Explore the seven patterns of hypothyroidism often overlooked by conventional lab tests. Despite ‘normal’ TSH results, many sufferers experience persistent symptoms and find little relief from standard thyroid replacement hormone treatments. Discover how functional medicine offers a more comprehensive approach, delving into narrower health ranges to address the root causes of hypothyroidism. Find answers and support for millions navigating the ‘gray area’ of thyroid health.
It is estimated that more than 20 million Americans suffer from low thyroid problems or hypothyroidism. One in eight women will develop a thyroid disorder during her lifetime. Weight loss resistance, fatigue, brain fog, irritability, depression, hair loss, brittle nails have all been linked to low thyroid function.
If you have these symptoms, you can go to your primary care physician or endocrinologist and have tests run. Typically they’ll run TSH (thyroid-stimulating hormone) and T4 Tests. If your TSH is high, you’ll be given a thyroid replacement hormone drug. In my experience, thyroid replacement hormones do very little to sustainably relieve symptoms in most cases, let alone fix the condition. This leaves many of those suffering with these symptoms left to fend for themselves. As with any chronic disease, the training in the mainstream system is to diagnose a disease and match it with a corresponding drug. So if your TSH lab is “normal,” you’re told you’re “normal,” even if you still have symptoms.
People who have symptoms but are considered “normal” in the eyes of the mainstream care. The standard of care for people struggling with low thyroid symptoms is incomplete and inadequate. In functional medicine, we look at a much narrower range that shows ultimate health and function. This detailed lab interpretation gives answers to millions of people in the “gray area.”
There are seven patterns of hypothyroidism that show up on conventional lab tests and are not effectively helped by thyroid replacement hormones:
1. Primary Hypothyroidism
If the hypothalamus is getting a poor sampling of thyroid hormones in the blood, messages are sent hormonally in the blood to the pituitary that the thyroid isn’t doing its job. The pituitary will pump out extra TSH, giving the thyroid notice to produce more thyroid hormones. Primary Hypothyroidism is a true thyroid dysfunction and is the only pattern that can be effectively managed through thyroid replacement hormones or short-term dosage of iodine supplementation.
2. Hypothyroidism Secondary to Pituitary Hypofunction AKA – Hypothalamus Pituitary Thyroid axis (HPT axis)
In this pattern, the hypothalamus, which sits in the base of your brain is not getting a good sample of thyroid hormones in the blood. This is likely due to ischemia (decreased blood flow) to the brain.
In this pattern the pituitary gland, which sits at the base of your brain, is getting inaccurate supply and demand messages from the hypothalamus. Consequently, the pituitary will then send the thyroid erroneous signals about the need to produce more thyroid hormones.
There’s nothing wrong with the thyroid itself, it’s just not being told to get to work! This pattern is associated with a Vasomotor Control imbalance of the blood flow in the body. Blood vessels in the abdomen are dilated resulting in a reduced sampling of hormones by the hypothalamus. Vasomotor Control imbalances can be caused by metabolic conditions, chronic stress levels or chronic bacterial and viral infections.
As you can see, thyroid physiology is complex and unique to the individual. There’s no such thing as a magic pill for everyone, and we need to get a comprehensive diagnosis to gain insight as to why someone is struggling with the symptoms they have. I consult people all over the world via Skype and phone consultations, clinically investigating these underlying factors.
3. Thyroid Under-Conversion
This pattern has been covered in medical literature for years, but is not effectively alleviated by thyroid replacement hormones. The majority of thyroid hormone is in the form of T4, which is metabolically inactive, and has to be converted to T3 for use in the body. Most thyroid drugs are synthetic T4, which isn’t deficient in this pattern. It’s the conversion of the hormone, which takes place in the liver and GI system, that’s the problem. This pattern is common with chronic adrenal stress and elevated cortisol levels in the body.
4. Thyroid Over-Conversion
You would think that if the body produces more T3, the metabolically active form of thyroid hormone, it would be a good thing. Too much of a good thing will overwhelm your cells and cause a resistance pattern. This thyroid pattern is seen in people with elevated testosterone levels, insulin resistance, type II diabetes and in women with PCOS (Polycystic Ovarian Syndrome).
5. Thyroid Binding Globulin Elevation
Thyroid hormones, as with all hormones, get transported throughout the body on protein carriers. When these protein carriers, thyroid-binding globulins (TBG), are elevated this will cause an increase of protein bound thyroid hormones which are inactive. This pattern is common with excess estrogen levels and women using birth control pills or estrogen creams.
6. Thyroid Resistance
Similar to insulin resistance, thyroid resistance is caused by cellular inflammation, which decreases hormone communication with the cell membrane. Thyroid hormone production isn’t the problem in this pattern, and TSH will be normal but the person will have symptoms. Labs such as homocysteine and reverse T3 will give us a look at the inflammation and hormone receptor site blunting that is seen with this pattern.
Thyroid Resistance is also created if replacement of thyroid hormones is not monitored adequately. Sometimes the phrase, thyroid hormone resistance is used to identify cases where patients with autoimmune thyroid disorders respond poorly to normal doses of replacement thyroid hormone. This is thought to occur when patients have developed antibodies to thyroid hormones. The majority of patients with thyroid resistance to TSH have compensated hypothyroidism.
7. Hashimoto’s Disease
Hashimoto’s disease is the most common cause of hypothyroidism in the United States. In these cases, the thyroid isn’t the true culprit, but is the victim of the immune system. Hashimoto’s typically involves a slow but steady destruction of the gland that eventually results in the thyroid’s inability to produce sufficient thyroid hormone. TSH can be normal, but until you deal with the underlying autoimmune response you’ll always struggle with low thyroid symptoms.
If TPO Antibodies are Elevated
Hashimoto’s disease is an autoimmune disorder in which the immune system inappropriately attacks the thyroid gland, causing damage to thyroid cells and upsetting the balance of chemical reactions in the body. The inflammation caused by the unregulated autoimmune system often leads to an underactive thyroid gland (hypothyroidism).
If TPO antibodies are Not Elevated
Fatigued Immune System – Do not assume your body is capable of continued production of antibodies. Just as you may be fatigued and not able keep up with the demands of daily life. The same is true for the cells producing the immune cells in your body. The White blood cells may be able to produce inflammatory mediators (cytokines and chemokines) capable of causing pain and inflammation. While the antibody producing cells are too pooped to pop. One of the main reasons for this is bacteria in the body.
Bacteria Invading the Immune System – Oral bacteria can access the blood stream when bleeding occurs during chewing, brushing or flossing. Of course you wouldn’t be able to see it when chewing. Signs of this would be pain or tenderness when chewing, sensitivity to cold or hot drinks and receding gum lines. Once in the blood, bacteria are attracted to areas of high metabolic activity looking for a free meal. The thyroid just happens to be the closest.
Related Keywords:
- Thyroid health
- Hypothyroidism symptoms
- Hashimoto’s thyroiditis treatment
- Non-thyroid conditions mimicking hypothyroidism
- Thyroid function tests
- Thyroid hormone replacement therapy
Top Competitor Sites with URLs:
- EndocrineWeb – https://www.endocrineweb.com/
- American Thyroid Association – https://www.thyroid.org/
- Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/hypothyroidism/
Suggested Sites for Outreach and Backlinks:
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – https://www.niddk.nih.gov/
- American Association of Clinical Endocrinologists (AACE) – https://www.aace.com/
- Thyroid Foundation of Canada – https://thyroid.ca/
