I find it fascinating that thyroid disease is one of the most under-managed as well as poorly managed conditions.  I cannot tell you how many times I have someone with a known thyroid condition, ON thyroid medication that still has every thyroid symptom in the book.

  • Low energy
  • Cold hands/feet
  • Difficulty losing weight
  • Constipation
  • Sleep issues
  • Hair loss

Years ago I received a letter from the FDA advising physicians of the dangers of using T3 preparations in the elderly.  They referenced it was dangerous and there were much higher incidences of heart issues while on T3 medications and basically said don’t do it.

Just last week, I came across a study looking at the risks of T3 preparations on cardiovascular risks and they didn’t notice any differences in adverse effects.  However, they noticed an improvement on quality of life with patients on combination therapy.

What does all this mean?  Let’s talk thyroid…

First you need to know some basic terms.  TSH is just the signal from the brain to the thyroid gland that says wake up make more thyroid hormone.  There is a feedback loop that tells the body to make more TSH or less which is why physicians have used this as a marker to monitor thyroid disease.  The higher the marker the less the thyroid is working.  20 years ago a normal TSH was considered to be 10 or lower and now it is 4.5 or lower.  However, I think optimal is less than 3 and if you have a thyroid condition then 2 is a good goal.

T4 is what the thyroid gland produces and then it gets converted by the body to the active thyroid compound T3.  Both of these should be relatively balanced for optimal performance.  Personally, I like measuring the free T4 and the free T3 to see how these work.  The “free” part means what is available for use.  Reverse T3 is elevated when the body has a difficult time converting T4 into T3 or sometimes has too much T4 to be able to process into T3.  If you know the free T4 and free T3 you often don’t need to measure the reverse T3 because you can predict by looking at these numbers if the reverse T3 will be high.  Basically, if you aren’t converting T4 to T3 then your reverse T3 will be high.  I know this is all confusing so don’t try to master this but just be familiar with the terms and what they mean.

Now let’s talk antibodies.  Antibodies are what we produce to fight infections but sometimes they seem to turn on ourselves and start attacking our body, in this case our thyroid gland.  I suspect in 20 years we will discover that they are really attacking some virus or infection within the thyroid gland trying to protect us but we have no way to determine that now.  There are three main thyroid antibodies:

  • TPO – thyroid peroxidase – typically found in autoimmune thyroid disease otherwise known as Hashimoto’s
  • Tg – thyroglobulin- also found in autoimmune thyroid/hashimoto’s and are usually present with nodules
  • TSI – thyroid stimulating immunoglobulin – typically found in Grave’s disease which is rare and not typically screened
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Medications that are used to treat thyroid conditions include:

  • T4 only preparations:  Levothyroxine, Synthroid or Tirosint
  • T3 only preparations:  Liothyronine, Cytomel
  • T3/T4 preparations:  Armour, Naturethroid, Westhroid, NP thyroid, etc

Regardless of which medication you are on the T4 and T3 need to be balanced.  If you are on a T4 only preparation then there is a good possibility your T3 will be low.  However, your TSH may be “normal”.

If you are on a T3 or a T3/T4 combination medication only, your T3 may be normal but typically the T4 will be low and your TSH may remain high which may lead to overdosing.  This is why elderly people were getting into trouble because many physicians who prescribe the T4/T3 preparations are dosing it by only monitoring the TSH and not looking at the T3.  The higher the T3 outside of optimal range, the more issues you have like rapid heart rate and arrhythmias.  Bottom line, if you are taking any T3 medication then you need to be measuring the T3.

If you have antibodies then I always recommend a gluten free diet.  This is not because you are allergic to gluten but it has been discovered that thyroid antibodies cross react with gluten and when you remove gluten the majority of people with antibodies feel much better.  I have seen the antibodies decrease as well.

Here are three take home points:

  • If you have a thyroid condition, you need to know the TSH, Free T4 AND the Free T3
  • Know what your medication is (a T4, T3 or T3/T4 combo) so you know what to watch for in your numbers
  • Test for antibodies:  TPO and TG are the two that need to be screened in most cases.  If you have them then go gluten free (regardless if your doctor tells you it won’t matter)!

Obviously, there is a whole lot more to getting the thyroid balanced and what seems to be a simple little gland is very complex.   I haven’t even gotten into the nutrients the thyroid needs to function or the under-functioning thyroid with “normal” thyroid levels. If you suspect you have a thyroid condition or are on medications but still feel like you have every thyroid symptom then you need to dive deeper into why and work with a physician that looks at the whole picture and is open to both types of medications.

To your health,