Regular thyroid on the left and an enlarged thyroid on the right. Image from Shutterstock.
When you feel fuzzy, depressed, struggling to control your mood, tired, cold and gaining weight easily, the chances are that you are aware it might be a good thing to get your thyroid tested. So you make an appointment, rattle of the list of symptoms to the doctor, they agree to test your thyroid and you feel great. You are going to get your answer soon, the end is near and soon you will be back to your old self.
Then you chase up the results only to be told: the results come back and you're fine. Fine? That can't be you feel rubbish and exhausted, are they sure? Yes the doctor insists you are fine and maybe offers you the birth control pill or an anti-depressant. Maybe you are just stressed or it's your age.
You leave your appointment feeling dejected and boom, it hits you. You know that your thyroid is playing up, you know your body, how can the results be fine. Your eyebrows are thinning your hair is thinning, you have no energy, certainly not to argue with a doctor, or maybe you should find a more sympathetic doctor for a second opinion.
If you are thinking this is your story, you are not alone. I hear this from literally hundreds of women and I can tell you that my women's health colleagues come across this story with alarming regularity too.
What Is Going On?
First of all, I am not going to doctor bash here. They do an incredible job, I have literally had my life saved my doctors and I am incredibly grateful for doctors and the NHS. They study for years, have to do crazy hours in their training which works out at about £1.50 a minute in some cases and I have so much respect for them. However, the human body is so beautifully complex and we are discovering so much about it all the time, and there are so many aspects, it just isn't possible for GPs or even specialists to know everything. I know for a fact some of them don't have time to eat lunch let alone read journals and squeezing in compulsory continuing education is difficult.
However, the thyroid is one area which we know more about now than we knew a few decades ago, unfortunately, many in the standard model aren't given the updates, where as doctors with a more functional approach will look at the thyroid with a completely different sense.
So let's look at the standard test that is done. Most doctors will only run the TSH test, and there are several issues with this: first of all a full thyroid panel should be done, secondly the ranges are not that accurate. Finally, there is a difference between a clinical diagnosis for illness and and optimal functioning.
But before we got into that, let's talk about what TSH is.
We have a few areas in our brains that are responsible for sensing the amount of hormones in the body and they tell the pituitary gland when we need more or less of those hormones. In the case of the thyroid, the pituitary produces a hormone called Thyroid Stimulating Hormone (TSH).
This stimulate the thyroid to produce more thyroid hormones (it produces a number of hormones, mostly Thyroxine T4 and some Triiodothyronine T3). T3 is the hormone our body needs for metabolism, however, the body has to convert T4 into T3 to get enough for the body to function.
This is a pretty amazing feedback loop which is similar to the other hormonal feedback loops in the system. Aren't our bodies incredible? Check out the picture below for an idea of what these organs look like and where they are in the body.
Image from Shutterstock
Back To The TSH Test
Many doctors are still using the original references ranges this is 0.5-5 mIU/L (or similar ranges). This only tells us if the body thinks there is too much or too little thyroid hormone in the system. Typically as it gets higher in women with hypothyroidism, which is logical, not enough hormone, tell the thyroid to get on to producing more.
However, according to Chris Kresser (who has a whole range of blogs and podcasts on thyroid that you should really check out if you are interested in getting to know the thyroid), the original range was decided based on a study of TSH ranges which not only included healthy test subjects but also people with both diagnosed and undiagnosed thyroid issues.
You many also want to know, a lot of research is done only on men as women have menstrual cycles which causes extra variability, so most test ranges are based on men only.
And even amongst the medical community there is a lot of too-ing and fro-ing on the test range. So even if your doctor is aware of the research narrowing the range, then with the changing recommendations it is pretty difficult to catch up anyway. Here's a great post on TSH test ranges varying.
Incase you are wondering, the range I look for following my various trainings is for TSH get to somewhere within the range of 0.5-2.5 mIU/L and looked at in conjunction with T3, T4, TPO and TgAb.
There is a huge difference between clinically unwell and well and a line has to be drawn somewhere as to when they treat and that is what doctors are trained to do. But in terms of feeling well and great it is important we understand this difference.
Image Copyright Rachel Dutton 2017
Health is actually a continuum not just a series of boxes you can put yourself in. Think about it there is the range where you are healthy according to all the measures but there is optimal health in which you feel great, have lots of energy to do what you want and feel like you are on top of the world.
There is also a huge difference between healthy and clinically ill. You can be feeling a bit "meh", not 100%, a bit tired, to having symptoms that are constant and not resolving but not bad enough for a diagnosis. Unfortunately, many people are in that range and know they are feeling better but not sure where to start. So your thyroid, could be not performing as it should be but no where near the level for a diagnosis. In the case of hypothyroid, this is often referred to as subclinical hypothyroidism. It isn't at the place where your doctor can make a clinical diagnosis, but it isn't functioning at it's best leaving you feeling tired, run down, cold and moody (not to mention a whole host of other symptoms).
What Do I Do?
There are many ways you can help thyroid issues that I will be exploring in a number of blog posts, so keep checking your e-mails from me, however, if you want a the full information on thyroid disease, don't miss out the documentary series, the Thyroid Secret coming soon.
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