If you are on thyroid medication for an underactive thyroid, it is routine procedure to have your blood work done every 2-3 months to monitor your thyroid hormone levels. Most practitioners will measure TSH and T4. TSH is a pituitary hormone that signals the thyroid to increase production of both T4 and T3. Thyroid medication such as Synthroid is a synthetic version of T4 (not T3). When T4 is administered, TSH level decrease. This is what leads to your labs appearing normal. Unfortunately, this is not where the tale of thyroid hormone ends. This article will discuss some important concepts with respect to thyroid hormone conversion.
A healthy thyroid mostly makes T4. In fact, the thyroid makes 90-95% T4 and 5-10% T3. T3 is the metabolically active thyroid hormone. It has a much shorter half life and is used up within a few hours. T4, on the other hand, has to be converted into T3 in the liver, kidneys, and by the gut bacteria. One iodine molecule is removed from T4 to convert it into T3. The enzyme requires both zinc and selenium to function optimally. Zinc is one of the most common nutrient depletions we see clinically in thyroid patients. In fact, taking thyroid medication (ie Synthroid), can further deplete both zinc and selenium levels since it calls for increased activity of the converting enzyme (de-iodinase enzyme).
To put this more simply, consider this simple analogy. Think of TSH like your payroll department and think of T4 as a check and T3 as cash. Assume your pay is $1000 per week for the purposes of this analogy. Under “normal” circumstances you would be paid $50 in cash and be handed a check for $950. The cash can be spent (metabolized) instantly but the check needs to be cashed before you can spend the money. In this case, the bank is the liver, the kidney, and the gut bacteria. Zinc, selenium and the de-iodinaze enzyme would be analogous to the bank teller. Now imagine it’s Friday night and the bank is closed or the tellers are all on break! All you have is $50 to spend.
Since most doctors only check for T4 (and assume the bank is open, ie your liver, kidney, and gut bacteria are doing their job and your zinc and selenium levels are normal), your T3 gets overlooked and you are told that everything is “normal”. Despite the fact that your energy is still low, metabolism is sluggish, and weight is not budging on the scale, you are given the green light.
Another aspect to consider once the hormone is converted is if it can hitch a ride to the target cell and get there on time. The cell is the like the store at the mall and inflammation would be equilievent to traffic. God forbid you can’t even spend the money you have because no one will drive you to the mall or you get stuck in traffic! Now let’s imagine you make it to the mall but the cash register is not working. This would be similar to the cell not working properly despite you having your cash in hand. Since your payroll department (TSH and thyroid) kept up their end of the deal they are off the hook. These issues are known as peripheral conversion problems that are not part of your thyroid treatment since they are extraneous to the thyroid gland. This is why millions of women get “normal” lab reports and still feel like “crap”.
Your doctor swears everything is fine and “life goes on”. Sadly, many women trust that everything is okay and this is as good as it gets. This could not be further from the truth.
Here are 5 red flags that your thyroid medication is not working optimally for you, despite normal lab work.
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1. Your weight is not budging
One of the most common complaints that patients have is difficulty losing weight. Due to the cosmetic nature of this symptom, many women lose their self confidence and their self image suffers. Of course many are not expecting for the weight to come down overnight but weight loss should reflect your nutritional and physical efforts to stay lean and fit. Some women will continue to gain weight even while on thyroid medication despite strategic weight loss measures. Sound familiar?
2. Your hair is still falling out
Another major physical concern is hair loss. While some hair loss is normal (50 hairs per day), excessive hair loss is a sign that your medication may not be doing the job. There may be other reasons why your hair is falling out such as; low iron, low protein intake or poor digestion (see below).
3. You still have sluggish digestion
Your digestive system is one of the most important systems for long term health. The tube that runs from your mouth to anus is about 22 feet long and has the surface area of a tennis court! Good digestion is imperative for vitality since it is a major elimination pathway but also this is where our nutrients are absorbed. A person with low thyroid function will experience symptoms such as bloating, gas, constipation, malabsorption, leaky gut, and even heartburn. When your thyroid hormone function is low (low T3), there is a decreased production of stomach acid and decreased motility leading to bacterial overgrowth, inflammation, poor elimination, low iron, low protein status and constipation.
A good test to measure your bowel transit time is the "sesame seed test". Simply mix a teaspoon of sesame seeds in a few ounces of water and make note of the time. When you see the seeds in your stool, you can stop the timer. The average American eliminates food that he/she ate 96 hours ago! Comparatively, a healthy person eliminates their meals between 18-24 hours after eating. This is a very inexpensive but extremely valuable self assessment. Try this test out immediately and make note of your transit time. It's critical to your health!
4. You continue to have depression, brain fog, and cloudy thinking
One of the main functions of thyroid hormone is to reduce brain-based inflammation. Lower levels of T3 often lead to persistent neurological inflammation. This can lead to depression, poor coordination, foggy thinking, poor comprehension, poor mental clarity, a hard time focussing, and forgetfulness. A fun and simple test of your cognitive function is to count backwards by 7 from 100. Go ahead, give it a try!
5. Your energy and motivation are still lower than you would like
Thyroid hormone plays an important role in the production of energy and neurotransmitters such as dopamine. Appropriate levels of dopamine are required to keep us both motivated and focused on our goals. Those with both low energy and low dopamine are victims of bad biochemistry, not bad intentions. We all need good brain and thyroid chemistry to go to the gym and see the fruits of our efforts. When your medication is not working the way it should your efforts will not go very far, leading to further frustration and decreased willpower to continue.
It is vital to communicate your issues with your doctor (or in some cases find a new one). There are several options to consider that have helped many of our patients, here are 6 things that you can do to optimize your thyroid function
- Get the following lab testing – TSH T4, T3, TPO Ab, TGB, Ab, Free T3.
- Optimize your diet by eliminating gluten, soy, and dairy. Eat lots of vegetables, pastured meats, wild fish, healthy fats. Keep the fruit intake as low as possible.
- Reduce inflammatory and stressful behaviours. Be sure to get plenty of sleep.
- Exercise or walk mid-day if possible.
- Get your nutrient levels tested and optimized, if deficient. We suggest an organic acid test.
- Consider taking a compounded or dessicated thyroid hormone medication. These include both T4 and T3.
We hope that this article helps you realize that there is much more that can be done to improve your thyroid hormone function. Your health is proportional to your ability to contribute to your family and community. We deeply value it and hope to empower thousands of women like yourself. Now that you are aware, please share!