Hidden Thyroid Problems

There is a good article here explaining the vagaries of thyroid testing:

Treating Thyroid Patients Like Children

Thyroid – Under or Over?

Hypothyroid – underactive is more common in women, but men can develop it. In the UK, it affects 15 in every 1,000 women and 1 in 1,000 men You should see your GP and ask to be tested for an underactive thyroid if you have symptoms including:

• tiredness
• weight gain
• depression
• feeling more cold than you think you should
• feeling dry – eyes, skin, hair etc
• muscle aches
• if your adrenals aren’t balancing
• hair loss
• lack of motivation, feeling flat

In contrast, these are the symptoms for an overactive thyroid, which is usually caused by autoimmunity (Grave’s Disease). nodules on the thyroid gland or certain medications can trigger it (like ones for arrhythmia) :

• nervousness, anxiety and irritability
• mood swings
• difficulty sleeping
• persistent tiredness and weakness
• sensitivity to heat, feeling hot inside
• swelling in your neck from an enlarged thyroid gland (goitre)
• an irregular and/or unusually fast heart rate (palpitations)
• twitching or trembling
• unexplained weight loss

Most of the time, I am asked about hypothyroid so that’s mostly what I’ll discuss here – with hyper it is important you get diagnosed and treated quickly and effectively as it is basically making your body work at top speed if you like, which shouldn’t go on for long as it puts the body under enormous strain.

I haven’t treated hyperthyroid directly but the one thing I do come across a lot is when someone has taken thyroxine or done something to boost their thyroid hormone production and the dosage has become too high. Several times I have asked them to talk to their doctors about a trial of lower meds. This has happened most often because the person has done quite a lot to correct their problem – such as correcting any conversion issues, knocking out an allergen or gluten to bring autoimmune antibodies down etc and their thyroid is producing more hormone more effectively than before, so do bear that in mind. A good thing, but if you were hypo and have gone hyper, check that out.

What to look for…

In short, what you need to know is that it is very unlikely that a normal TSH/T4 test in mainstream medicine will diagnose a more hidden thyroid disorder. Sad, but so very true. I have lost count of the number of people who have been left with ‘no problem found’ and still feel completely on their knees because of a thyroid disorder.

My own approach has been specifically to look for conversion problems – where someone shows enough TSH or T4 but it isn’t converting into the active hormone – T3 – enough. Very common. See the iodine and selenium issues below – once you’ve identified this, it is relatively simple to solve and can save a lot of suffering!

Secondly, someone could be producing enough T3 but too much of it is being converted into Reverse T3, which is the inactive form of it. So, again, someone would look OK but really hasn’t got enough active hormone even though the surface situation on tests looks OK.

The third angle to look at is the autoimmune antibodies. If someone’s thyroid has been identified with a problem, one of the major causes of that is autoimmune attack on the thyroid gland. Have your levels of peroxidase AND thyroglobulin been checked; often only one of them is and I have often found the other one high when I double-checked? Some docs do, some don’t. I always check as sometimes it can be the only indicator of a developing problem – early identification means early heading it off! And you can. I regularly see antibodies reducing – just this morning, in fact. Always so nice to see.

The most common cause of autoimmune attack on the glands – adrenal or thyroid – in my clinical experience is a form of gluten related disorder – not necessarily coeliac disease. And PLEASE don’t tell me you’ve had a coeliac test done and you were fine – this is another test that you simply cannot rely upon. See my Gluten Illness page for more on this and Gluten Tests here. In short, I have seen loads of people have seemingly intractable adrenal and thyroid issues helped by treating the gluten disorder. Don’t shoot the messenger ;).

I have written quite a bit about the Thyroid-Gluten link on the blog. Here’s one post to start you off:

Thyroid or Adrenal Problems? Check Gluten!

A fourth angle to consider is if you have some genetic weaknesses impacting on thyroid function. You can read my blog post here on that. It might be that you need a higher than normal dose of thyroxine because of your genetic make-up, or to take T3 with your T4 for it to work etc. It could also be that you are susceptible to inflammation or high stress that impacts thyroid function, and that neatly brings me onto…

Finally, you need to consider what your adrenals are up to. I’ve touched on this more below for you, but so often a ‘resistant’ thyroid issue is hiding an underlying adrenal problem that has to be fixed first. I come across this quite a lot. Here is a blog post, for example, I wrote a while ago now but has some good tips for you on this:

Scottish Bid For Better Thyroid & Adrenal Care

Here’s a useful overview of thyroid disorders, too, for you. This is from a mainstream perspective so do continue reading below for more on causes and treatment approaches. 

I have written a full Thyroid Tests Guide here for you and detail some of it here (there are more hints & tips etc there so do check it out fully).

Adrenal and thyroid glands are so interlinked and if one is having an issue, very likely so is the other. In most cases I come across, you have to treat the adrenal glands first before the thyroid will pick up so if your thyroid approach isn’t currently working as it should be, then do bear that in mind.

There is, in fact, a whole chapter on thyroid and adrenal relationships (and higher up the chain – pituitary, hypothalamus and the connection with your steroid hormones oestrogen and progesterone too) in my Adrenal Plan, which should help you understand these complexities a bit more and get a handle on what you need to do for your case.

For thyroid, things are a little simpler for testing [than adrenals] in my view. In general, look for the usual TSH, free T4, free T3 etc, but also how much inactive reverse T3 you are making, plus at least 2 autoimmune antibodies.

I can do any number of urinary thyroid screens but I usually do the blood rather than urine because I often find antibodies and reverse T3 come up, which just don’t show in urine tests.

You can also check for genetic problems, especially if you’re not getting well. For example, do you have DI02 Deiodnase 2 Thyroid Gene problems, maybe? This gene is responsible for the levels of T3 in the brain. T3 levels show fine in the body but these people tend not to do well on thyroxine treatment or need T3 with it even though their T3 body levels on tests look OK. 

With all that info, you can make a start on seeing what is going wrong, what further investigations might be useful and how to treat effectively.

First, start with the basal temperature test, which is the age-old way of finding hidden thyroid issues. Download the free factsheet on how to do it here.

When dealing with the thyroid, one thing crops up time after time and that is the need for iodine and selenium at different stages of the conversion processes.

Iodine and the Thyroid

The most suspect pattern here is if T4 is low with normal or high T3.

When I was trained, we didn’t really do a lot about iodine deficiency at that time because it was assumed everyone had plenty. But that has not turned out to be the case in my clinical experience.

I started testing people for iodine deficiency using the Iodine Loading Test about 10 years ago and it comes up positive a lot. There is then a protocol to use to correct it and retesting after 3-4 months usually shows not only has the iodine itself corrected, but so has the T4 if the iodine was a factor.

Anyway, I came across this really useful video on iodine recently which might be useful for you to watch. Some of the stuff he says is US rather than UK info, but it is all relevant. He likes the patch test; I find the loading test more accurate.

Have a look anyway. Iodine.

Symporter Iodine Transport Problem

A quick note on this one too. Some people can’t transport the iodine to the receptors properly and, quite commonly, this is because the other halides that compete with it are too high: bromide and flouride. The best way to check this out is with a Halides Loading test. You can read a technical, if useful, factsheet on Symporter Transport Thyroid Problems here.

Selenium and the Thyroid

Selenium is specifically needed to convert the inactive T4 into the active T3. If you don’t have enough of the selenium in the right place at the right time, it will impact your T3 levels. The most usual pattern to suspect is low T3 with normal TSH and T4.

The simple approach is to ensure enough selenium. You can check your levels using a Nutrient Test and I most often recommend checking all mineral levels if you can because one mineral deficiency can usually mean others are out too. For that, I would use the Nutrient & Toxic Elements test because it also looks for heavy metals, which we know can have a major impact on the thyroid. 

Check out the full Thyroid Tests Guide here.