SUBCLINICAL HYPOTHYROIDISM

In cases where the patient’s hypothyroidism doesn’t correlate with the ranges from a given lab, a test result within laboratory reference limits is not necessarily normal for an individual.  According to Anderson, Pedersen, Brunn & Laurburg, 2002,  “Because serum TSH responds with logarithmically amplified variation to minor changes in serum T(4) and T(3), abnormal serum TSH may indicate that serum T(4) and T(3) are not normal for an individual.  A condition with abnormal serum TSH, but with serum T(4) and T(3) within laboratory reference ranges is labeled subclinical thyroid disease. Our data indicate that the distinction between subclinical and overt thyroid disease (abnormal serum TSH and abnormal T(4) and/or T(3)) is somewhat arbitrary. For the same degree of thyroid function abnormality, the diagnosis depends to a considerable extent on the position of the patient’s normal set point for T(4) and T(3) within the laboratory reference range.”  Abnormally high (subclinical hypothyroidism) or low (subclinical hyperthyroidism) is defined by the TSH within reference ranges.  However, the common population will have frequently have subclinical abnormalities.  While these result have been thoroughly reviewed and studied in textbooks, subclinical hypothyroidism is common especially in elderly women, yet there is no clear evidence to date that subclinical hypothyroidism causes clinical heart disease.  “Estimates of average normal secretion for euthyroid humans are 94-110 µg T4 and 10-22 µg T3 daily (259).”  (Bowthorpe, 2011)

Overt Problems in the Doctor’s Office with Hypothyroidism Diagnosis

      Doctors get trapped in the lab-obsessed ranges, which are merely guidelines, rather than giving credence to clinical presentation.  Without having made the request for additional testing initially beyond looking at my TSH score, I would have remained undiagnosed for years before the number rises high enough to reveal the condition.

T3, Free T3, and Reverse T3

“While the thyroid gland produces both T4 and T3, the T4 is inactive. In order to be of use to the body, the T4 is converted to T3.  Increasingly, however, experts are identifying that nutritional deficiencies, toxins, and a variety of other physiological factors may prevent the body from accomplishing that conversion process effectively, leaving some patients deficient in this most important thyroid hormone.”  (Shamon, 2012).   This was evidenced in the initial lab results of February 2013.  Though my T4 level was approximately mid-range, both my T3 and my Free T3 (FT3) were low, negligible in fact.  What this indicates is that my body was not converting the T4 to T3 usable hormone, at all.  This means that giving me T4 supplements really won’t have any effect on me if the body isn’t converting it anyway.

FREE T3 LAB TEST: T3 is the active thyroid  hormone. Free in front of the T3 means you are measuring what is available and unbound.  Those on an optimal amount of desiccated thyroid, with no lingering hypothyroid symptoms and in the presence of healthy adrenals, tend to have a free T3 at the top of the range. If you are on desiccated thyroid (especially if lower than 3 grains) and find yourself with the free T3 high or above range in the presence of continuing hypothyroid symptoms, or even hyper-like symptoms (anxiety, shakiness), it’s a clue you have adrenal fatigue, aka low cortisol.  If not on thyroid medication: 1) If your free T3 is high, you could have Hashimoto’s disease, which will need the two antibodies tests to discern it, or Graves disease, which needs the TSI test. 2) if your free T3 is mid-range or lower, and in the presence of hypothyroid symptoms, you may have hypothyroidism, no matter how low the TSH. You should NOT take any T3-containing product on the morning of a test.

REVERSE T3 TEST: This test has to be done at the same time you do the free T3, and you then measure the ratio between the two by dividing the RT3 into the Free T3.  The body produces the benign RT3 naturally to rid itself of excess of T4, but in some cases, such as high or low cortisol, it’s made in excess and that excess clogs your cell receptors from receiving regular T3. FT3 should be twenty of more times higher than RT3.  (Barthorpe,2005, pgs 162-163)

T4 and Free T4

            “T4 is one of five hormones made by the thyroid– the latter which includes T4, T3, T2, T1 and calcitonin.  T4 is a storage hormone with the purpose of converting to the active hormone T3, though the thyroid also makes some direct T3.  T3 is the hormone which gives health and energy to every cell in the body.”  (Bowthorpe, 2011)

Low Iron and Hyprothyroidism

            Because being hypothyroid can result in a lowered production of stomach acid (frequent heartburn) which in turn leads to the malabsorption of iron, whether revealed with low ferritin, or with inadequate levels of serum or saturation. It can also lower your body temperature (common for those on T4-only thyroxine, as well) which causes you to make less red blood cells. Some even find themselves with a higher-than-normal temperature with on-going iron problems.

Low iron levels decreases deiodinase activity, i.e. it slows down the conversion of T4 to T3.  Biologically, insufficient iron levels may be affecting the first two of three steps of thyroid hormone synthesis by reducing the activity of the enzyme “thyroid peroxidase”, which is dependent on iron.  Thyroid peroxidaxe brings about the chemical reactions of adding iodine to tyrosine (amino acid), which then produces T4 and T3. Insufficient iron levels alter and reduces the conversion of T4 to T3, besides binding T3. Additionally, low iron levels can increase circulating concentrations of TSH (thyroid stimulating hormone).

Even worse, good iron levels are needed in the production of cortisol via the adrenal cortex. This study reveals that an iron-containing protein is present in high amounts in the adrenal cortex and is involved in the synthesis of corticosterone.  So by having low iron, you can potentially lower your cortisol levels.

Iron, in addition to iodine, selenium and zinc, are essential for normal thyroid hormone metabolism.  Avoid calcium foods, coffee, tea or wine (tannins interfere with absorption), the fiber of bran, and chocolate at the same time you take iron. Also avoid mixing iron with your thyroid pills. Keep them all 2-4 hours apart from each other he iron won’t bind to some of the thyroid hormones as they mix in your stomach and bind some of that NDT.

Adrenal Fatigue and Estrogen/Progesterone

     They point to high cortisol, low cortisol, or often a combination of both. These can also be found or exasperated while raising natural desiccated thyroid or T3, and can occur at low doses of desiccated thyroid or T3, or waited until the patient got as high as 3 grains and more. They are in no particular order, and you can have some and not others:

  • continuing hypothyroid symptoms with a high free T3
  • shaky hands; shakiness
  • diarrhea
  • bad palps
  • higher heart rate
  • pounding heart
  • feeling of panic
  • weakness
  • inability to handle stress
  • inability to handle interactions with others
  • inability to focus
  • rage or sudden angry outbursts
  • emotionally hyper sensitive
  • overreacting
  • highly defensive
  • feeling paranoid about people or things
  • exacerbated reactions to daily stress
  • no patience
  • easily irritated
  • mild to severe hypoglycemic episodes
  • nausea in the face of stress
  • taking days to recover from even minor stress
  • taking days to recover from a dental visit
  • flu-like symptoms
  • headache
  • all over body ache
  • super-sensitive skin
  • extreme fatigue
  • scalp ache
  • hyper feeling
  • jittery
  • clumsy (drop things, bump into things)
  • confusion
  • suddenly feel extremely hungry
  • low back pain
  • dull
  • cloud-filled head (happens when this patient is due for a next cortisol dose)
  • jumpiness
  • muscle weakness
  • “air hunger”
  • dizziness
  • light headedness
  • motion sickness
  • coffee putting patient to sleep
  • vomiting even running up the slightest incline
  • almost passing out every time patient gets up
  • dark circles under my eyes
  • waking up in the middle of the night for several hours
  • difficulty falling asleep
  • frequent urination
  • IBS symptoms
  • worsening allergies

If you have any of the above, it is highly recommended that you confirm sluggish adrenals with Discovery Steps One and Two found on the Adrenal-info page or Chapter Five in the STTM book with more in the list, and doing the 24 hour adrenal saliva test, which we have found to give far more important information than a one-time blood test or a urine test. The ACTH STIM may be good to detect if you have a pituitary problem, but may fail you to detect the kind of adrenal dysfunction that many hypothyroid patients have.

Reading the Numbers Correctly

Ranges are merely a guide and if a value falls outside the normal values listed, they may still be normal for you or your lab.

Reference Values

T-UPTAKE

Males: 27-37%

Females: 20-37%

To measure and validate the uptake, use the following calculations:

Free Thyroxine Index (FT4)  x   uptake percentage (30%) = TU

FTI  x Uptake

TU

THYROXINE, TOTAL (T4)

Females

0-11 months: not established

1-9 years: 6.0-12.5 mcg/dL

10-17 years: 5.0-11.0 mcg/dL

> or =18 years: 5.0-12.5 mcg/dL

FREE THYROXINE INDEX (FT4)

Females

<1.3 suggests hypothyroidism

1.3-3.0 suggests euthyroidism – a state of NORMAL thyroid function.

            (11/21/13, I am 1.6, previously 10/12/13 I was 1.3)

>3.0 suggests hyperthyroidism

Though my TSH is currently .01, the more important factor is that I am barely in a state of functioning euthyroidism while medicated.  This is yet another reason doctors should evaluate a patient based on clinical symptoms and the variety of ranges for their patient and in some cases, omit the TSH entirely as it is not a normal range for everyone, especially those with subclinical or secondary hypothyroidism.  This isn’t rocket science but should be taken into consideration as a legitimate fact.  “The best use for the TSH pertains to what is IS: a PITUITARY HORMONE! And for that, it’s a good guide to reveal if you have a malfunctioning pituitary gland, especially if you have a very low TSH and low free T3, accompanied by raging hypothyroid symptoms.”  Thyroid disease management via the TSH number alone is an insufficient method of measuring the actual levels in the body.  To get a patient in the normal euthyroid range effectively, a dosage of the equivalent to 3-5 grains desiccated thyroid is necessary. When a patient gets close to or in that range of desiccated thyroid, you will have a suppressed TSH lab result, which clearly reveals the lack of understanding and how the man-made and outdated procedure for the TSH range is. (Bowthorpe, 2011).

REFERENCES

     Andersen S, Pedersen KM, Bruun NH, Laurberg P., (2002, March).   Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease; J Clin Endocrinol Metab. 2002 Mar; 87(3):1068-72.  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11889165

     Barthorpe  M.Ed, J., (2011).  Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Treatment.  Fredericksburg, TX, Laughing Grape Publishing.

Barthrope M Ed, J., (2005).  Stop the Thyroid Madness: TSH – Why It’s Usless.  Retrieved from             http://www.stopthethyroidmadness.com/tsh-why-its-useless/.

     Shamon, M., (Sept. 2012).  Thyroid Patients: Do You Need T3 or Natural Desiccated Thyroid?  Retrieved from http://thyroid.about.com/od/hypothyroidismhashimotos/a/Thyroid-Patients-Do-You-Need-T3-Natural-Desiccated-Thyroid.htm 

Surks MIOrtiz EDaniels GHSawin CTCol NFCobin RHFranklyn JAHershman JMBurman KDDenke MAGorman CCooper RSWeissman NJ., (2004).   Subclinical thyroid disease scientific review and guidelines for diagnosis and management. The Journal of American Medical Association, 291(2), 228-238. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=197994

Trbojević B., (2003, Dec.). Subclinical thyroid disease-should we treat, should we screen for it?;    Srp Arh Celok Lek. 2003 Nov-Dec;131(11-12):467-73.  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15114790

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