A Functional Medicine Hypothyroid Assessment

This is the second post in a series on women and hypothyroidism. Start with the first post in this series.

Step 1 in Thyroid Assessment

As mentioned in the last post, your conventional doctor will test TSH and T4. (Your doctor should also feel and palpate your thyroid to assess for nodules or swelling in every annual exam). If TSH, T4, or your physical exam are concerning, your doctor may treat you herself, or she may send you to an endocrinologist who specializes in thyroid conditions. If your doctor is thorough, she may differentiate between, and test for, the types of hypothyroid below, however, the “functional” type gets overlooked in a conventional assessment. Unfortunately, the other types, including Hashimoto’s, can also be overlooked. Women often do not find out their type of hypothyroidism in a timely manner, and sometimes they never find out.

Types of hypothyroidism

  • Primary: the problem is in the thyroid gland. Depending on your geographical location, this is primarily due to iodine deficiency or autoimmunity. It can also be from treatment such as radiation, surgery, and many different medications.
  • Secondary: the pituitary does not produce enough thyroid stimulating hormone (TSH).
  • Tertiary: the hypothalamus does not produce enough thyroid releasing hormone (TRH).
  • Clinical or Overt: TSH is elevated and T4 is low.
  • Subclinical: minimal or no symptoms, normal T4, but elevated TSH. This is very common, and affects 15% of elderly women in the United States. It can mean Hashimoto’s. It usually results in symptoms and overt hypothyroidism within 10 years. These women are also more likely to have hypercholesterolemia and atherosclerosis.
  • Inherited: about 1 in 2000-4000 newborns, symptoms are decreased activity, increased sleep, feeding difficulty, constipation, and prolonged jaundice.
  • Autoimmune: Hashimoto’s thyroiditis.
  • Gestational: low thyroid that starts in pregnancy, usually caused by iodine deficiency.
  • Functional: impaired function of various body systems, such as poor conversion of T4 to T3, other hormone imbalances, gut bacterial overgrowth, insulin resistance, and more.

How to identify your type

The problem with conventional labs is that they are based on a bell curve, and simply being on the curve of what’s “in range” does not mean you’re in an ideal range. So look at your results yourself to determine if they are “normal.” Normal does not necessarily equal ideal. Your conventional doctor tests TSH and possible T4:

  • For T4, the conventional range is 4.5 – 12 µg/dL, but the ideal range is 6 – 12 µg/dL.
  • For TSH, the conventional range is 0. –4.5 IU/mL, but the ideal range is much tighter at 0.5–2.0 µIU/mL.

If T4 and TSH are out of the ideal range, and/or you have many of the symptoms (unexplained weight gain, dry skin, fatigue, depression, hair loss, sleep alot, constipation, cold extremities), we functional practitioners dig deeper. Some of the markers we test include:

  • The free forms of T4 and T3.
  • Thyroid antibodies (TPO and TgAB).
  • Reverse T3.
  • Nutrients related to thyroid function.
  • Adrenal and sex hormones.

Once we determine what your hypothyroid type, we can then dig into your root causes and create a precise individualized treatment plan for you. If it’s Hashimoto’s, this is an immune system condition that you can learn more about here. It’s very important to treat your immune system with Hashimoto’s!

To learn more, continue with the next post in this series: Nutrition for Your Thyroid.

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  1. I love these informative articles Laura Paris. The thyroid is such a complex integral part of our health and can be affected by so many different factors. Thank you for sharing this knowledge and educating us so we can be empowered and make better choices!

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