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The thyroid is a small gland with a very big job.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Located at the front of your neck, the thyroid produces hormones that help regulate <\/span><\/span>metabolism, energy production, heart function, digestion, body temperature, brain function, bone health and much more<\/span><\/span><\/strong>.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Thyroid hormones also influence mitochondrial function\u2014the tiny energy-producing centers inside your cells\u2014which helps explain why changes in thyroid function can affect so many different areas of the body.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
When thyroid function slows down, you may notice fatigue, feeling cold, constipation, dry skin, hair changes, brain fog, weight changes or difficulty maintaining your normal energy.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
But here’s something I think is important:<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Having thyroid symptoms doesn’t automatically tell us why your thyroid isn’t functioning optimally.<\/span><\/span><\/strong><\/span><\/p>\n<\/div>\n\n
That’s where I like to dig deeper.<\/span><\/span><\/span><\/p>\n<\/div>\nLooking Beyond TSH<\/span><\/span><\/span><\/h2>\n<\/p>\n\n
Thyroid disorders are incredibly common, yet many patients come into my office after having only a TSH test performed.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
TSH is important, but it doesn’t always give us the complete picture.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Depending on the patient and clinical situation, I may want to look at additional markers such as <\/span><\/span>Free T4, Free T3 and thyroid antibodies<\/span><\/span><\/strong>, along with other laboratory markers that can help us understand what’s happening elsewhere in the body.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
From a functional medicine perspective, I also want to consider things that may influence thyroid health, including <\/span><\/span>nutrient deficiencies, autoimmune disease, metabolic health, medications, stress, liver function and environmental exposures<\/span><\/span><\/strong>.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Instead of simply asking:<\/span><\/span><\/span><\/p>\n<\/div>\n\n
\u201cIs your TSH normal?\u201d<\/span><\/span><\/em><\/span><\/p>\n<\/div>\n\n
\u201cWhy are you experiencing these symptoms in the first place?\u201d<\/span><\/span><\/strong><\/span><\/p>\n<\/div>\n\n
Here are eight areas I consider when evaluating thyroid health.<\/span><\/span><\/span><\/p>\n<\/div>\n1. Thyroid Gland Dysfunction<\/span><\/span><\/span><\/h2>\n<\/p>\n\n
Sometimes the problem really does begin with the thyroid gland itself.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
In primary hypothyroidism, the thyroid isn’t producing adequate thyroid hormone despite receiving signals from the pituitary gland to do so.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
One of the most common causes of hypothyroidism in the United States is <\/span><\/span>Hashimoto’s thyroiditis<\/span><\/span><\/strong>, an autoimmune condition in which the immune system targets thyroid tissue.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Other factors can also directly affect the thyroid gland, including certain medications, thyroid surgery, radiation treatment and significant abnormalities in iodine intake.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
The important part is determining <\/span><\/span>what type of thyroid dysfunction is actually occurring<\/span><\/span><\/strong> rather than assuming every case of hypothyroidism has the same cause.<\/span><\/span><\/span><\/p>\n<\/div>\n2. Pituitary Dysfunction<\/span><\/span><\/span><\/h2>\n<\/p>\n\n
Your thyroid doesn’t work alone.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
It is part of a communication system between your <\/span><\/span>hypothalamus, pituitary gland and thyroid<\/span><\/span><\/strong>, commonly referred to as the <\/span><\/span>HPT axis<\/span><\/span><\/strong>.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
The pituitary produces thyroid-stimulating hormone, or TSH, which tells the thyroid to produce thyroid hormones.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
If pituitary function becomes impaired, that signal can be disrupted.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Pituitary disorders are much less common than primary thyroid disease, but tumors, traumatic brain injury, surgery, radiation and other medical conditions can affect pituitary hormone production.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
This is one reason thyroid labs need to be interpreted together rather than looking at one number in isolation.<\/span><\/span><\/span><\/p>\n<\/div>\n3. Hypothalamic Dysfunction<\/span><\/span><\/span><\/h2>\n<\/p>\n\n
The hypothalamus is a small but incredibly important area of the brain that helps connect the nervous system with the endocrine system.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
It plays a role in temperature regulation, appetite, sleep, stress responses and hormone signaling.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
The hypothalamus communicates with the pituitary, which then communicates with the thyroid.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Significant injury or disease affecting the hypothalamus can therefore interfere with this signaling pathway.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
True hypothalamic thyroid dysfunction isn’t something I assume every fatigued patient has, but understanding the <\/span><\/span>brain-pituitary-thyroid connection<\/span><\/span><\/strong> helps illustrate why thyroid health is much more complex than simply looking at the thyroid gland itself.<\/span><\/span><\/span><\/p>\n<\/div>\n4. Thyroid Hormone Conversion<\/span><\/span><\/span><\/h2>\n<\/p>\n\n
Your thyroid produces primarily <\/span><\/span>T4<\/span><\/span><\/strong>, which is considered a relatively inactive thyroid hormone.<\/span><\/span><\/span><\/p>\n<\/div>\n\n
Your body then converts T4 into <\/span><\/span>
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