Did you know that 27 million Americans have some form of thyroid dysfunction? Even more shockingly, as many as 60 percent of them don't even know it. The American Thyroid Association estimates that one in eight women will develop a thyroid disorder in her lifetime. Yet I see this day in and out in my clinic. Patients come to me with thyroid dysfunction that hasn't been properly diagnosed by the multiple doctors they saw before coming to me.
This is a major problem because your thyroid regulates all of your metabolic processes. When it is underactive, also known as hypothyroidism, everything slows down, leading to weight gain, fatigue, dry skin, hair loss, poor concentration, constipation, infertility, low libido, depression, and low body temperature. When it is overactive, your metabolism speeds up, leading to weight loss, anxiety, insomnia, fast heartbeat, and loose stool.
If you suspect that your thyroid is out of whack, or you're already being treated for thyroid dysfunction and still have symptoms, take a look at the seven common missteps conventional doctors make in diagnosing thyroid dysfunction:
1. They're not checking for thyroid dysfunction.
This may sound shocking, but some thyroid dysfunction goes undiagnosed simply because your doctor never tested for it. If you're a woman under 40, you recently gave birth, or are a man, or you already have a condition such as fibromyalgia, chronic fatigue, or an autoimmune disease, which have many overlapping symptoms with thyroid problems, your doctor simply may not order thyroid lab testing.
On top of that, symptoms of thyroid dysfunction can be vague. Fatigue, anxiety, hair loss, weight gain, depression, and other symptoms are often written off as signs of aging or stress. So first things first, it is important to make sure your doctor is including a complete thyroid panel as part of your workup.
2. They're not testing ALL of your thyroid levels.
If your doctor does order thyroid lab work, they often only check thyroid stimulating hormone (TSH) levels. Conventional medicine still uses TSH levels as the key marker in diagnosing thyroid dysfunction because in many cases it's elevated in patients with an underactive thyroid. An elevated TSH level means your pituitary is signaling that you're low in thyroid hormone but your thyroid isn't ramping up production. However, this only tells you what the pituitary is doing, it doesn't tell you what levels of hormones your thyroid is producing, or your level of the active form of thyroid hormone vs. the storage form.
At a glance, here are the levels I recommend testing. You can bring this list in to your doctor and request this exact panel:
- TSH
- Free T4 (the storage form)
- Free T3 (powers metabolic processes)
- Reverse T3 (slows down metabolic processes)
- TPO, TG -AB (more on these below)
3. They rely on "normal" reference ranges instead of optimal levels.
Even if your doctor does order a full thyroid workup, they're usually relying on "normal" reference ranges that are too broad and often inaccurate. When they created the lab reference ranges for a healthy thyroid, they later discovered that they had included people who already had thyroid dysfunction! Because of this, in 2003, the American Association of Clinical Endocrinologists recommended that the lab reference ranges become more narrow; however, still today, most doctors and laboratories haven't updated their practices.
This is why many patients come into my office saying their doctor told them their thyroid levels are normal but they still have symptoms. Instead, I and other functional medicine doctors aim for optimal thyroid ranges in all of our patients, which are much narrower and catch thyroid dysfunction much sooner. I've included these optimal ranges as well as a letter for your doctor explaining why I, and many other physicians, recommend them, in my book.
4. They don't test for thyroid antibodies.
The vast majority of thyroid dysfunction is caused by autoimmunity, meaning your immune system is attacking your thyroid and causing it to underproduce (Hashimoto's) or overproduce (Graves' disease) thyroid hormones. Conventional medicine uses the same treatment protocol for autoimmune and non-autoimmune thyroid dysfunction, so they don't care if you have thyroid antibodies.
In functional medicine, we want to know if your condition is caused by autoimmunity because it changes what the treatment plan is. Environmental factors including diet, gut health, toxins, infection, and stress are the underlying causes of autoimmunity, and we want to address them, because once you have one autoimmune disease you're three times as likely to develop another one.
5. They don't test for nutrient deficiencies.
In order for your thyroid to function properly, we need certain nutrients. These nutrients help you produce thyroid hormones, convert them from their storage to their active form, allow them to enter your cells to attach to thyroid receptors, and support immune function.
Here is a list of the nutrients needed for optimal thyroid function:
- Iodine
- Tyrosine
- Selenium
- Zinc
- Iron
- Vitamin A
- B vitamins
- Vitamin D
6. They don't test sex or stress hormones.
The thyroid is just one component of our complex endocrine system that controls our hormones. Conventional medicine still tends to view each piece of the endocrine system as separate rather than working with them as an integrated whole, even though stress hormones and estrogen levels have a remarkable impact on the thyroid.
Cortisol, the primary stress hormone, can cause you to underproduce thyroid hormones, which keeps them in their inactive state and desensitizes thyroid receptors in your cells. Many patients with adrenal fatigue—often caused by chronic stress—also have thyroid dysfunction. Excess estrogen also binds up thyroid hormones, which is why many women who are pregnant or on birth control have thyroid problems.
7. They don't consider the root cause of thyroid dysfunction.
The body is a complex, integrated system, and many factors can influence thyroid function. As I mentioned before, there are certain key environmental factors that play a big role in thyroid health, namely leaky gut, diet, toxins, infection, and stress. Unfortunately, because your doctor spends only a few minutes with you and is primarily concerned with offering prescriptions, they often aren't interested in addressing lifestyle factors to actually reverse your condition.
In functional medicine on the other hand, we spend far more time learning our patients' health history, ordering comprehensive lab work, and optimizing lifestyle changes. While this process takes a lot more time and patience, it also leads to far better results.
~Thanks to Dr. Amy Myers
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