While most doctors prescribe antacids to lower stomach acid for heart burn and acid reflux, the real culprit may be that your stomach acid is already too low. This is called hypochlorhydria and it plays a role in autoimmune diseases such as Hashimoto’s hypothyroidism.
Sufficient stomach acid, or hydrochloric acid (HCl), is necessary to:
Protect the body from pathogens. When we consume food, bacteria and other microorganisms come along with it. Stomach acid helps neutralize the ones we don’t want in our bodies. HCl also acts as a barrier against bacterial and fungal overgrowth of the small intestine. This is important to preventing inflammatory compounds into the bloodstream where they can trigger Hashimoto’s hypothyroidism.
Activate pepsin. HCl triggers the production of pepsin, which helps break down proteins to be absorbed in the small intestine. When proteins are not adequately digested, they can escape into the bloodstream where they trigger inflammation food sensitivities.
Digest proteins. If you have ever made ceviche or marinated meat in vinegar or lemon, you can see how acid breaks it down. Our stomach acid works much more quickly and efficiently than this.
Activate intrinsic factor. Stomach acid helps activate intrinsic factor, a glycoprotein made in the stomach that is necessary for absorption of vitamin B12.
Stimulate delivery of bile and enzymes. Adequate stomach acid stimulates release of bile from the liver and gall bladder and digestive enzymes from the pancreas. This also supports digestion of carbs, fats, and vitamins A and E.
Close the esophageal sphincter. Located between the stomach and the esophagus, the esophageal sphincter protects the delicate tissue of the esophagus from the strong acids of the stomach.
Open the pyloric sphincter. Stomach acid helps open this gateway between the stomach and the small intestine.
Absorb vitamins and minerals. Absorption of folic acid, ascorbic acid, beta carotene and iron are made more bioavailable by HCl in the digestive tract. Low stomach acid can cause poor absorption of calcium, magnesium, copper, chromium, manganese, selenium, vanadium, zinc, molybdenum and cobalt.
The gut is the seat of the immune system and all of these functions are vital for healthy gut function that can help you manage your Hashimoto’s hypothyroidism and prevent inflammation and flare ups. If you want to get to the root cause of your thyroid or acid refulx problems, schedule a FREE 15-minute consultation with Dr. Celaya.
Hypochlorhydria is under diagnosed
An estimated 90 percent of the population suffers from hypochlorhydria (low stomach acid), yet most of us have never heard of it.
When stomach acid is too low your body cannot digest food thoroughly. The food in the stomach begins to rot and putrefy, the small intestine attempts to reject it, and the rotten food moves back up into the esophagus. While the food is not acidic enough for the small intestine, it is far too acidic for the esophagus.
In addition, low stomach acid leads to bacterial overgrowth, gut inflammation, increased food sensitivities, and higher risk for inflammatory disorders such as Hashimoto’s hypothyroidism.
Key hypochlorhydria signs and symptoms include:
Burping, bloating, gas after meals
Upset stomach after eating
Nausea when taking vitamins and supplements
Indigestion, heartburn, acid reflux
Desire to eat when not hungry
Undigested food in stool
SIBO (small intestine bacterial overgrowth)
Iron deficiency anemia
Deficiencies of vitamin B-12, calcium, and magnesium
Taking supplemental HCl can help support your own production and help you better digest your food. Take just enough so it doesn’t cause burning. If taking even a little bit causes burning, you may have ulcers and an H. Pylori infection, which are not uncommon with hypochlorhydria.
Schedule a FREE 15-minute consultation for more advice on improving your digestion, relieving your heartburn symptoms, and managing your Hashimoto’s hypothyroidism.
If you’re getting your TSH levels checked to monitor your thyroid health, it’s best to get that done in the morning. Otherwise, your results may come back normal even though you have hypothyroidism.
All the body’s hormones follow a daily rhythm, including thyroid hormone. This means there are times of the day when it naturally higher or lower. Researchers tested the blood of hypothyroid subjects both before 8 a.m. and again between 2 and 4 p.m.
In hypothyroid patients both untreated and on thyroid medication, TSH dropped was substantially lower during the afternoon test. This means an estimated 50 percent of people with hypothyroidism are not being diagnosed.
In the untreated group, TSH was 5.83 in the morning and 3.79 in the afternoon. In the treated group, TSH was 3.27 in the morning and 2.18 in the afternoon.
A 2004 study also showed late morning, non-fasting TSH was 26 percent lower compared to the early morning, fasting TSH. This means even a late morning blood draw could result in a failure to diagnose. Do you really want to know what is going on with your thyroid? Schedule a FREE 15-Minute Consultation with Dr. Celaya.
TSH blood test timing and functional medicine ranges
The timing of your blood draw plays an important role in reading a thyroid panel. However, there is more to it.
Even with an early morning blood draw, many doctors will still fail to diagnose hypothyroidism because they use lab ranges that are too wide and that do not reflect genuine thyroid health.
Many doctors still use a hypothyroidism TSH range of 0.5 to 5.0 even though the American Association of Clinical Endocrinologists recommends 0.3 to 3.0.
In functional medicine, we use an even narrower range of .25 to 1.25. We also know that only looking at TSH can miss hypothyroidism.
For example, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that includes total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Ordering these other thyroid markers provides more insight into such imbalances.
Always include a test for autoimmune Hashimoto’s hypothyroidism
In addition to these markers, anyone with symptoms of hypothyroidism should also test for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland.
Why? About 90 percent of hypothyroidism cases in the US are caused by Hashimoto’s. To screen for Hashimoto’s, order TPO and TGB antibodies.
Thyroid medications may be necessary to support thyroid function, but they do not address the autoimmunity attacking the thyroid gland. Failing to manage Hashimoto’s increases the risk of developing other autoimmune diseases such as pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes. It will also make it more difficult to manage your symptoms.
Because women make up about 75 percent of autoimmune disease diagnoses, this means many sufferers of chronic illness are also raising children. It’s common for women to feel disappointed or inferior because they are not the kind of mom they had envisioned. But the perfect mom is an unattainable myth, and it’s possible your illness is even cultivating good qualities in your children. In fact, some of the world’s greatest functional medicine researchers and innovators who have helped countless numbers of people discovered their passion because of their mother’s autoimmune illnesses.
A chronic autoimmune illness means days when energy is low or non-existent, or when brain fog, pain, anxiety, or depression rule. Regular life may include long treks to other cities or states to see a doctor who understands your condition, but it doesn’t have to. Dr. Celaya can help and can see you by phone or skype. Click here for a FREE 15 minute consultation. Your diet is restricted and the house is void of junk food and sodas. Weekends may be devoted to batch cooking meals for the week and your autoimmune disease may require you to delegate chores to your kids. But none of this has to stand in the way of loving your kids and it may even make them better people.
A recent New York Times article explored the ways in which having a chronic autoimmune illness can benefit your children:
Patience. Everything moves more slowly when you’re chronically ill. Gratifications are delayed and trips to the doctor’s office long. When your kids are in tow, this can teach them patience, something most kids struggle with.
Flexibility. Having an autoimmune disease sometimes means canceling well laid plans because you are having a flare. Though disappointing, this prepares children for the inevitable snafus of life.
Self-sufficiency. Children who have everything done for them suffer when they strike out on their own. The child of an autoimmune mom has long been learning how to do their laundry, make their meals, walk the dog, clean the house, and so on. Adulthood won’t seem like such an ugly shock as a result. Though they may complain, this self-sufficiency is also a wonderful confidence builder.
Consideration. Children are egocentric by design. Having a mom with a chronic illness teaches them about the universality of human suffering and that sometimes we are all weaker than we’d like to be and need help.
Self-care. Autoimmunity means seizing the day when you feel good and retreating and resting when you feel bad. This teaches children the importance of a healthy diet, sleep, and other often ignored facets of good health. If you have a partner who helps and supports you, they also benefit from seeing that partnership in action.
Compassion. By seeing someone they love suffer, your children learn compassion for suffering in all people, including themselves. They may also be more likely to see grumpiness or impatience in others as symptoms of a possible illness.
Emotions. Living with a chronic illness is hard work. Sometimes the fatigue, pain, or disappointment can send us into an emotional tailspin, making it impossible to put on a happy face. Seeing a parent express their emotions around suffering can help children be more ok with their own bouts of emotional turmoil.
If you want to know more about your health, click here for a FREE 15 minute consultation to see if Dr. Celaya can help you.
A recent study showed a low-carbohydrate, whole foods diet low in inflammatory foods significantly decreases thyroid antibodies — the marker for autoimmune thyroid disease, or Hashimoto’s. Hashimoto’s occurs when the immune system attacks and destroys the thyroid gland; it is the cause of about 90 percent of hypothyroid cases. This study is further evidence you can profoundly influence autoimmune Hashimoto’s through diet and lifestyle interventions.
In the three-week study, almost 200 people with Hashimoto’s were divided into two groups. One group followed the low-carbohydrate study diet while the other followed a standard low-calorie diet.
The results were significant: Levels of several different thyroid antibodies that serve as markers for Hashimoto’s dropped between 40 and almost 60 percent! This group also lost a little weight.
Meanwhile, the group that followed a low-calorie diet saw antibody levels go up between 9 to 30 percent!
What the study group ate to tame Hashimoto’s
The study designers chose a curious route for their research in having their subjects follow both a low-carbohydrate, anti-inflammatory diet as well as a diet low in goitrogens. Goitrogens are compounds that lower thyroid function and are found in raw cruciferous vegetables (broccoli, cauliflower, cabbage, etc.), soy, and other foods.
Before people understood the mechanisms of autoimmune Hashimoto’s, it used to be the rule of thumb was to avoid goitrogenic foods.
However, through the evolution of functional medicine, we have learned most people with Hashimoto’s can safely eat normal amounts of cruciferous vegetables. In fact, they contain many beneficial nutrients as well as fiber. People with unresolved small intestinal bacterial overgrowth (SIBO) or genetic difficulty metabolizing sulfur may not do well with these vegetables. So we don’t know how subjects would have fared in this study had they included these vegetables.
Soy, on the other hand, has been shown to lower thyroid hormone levels in studies and is best avoided by those with Hashimoto’s.
The study diet that improved Hashimoto’s
Here is the diet the study subjects ate that lowered their thyroid antibodies:
Low carbohydrate diet that was 12 to 15 percent carbohydrates, 50 to 60 percent protein, and 25 to 30 percent fats. (Most people eat a diet that is about 50 percent carbohydrates.)
Lots of different vegetables. Research shows a diet high in veggies improves immune health through its impact on beneficial gut bacteria.
Lean meats and fish.
No goitrogens: cruciferous vegetables (which, if not eaten to excess, improve beneficial gut bacteria), canola, watercress, arugula, radish, horseradish, spinach, millet, tapioca, nitrates.
Eggs, legumes, dairy products, bread, pasta, fruit, and rice. In functional medicine we know gluten and dairy exacerbate autoimmune Hashimoto’s for the most part. Eggs, legumes, and grains are inflammatory for many people as well. People with poor blood sugar stability may need to limit their fruit intake.
In functional medicine, we see the best results with a diet very similar to this one called the autoimmune paleo diet (AIP). In fact, a recent study showed the AIP diet significantly improved autoimmune gut disorders.
Ask my office for more advice on managing your Hashimoto’s hypothyroidism or other autoimmune disease.
Most thyroid issues are autoimmune by nature. Around 70-80% of the autoimmunity issues can be traced to gut infections. On the flip side, having gut infections can increase the likelihood of an autoimmune disease.
Autoimmune disease needs three things to occur.
The three risk factors include genetic predisposition, intestinal permeability, and environmental triggers like bacteria, virus, foods proteins, or inflammation. While we can’t do much about the genetics part, we can certainly do something to avoid the other two factors by first becoming aware of how they affect you. It’s all about lifestyle.
1 – Genetic predisposition is kind of obvious.
Parents’ traits may be passed down to children but is not always the case. Take, for example, genetics versus epigenetics. I like to look at this like a computer. Genetics can be considered the hardware and the epigenetics is the software. The hardware is not readily changeable but the software may vary. If you choose the wrong software, the hardware or genetics won’t operate correctly. You may have the propensity to get the disease, but it takes the two other triggers autoimmunity.
2 – Leaky gut or gastrointestinal permeability is one of the ways that autoimmune conditions start.
This is why it’s important to make sure that gluten and cross-contamination testing is part of every thyroid patient’s workup. Many patients don’t even know if they have an issue with gluten if they don’t have any abdominal pain.
The immune system acts in the mucosal area of the gut, a long tube lined with mucous tissue. This is where food is absorbed into your body. The immune system must be on high alert because this is where many things enter that could possibly be dangerous to the body. The gus is also lined with bacteria. Good and bad, our gut has to know the difference between the two.
The bad bacteria can release byproducts and toxins that can damage the intestinal wall. Intestines can also be damaged by processed foods, food preservatives, stress, alcohol, toxins, infections, inflammation, medication, and a lack of fiber. A protein called Zonulin is responsible for increasing the spaces between the intestinal cells so nutrients and other molecules can be absorbed into the body. However, when leaky gut is present, the spaces between the cells open too much. This eventually lets protein particles or amino acid sequences ease their way in your bloodstream. From there, an immunological reaction can take place.
The immune system has several different types of white blood cells. B lymphocytes, a certain kind of immune cell, makes antibodies. Antibodies are like a tag or marker that attaches to the foreign invader or pathogen. When immune cells see this tag, they know that a foreign invader needs to be destroyed. These antibodies continue to stay in the body. They wait in case the pathogen returns. Their job is to mark the foreign invader for destruction.
Certain amino acid sequences get absorbed into the body without digestion. These sequences tend to look a lot like body tissue amino acid sequences, causing the immune system to attack both. This is called molecular mimicry.
Take a look at the top of each drawing where you can see that the sequence of letters looks somewhat alike. This represents the amino acid sequence we may see common in these three things – thyroid tissue, gluten and casein.
The gluten or casein polypeptide chain looks a lot like the thyroid in some aspect. The antibodies can also tag thyroid cells for destruction if our leaky gut leaves in a peptide from gluten. This is in addition to tagging gluten or casein. This is called autoimmunity. Once you have the antibodies, your body can continue to make them if the pathogen still invades the body.
3 – Environmental triggers are important to eliminate.
The first pathogen is Yersenia Enterocolitica bacteria. This bacterium is prevalent in thyroid autoimmunity and resides in the gut. It has receptors to our thyroid stimulating hormone. TSH receptor antibodies are then made. This can trigger the immune response not only to the bacteria but also to the TSH receptor. We see higher antibodies for Yersenia in autoimmune thyroid patients.
Mycobacterium Avium Paratuberculosis, or MAP for short, is another bacterium in the gut. Molecular mimicry between this bacteria and human proteins is a likely cause of autoimmune disorders. Some autoimmune disorders this may cause include Crohn’s disease, Type I Diabetes, Hashimoto’s Thyroiditis, and Multiple Sclerosis. H-pylori and other bacteria can cause gastritis and cancer. This is also thought to play a part in Hashimoto’s and Grave’s disease. However, newer evidence shows that it can also be protective for chronic inflammatory diseases, autoimmunity and allergies. At this point, more research is definitely needed to further validate this claim.
Next, we have Lyme disease. Borrelia bacteria strain causes this condition. Research also shows that this can trigger Hashimoto’s disease as well. Epstein-Barr virus and Herpes virus have also been linked to leaky gut which, in turn, causes thyroid issues.
Under environmental factors, we also have medications, primarily antibiotics. They can destroy the beneficial bacteria in addition to the pathogenic bacteria. Aside from this, pathogenic or opportunistic bacteria can flourish, breaking down hormones which are secreted from the liver into the small intestines. If you lack the beneficial bacteria to break down estrogen and have a leaky gut, you may now reabsorb estrogens which can then affect thyroid function.
A second medication is non-steroidal anti-inflammatory medication. Inflammation-causing factors like food sensitivities, allergies, alcohol, and stress can cause inflammation. This can then cause an increase in intestinal permeability. Processed foods like sugar, grains, gluten, artificial sweeteners, processed meats, certain processed oils, corn, soy, cottonseed, omega-6 fats, and canola oil can also cause inflammation, which then can cause a leaky gut.
What about the flora in your mouth? Can your mouth be leaky? Oral health issues can be important to look at, not just bad odor, but also chronic gum or tooth infections that can lead to autoimmune diseases. There has also been research that showed that urinary bacterial overgrowth is strongly linked to different forms of autoimmune arthritis.
A lack of stomach acid (HCl), digestive enzymes, and bile can also cause a problem. If you don’t properly digest food, it can become inflammatory and cause damage to the intestinal walls. In addition, if proteins are not broken down into amino acids, they can pass through an already leaky gut, causing more immune responses and possible autoimmunity.
There are different ways to look for infection.
The first is with a simple blood lab test.
A simple CBC or complete blood count looking at cell types can really catch large infections. I would also look at inflammatory markers like hsCRP, ESR, and plasma viscosity.
The next test I would look at is stool testing.
Polymerase chain reaction technology or PCR looks at the DNA of microbes. This can help us get a good assessment of what normal bacteria is there. Most non-DNA stool tests take a sample and then culture the bacteria in a dish with a food medium. The problem is that 95% of your gut bacteria will die if they’re exposed to air, as they are anaerobic. They can’t survive in oxygen and they can’t be grown.
There are also other problems trying to grow the air-breathing bacteria. Some bacteria might flourish in certain types of medium, which is a food given to them so they can grow, while some may not flourish. Some may like different temperatures more than others. It’s hard to tell exactly what’s happening in a person’s gut without DNA. With functional medicine, we look at DNA since culture doesn’t give an accurate representation of the types and quantity of bacteria.
This is a great test and it’s one of my favorites. In this test, we also look for inflammation markers. Calprotectin is a marker of neutrophil-driven inflammation fecal secretory IgA. IgA is a marker of gut immunity and barrier function. It’s also important to follow up with testing for fecal Lactoferrin.
Pancreatic elastase is considered an exocrine pancreatic function indicator. We should also look at the products of protein breakdown. These are indicators of the presence of undigested protein. We also want to understand fecal fat and the markers of fat absorption and breakdown. We’ll also look at short chain fatty acids as indicators of gut microbe health. Another component is beta glucuronidase, which is an enzyme involved in the metabolism of complex carbohydrates.
We also want to look at the commensal bacteria or the friendly bacteria. This demonstrates the diversity, composition, and relative abundance of organisms in the gut. These things are directly linked to both your general health and your gastrointestinal system’s overall well being. Next, we get into parasitology and that involves microscopic examination of fecal specimens for OVA and parasites.
The next test is a urine test where we look for oxidative stress markers which can be present as a result of chronic infections.
The first part of this urine test looks for lipid peroxidation. They’re reflective of oxidative damage to polyunsaturated fats which are components of cell membranes. We’ll next look at 8-OHdG (8-Oxo-2′-deoxyguanosine) which is reflective of oxidative damage to DNA.
Autoimmunity is very common in industrialized Western countries as opposed to the rest of the world.
What’s the difference? Well, we’ve scrubbed and cleaned our world with chemicals and cleansers and killed off beneficial bacteria. We have also limited our exposure to diverse strains of microorganisms. The cleaner we are, the more chronic diseases we have when certain parasites are present. They release chemicals that regulate the body’s immune response. It ensures that it doesn’t overreact. In other countries, inflammatory bowel disease–an autoimmune disease, is treated with Helminth interactions, which is a parasite. This type of treatment needs more research.
The following are some ways to help you avoid autoimmunities and thyroid disorders:
Remove food sensitivities including gluten and other immune sensitive foods.
Optimize vitamins, as they enhance our immune system.
Reduce opportunistic and remove pathogenic bacteria and micro-organisms.
Enforce diet changes to reduce inflammation.
Further help reduce inflammation by taking resveratrol, turmeric and fish oils.
Reduce stress, which also reduces cortisol.
Heal the gut. I would feed the intestinal cells with different fibers, probiotics, glutamine, and acetyl glucosamine. Perhaps antifungals like oregano oil would help with infections.
Make sure digestion is occurring well with proper digestive acid, enzymes, and proper bile production and delivery.
The protective barrier of the intestines plays an important role in human health. It encourages nutrient absorption from the food that we consume each day. It also provides some protection against invasion of bacteria, toxins, allergens, fungus and parasites.
Most doctors will only address the lack of thyroid hormone, but very few will consider autoimmunity. Again, remember if you have an autoimmune condition, you are 70-90% likely to get another autoimmune condition. To learn more about your condition, please contact me.
Do you really understand your thyroid labs, and why should you care? It’s important to know what is happening with your labs because knowing is power. Getting to the root cause of your problems can make a big difference in your health.
When you have lab work performed, your results are compared to normal ranges.
Most people think these normal ranges are set as a standard across all labs, but they’re not. Labs follow clinical and lab standard institute guidelines that the FDA recognizes. These guidelines suggest that every lab create their own lab normal from patients that come into their labs for testing. They suggest that the lab compile results from as little as 20 patients up to 120 patients. You must wonder if these are normal healthy individuals who are getting tested? In addition, they recommend that each lab’s normal ranges be compiled from 95% of the tested individuals. This leaves only 5% that is outside the range – 2.5% higher than 95% and 2.5% lower than the 95% middle range.
In functional medicine, we use ranges from truly normal, healthy individuals who never had problems–those with optimal health. Many doctors never look at your lab values but instead look at a place where the lab signifies that it is out of the lab’s normal range. This can be a problem because you never really know what optimum levels are.
TSH (Thyroid Stimulating Hormone) is a hormone produced by the pituitary gland.
TSH tells the thyroid to speed up and produce more hormones. This is considered a negative feedback loop. For example, when the pituitary increases TSH, the thyroid increases its production of thyroid hormone. The pituitary then senses the thyroid hormone levels increase and then reduces its output of TSH.
The typical lab range for the TSH value is 0.5-5.5 mU/L, which is too large of a range. If you get a TSH lab result of 3.5 and up, by functional medicine standards, this means that you may have hypothyroid problems, but conventional medicine considers this normal.
On the other hand, the functional range is 0.3-2.5 mU/L. This is a good lab value to have. Normally, TSH should be well balanced with T3 and T4, according to functional medicine standards.
In hypothyroidism, there is a decrease in T3 and T4 levels while there is an increased level of TSH in the body.
TSH is produced by the pituitary in a response to get your thyroid gland to produce more hormone. The increase in TSH levels is relatively gradual as it keeps on “telling” the thyroid to produce more hormone.
Some of the signs and symptoms of hypothyroidism include obesity, swelling, being cold, constipation, thinning hair, slow heartbeat, loss of the outside 1/3 of your eyebrows, and edema in the eyes, especially when you wake up in the morning. And there are many more symptoms. Hashimoto’s disease, an autoimmune disease, is considered one of the leading causes of hypothyroidism. If you have this problem, your immune system is attacking your thyroid gland. If this goes on long enough, your thyroid gland may be completely destroyed, rendering its hormone production absent.
In hyperthyroidism, there is a decrease in TSH and an increase in T3 and T4 levels.
In this case, the body produces too much thyroid hormone causing the TSH levels to decrease. Values may go from 2.5 down to 0.2 and sometimes 0. If you have this dysfunction, you are likely to have Graves’ disease, which can also be accompanied by ophthalmopathy/ophthalmology (bulging eyes). Once you have it, it won’t go away even if your thyroid hormone levels start to get better. There are surgical means that can help minimize this condition, but it’s a tough one to have even with this intervention.
T4 is a tyrosine-based amino acid hormone.
It makes up about 93% of your thyroid hormone. It’s inactive and gets converted in the liver (60%) and your gut (20%). The remainder is eventually processed in the peripheral tissues. This is converted into T3 which is the active thyroid hormone.
It is also made up of iodine placed in each or all of the corners of the molecule depending if its T4, T3 or rT3 (reverse T3). This arrangement makes it fit into the receptor site if it is in the active T3 or rT3 form. T4 is not active and doesn’t fit into the receptor on the cell.
This inactivity happens for a good reason. Can you imagine all the thyroid hormones being active at the same time? Certain cells close to the thyroid would always be in overdrive while others far away from the gland may not get any at all.
In addition, T4, the inactive hormone, lasts longer in the system than T3, which is the active form. T4 (protein bound) is attached to thyroxine binding globulin (also known as TBG) which transports the thyroid hormones in circulation.
T4 free is not bound to protein and has a great propensity to be converted to T3, the active thyroid hormone. The typical lab range for T4 (protein bound) is 4.5 – 12.0, while T4f (free) is 0.8 – 1.70. On the other hand, the functional range for T4 (protein bound) is 6.0 – 12.0, while T4f (free) is 1.0 – 1.50. Most doctors only check TSH and T4, and if you’re lucky, they may check T3, but it’s quite rare.
T3 is the thyroid hormone that does all the work.
T3 is also produced at the thyroid gland (7%), though its mainly produced through conversion. T4 is transformed into T3 by an enzyme called 5’ deiodinase. This is an enzyme that depends on the mineral selenium.
T3 is bound to protein which is regarded as a transport mechanism. It’s not an active hormone at that point in time until it becomes free. T3 free is what we usually evaluate. If you observe the following values, you will see that the typical lab ranges versus the functional lab ranges are quite different:
Typical Lab Range
T3 (protein bound): 71 – 180
T3f (free): 2.1 – 4.5
T3 uptake: 24 – 39
T3 (protein bound): 100 – 180
T3f (free): 3.0 – 4.5
T3 uptake: 27 – 37
There are various differences between T3 and T4.
For these values, “secretion” is the difference in how much hormone is actually made. The “source” is the location where the hormone is produced. “Half-life” is the amount of time it takes for the quantity to reduce to half of its initial value. “Potency” is how much the hormone is effective in doing what it’s supposed to do.
Secretion: 18-30 micrograms/day
Source: 20-25% by the thyroid; 75-80% by conversion (in the gut and the peripheral tissue)
Half-life: 1 day (active hormone is used up pretty quickly)
Potency: 3-4 times more potent than T4
Secretion: 80 micrograms/day
Source: by thyroid only
Half-life: 7 days (the inactive hormone stays around for quite some time before)
T3 uptake is done to see how much thyroxine binding globulin (TBG) is available.
TBG is one type of protein that transports most of the T4 and T3 in your blood. T3RU is a lab test that measures the level of proteins that carry thyroid hormone in the blood. This is typically tested if you have signs and symptoms of hyperthyroid, hypothyroid or liver problems.
RT3 (reverse T3) is another thyroid hormone made from T4.
It looks a lot like T3, but it’s a little bit different as far as function is concerned. Approximately 60% of T4 is converted to T3. On the other hand, 20% is reverted into the inactive form of your thyroid hormone. This is called the reverse T3 (rT3) and this will attach itself to T3 receptors. Because of this, it will block T3 from stimulating the cell, creating hypothyroid issues.
It’s important that we have enough T3 and not so much RT3. RT3 will bind to those receptor sites, creating a problem with the cell not getting enough thyroid stimulation and therefore decreasing the cell’s metabolism.
Typical lab range for reverse T3 is 11-23. The functional range is also 11-23. Reverse T3 may be both good and bad even if it is inactive by nature. The problem is that most doctors do not check for these RT3 values.
Too little or too much cortisol that the adrenals produce in response to stress will increase the circulating amounts of your reverse T3. It slows down the metabolism so you can better deal with adrenalin’s actions.
Cortisol production, because of stress, will also blunt the function of TSH, prevent conversion, and increase rT3. As a result, thyroid hormone levels drop. The following are some things that can cause high levels of RT3:
Immune system issues
Excess free radical damage
Low iron and B12
To better assess reverse T3, you may refer to the following ratio:
FT3/RT3 ratio: >20
T3/RT3 ratio: >10
Most conventional providers do not even bother looking at autoimmunity. They just treat the low or high thyroid issues. However, it’s a very important thing in functional medicine because if you have one autoimmune disease, you’re 70-90% likely to develop an additional autoimmune disease.
The functional ranges of autoimmune labs:
TGAb (thyroglobulin antibody). Thyroglobulin is a protein involved in thyroid hormone production.
Don’t confuse this with thyroid binding globulin which transports thyroid hormone to the blood. TGAb can be ordered for hyperthyroid evaluation and management. This is also ordered for proper diagnosis and treatment of tumors and cancer.
TPOab (thyroid peroxidase antibody). Thyroid Peroxidase is an enzyme that helps activate iodine in the making of your thyroid hormone.
It also helps connect tyrosine together for making the thyroid hormone. This test is used to determine if the person has Graves’ or Hashimoto’s disease.
TSHRab (thyroid stimulating receptor antibody) is divided into two subtypes.
There are two types of antibodies that attach to proteins in the thyroid to which TSH normally binds. This can be seen in Hashimoto’s and Graves’ disease.
TSI (thyroid stimulating immunoglobulin).
TSI is seen in Graves’ disease. One big problem is when this is positive coupled with a negative TPO, the risk of Graves’ ophthalmopathy increases (bulging eyes).
TBII (thyroid binding inhibitory immunoglobulin).
This is important for diagnosing Graves’ disease.
There is more to thyroid than just running a TSH and T4, like your conventional doctor would do.
You look at everything! You look at the different hormones: T3, T4, inactive T3 and T4. It is important to understand conversion from the inactive to the active hormone. You also look at autoimmune conditions. You especially want to look at reverse T3 because when it is high, you’re not binding T3 to the active hormone and then to cell receptor sites. Therefore, this could create symptoms of hypothyroidism. When you look at your thyroid lab test, you might see that everything is normal. If that is the case, you should also look at adrenal gland function, as they can actually have very, very similar symptoms as those with thyroid disease.
Have you ever wanted to know everything there is to know about your thyroid? This 7-part video series will cover thyroid lab testing, nutrition and infections that affect the thyroid, toxins, thyroid hormone conversion, lifestyle, and adrenal interplay.