Here is a typical scenario:
I don’t know what to do… I have all the symptoms of low thyroid. My hair is falling out. I am exhausted, no energy whatsoever. I have gained weight, even though I try to eat well and exercise. But honestly, I am too tired to exercise. Sorry for the TMI, but I am constipated, bloated and fiber makes it worse. I am feeling pretty low mood wise and so tired. My skin is really dry, and all I want to do is sleep.
I went to my general practitioner, and she ran my blood work for thyroid. My doctor says my thyroid is fine. But I don’t feel fine! Then she just told me to go on a diet and gave me a prescription for an antidepressant.
I cannot tell you how many times I have seen this scene. That is because your general practitioner, endocrinologist, internist, PCP are looking for disease or if something is “broken.” But what if there is not a disease (thank goodness)? They really do not know what to do with you. To check for thyroid disease, your doctor will run a TSH (thyroid stimulating hormone).
The TSH is a signal from the brain monitoring the thyroid status. If you have thyroid disease causing an underactive thyroid, the TSH will be elevated. And if you have an overactive thyroid, the TSH will be very low. But the TSH is checking for thyroid disease. We have a lot of patients that do not have thyroid disease but still have a subclinical, ‘hypofunctioning’ of the thyroid.
Trying to keep this relatively simple, your thyroid gland makes T4 thyroxine, which is a very stable molecule and will travel in the system and mainly your liver will convert T4 to T3. Triiodothyronine (T3) is a very unstable molecule but is the active thyroid hormone. In Subclinical Hypothyroid, you will often see a normal TSH, normal T4 and a lower Free T3.
- TSH reference range is .45-4.5 = see anywhere from .45 to 2.5
- FreeT4 reference range is .8-1.8 = will see .8 to 1.1
- FreeT3 reference range is 2.2-4.4 = will see 2.0 to 2.9
Again, your conventional primary care doctor, endocrinologist, GP, internist are looking to make sure you are not going to die of a disease. They are not going to check your Free T3. And rarely they may check your Free T4. But if they do, they do not know what to do if the TSH is normal.
We find by optimizing your T4 and especially your Free T3; the Subclinical Hypothyroid symptoms go away. We still keep the TSH in the normal range but try to optimize the Free T3 to 3.5-4.4.
This is done in many ways based on the patient’s personal and family health history, their symptoms and goals. We might implement a combination of vitamins, minerals, glandulars, medication and lifestyle factors to treat subclinical hypothyroid.
Hopefully, this has been informative and helpful to you. If you have any questions or personal stories, please feel free to email us at firstname.lastname@example.org.