Everyday in practice I see a patient where I have to consider if there is an underlying problem with the thyroid, a gland shaped like a butterfly that rests in the middle of the throat. Often these patients have had a conventional blood test done with their doctor and been told that they are fine. They come to the clinic and are unconvinced that they are fine based on the symptoms they have looked up online. Common symptoms that are associated with a low functioning (hypo) thyroid are fatigue, weight gain, dry hair/skin/nails, constipation, cold intolerance and depression. These symptoms can be associated with many other illnesses but when seen in an individual it makes sense to investigate if the thyroid is working properly.

The conventional test that is used to measure the thyroid’s function is TSH (thyroid stimulating hormone) and is a measurement of the communication from a part of the brain directly to the thyroid. If the test is within the ‘normal’ range (which varies from province to province and is quite different in other countries) then the thyroid is considered ‘normal’ and is not a problem. But, when further testing is ordered, it can pick up the markers of thyroid function that show the true activity of the thyroid.

Labs such as fT4 and fT3 measure the activity of the gland after it has been “woken” up by the brain. Another important blood test is to check for antibodies to the thyroid and rule out an autoimmune issue with the thyroid. Hashimoto’s thyroiditis is a disease of the thyroid that affects nearly 10% of patients who have thyroid illness and is often missed by just a TSH test. In my practice, I have dozens of patients who we’ve tested for this disease and have come back positive, especially after major hormone changes (pregnancy, miscarriage, menopause, Pill use etc). It requires a special approach compared to traditional thyroid treatments and can go undetected for years until the gland is destroyed and TSH is altered.

What is ‘normal’ v.s. ‘optimal’ when checking a thyroid gland? Unfortunately, our current lab values only tell us when a gland is diseased and requires a prescription to replace the missing hormone. Synthroid is the number one selling drug in the United States with $6.9 billion in sales yearly and hypothyroidism has become a huge health concern. Understanding lab testing, nutritional support, natural and conventional thyroid hormone replacement and seeking an “optimal” lab value is important in keeping this significant butterfly gland healthy through all stages of life.