%20of%20their%20condition.
- https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism#:~:text=About%201.2%20percent%20of%20people%20in%20the%20United%20States%20have%20hyperthyroidism.&text=That’s%20a%20little%20more%20than%201%20person%20out%20of%20100.
- https://www.uclahealth.org/endocrine-center/normal-thyroid-hormone-levels
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559105/#:~:text=Resistance%20to%20thyroid%20hormone%20alpha,constipation%2C%20dyspraxia%20and%20intellectual%20deficit.
Understanding thyroid gland diseases and disorders is crucial for effectively managing one’s health. Thank you for shedding light on this topic. Everyone needs to be aware of the symptoms, treatments, and potential impacts on overall well-being. Let’s continue to spread awareness and support those affected by thyroid conditions. Thanks for your work.
Hi Keepey,
Thank you so much for your thoughtful comment! I’m glad to hear that you found the information helpful. Raising awareness about thyroid gland health and supporting those affected by these conditions is important. Your encouragement means a lot!