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Patterns of Thyroid Dysfunction- Why You Still Struggle with Thyroid Symptoms

It’s no surprise that the traditional medical system is failing patients who have thyroid disease (*),(*),(*). Just ask the number of patients who are taking thyroid medication if they feel better and you will quickly see how many still suffer from unresolved thyroid symptoms. Accurate diagnosis is crucial in medicine to determine the most effective treatment for thyroid patients. Unfortunately, a one-size-fits-all all-treatment approach which includes thyroid replacement, seems to be the only tool in the 21st century medical toolbox. The overwhelming majority of patients with thyroid dysfunction suffer from one or more thyroid patterns that are missed with standard thyroid testing. These dysfunctional thyroid patterns, don’t show up on your usual thyroid testing.

If you feel there is more to your thyroid story, stay with me as we review these patterns of thyroid dysfunction, as well as review the inherent problems with the Standard Thyroid reference ranges. There is a lot of information contained in this article and you may want to bookmark this page and come back to it. Let’s jump in… Let’s first review why the standard reference ranges are a problem.

Why Thyroid Patients Continue To Suffer…..

1. The Problems with the Standard Thyroid Panel

If you are one of the many thyroid sufferers out there, the problems with the standard thyroid panel and thyroid testing are where all your problems begin. Let me explain. Let’s assume you have been suffering from weight gain, brain fog, anxiety, heart palpitations, constipation, and hair loss. You make an appointment to see your doctor and your doctor right out of the gate recognizes these symptoms as being caused by your thyroid. Your doctor will then order a standard thyroid panel.

Problem number one for many thyroid patients starts with testing. The standard thyroid panel or testing usually includes only TSH and T4. There are many factors involved in optimal thyroid function, and TSH and T4 only tell a small part of that story. Most clinicians now agree that to better evaluate a patient with the different patterns of thyroid disease, additional thyroid biomarkers such as free T4, free T3, TBG, reverse T3 (rT3), and antibody testing are essential. Problem number one can be summarized in a few short words. It’s missing too much of the picture. TSH and Free T4 don’t tell us the entire picture. 

2. The Problems with the Standard or “Normal Thyroid Reference Ranges”

The second problem encountered by people who have thyroid dysfunction has to do with what we call normal. What is a normal TSH?, What is a normal Free T4? How do we determine what’s normal and what’s not normal?

Let’s talk about TSH to start with.

The “Normal” TSH levels fall within a range of .05 to 5.0. As you can see this is a very broad range. But how do we determine this range? This range is based on the average values in a population, rather than individualized values.

This “Normal” reference range does not take into account the clinical picture of the patient but is simply the average values and standard deviations of adults in an area who have their blood drawn.

Unfortunately, most people who go to labs to have bloodwork done are struggling with health issues, in other words, they are sick. This means that the “normal” ranges for TSH and T4 are based not on values shown to promote optimal health, but rather on a range of values collected from a sick population. For this reason, we must use functional ranges rather than standard “Normal” ranges when assessing the thyroid status of our patients.

Furthermore, the reference ranges often focus on TSH (Thyroid-Stimulating Hormone) levels, which may not present a comprehensive picture of thyroid health. Other important markers such as Free T3, Free T4, and thyroid antibodies are sometimes not included in standard thyroid panels, leading to potential oversight of crucial aspects of thyroid function.

Problem number two can also be summarized in a few short words. Normal reference ranges based on sick people, are too broad and are based on statistical averages, not on healthy people.

Patterns of Thyroid Dysfunction

To understand why you still struggle with thyroid symptoms despite your doctor insisting that there is nothing wrong with your Thyroid comes down to having a better understanding of the pattern of thyroid dysfunction you have. Let’s review these dysfunctional thyroid patterns.

Primary Hypothyroidism

If you are taking thyroid hormones and you feel great, Chances are this is the pattern of thyroid dysfunction you have. It is also the least common pattern of thyroid dysfunction, which is why the prevailing treatment doesn’t work. I’m going to assume if you have been diagnosed with thyroid disease and you feel great you are not reading this article, so let’s review the patterns that the majority of people who have thyroid disease have and what contributes to this thyroid pattern.

Which Pattern Of Thyroid Dysfunction Do YOU Have?

1. Hypothyroidism Secondary to Decreased Pituitary Output

This pattern of thyroid dysfunction is often caused by high cortisol. Cortisol, in turn, is elevated in response to active infection, Inflammation; (*) blood sugar dysregulation, hypoglycemia, insulin resistance, or chronic stress; (*) or pregnancy. These stressors fatigue the pituitary gland; as a result, it can’t release enough thyroid-stimulating hormone (TSH) to stimulate the thyroid gland to produce T4 and T3. In other words, there is nothing wrong with the thyroid gland itself; the problem lies with the pituitary gland(Brain).

Patients with this pattern will present with hypothyroid symptoms, TSH below the functional range (1.8–3.0) but within the standard range (0.5–5.0), and T4 that is low in the functional range and possibly the standard range as well.

The key to correcting this pattern is to uncover the underlying causes of pituitary dysfunction by treating infection, balancing blood sugar, improving insulin sensitivity.

For more information on what to do next Schedule a 15-minute Discovery call here

2. Thyroid Under Conversion – aka Low T3

Thyroid underconversion is better known as low T3 and is probably the 2nd most common pattern of thyroid dysfunction we see. T4 is the inactive form of thyroid hormone. It comprises 90 percent of thyroid hormone produced by the thyroid gland and must be converted to T3 before the body can utilize it. When T4 is not converted into T3 in adequate amounts, symptoms of hypothyroidism result. This pattern of thyroid dysfunction characterized by under-conversion of T4 to T3 has many potential causes, including inflammation, elevated cortisol, nutrient deficiencies, and intestinal dysbiosis. Patients with this pattern present with hypothyroid symptoms, normal TSH and T4, and low T3.

Twenty percent of thyroid hormone activation is initiated in the gastrointestinal tract by gut microbes, which produce deiodinase enzymes that convert T4 into T3. Disruption of the normal gut microbiota leads to gut dysbiosis resulting in a decreased amount of T3 and symptoms of hypothyroidism. (*, *, *) Lipopolysaccharides produced by pathogenic bacteria also impair T4 to T3 conversion by inhibiting thyroxine 5′-deiodinase, an enzyme that catalyzes the conversion. (*)

T4 to T3 conversion occurs in cell membranes. Chronic inflammation involves the production of inflammatory cytokines, which damage cell membranes and impair thyroid hormone conversion. (*) Chronic fatigue syndrome and Crohn’s disease patients are two examples of patient subsets who may present with “low T3” syndrome due to chronic inflammation. (*, *) High cortisol, which can become elevated due to chronic inflammation and stress, also suppresses the conversion of T4 to T3. (*)

Nutrient status is essential in the pathogenesis of thyroid disorders. Nutrients such as iron and selenium serve as cofactors for enzymes involved in the conversion of T4 to T3. Deficiencies of iron and selenium may reduce T4-to-T3 conversion and promote symptoms of hypothyroidism. (*, *)

This pattern of thyroid disease can also be seen in people who have liver problems including fatty liver.

No amount of replacement hormone will fix this unless all of the things that affect conversion are fully evaluated and fixed.

3. Thyroid Over Conversion

Have you had enough of these Thyroid patterns yet? Thyroid Over Conversion is a thyroid pattern that can often be seen in women who have elevated levels of testosterone, suffer from PCOS, or have insulin Resistance. Some people, due to various metabolic imbalances convert too much hormone into the active T3 form. This sounds like it would be a good thing, but it is not, and here’s why. The extra T3, causes the cells to produce fewer receptor sites because they are being bombarded with T3 thyroid hormones. Often seen in conjunction with thyroid resistance.  These patients often have symptoms of hypothyroidism, despite high levels of hormones in the body.  Doctors who fail to recognize this often just increase the patient’s thyroid medication.

4. Thyroid Resistance

In this pattern of thyroid dysfunction, the thyroid and pituitary glands are functioning normally, but thyroid hormones are unable to get into cells where they are needed. TSH, T4, and T3 are all normal in this pattern. Chronic stress and high cortisol are two key contributors to this pattern. (*) Elevated homocysteine and genetic factors can also cause thyroid hormone resistance. (*, *) Correcting imbalances in the HPA axis may help to resolve this pattern. 

5. Thyroid Binding Hormone Elevations

Thyroid binding hormone Elevations. Many women, especially those on Birth control pills, estrogen replacement and women suffering from endometriosis have this pattern due to estrogen dominance. Another concept you must understand about thyroid hormones is that because they are steroid-based, meaning they do not mix well with water, they must be bound to proteins to be transported through the blood to cells. If your body creates too much binding protein then you don’t have enough hormones in a “free unbound state” to bind to receptors on cells. This will create symptoms of hypothyroidism despite normal thyroid levels on lab testing.

6. Autoimmune Thyroid

Autoimmune Thyroid disease is where your body attacks and kills your thyroid cells. This is the most common cause of low thyroid function in the United States and this is by far the most common pattern of thyroid dysfunction. (*). This is also known as Hashimotos Thyroiditis. This requires special testing. Hashimoto’s Autoimmune Thyroid Disease is the most common cause of hypothyroidism in the United States. Being the most common presentation of hypothyroidism would suggest that it would have the most effective and refined treatments, given that it is encountered by doctors so often. Unfortunately, this is not the case, it is actually the most mismanaged type of hypothyroidism. Most people who are diagnosed with Hashimoto’s Disease receive only thyroid hormone replacement, yet continue to suffer from all of the same symptoms.

How Do I find out which Thyroid pattern you have?- This can only be determined with a Comprehensive Thyroid Panel that looks at more than just TSH and free T4.

Schedule a Free 15 minute Phone Consult to See If My Program is Right For You- See My Availability here

Some Additional Articles We Recommend Reading

  1. Thyroid and Blood Sugar Connection. Everything You Need To Know About Blood Sugar and Thyroid Disease
  2. Ingredients Binders and Fillers in Thyroid Medication
  3. Low T3 Explained. What You Should Know About this Thyroid Hormone
  4. Adrenal Fatigue and Thyroid: How Are They Connected?
  5. The Stress Hormone Cortisol and Blood Sugar
  6. Iron Deficiency and Hypothyroidism- How Iron Anemia Shuts Down The Thyroid


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