Am I hypothyroid? How do I know if I have have hypothyroidism?
In this post I am going to answer your question of “am I hypothyroid, or do I have some degree of hypothyroidism?” If you stick around to the end of this post, you’re going to have all the tools that you need to really put this into perspective. I’m making these videos and posting these blogs, because I think you want good information about your health. I want to provide you with the tools to really make some lasting and durable changes based on good information. At the end of the day, I want you to look and feel great and to live a long time, so stick with me through this video and you will have a complete understanding of everything you need to know to fully assess your thyroid state.
As a physician and having taken care of thousands of patients over the course of my 27 year career at this point, that any number of people are walking around out there with all the symptoms and signs– in addition to laboratory testing– that suggests a hypothyroid state, but their complaints are falling on deaf ears.
I think the reason is that the majority of physicians in this country are either relying on the incorrect laboratory tests to assess thyroid function, or they’re not listening to what the patient is telling them. I’ve had so many patients who are basically through their symptoms just screaming, “I’m hypothyroid”, and yet their physicians don’t seem to be listening.
In order to really make a comprehensive assessment of your thyroid function, you need to have a sort of a clinical look at what’s going on with the thyroid in addition to the correct objective or laboratory measurements. So let’s first review some of the classic symptoms that I see in descending order in terms of their frequency.
The first thing that I see in my hypothyroid patients is fatigue, which is pretty much proportional to the degree of hypothyroidism.
The next thing that I see, which is really common, is the complaint of cold hands and cold feet. Oftentimes it could be a person’s bed partner who notices that her feet are cold in spite of being under the covers.
After that, I would probably say that most people are complaining of changes in their hair and their skin. It’s not uncommon for me to see a woman who’s been to her hairdresser who says that her hair has changed. Her cuticles and nails feel a little different. As people get into more advanced stage stages of hypothyroidism, we begin to see a loss of the lateral third of the eyebrows.
People who are pretty significantly hypothyroid have numerous bowel complaints, with a tendency towards constipation, and hard, dry infrequent stools.
So if you’re having a bowel movement less than once a day, if you’re having a poop every two to three or maybe four days, that is just a very strong clinical suggestion that you are in a hyperthyroid state.
Finally, hypothyroidism is associated with any number of mental changes, from foggy thinking to memory changes, to poor concentration and depression.
Changes in hair, skin or nails
Constipation, dry, hard or infrequent stools
Mental status changes, memory loss, depression
I want to now go over a few objective studies. These are measurements that you can begin to make to really get a sense of where your thyroid function is. The first set of objective measurements are at home measurements that can be done in the privacy of your own home.
First, check your weight. Take off all your clothes, get on your scale, and write it down. Don’t be shy. All of these numbers will go in the right direction once you get your thyroid function optimized.
The next thing that I want you to do is to check your pulse. I think this is one of the most important measurements that a physician can make, and I can tell you that I never see doctors take their pulses anymore of their patients. It has become a lost art, yet is so simple.
Here’s how you take your pulse. What you do is you start with your three fingers on the outer side of your wrist and then roll them towards the front side of the wrist. And as you roll off of the bone, you’re going to start to feel where your tissue gets a little more fleshy. Press down there. That’s your radial pulse. The first thing that I want you to do is count how many beats you feel in 30 seconds. Multiply this number by two, and this is the number of beats per minute.
The last object of measurement that I want you to get is your basal body temperature. One caveat I want to offer here is that in women who are ovulatory, meaning they’re having monthly cycles. At the mid point of the month an woman who is ovulating will normally have about a one degree elevation in body temperature. So if you’re in the middle of your cycle and you want to get your basal body temperature, just wait a few days. Simple.
I’m recommend that you get a good digital thermometer and check your body temperature first thing in the morning upon waking. Now we’re looking for trends here, right? So there will be some fluctuations, but really what I want to get an idea of is how are you trending? Most people who are hypothyroid have a lower basal body temperature.
I pulled a paper entitled “Normal Body Temperature, a Systematic Review published in the Open Forum of Infectious Diseases in 2019, They showed that the average basal body temperature is 36.7 degrees celsius, which is equivalent to about 98 degrees Fahrenheit.
Normal Basal Body Temperature:
- 36.7 degrees Celsius
- 98.0 degrees Fahrenheit
So measure this on a few consecutive mornings. If you are consistently between 0.5 and 1.0 degree lower on either of these scales, you’re probably in some degree of hypothyroidism. And I would expect for this to be reflected in your laboratory values as well, and understanding laboratory values is where we’re going in the last part of this talk.
I want to preface this with a story about when I was in medical school. I had a self-proclaimed thyroid expert tell us that understanding thyroid health is really simple. All you do is check what’s called a TSH. If the TSH is in the normal range, you’re done. The thyroid is normal. We don’t have to do any more thinking.
TSH alone will not tell you if you are hypothyroid unless it is really elevated
TSH is probably what many of you have studied had in the past. This stands for Thyroid Stimulating Hormone, and it is a hormone that is released by the brain to tell the thyroid gland, which is here in your neck to begin to make more thyroid hormone. The simplistic view of this is that as thyroid hormone goes down, TSH goes up and as thyroid hormone goes up, TSH goes down. But I can tell you having examined thousands and thousands of patients and having performed thousands of these studies in my medical career, that it’s not that simple. Many of you will find yourself going to the doctor and saying, “My hair is dry. I’m putting on weight. I’m tired all the time.”
Your doctor following the erroneous teachings of the thyroid expert checks only a TSH and says, “Oh, your TSH is right in the middle of that normal range. We are done. Your thyroid is normal.” Recall the misguided teaching?
So you go home, you come back next year, and what has changed? Nothing. You’ve been suffering for yet another year. You are still hypothyroid.
What I want to do is first introduce this idea of a feedback loop because it’s important to understand that it also applies to other biological systems as well. When the brain senses a low degree of thyroid hormone, it makes TSH, TSH tells the cells and the thyroid gland to begin to make it the active hormones T3 and T4. T4 is a tyrosine molecule bound to four molecules of iodine. And this is an inactive precursor hormone. The active thyroid hormone is T3, which is the same tyrosine molecule, but with three molecules of iodine around the outside. It’s been modified to its active form.
Here’s a fun fact. We have that 10 trillion cells in our body and every one of those 10 trillion cells has a receptor for thyroid hormone. That should tell you that the hormone is pretty important. That’s like having a Twitter account with 10 trillion followers.
Now, TSH works only on the thyroid gland. It doesn’t affect any of these 10 trillion cells, with one exception. There has been some data recently that suggest that that TSH hormone can have some effect on the bones as well. But for the time being, let’s just assume that the TSH doesn’t speak to the cells in our body and it doesn’t directly reflect the amount of free thyroid hormone that is accessible to those cells.
You’ll notice as I go through this discussion that I refer to free thyroid hormones. We need to talk about that right now.
A lot of these older and cheaper tests measure TSH, which as you’ll recall, does not directly reflect what our cells are seeing. It also measures some of the thyroid hormones, but typically this will be a total T4 or what known is a T3 RUI.
TSH alone is not adequate information to determine if you are hypothyroid
What I recommend for all my patients is to obtain a TSH, a free T3 and a free T4. What happens is the total thyroid measurements reflect the thyroid hormone that is in our bloodstream, but a lot of that thyroid hormone is bound to carrier proteins.
If you have a set number of units of thyroid hormone and all of them are bound to the carrier protein, it makes sense that none of these molecules are available to talk to the DNA in our 10 trillion cells that are waiting for its message. Conversely, a free thyroid hormone measures the free hormone that is unbound from the carrier proteins, and tells us what is accessible to the cells.
A typical range of TSH is between 0.5 and 5.0, but I know that as the TSH gets into these higher ranges, this really represents an abnormal TSH, particularly if you have a number of the hypothyroid symptoms that we discussed earlier. In my opinion, an optimal TSH range should be between about 0.4 and 3.0 with an optimal TSH range being between about 0.4 and 1.5.
When it comes to ranges for the free hormones it is important to recall that T4 is an inactive precursor hormone to the active T3. The free T4 range is somewhere in the 0.6 to 1.4 range and the free T3 range is 2.4 to 4.2. Now when I see an optimized set of thyroid hormones, and again, this has to be done in conjunction with improved symptoms as well, the TSH is in the range of 0.5 to 1.5. Free T4 is in the 1.2 to 1.3 range and the free T3 is in the 3.4 to 3.6 range.
Thyroid Tests Results Chart (in mIU/l)
TSH: 0.5 to 1.5
Free T4: 1.2-1.4
Free T3: 3.4-3.6
When I see patients that get their thyroid hormone into these ranges, what happens? Their weight comes down, their energy comes back, their skin begins to feel better and their bowel function begin to improve. Everything seems to turn the corner.
Let’s take a brief moment here and talk about natural treatment of thyroid hormone. Now there are numerous doctors and websites out there that will gladly sell you remedies to help to turn around your thyroid function.
In an earlier video I referenced the fact that there are some cases where our thyroid function can be tampered down in ways that can be reversible. Typically this would involve replacing nutrients such as deficiencies in Selenium and Iodine, or by modulating stress. But I can tell you having seen tons and tons of patients who’ve tried some of these natural thyroid replacement approaches, the vast majority of people are really going to start feeling better when they get on some form of pharmaceutical form of thyroid replacement therapy.
You can obtain all of these laboratory studies, do these tests on yourself and have this information to be better equipped, more well informed for a discussion with your doctor. So let’s recap from the beginning. Shall we?
Am I Hypothyroid? A review.
Number one, I think there are hundreds of thousands if not millions of people out there who are walking around in a relatively hypothyroid state, but we’re not using the right assessments to actually make the measurements to determine it.
In order to determine if you are truly hypothyroid, you have to first take a good look at your subjective complaints. If you come back positive for two out of those five different subjective complaints that I reviewed earlier, you probably have some degree of hypothyroidism; so don’t be surprised to see abnormalities on your (comprehensive) thyroid hormone testing.
Number two, get the objective data. Get your weight, basal body temperature, and your baseline pulse. This will also help you to know if you’re being over-corrected with thyroid hormone should you and your doctor choose to initiate treatment. And finally, be sure to get the right testing to really assess your thyroid function; TSH, a free T3 and a free T4.
If you need to rewind back in the video and remind yourselves of what the optimized levels are, do it. Hopefully this video gives you all the information that you need to get the most insight that you can into your thyroid function.
It is essential that we look at thyroid health with a combination of subjective and objective studies, in addition to a comprehensive thyroid panel. It is quite possible that you could feel a lot better by really getting these numbers into their right range.
If your TSH levels are towards the higher part of the range, I mean like a TSH anywhere above the range of 4-5, you are hypothryoid, and it’s absolutely imperative that you make some measurements to look into Hashimoto’s Thyroiditis, and to consider the health of your immune system. But I will need to cover this in another video, where we will continue this discussion.
To conclude, I’m sharing this information because I think you folks are smart, you want good information and you want to be able to turn your health around to live optimally. I’m giving you this information because I want to help you to be the your best possible. So thanks for your time, be well, and I will see you in the next video.
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