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.
Want to see if Dr. Celaya is the right fit for you? Schedule a FREE 15-Minute Consultation with Dr. Celaya to talk about your thyroid.
If you struggle with chronic exhaustion, insomnia, poor immunity, and persistent low blood sugar symptoms, you likely have poor function of the adrenal glands, which sit atop the kidneys and secrete stress hormones. However, your conventional doctor may have told you there is no such thing as adrenal fatigue based on guidance from The Hormone Foundation. What they may not understand is that there is a continuum of adrenal function and that the brain plays a role in adrenal fatigue.
The debate about adrenal fatigue versus primary adrenal insufficiency
The term “adrenal fatigue” has become a household word in the chronic illness world, and for good reason. The adrenal glands are our frontline against stressors large and small. In our constantly chaotic and nutritionally-depleted lives, these hard-working little glands can become worn down, sometimes to the point of barely working, right along with the areas of the brain that govern them.
What’s confusing is a recent statement by The Hormone Foundation which claimed adrenal fatigue does not exist and is not supported by any scientific facts, and that primary adrenal insufficiency is the only real version of adrenal dysfunction.
However, according to integrative physician Richard Shames, MD, both adrenal fatigue and primary adrenal insufficiency exist along the same continuum but are separated by the severity of symptoms and treatment methods. In a nutshell, adrenal fatigue can also be referred to as mild adrenal sufficiency.
If you really want to know about your adrenal health, schedule a FREE 15-Minute Consultation with Dr. Celaya.
Primary adrenal insufficiency is caused by damage to the adrenal glands, such as by an autoimmune condition like Addison’s disease that attacks and destroys adrenal tissue. Primary adrenal insufficiency is diagnosed through blood tests and can be treated with medications that replace adrenal hormones.
Symptoms of primary adrenal insufficiency include:
- Muscle aches
- Loss of appetite with weight loss
- Craving salty foods
- Dizziness, low blood pressure
- Feeling lightheaded when standing up
- Gastrointestinal symptoms such as nausea, vomiting, and abdominal discomfort
Adrenal fatigue describes when lab tests don’t support a diagnosis of primary adrenal insufficiency but a person still experiences adrenal-related symptoms such as:
- Excessive fatigue and exhaustion
- Non-refreshing sleep
- Feeling overwhelmed by or unable to cope with stress
- Craving salty foods
- Difficulty concentrating
- Brain fog
- Poor digestion
Functional medicine practitioners diagnose adrenal fatigue by considering symptoms as well as results from a 24-hour saliva cortisol test.
Current blood tests are good at diagnosing severe forms of adrenal insufficiency such as Addison’s disease but not mild adrenal insufficiency, or adrenal fatigue.
This debate between adrenal fatigue and primary adrenal insufficiency is reminiscent of the former debates about “mild” hypothyroidism. Twenty years ago, many endocrinologists denied mild hypothyroidism as a true diagnosis because they believed that as long as a patient was within conventional TSH reference ranges they could not possibly be sick.
However, doctors trained in functional medicine recognize that a functional reference range — a narrower TSH range that reflects optimum thyroid health — means that a serious thyroid problem can exist within the conventional TSH range.
As testing and recognition of adrenal fatigue, which affects many people, continues to gain medical acceptance, we will start to refer to it as mild adrenal insufficiency.
The role of the brain in adrenal fatigue
It’s important to understand the brain plays an important role in adrenal fatigue. This explains why nutrients to support your adrenal glands may not go the full mile when the real problem is happening between your ears.
Adrenal fatigue has at its roots poor function of the hypothalamus-pituitary-adrenal (HPA) axis. The HPA axis refers to the feedback loop between your body and areas of your brain that govern adrenal function. Unrelenting stress beats up this entire system, not just the adrenal glands, and it is more complicated and involved that simply low cortisol. The problem is compounded by the brain’s predilection for efficiency, in this case becoming so efficient at stress until the tiniest thing triggers a big stress response. Or, you are so advanced you are too tired to respond to anything.
How the adrenals become fatigued
When our bodies experience stress, no matter how small or large, our adrenals pump out hormones such as adrenaline and cortisol to help us fight or take flight. Our bodies are designed to return to baseline after a stressor so the nervous system can return to a “rest and digest” state necessary for daily function.
However, in our chronically stressed modern lifestyles, our bodies are constantly reacting to stressors, many we are not even aware of, such as dietary triggers, toxins, and even electromagnetic frequencies.
This constant state of high-stress hormones damages tissues in the body and brain and is linked to:
- Suppressed immunity
- Low energy
- Insulin resistance and diabetes
- High blood pressure
- Heart problems
- Increased belly fat
Removing all stressors in life is impossible, but there is much we can do to support adrenal function and buffer the damage of stress.
Adrenal adaptogens and phosphatidylserine are two natural routes that especially support the HPA axis and the brain’s ability to handle stress.
There are so many issues related to adrenal problems. To get to the root cause of your problems, schedule a FREE 15-Minute Consultation with Dr. Celaya.
If you have symptoms of hypothyroidism, how do you know if it’s caused by Hashimoto’s, an autoimmune thyroid disease? Although about 90 percent of hypothyroidism cases in the United States are caused by Hashimoto’s, most doctors do not test for it. Why? Because it does not change their treatment. However, it’s vitally important for you to know whether you have Hashimoto’s to stop the damage to your thyroid and prevent other autoimmune diseases.
Hashimoto’s is an autoimmune condition in which the immune system attacks and destroys the thyroid gland over time. Even if medications normalize TSH (thyroid stimulating hormone) on a blood test, an unmanaged autoimmune Hashimoto’s condition continues to damage and destroy the thyroid gland and cause symptoms.
One of the most common scenarios with undiagnosed Hashimoto’s is that your hypothyroidism and symptoms continue to worsen even through you take your thyroid hormone medications. Your doctor may also continually increase your dosage.
Another common scenario is when symptoms and TSH levels fluctuate between being under active and over active. The person can feel like they are hypothyroid one week and hyperthyroid the next. In fact, some doctors may even mistakenly diagnose them with hyperthyroidism when in fact it’s the result of autoimmune Hashimoto’s waxing and waning attacks on the thyroid gland.
This means the patient could suffer from fatigue, headaches, constipation, and depression one week and then when the thyroid becomes over active they suffer from heart palpitations, anxiety, tremors, and insomnia. Blood tests will also show the TSH level going up and down during these swings, which may result in an inaccurate diagnosis.
Sometimes TSH can even be normal as it’s going through a swing resulting in a misdiagnosis all together. Instead, the patient is diagnosed with an anxiety disorder or even bipolar disorder.
What causes these swings with Hashimoto’s hypothyroidism? Autoimmune diseases are not steady. Instead they flare up or go into remission depending on triggers, which can be dietary, chemical, stress related, hormonal, and so on.
When an autoimmune flare damages the thyroid, it releases hormones that are stored in the gland. These thyroid hormones flood the bloodstream in excess causing symptoms that look like hyperthyroidism.
To confirm whether you have Hashimoto’s, you need to run thyroid peroxidase antibodies (TPO Ab) and thyroglobulin antibodies (TGB Ab) test. It’s also helpful to rule out hyperthyroidism, or Graves’ disease.
But keep in mind that because the immune system fluctuates with autoimmune disease, it’s possible to produce a negative antibodies test result. If symptoms strongly suggest Hashimoto’s it’s important to test again.
Ask my office for more advice on identifying Hashimoto’s hypothyroidism.
While the eight-to-five workday may suit a man’s physiology, female researchers are finding women can capitalize on periods of heightened creativity, productivity, enhanced communication, and reflection depending on where they are in their menstrual cycle. We tend to think of female hormonal cycles as problematic or negative, but the truth is they can facilitate different aspects of productivity once you learn how to use them to your advantage.
Understanding your hormonal cycles of productivity can help you learn the best time to launch or finish a project, brainstorm a creative endeavor, meet with a boss or coworkers, or step back and reflect on operations.
Looking at a functional medicine view of female hormones — aiming for optimal functional and balance instead of just focusing on when things go wrong —can help you plot your course through each work week. Women can look at their cycles as offering four different periods of enhanced performance, with day 1 representing the first day of your period:
Days 1-5, Intuition and Reflection: During your period, your left and right brains are communicating more efficiently, allowing you to better access intuition, analytical thinking, and long-range visionary thinking. This is the time to reflect on past and future endeavors, re-evaluate whether your course aligns with your vision, and consider which relationships need attention.
Days 6-14, Creativity: During the follicular phase, which actually begins day 1, estrogen is increasing and you are at your creative peak. This is a good time to start new projects, plan, strategize, and brainstorm.
Days 15-17, Communication: During the ovulation phase your communication skills and magnetisms are at their height. This is a great time for negotiations, meetings, and pitches.
Days 18-28, Power: During the luteal phase you are primed to power through project completion, take care of all those administrative tasks, and follow up on meetings.
When your hormones are out of balance
Unfortunately, thanks to stress, unhealthy diets, environmental toxins, and other facets of modern life, it’s easy for your cycles to become unbalanced.
One of the most common causes of hormonal imbalances in women is chronic stress and poor blood sugar balance (another form of stress).
Eating a high-carb diet of pastas, breads, and other processed carbohydrates, eating too many sweets, drinking too many sweetened coffee drinks, not sleeping enough, being too stressed out, not getting enough physical exercise — all these things can drive both estrogen and progesterone out of whack and give you miserable hormonal symptoms.
PMS, irregular periods, infertility, hair loss, overly heavy periods, and other symptoms of hormonal imbalance are signs you need to bring your diet and lifestyle habits more in line with nature’s design.
Through functional medicine protocols of anti-inflammatory diets, blood sugar balancing, gut healing and repair, liver support and detoxification, and stress-reduction, our office can help you better balance your hormones so you can function at your best.