Thyroid disorders are extremely common, especially in women.
Most people know thyroid dysfunction can affect metabolism, making it extra hard to shed unwanted pounds. The truth is, undiagnosed or under-treated thyroid diseases can affect almost every organ system in the body.
The symptoms of thyroid disease can be far reaching and may include:
- Weight gain
- Mental fog
- Swelling in legs/ankles
- Tongue swelling
- Dry skin
- Hair loss
- Muscle pain
- Always feeling cold
- Hot flashes
- Menstrual irregularities
- Brittle nails
- Low body temperature
The test most commonly used to check for thyroid dysfunction is TSH, or thyroid stimulating hormone. The pituitary gland produces TSH, which constantly communicates back and forth with the thyroid.
Ideally it works like this…the pituitary detects the body needs more thyroid hormone, so it increases the TSH level. The increase of TSH signals the thyroid to increase thyroid hormone (T4 and T3) production. On the other hand, if there is too much thyroid hormone being made, the pituitary will get the message to reduce TSH release, thereby reducing T3 and T4. Get it?
TSH is included routinely in annual exam screening lab panels. Despite this, the American Thyroid Association estimates approximately 20 million Americans have some form of thyroid disease, with up to 60% unaware of their condition. So why are so many people with thyroid disease are still being misdiagnosed despite routine screening?
Here are the most common reasons:
- The reference range for TSH is too wide. Several years ago it was recommended by the American Association of Clinical Endocrinologists (AACE) that the normal reference range for TSH be lowered to 3.0. Unfortunately many labs and providers are not utilizing these updated ranges and patients with thyroid disease continue to fall through the cracks.
- Limited testing. Many medical providers were not trained to do advanced testing for thyroid diseases so they are limited in their diagnostic approach. You want to work with a provider that routinely utilizes testing beyond just TSH to include free and total thyroid hormones (T3 and T4), reverse T3 (an inactive form of T3) and thyroid auto-antibodies (thyroid peroxidase antibody and anti-thyroglobulin antibody). This improves the likelihood a sub-clinical thyroid condition will be detected.
- Broken feedback loop. We expect the hormonal feedback loop to always work perfectly in the body, but what if the thyroid is not responding to the pituitary’s signals or vice versa? The TSH level may not always correlate with how the thyroid is actually functioning. This highlights the importance of comprehensive testing as explained above.
- Autoimmune attack on the thyroid. Hashimoto’s thyroiditis, is a fairly common autoimmune process, in which the body’s immune system mistakenly attacks the thyroid gland. This can be detected by checking thyroid auto-antibodies. If you are diagnosed with Hashimoto’s disease you need to address the underlying immune dysfunction as well as correcting thyroid levels before you will feel your best.
Finding a Thyroid Literate Medical Provider
Ideally you should be able to go to any doctor with your symptom list and they will do the battery of tests described above. Unfortunately this is not always the case. The following resources can link you to medical professionals that have a more comprehensive approach to thyroid health.