“It ain’t what you don’t know that gets you in trouble, it’s what you know that just ain’t so” – Mark Twain, quoted from Hypothyroidism Type 2, by Mark Starr

Does this scenario sound familiar? You are tired all the time, somewhat down emotionally. It all may have started after you recently had a baby, or it may have been going on for quite a while. Your once beautiful hair is much thinner and your skin is dry despite constantly using lotion. You are in the battle of your life to maintain your weight and are losing. Your hands and feet feel cold. Being intelligent and motivated, you know there is something wrong. You have done your homework online and with your new knowledge, think you have a thyroid problem, specifically low or hypothyroidism. Armed with this, you feel confident that your doctor will listen to you and agree. At your appointment, you run through your list of symptoms. Your doctor is busy on the computer and paying little attention to your history. He/she says something like “Well you are probably just tired from your baby”, or “Well that’s all part of getting older”. Your doctor doesn’t examine you and orders some labs, just to make sure. At your next appointment, your doctor again makes some inane comment like “All your labs are fine. There is nothing wrong. It’s probably just stress”; or “I think you are depressed. Here is a prescription for an antidepressant”.

You are now, rightfully angry. You have been totally dismissed and treated as though you are a mental case. You know in your heart that despite the “Normal” labs, there definitely is something wrong. You are frustrated and don’t know what to do. You justifiably assume that when your doctor says that your “Labs” are “Normal” that he/she has run a comprehensive set of labs to fully assess your thyroid. Unfortunately, you are probably incorrect in this assumption. In all probability, your doctor has performed a set of labs called a “Comprehensive Metabolic Profile” (which in fact is neither comprehensive nor does it relate to your metabolism). This is actually a basic panel looking for overt disease and includes only one thyroid test for Thyroid Stimulating Hormone (TSH) – not that great for a hypothyroidism diagnosis. To put this into perspective, my Comprehensive Thyroid Panel includes 9 tests relating to thyroid hormone. I call this basic thyroid testing, because it only tests for things relating directly to thyroid hormone, and does not consider the multiple other factors that can cause a thyroid problem. A thorough thyroid evaluation involves many more tests. There is a high probability that you are right and your doctor is wrong and that you do have a thyroid issue such as hypothyroidism. Would you like to know why, and what to do about it?

Before we get into the details, let’s look at a real patient of mine with a “Normal” TSH. This is the case history of Liz, a 63-year-old woman, with many health issues. She had multiple symptoms of low thyroid, including fatigue, weight gain, constipation, hair loss and more. On examination, she had obvious myxedema (swelling of the face) and loss of the lateral 1/3 of her eyebrows (another classic sign of hypothyroidism). Her primary care doctor had her on replacement synthetic T4. The only lab test being used to monitor her T4 levels was TSH. Here is Liz’ TSH value: 1.17. Lab “Normal Range”: 0.27-4.2.

From this, can you tell me what a TSH level in the low-normal range should mean according to the standard medical model? Exactly – a low normal TSH is supposed to mean that your thyroid levels are good to high normal, right?

Let’s see what a more comprehensive test showed as out of the normal range:

Test Patient Value Lab Range Flag
TT4 2.9 5.1-14.1 Low
FT4 0.27 0.9-1.7 Low
TT3 65 80-200 Low
FT3 1.1 1.8-4.6 Low

 

So her real thyroid hormone lab values are only 50% or less of the lab values of the average person (midway between the low and high range). How well do you think you would feel if you got only 50% of the oxygen, food or water that an average person gets? How long would you live? So the rest of this article is about telling you why you may feel terrible when you lab values are “normal” according to your doctor. Unfortunately your doctor is often wrong, to your detriment. Read part 2 to learn more about TSA and hypothyroidism.