I want to share a secret with you… and the secret is the reason why your thyroid hormones, either your own or supplemental, aren’t working.
There are about 7 main reasons why you’re having thyroid issues.
- You’re not secreting enough TSH (this is pretty rare)
- Your thyroid is not creating enough thyroid hormones in response to TSH.
- Your T4 isn’t converting to T3.
- More T4 is converting to rT3 than to T3. An excess rT3 can actually block the effect of T3 on the receptor.
- You have an excess of thyroid binding globulin (TBG), which lowers free T4 and free T3 too much.
- You have too little TBG, which prevents enough T4 and T3 from circulating the body.
- Your T3 can’t enter the cell to exert its actions.
All of these issues will result in hypothyroid symptoms. 7 different reason but all result in the same symptoms. How well would you be able to identify where you issue is if you test only TSH, or even only the free T4 and T3?
Not very well.
A proper thyroid panel includes:
- Total and free T4
- Total and free T3
- T3 resin uptake (this will show you if the T3 is actually entering the cell and doing its job)
- Thyroid antibodies: TPOAb & TgAb
The problem is that not a lot of doctors will measure those, especially the rT3, which is almost the most important marker to see.
So let’s assume you can test all of them or have tested all of them, here is how to interpret them.
A TSH reading to absolutely useless. There is a lot of things that can increase or decrease TSH that doesn’t necessarily affect your thyroid hormone production. You might have high TSH, but also normal thyroid hormones, or very low TSH and T4, but normal to high T3.
Point is, don’t get hung up on this marker at all.
Total and free T4
Ideally, you want to be in the mid range for this one. High free T4 could be a red flag and should be around 1.3-1.4ng/dL.
Total and free T3
You want both of these in the normal to high end of the range. If total T3 is rather high, free T3 might be too low and then you should focus on lowering TBG or increasing the conversion. Estrogen is one the most common promoters of TBG. But if total T3 is high and free T3 is also high, then there is no need to worry.
According to Bryan Walsh, very high free thyroid hormones can actually shuts down receptor sites and cause hypothyroid symptoms. But if you’re on T4 and T3, high free T3 is normal and if you’re on T3 only, then free T3 might be 10-20% over the upper range, which is also normal.
So what is inhibiting the T4 to T3 conversion? There is actually quite a few and here are some of them:
- Iron deficiency – do an iron panel before supplementing
- Selenium deficiency – 100-200mcg of selenomethionine is a good dose if you’re deficient
- Cortisol excess
- Low calorie diet
- Heavy metal excess, such as mercury
- Flame retardants found in clothes, mattresses and other house hold stuff.
- Low growth hormone (R)
- Pain (physical/emotional)
For this one you want a ratio.
- Free T3/rT3 ratio: 20 or higher is normal
- Total T3/rT3 ratio: 10 or higher is healthy
So for example, if rT3 is 20 and your free T3 is 3.2 (multiple by 100 = 320), then divide 320 by 20 (rT3 number) and you get 16. Thus your rT3 is too high, even though you might have enough free T3.
The formula works like this.
Take your free T3 number:
- and multiply it by 100 if it’s not in the hundreds
- and multiply it by 10 if the rT3 is in the hundreds
and then divide free T3 number with your rT3.
Another two example is 3.2 (320) free T3 and 13 rT3 gives you 24.6 which is health.
Same goes for the total T3. Lets say you have a total T3 of 2.3 (230) and a rT3 of 13, then the ratio would be 17.7, which is healthy.
If you’re supplementing T4 and T3, you might still experience hypothyroid symptoms because the T4 is converting to rT3. So even though you’re supplementing T3, the excess rT3 will block the effect of T3 and you might still experience hypothyroid symptoms.
Most doctors recommend T4 only and this rarely resolves hypothyroid symptoms, either because the conversion to T3 is dysfunctional or an excess of rT3 is created.
Thyroid anti-bodies – TPOAb & TgAb
Thyroperoxidase autoanti-bodies (TPOAb) show that the enzyme that is converting T4 to T3 is damaged and might not be working optimally.
Thyroglobulin autoanti-bodies (TgAb) show that the precursor to T4 and T3, thyroglobulin, is being damaged and this could lead to low T4 and T3, even with elevated TSH.
TSH receptor autoanti-bodies (TRAb) may either mimic the action of TSH and cause hyperthyroidism as observed in Graves’ disease or antagonize the action of TSH and cause hypothyroidism.
These are elevated due to an immune reaction and the faster you can find the cause of the immune reaction, the faster you can fix this. Gluten, gut irritating foods (raw food, oxalates, phytates, other toxins in food and anti-nutrients), inflammatory foods (omega 6 rich foods, iron fortified foods, etc), poor sleep, lack of vitamin D, excess blue light, lots of stress, infection, heavy metals, pollutants, etc., can cause an chronic immune reaction.
A few additional things that can suppress thyroid function is:
- Low vitamin D
- Elevated parathyroid hormone
- Elevated serum phosphorous
A few free and relatively cheap ways to test thyroid function:
- Body temperature – You want to be at 98.6F (∼37C) throughout the day. It’s normal to be a little lower in the morning, but it should go up after breakfast.
- Heart rate – Between 70 and 90 BPM is pretty optimal. Lower could indicate compromised thyroid function and higher could indicate that you’re running on stress hormones.
- Blood pressure – hypothyroidism can lead to high blood pressure
- Cholesterol – elevated cholesterol is one of the best markers to see if thyroid function is optimal or not. Cholesterol over 220-230 is pretty much indicative that thyroid needs a little boosting.
If you need help interpreting your blood test results or need help with dietary or supplemental recommendations, I can help you with that, so just drop me an email.
As always, thanks so much for reading my article. Let me know if this article was helpful in the comments below.
If you found it helpful and insightful please like and share so others can also benefit from this information and feel free to leave a comment down below if you have any questions for me.
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