Thyroid problems affect one out of every eight women. While the reasons for this are not entirely clear, the symptoms themselves and their prevalence are difficult to ignore. After all, the thyroid is responsible for many of the body’s processes, including metabolism. This means that an imbalance of the thyroid in any way can lead to a plethora of unpleasant symptoms. Of course, treating thyroid issues in women is not as simple as taking medication (although this can be part of a treatment plan). Rather, a holistic approach is best when diagnosing and treating thyroid disorders. Read our article to learn more.
When it comes to diagnosing and treating thyroid issues in women, a basic blood test is often not enough. Many women present to their doctors with common thyroid-related symptoms only to be told their thyroid levels are normal. However, most thyroid panels include only one or two markers in the blood, which is not enough to accurately ascertain thyroid function. There are actually at least eight different markers that should be checked in order to completely rule out (or confirm) thyroid dysfunction.
TSH is produced by the pituitary gland and stimulates the thyroid gland to produce T3 and T4. Elevated TSH levels may indicate hypothyroidism, while low levels may suggest hyperthyroidism.
TSH is the most commonly ordered lab test to check for thyroid issues in women. However, it is not an accurate gauge on its own for several reasons. First, laboratory ranges are based on local averages and are not necessarily optimal for an individual. Second, autoimmune thyroid disorders and early thyroid disorders may not affect TSH levels right away. And third, TSH is not an accurate measurement of actual thyroid hormones and, therefore, not a good basis for medication dosage.
T3 is the active form of thyroid hormone that affects the body’s metabolic processes. It is transported in the bloodstream bound to a carrier protein. When it is released from this protein, it is in its “free” active form. Low Free T3 levels may indicate hypothyroidism, while high levels could mean hyperthyroidism.
T4 is the inactive form of T3 and accounts for more than 90% of the available thyroid hormones in the body. Abnormal levels (high or low) may suggest thyroid dysfunction.
These tests measure the total amount of T3 and T4 in the blood, including both bound and unbound forms. They provide a broader picture of thyroid function and can be used in combination with other tests to evaluate thyroid health.
Reverse T3 is an inactive form of T3. This is not simply a conversion back to T4, but rather a deliberate attempt by the body to block certain processes.
Remember that T3’s full name is “triiodothyronine.” The name is related to the presence of three (tri) iodine atoms (iodo) within the molecular structure of T3. Reverse T3 is produced when one of these iodine atoms is cleaved from the molecule. It is not T4, because the iodine atom that is removed is the mirror image of the one on T4.
The reasons why this occurs are varied, but it tends to happen in times of stress or severe illness. Other conditions known to increase serum RT3 levels include diabetes, crash dieting, and iron-deficiency anemia. If the body continues to produce abnormally high levels of RT3, symptoms of hypothyroidism will occur due to lack of active T3.
Because elevated stress levels can cause an increase in RT3, it makes sense to check for the presence of stress hormones in the blood when looking for thyroid issues in women. Cortisol is an adrenal hormone that has a direct affect on the body’s production of active thyroid hormone. High levels are secreted during times of stress. This not only blocks the conversion of T4 to T3, but also stimulates the body to deactivate protein-bound T3 (i.e. RT3).
The presence of certain antibodies in the blood indicates that the body is fighting a disease. In the case of the thyroid, TPO antibodies are markers for autoimmune disorders such as Hashimoto’s thyroiditis. Hashimoto’s can inhibit the body’s production of active thyroid hormone, resulting in symptoms of hypothyroidism.
Similar to TPOAb, Thyroglobulin antibodies are associated with autoimmune thyroid diseases, particularly in cases of Graves’ disease. This is a disorder that stimulates the thyroid to produce too much hormone, resulting in symptoms such as tremors, weight loss, and a characteristic “bulge” to the eyes.
TBG is a protein that transports thyroid hormones in the blood. When these carrier proteins are released, the result is free T3 and T4 (see above). Abnormal levels can give information about the availability of thyroid hormones in the blood.
Likewise, T3 uptake can indicate the availability of binding sites (carrier proteins) for thyroid hormones to be transported in the blood. Because both of these tests provide similar information, a provider may choose only one.
Another part of comprehensive thyroid testing should include an ultrasound. Ultrasounds visualize the thyroid gland’s structure, allowing for the detection of inflammation, nodules, cysts, tumors, poor blood flow, or other abnormalities. An ultrasound is usually ordered following an abnormal blood test or the presence of swelling noted during a physical exam. However, ultrasounds may be ordered at any time throughout the diagnostic process if thyroid dysfunction is suspected.
While symptoms will vary depending on the root cause, comorbid conditions, and other factors, patients with thyroid disorders often present with similar complaints.
In hyperthyroidism, your body’s active T3 is too high, putting your body’s systems into overdrive. The result is a sped up metabolism, leading to symptoms such as:
By contrast, hypothyroidism occurs when the body has too little active T3. This slows down the metabolic rate, leading to things like:
Treatment for the presence of thyroid-related symptoms in women will depend on the results of lab work, physical exam, patient history, and other important factors. A nuanced, holistic approach will have the best long-term results, since it addresses both medical and lifestyle factors.
A functional medicine practitioner will discuss your symptoms with you and determine the best approach for treating both the discomfort and the underlying cause. This will likely include a combination of the following:
Your provider will discuss ways to incorporate hormone-supporting vitamins and minerals into your diet. This will be especially important if your thyroid is sluggish. Eating foods rich in selenium, zinc, and iron will help boost your thyroid and avoid certain scenarios known to cause increased RT3 (see above).
Again, high stress has been linked to higher levels of cortisol and lower levels of free T3. Your provider will suggest ways to manage stress through practices like yoga, meditation, and deep breathing exercises.
If you have a comorbid condition, such as diabetes, your provider will also recommend ways to promote weight loss and regulate insulin levels. This may involve increased physical exercise, dietary changes, and/or medication.
Your provider may also recommend oral supplementation to support overall thyroid health. These supplements often contain a blend of ingredients that work together to help regulate thyroid function.
Some, for example, may contain iodine and L-tyrosine, which are the common elements of both T3 and T4. There may also be thyroid-boosting vitamins and minerals (selenium, zinc, Vitamin A, etc.), along with botanical extracts designed to enhance thyroid hormone production.
Your functional medical provider may also recommend medication to treat low or high levels of thyroid hormone.
Traditional therapies for hypothyroidism typically address only T4. By far the most common recommendation for hypothyroidism is levothyroxine, a synthetic form of T4 sold under the brand name “Synthroid.” Less frequently, liothyronine (synthetic T3) is prescribed.
Many functional medicine specialists choose a middle ground in the form of “dessicated” thyroid. This is an extract prepared by powdering a dried thyroid gland derived from an animal source, such as a pig or cow. This method is preferred by many providers, since it includes both T3 and T4. It may be used on its own or in tandem with traditional T4 therapies.
As for hyperthyroidism, medications to help regulate the production of your thyroid hormones may be prescribed. This may include a combination of thyroid blockers along with dietary support to increase TSH production.
Thyroid health is crucial for women’s overall well-being, and understanding the symptoms of thyroid imbalances, the influence of other hormones, and adopting a holistic approach can contribute to maintaining optimal thyroid function.
In Omaha, Balanced Body Health & Wellness is a licensed functional medicine clinic that supports women in achieving harmony between their physical and mental health. With a variety of both natural and traditional resources, we offer services for hormonal health, weight loss, nutrition, and more. Call today to get started, or go online to schedule a free 15 minute phone consultation. The journey to better health starts today!