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What You Can't See Can Hurt You!
Thyroid Testing Is Inadequate: What I Realized Upon Researching This Disease
When I had my thyroid tested by multiple doctors over the years, I requested a copy of the lab work each time. In order to determine how the thyroid gland is checked and ultimately diagnosed, I used my own lab tests as a starting point. Upon reviewing my lab tests, I realized that there was only one test that was being used to analyze my thyroid glands functioning: TSH. Since this was the only test I found on my own personal lab work, my initial research was simple. I began researching the TSH test, specifically what TSH stood for, what it tested, what it meant, and whether a person with hypothyroidism could still test normal on the TSH test.
I expected to find the TSH test to be intricate, complicated, & important. What I discovered, though, was that it was not. The Thyroid Stimulating Hormone test does not even test a person's thyroid gland, but rather tests the pituitary gland. The theory behind the TSH test that I found in every thyroid documentation I read is that the more thyroid stimulating hormones that your pituitary gland produces, the less active your thyroid must be. Therefore, if your pituitary is actively trying to stimulate your thyroid gland, then your thyroid must be under active
The TSH test produces results that are in a whole number format. The thought is that the higher the number on your TSH test is, the slower your thyroid must be functioning. In order to fully interpret the results of a TSH test, though, one needs to know what the acceptable range of normal is. This is where the TSH test loses any validity it might otherwise have had. The generally accepted range for normal thyroid functioning as tested by the TSH test varies from one lab to another. I found acceptable ranges varying from 0.5 to 4.5, or 1.5 to 6.5. What this means is the same exact blood test from a TSH will produce differing diagnoses depending entirely upon the laboratory your blood was drawn by. A person testing 4.8, for example, on the TSH test could test normal at one laboratory, yet abnormal at another.
[You can check out the "Relate Links" on this site to see the article posting the newly accepted range of normal on TSH testing at 0.3 to 3.0]
One thing I did note, however, is the fact that the TSH test is simply a range, and multiple sources indicated that people in general cannot be expected to feel the same within the varying levels included in this range. Further, I found an article by the British Journal of Medicine [a link to this article can be found on the Related Links page to my site] indicating that anything above a 2.0 on the TSH test is itself indicia of hypothyroidism.
Based upon my personal research, I came to believe that the TSH test is not itself a valuable source of information to diagnose hypothryoidism. If my hunch on the validity of the TSH test alone were true, then there had to exist alternative methods of diagnosing a person with a slow functioning thyroid. Mary Shomons web page included a detailed explanation of alternative tests to diagnose a slow thyroid, as well as offering several quotes from doctors specialized in this field. I found out that there are many other tests that should be conducted simultaneous with the TSH test.
At this point, I was much more educated in thyroid functioning and the related blood work than previously. I decided to attempt one more doctors appointment, but this time I was not going to visit with just any doctor. I found the Top Doc Directory on Mary Shomons web pages, and proceeded to research local doctors in my area. I found one such doctor that received much praise from the women posting him on the site. One such woman posted that she was testing normal on all of her thyroid tests, but was still exhibiting multiple symptoms of hypothyroidism. That sounded just like me!
I decided to set up an appointment with Dr. Kent Holtorf. Although Dr. Holtorf was reported as receptive and knowledgeable, and even though I had more information on how the thyroid gland worked, I was nervous about contacting him for help.
I visited with Dr. Holtorf shortly thereafter. I went prepared with prior blood tests and all of my research on thyroid related problems. I was very much afraid that Dr. Holtorf, generally lauded for his thyroid expertise, would tell me that I was normal. If that were the case, then I didn't know what I was going to do about the hair loss - but I figured I could live with a few extra pounds.
Dr. Holtorf was very receptive to my complaints. For the first time, I found a doctor to listen to me as I described my complaints. Dr. Holtorf told me that my thyroid gland was visibly swollen, and my old blood work [although incomplete] showed some questionable results. Dr. Holtorf was not only able to diagnose me with hypothyroidism, but he was also able to tell me that my past four years of complaints were valid.
Dr. Holtorf scheduled some follow up blood tests, and then prescribed me to medication for my thyroid problem. I had several follow up appointments with Dr. Holtorf in the months following, all to secure adequate thyroid functioning. Over that time frame I began to feel increased energy levels, and began to lose weight. Most important to me, though, was the fact that I began to experience hair growth.
As I began to experience life anew, I began to share my experiences with other women, and began to realize how prevalent this problem is. I began to dig deeper into how the thyroid gland is mainly tested, and how my doctor believes that it should be tested.
Dr. Holtorf gladly shared with me his knowledge on thyroid functioning, and tried to explain it to me as generically as possible. I followed up on what Dr. Holtorf shared with me after our visits, again conducting my own research into thyroid functioning. Once again, I was surprised with the information I had found.
I found that the thyroid gland secretes two types of hormones: triiodothyronine (T3) and thyroxine (T4). The thyroid gland secretes much more T4 than it does T3, but the body naturally converts its T4 into T3. T3 is the hormone that is generally attributable to a person feeling energy and their metabolic functioning.
With that alone being understood, it makes sense that the TSH test would miss crucial thyroid values. The TSH tests does not even test the thyroid gland, but only the pituitary. Naturally, then, it would not be able to distinguish between a thyroids T3 and T4 hormone secretion values. Testing the T3 and T4 directly is more helpful, and can be done through a simple T4 test and T3 test. Although this is much more specific than a TSH tests results, it does not account for all of the variables that present themselves to T3 and T4 being absorbed into the body. A thyroid can be producing sufficient T3 and T4, have normal results on both the TSH tests and the T3 and T4 tests, but the T3 and T4 might still not be absorbed into that persons blood stream. Therefore, a person can test normal on all three of these tests and still require medication for hypothyroidism to feel normal.
The most obvious example of this comes from a woman being on birth control pills. My doctor told me that when a woman is on the pill, her body produces binding proteins. These proteins then attach themselves to a bodys other hormones. This effectively eliminates that particular hormones effectiveness. A woman may have X number of T3 hormones & Y number of T4 hormones in her body. The binding proteins could attach themselves to half of her T3 & T4 hormones, effectively eliminating their absorption into her bloodstream. Therefore, although that woman has X number of T3 & Y number of T4 hormones in her body, she is effectively metabolizing only half X & half Y. This woman would test normal on all three tests, but her body would still not be absorbing sufficient amounts of her thyroid hormones. This person is NORMAL under these three tests, but would still require medication to feel better.
There are tests to account for these binding proteins, and they are known as Free T3 and Free T4 tests. These tests look specifically at the levels of thyroid functioning that are not bound up by proteins. By utilizing these tests, the woman described above would test at X and Y levels in her T3 and T4 blood tests, but would test at only half X & half Y on her Free T3 and Free T4 blood tests. These two additional tests provide the answers that this particular woman would be looking for. She has normal levels of TSH production, normal levels of T3 and T4 production, but she is still not feeling well. That is because her body is not able to use all of the hormones present in her body due to her binding proteins.
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