PDF Understanding Thyroid Markers and Panels

Understanding Thyroid Markers and Panels

Hormones of all types are released by their respective gland in response to a communication from another gland or chemical such as immune inflammatory chemicals. The hormones are found in "protein bound" or inactive hormone, and "unbound" or free hormones which actively interact with hormone receptor sites on a variety of cells and ultimately "do their job." There is typically some type of chemical transition to the active form, and another chemical interaction with the target cells, tissues and organs.

TSH: Thyroid Stimulating Hormone is released by the pituitary gland in response to a release of Thyrotropin-Releasing Hormone (TRH) in the hypothalamus. This is the most common marker used to assess thyroid function. The TSH levels increase when T4 levels drop, and decreases when T4 increases. This is often the only test performed in the traditional medical model as a screen for thyroid disorders, or more accurately, as a screen for a "need" for thyroid hormone replacement. TSH testing does not accurately report autoimmune issues, conversion of T4 to T3, or the communication networks between the thyroid and pituitary. If it is high or low, it does indicate hyper or hypo thyroid function, respectively.

Total T4: T4 is the actual hormone released by the thyroid gland, called Thyroxine. This test measures what is called "bound" and "unbound" or free Thyroxine. Thyroxine is bound by proteins and technically inactive until it is released chemically to free T4. This test best reflects total output of the thyroid gland, but there are other factors that can inhibit the unbinding or freeing of the hormone leading to low "active" thyroxine.

T3 Uptake: This measures the number of sites for active T3 to bind with T4 binding proteins, so really is a protein measurement that interacts with T3. These protein binders are affected directly by changes in steroid hormones, particularly testosterone and estrogen.

Free Thyroxine Index: FTI is a calculation using Total T4 and T3 Uptake, and helps to determine the amount of active T4 available.

Free T4: This is a direct measure of the active T4 in the blood, but still must be converted to T3 to impact your metabolism and energy, so more accurately, it is the measure of the potential thyroid output if the next step is working.

Free T3: This test measures the free or active T3 hormone levels, which is the actual hormone that binds to thyroid receptors and culminates in an increase in metabolism and energy. So you still need healthy receptors for this hormone to be effective.

Reverse T3: This is a measure of a bound T3, that is unable to be used for your metabolism, and is increased by elevated cortisol levels, which is a "stress" induced hormone.

Thyroid Antibodies: These are immune markers that indicate that the immune system has "tagged" thyroid tissues for destruction. It is an indicator of some level of immune dysregulation, and does not reflect a thyroid dysfunction, although thyroid hormones are affected in the attack. This test is partnered with the Lymphocyte subpopulation study, which informs whether the immune system is out of regulation, or unbalanced, and in which direction it is shifted. Many people with thyroid symptoms, but "normal" thyroid tests, namely TSH, have an autoimmune process in play affecting the function and feel of the thyroid hormones.

Adrenal Stress Index: This is a test that measures cortisol and DHEA, both adrenal hormones, using saliva samples throughout the day so we actually get a picture of the rhythm of the adrenal output. Chronic elevated cortisol or low cortisol will directly impact the thyroid output and conversion to active hormone.

As mentioned, all hormones affect all hormones, so with more resistant or difficult situations, it is often necessary to check other hormones to understand the impact of the messages coming from other tissues. The immune system and adrenal system has the most direct impact and will confuse the picture in treating thyroid, which is why we suggest testing these at the outset to get the whole picture.

And, if you think about it...when you get stressed you get sick, and when you get sick you get tired. So if these systems are dysfunctional, you will always feel just a little (or a lot) sick and tired.

If you are "DONE" feeling sick and tired, we have your solution. You will be amazed at the level of insight we can get from this testing, I guarantee it. And, more importantly, this information will provide the "map" that leads you from low thyroid and metabolism, and feeling lousy, to your old self again.

Yours in Health,

Dr. Akiba Green

The Influences of Thyroid Hormones on Physiological and Metabolic Function

Bone: Deficiency of thyroid hormones lead to a decrease in bone development and an abnormal architecture of the bone that is created. Generally, a functionally low (which means low but not flagged as of yet) serum calcium is noted in hypothyroidism. Elevated thyroid hormones causes an increased serum calcium, as it pulls calcium from the bone, leading to increased risk of pathological fractures of the spine and weight bearing joints.

Gastro-Intestinal Function: Transit time is affected directly by thyroid hormones as is absorption of nutrients.

Male Hormones: Hypothyroidism has been linked to diminished libido and impotence. Although this condition is more rare in men, it must be considered in treating these conditions.

Liver and Gallbladder Function: Low thyroid function caused decreased liver clearance and gall bladder congestion through thickening of the bile, often also associated with an elevation of cholesterol. Unfortunately this is also often treated with cholesterol lowering drugs while the thyroid function is the cause of the elevated cholesterol.

Body Composition: As you may know all too well, low thyroid function causes an inability to lose weight. This is caused by a slowed conversion of glucose and fat into energy, and altering the way Human Growth Hormone (HGH) is metabolized in the body.

Blood Sugar Regulation: Low thyroid slows the insulin response to glucose following eating carbohydrates or sugar and it also slows glucose uptake into cells and tissues, and slows absorption of glucose from the intestinal tract. In other words, your entire energy production system is slowed. It is quite confounding to your body and brain, in that the glucose is in the blood, but the tissues are not able to absorb it. This really confuses the pituitary gland and adrenal glands, resulting in a "stress physiology," even if life is good.

Cholesterol: As mentioned earlier, low thyroid increases your cholesterol and triglycerides, so your doctor tells you your diet is poor. You become even more strict in your diet, and the tissue starvation (low glucose, low energy) gets worse, which makes the stress physiology worse, which makes your cholesterol higher, which prompts your doctor to put you on cholesterol medication, which interferes with energy production, which further stresses your physiology...whew! You are frustrated!

Depression: Low thyroid impairs the production of stimulating neurotransmitters, which are the chemicals that antidepressants work on. Low stimulating neurotransmitters leaves you, as one of my professors described, feeling "lower than a snakes belly."

Female Hormones: Low thyroid changes the way estrogen is metabolized in the body, shifting toward an estrogen metabolite that has been proven to increase the risk of breast cancer.

Stress: Low thyroid slows the elimination of the stress hormone cortisol, which leaves you feeling stressed out, not because of "stress," but because the stress hormone can't be removed efficiently.

Detoxification: Low thyroid slows an enzyme critical for metabolic biotransformation, or detoxification, the process by which the body binds and removes all environmental chemicals, and normal byproducts of metabolism, including hormones. "Toxicity" further slows your metabolism, and leads to headaches and other toxic symptoms.

Digestion: Low thyroid reduces the release of Gastrin, which determines the output of hydrochloric acid in the stomach, leading to poor protein digestion, sour stomach, and GERD.

Thermoregulation: Regulation of body temperature is affected by low thyroid, resulting in hot flashes and night sweats, which is especially prominent in perimenopausal women. This is often blamed on estrogen dropping, but may be directly caused by low thyroid.

PMS and Infertility: Low thyroid affects the progesterone receptors, making them less sensitive to progesterone, which feels like low progesterone, although the progesterone levels may be normal. Since the activity of progesterone is diminished, the health of the uterus is insufficient for implantation in the second half of the female cycle, leading to difficulties getting pregnant and PMS. Low thyroid also reduces sex hormone binding proteins, leading to an increase in estrogen activity.

Anemia: Low thyroid, as mentioned affects protein metabolism, which then lowers the red blood cell mass, which carries oxygen to tissues for metabolism of energy. Yes, another mechanism for feeling lousy.

Homocysteine: Low thyroid slows a process called methylation, often evidenced by elevated serum levels of homocysteine. Elevated homocysteine in the blood has been proven as a risk factor for cardiovascular disease, alzheimers and other neurodegenerative disorders, and cervical dysplasia.

As you can see, living with low thyroid has far reaching effects on your health and function. There are as many as 23 published mechanisms for thyroid function to be impaired. Give us a call today to get the right diagnosis, and truly "heal" your thyroid and protect your health.

Warm Regards,

Dr. Akiba Green

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