What Your Thyroid Numbers Really Mean and Why They Matter

Feb 13

You may have heard the term “thyroid” and even thought about getting it tested. But what exactly is "thyroid" and how does it affect our health?

WHAT IS THYROID?

The thyroid is a small yet powerful, butterfly-shaped gland located at the base of the neck and envelopes a small section of the trachea.

The thyroid gland makes two main hormones: thyroxine (or T4) and then T4 converts to triiodothyronine (or T3) via thyroid peroxidase enzyme.

These two hormones affect every cell in the body and they support the rate at which the body uses fats and carbohydrates–essentially your metabolism. This is one of the reasons why declining thyroid levels are also linked to metabolic diseases including diabetes.

Besides our metabolism, thyroid helps maintain optimal immune function and impacts reproductive hormones as well.

Thyroid hormones can start to decline in our mid 30’s resulting in something called “thyropause,” which can lead to early perimenopause and menopause. Thyropause is not a medically recognized term, but it’s something providers have observed happen.

WHAT ARE THE OPTIMAL RANGES FOR THYROID LEVELS?

Many providers are unfortunately stuck in outdated ways of looking at and treating thyroid:

Number one, they only look at the TSH. Number two, they don’t look at total thyroid levels and frequently don’t even check for antibodies. Lastly, they just look at the “standard range.”

Here’s what optimal thyroid numbers look like (and by the way this should be applied in the context of how the person is feeling).

In my practice and how I teach other physicians, I always put patients first and use numbers for guidance:

Ideally with thyroid you want the TSH to be 1.1 uIU/mL or below
Free T4 to be 1.2 ng/dL or above
Free T3 to be 3.3 pg/dL or above and
Reverse T3 to be 15 pg/dl or below

HOW ARE THYROID LEVELS TESTED?

The best way thyroid hormones are tested is via a blood draw.

And by the way, you don’t just want to look at thyroid hormones!

You also want to test the key thyroid nutrients including iodine, selenium, iron and ferritin (not a nutrient, but indicator of iron stores).

Why?

Because iodine is one of the building blocks of thyroid, and selenium together with iron help convert T4 hormone to T3 hormone.

You want to test thyroid (and other hormones) early in the morning because that is usually when hormones peak. Don’t go to your doctor’s office in the afternoon for a blood draw!

Is a neck check or palpation of the thyroid gland enough as part of the thyroid exam? The answer is no. A proper thyroid evaluation needs to be paired with a blood test.

WHAT SHOULD I EXPECT FROM MY PROVIDER IF MY THYROID NUMBERS COME BACK OUT OF BALANCE?

Good luck! Seriously, you will need it to have your thyroid properly evaluated. Most providers again will look at the range. You can expect the following:

“Everything is normal.” In which case, verify this with another provider (preferably a functional medical provider). I teach this in my Hormone Potential Foundations course
Your doctor just puts you on T4 medication (levothyroxine), and fails to make sure T3 levels are optimal and that there is no conversion problem between T4 and T3
Your doctor puts you on T4 and T3 medication, but fails to address other factors including diet, lifestyle, supplements, and gut health
Your doctor is a fabulous physician who looks into the potential causes for thyroid dysfunction, and provides a total body approach that may or may not include thyroid hormone prescription. This is preferred!

WHAT ARE COMMON SYMPTOMS CAUSED BY LOW THYROID LEVELS? HIGH?

First, let’s breakdown the 5 major causes for hypothyroid symptoms:

Production problem: you’re not producing enough of T4
Conversion problem: you’re not converting T4 to T3
Destruction problem: as in Hashimoto’s, the immune system is attacking the thyroid gland
Poor nutrition: which can results in the above 3 issues
A mix of the above

Symptoms of hypothyroid include:

weight gain
constipation
acid reflux
infertility
hair loss
brain fog
low energy
dry skin
brittle nails
cold intolerance
brittle hair
trouble sleeping

Major causes of hyperthyroid:

Overmedication
Over supplementation with iodine and iodine rich foods
Overstimulation: as in Grave’s and overstimulation of thyroid receptors
Stress
Mix of the above

Symptoms of hyperthyroid typically include:

rapid heart rate
night sweats
weight loss
anxiety
shortness of breath
trouble sleeping
hair loss
protruding eyes associated with Graves disease

DOES PREGNANCY/POSTPARTUM IMPACT THYROID?

You bet!

Most women need thyroid medication adjustments during pregnancy and postpartum. Some women go into pregnancy not having any issues and develop hypothyroid during pregnancy.

Most doctors pull women off thyroid medication after pregnancy, which is unfortunate as women tend to need it postpartum. Thyroid medication is safe to take in all phases of life, even when breastfeeding.

Many women develop low thyroid symptoms postpartum and because of stress, hormonal fluctuations particularly reproductive hormones and adrenal issues.

Because thyroid specific herbs are not safe during pregnancy, thyroid medication is usually the best option.

However, Ashwagandha is safe postpartum for breastfeeding moms and can be a great herb to incorporate along with the recommendations below to try to improve thyroid function naturally.

HOW IS THYROID IMBALANCE TREATED?

Some people can treat thyroid related imbalances naturally with:

A Paleo or Whole 30 diet
Correcting nutrient imbalances such as starting on a iodine, selenium, tyrosine supplement, correcting low iron levels, and including a multivitamin that contains zinc, vitamin A, and Vitamin D. It’s important to test nutrient levels first before taking iodine, selenium, Vitamin D, or iron. These nutrients are also great for those looking to maintain optimal thyroid without an actual diagnosis of thyroid dysfunction.
Practicing stress management and modifying workouts by moving away from heavy HIIT workouts, for example, to weight training which builds resilience
Including herbal supplementation such as kelp and ashwagandha which can help improve thyroid function. Not in case of Grave’s or hyperthyroidism, but keep reading, there’s more to this!
Red light therapy has been shown to reduce thyroid antibodies as well and optimize thyroid function

If natural doesn’t work, I suggest pairing the natural treatment with a medication (if you can’t produce or convert enough of the thyroid hormone why suffer?).

Finding the right thyroid medication can take some time as you have to balance: dose, brand or generic, synthetic or glandular medication, compounded or conventional. Thyroid is the only hormone that is totally ok to take in synthetic form. It’s simply about trying and finding what formulation works best!

Keep in mind: it’s important to test thyroid 6-8 weeks after starting treatment. To check for absorption, I like to test thyroid hormones sometimes 7 hours after the medication is taken.

ARE THERE ANY FOODS THAT CAN BE EATEN TO CHANGE (DECREASE/INCREASE) THYROID LEVELS?

To improve thyroid levels such as with Hashimoto’s, hypothyroid or suboptimal thyroid (“normal” thyroid labs), you want to include foods that contain iodine including wild caught fish, eggs and seaweed.

With Hashimoto’s you want to make sure that you minimize inflammation by avoiding nightshade family of vegetables (tomatoes, eggplant, white potato and bell peppers), gluten and dairy.

You may be able to consume some gluten from Italy and dairy from the UK–but it’s wise to limit these foods.

Brazil nuts are excellent sources of selenium and leafy greens are rich in vitamins and minerals that are essential for proper thyroid hormone utilization.

Including antioxidant and flavonoid rich foods including berries, turmeric, ginger and cacao can support a proper immune response and protect thyroid gland.

With both hypo and hyperthyroidism, you want to limit alcohol, caffeine, processed sugar and grains, and vegetable oils like canola, rapeseed and sunflower. Opt for healthy fats like olive oil, avocado oil, ghee, and fatty cold water fish like anchovies and sardines.

With hyperthyroidism you want to include similar foods as with Hashimoto’s minus the iodine rich foods–avoid eggs, seafood, seaweed, grains and legumes which all can have higher levels of iodine and make the situation worse.

WHY DO SOME PEOPLE FEEL WORSE WITH THYROID MEDICATION?

HOW CAN SOMEONE STOP TAKING THYROID MEDICATION?

WILL I HAVE TO BE ON THYROID MEDICATION FOREVER?

The sad truth is, ,ost providers don’t treat thyroid properly. They’ll prescribe just T4 medication such as Synthroid or Levothyroxine, won’t test T3 levels, and people feel terrible because they aren’t converting T4 to T3 and have rising levels of Reverse T3, which makes things worse.

Before you give up on the thyroid medication, find a good provider. I teach this in my Hormone Potential Foundations course. A good provider will prescribe the right medication with the right formulation.

Something else to consider–many conventional medications have additives like dairy in them. You may not tolerate the medication well because of the additives, not the medication itself. In this situation a compounded medication would be best.

If you want to quit your medication, then follow the dietary, lifestyle, supplement recommendations in this blog. With thyroid medication there is no weaning off period.

As with any hormones, if your body doesn’t produce them naturally on its own, you do have to take the hormones indefinitely. But the same goes for supplements.

I never start someone on thyroid medication without incorporating the dietary, lifestyle and supplement recommendations included here, and I am always open to letting my patients decide what works best for them, their life and their health.

DOES THYROID IMBALANCE IMPAIR GUT FUNCTION OR DOES POOR GUT HEALTH LEAD TO THYROID IMBALANCE?

Because poor thyroid function —as with hypothyroidism— can slow down digestion with constipation being one of the major symptoms, it can lead to SIBO (small intestinal bacterial overgrowth), proliferation of opportunistic bacteria and even estrogen dominance.

However, poor nutrition and nutrient malabsorption can lead to poor thyroid function which then can result in digestive issues including SIBO.

In the real world, both scenarios can happen!

WHY DO WE GET THYROID NODULES AND WHEN SHOULD WE BIOPSY THEM?

Just like overgrowth of cells can happen anywhere else in the body, thyroid nodules are caused by an overgrowth of cells in the thyroid gland.

Nodules can be non-cancerous or benign, thyroid cancer or malignant, fluid filled cysts, and other cancers or infections.

Generally, if the healthcare provider or yourself can’t feel the nodule whether through palpation or swallowing, and thyroid ultrasound is not concerning, then the nodule doesn’t need to be biopsied.

However, if you or your provider can feel the nodule, then it is best to biopsy it to rule out anything serious.

Over supplementation of iodine can cause overgrowth of thyroid gland cells and hyperthyroid symptoms, which is why it is always important to test nutrient levels.

DO HEAVY METALS AFFECT THYROID HEALTH?

Environmental toxins including heavy metals, mold, herbicides and pesticides can block thyroid and other hormone receptor sites as well as affect the gland function as well. Testing for this is possible via urine testing to understand if this is a culprit to thyroid gland function before trying to “detox” or cleanse from something that may or may not be an issue. Usually with environmental toxins nothing you do seems to make a difference–that’s a key sign that there is most likely a higher than normal toxin burden.

Ready to really deep dive into your thyroid health? When you join the Health Mastery Club, you get instant access to my De-Mystifying Thyroid masterclass and more!

I’m sharing my knowledge as an insider in the medical field to teach you:

How conventional medicine has failed to treat thyroid related conditions and what exactly is subclinical hypothyroidism
Why TSH is not a marker for thyroid health and what exactly do we need to look at when testing thyroid?
How to test thyroid and beyond: what other tests should you consider?
The body temperature test anyone can do at home to check how well their thyroid is functioning and to monitor treatment efficacy
How to reduce thyroid antibodies as it relates to Hashimoto’s and Graves, and the role of LDN (low dose naltrexone) as treatment
Optimizing thyroid gland without being hypothyroid
Understanding what is “Thyropause”
Best supplements for thyroid health
Thyroid and gut health--the role of nutrition and foods to include and avoid with hypothyroidism, hyperthyroidism, Graves and Hashimotos
The role of thyroid on our immune system, metabolism, fertility and cognitive function
Understanding your options when it comes to treating thyroid with medications and natural treatments
How to reduce environmental toxin burden fear free