Thyroid 101: Digging Deeper, Part 2


In my last article I focused on the importance of looking deeper when evaluating thyroid health by looking at more labs than the standard TSH. Let’s assume you now have more detailed labs but now have questions about treatment options.


There are times when the answer is fairly obvious. If TSH is significantly elevated in combination with low free T4 and/or low free T3, the general rule is thyroid replacement is needed but there are always exceptions to the rule.


Thyroid hormone is critical for your overall health so when you need it, you need it. Once someone starts taking thyroid hormone, 99% of the time they are on it for life and this may be the absolute right answer in regards to treatment. But there are times when something else might be going on, contributing to or even causing thyroid levels to be off. Here’s where the digging deeper comes in again.


When I see labs showing a normal TSH but low free T4 and/or low free T3 or a slightly elevated TSH but normal T4 and/or T3, I like to consider what other stressors might be negatively impacting thyroid function. If we can correct what might be acting as the stressor then thyroid levels may return to healthy ranges.

Here’s where I like to start:

  • Check ferritin levels. This is your storage iron and can frequently be low in women that are still having a menstrual cycle. Your thyroid functions optimally when this is around 80 and many are well below this level.


  • Assess and treat (as needed) adrenal health. This may be as simple as doing an honest assessment of stress levels and how well they are being managed or looking deeper and completing adrenal testing. I prefer what’s called 4 point salivary cortisol tests to assess how the adrenals are functioning.


  • Evaluate and treat chronic inflammation. Inflammation is a stressor and negatively impacts pretty much every body system. The “digging deeper” can start with blood inflammation markers such as hsCRP as well as looking for symptoms. Chronic joint and/or muscle pain as well as GI symptoms of frequent heartburn/reflux, gas and bloating can be signs of chronic inflammation.


  • Assess sex hormone levels. I like to think of the thyroid, the adrenals and sex hormones as existing together on a triangle. (My patients are very familiar with this picture I often draw them!) They exist as “points” of the triangle because they each impact how the other functions. Similar to the adrenals, if the sex hormones are unbalanced, it’s worth considering how this is impacting thyroid health.

As you can see, there’s not always just one answer in addressing thyroid health and I hope this helps illuminate some other avenues to explore if you’re struggling. As always, I’m here to help!


* Article first published in the October, 2021 issue of Tigard Life

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