Hashimoto's Part 1 Thyroid Testing, & Thyroid Physiology

(00:02):

Hypothyroidism, TPO antibodies, some lab numbers kind of criteria for diagnosis and the physiology of making thyroid hormone. Let's talk about that today. I've had some questions lately. I realize I haven't done one of these videos in quite a while, so let's knock this out. Hashimoto's is going to be a name used for the condition of having antibodies toward your thyroid. I'm going to get a little more specific with you, but I think in common terms, I think we've come to the point where if you have an autoimmune thyroid condition, they're just going to call it. I think that's probably fine. I don't think getting super specific about that really makes much of a difference. You'll see why I say that in a minute. So if you have an autoimmune attack on your thyroid, it's going to be called Hashimoto's. Now, let's go through how you make thyroid hormone so that we kind of have the same terminology as I talk about testing and diagnosing.

(01:00):

So you have a gland kind of tucked behind your forehead up under the front of the brain, and that's called the pituitary gland. It kind of tells your thyroid ovaries or at testes, your adrenals, your pancreas. It tells those what to do. So it kind of coordinates your endocrine system or your hormone system. There are a few other working parts to this, but we're going to stop with just the thyroid there or the pituitary there. So the pituitary tells the thyroid to make T4. T four is tyrosine, which is an amino acid with four iodines attached to it. That's where it gets its name T4, also called thyroxin. So it has multiple names, but T four is what we typically call it. It's just more descriptive. T4 is not active. It's a packaged form or a transport form of thyroid hormones that floats around.

(01:52):

Your bloodstream eventually gets converted into something called T3. Now, you would guess if T4 is tyrosine with four iodines, T three is tyrosine with only three iodines. So at some point you removed one of the iodines. Now you've got T3 that's more active when you get down to free T3, that's active thyroid hormone. That's what all of this is about, is making free T3. It's pretty much the only one that does all the stuff that thyroid hormone does. Thyroid hormone manages your metabolism sets the RPM for the engine. How active is your body going to be or how subdued is your body going to be, right? That's kind of what thyroid hormone does. Symptoms of not having enough, it can be pretty varied. You can have thinning hair, weak nails, cold hands and feet, dry skin, constipation, weight gain, lack of motivation, brain fog, depression, increased joint inflammation on lab work.

(02:54):

You can have elevated cholesterol numbers from not having enough thyroid hormone. There can be some issues with converting cortisol from the active form to the metabolized form. If you don't have enough thyroid hormone and if it's really profound, sometimes you don't even make enough red and white blood cells so it can have far reaching effects. You don't have to have all of those symptoms. Many times I'll give a list like that and people will just kind of give me a general sense of, oh yeah, I was in there, or, yeah, I got one or two of those, but otherwise it's not really me. That's kind of how I assess, at least symptomatically what's going on now. So we kind of know how thyroid hormone is made on a lab test. Those would be represented by TSH. That's thyroid stimulating hormone that's made by the pituitary.

(03:41):

That tells the thyroid how much T4 is needed. So it's asking for or demanding that the thyroid make T4. So generally speaking, you would assume that the more T4 you need, the higher the TSH would be, and if you don't need any T4, the TSH would be lower. So it should run opposite of your T4 levels. I think when things are working well, that's the case, but I think a fair amount of the time when people have an autoimmune thyroid problem, they become disconnected from each other, and so your TSH can just go rogue and say what it wants to say even sometimes where your T4 levels are perfectly normal test after test after test. So you can't always trust the TSH. In the beginning, it was the only test we had, but for many years, like multiple decades, we've been able to test for the other hormones.

(04:33):

So it's just I think become a much less relevant number. Now that being said, TSH tells the thyroid what to do. Thyroid produces T4 tyrosine for iodines, puts that out into the bloodstream very quickly. Most of that is bound to proteins in the blood, so it's not available anymore, but some of it's not. That's free. T4, okay, so free T4 floats around that gets picked up by the liver and then some by the intestines, little bit in some other organs or glands or cells here and there. But about 60% of this conversion, this next step happens in the liver, 30% in the intestines. The rest is spread out. This is where I'm just going to talk about the liver. It goes into the liver. An enzyme called five prime de-iodinase removing an iodine, right? De iodine-ase. So it removes one of the iodines.

(05:26):

Now you've got T three. That's where the name T3 comes from. It's T4 lost an iodine. So now you have T3 that gets released into the bloodstream. Again, most of that's going to be bound to protein. The small amount that's not bound to protein is free. T3 that's available to do the job that thyroid does. This whole cascade, all this back and forth is to create free T3. That's the number. That's the end game, so to speak. So if you get a thyroid panel and it have free T3 on it, they stop short. It's one of the most important numbers there is. It's what this is all about, and none of the rest of that is going. If you supplement with T4, so to speak, T4 is not going to fix your symptoms unless you can convert it into T3.

(06:15):

So really free T3 is the most important number there and probably the most often ignored number. They just don't test for it. So a normal, an appropriate, functional, applicable, usable, relevant thyroid panel should have TSH total and free T4 total and free T3, and then two antibodies, which we'll get to in a minute. You can add a reverse T3. Sometimes you make a version of T3. That's kind of a mirror image of what you need to have. I think it's useful to have that on there, but I'm not going to say it's mandatory. I mean, if you're fine tuning things later on, it becomes more important, but initially, probably not mandatory to have that.

(07:00):

If you were really minimizing this, you could probably do a panel that has a TSH total T4, and then maybe a free T3 if you really wanted to minimize it. You are missing information there. There will be questions that you can't answer, but if you want to do just a quick screen with as little as possible to see if there's an issue, that's kind of what I would do. We'll talk numbers on those in a minute. Now, antibodies, now that you know what's in the test, you know why it's there. You know how you make thyroid hormone antibodies. There are two tests commonly done for thyroid antibodies. Now, what are antibodies? Antibodies are how you fight off infection. Foreign invaders, okay? They're your border patrol, so to speak. So a bacteria comes in, you make an antibody, it kills that bacteria. Now you're doing well, but what if you make an antibody that instead of fighting off a foreign invader, it attacks a tissue that's normally yours like thyroid, so that would be an autoimmune condition.

(07:59):

Your immune system is going after your own tissue autoimmune. There are ways that happens. I can do 10 videos on that. We'll do that in a separate video. But for the thyroid, the two antibodies you want to see are thyroid peroxidase antibodies and thyroglobulin antibodies. There'll be abbreviated TPO as in peroxidase, TPO for the thyroid peroxidase and TGB for thyroid globulin. Now, technically, my understanding always was if you have elevated TPO antibodies that gets diagnosed as Hashimoto's. I think practically speaking these days, if you have any sign of autoimmunity to the thyroid, they're going to call it Hashimoto's. Whether it's thyroid globulin antibodies, thyroid peroxidase antibodies. I don't think it matters anymore. If there's something autoimmune, they're going to call it Hashimoto's. I just think that's the way it works. Does it matter? Probably not. I really don't think so. If it's autoimmune, that's all we need to know.

(09:00):

Now, what does TPO stand for? What's thyroid peroxidase? Why do we care? Let me handle thyroid globulin first because it's quick. It's just a binding protein for thyroid hormone. That's all. It's now thyroid peroxidase antibodies. The thyroid peroxidase enzyme is what the part or the machine or the part of the physiology in the thyroid that assembles T4. It takes tyrosine, it takes iodine, and it puts them together and creates T4. So you can see very quickly how if you were attacking that particular mechanism, that piece, that active component, that you could end up in a situation where you have trouble producing T4 that could lead to not having enough T4 in the system. Now, for whatever reason, if you don't make enough T4, you will be diagnosed or should be diagnosed as hypo. Hypo is low, hyper is high. So hypothyroid just means the thyroid's not making enough T4.

(10:02):

Some doctors will diagnose it just from an elevated TSH, assuming that that's responding to a low T4. I disagree with that. Look at the T four. We've been able to do that for decades. So if your T4 level's too low, that's hypothyroidism with or without the antibodies, doesn't matter. It's hypothyroidism. You can have antithyroid antibodies. Say you have the TPO antibodies above the level where the lab says you're positive for an autoimmune condition. You can have that and still have perfectly normal thyroid hormone. So you can be Hashimoto's without being hypothyroid. You can be hypothyroid without being Hashimoto's if you don't have the antibodies, but you don't make enough thyroid hormone. There you go. Where you run into a little bit of a gray area, kind of an empty spot is where you make plenty of T4. So you're not hypothyroid, but you don't convert it very well into T3.

(10:57):

So you're low in thyroid hormone. You've got all those symptoms, but the thyroid wasn't the problem. It was the conversion. You're not hypothyroid. It did its job, but yet you don't have enough thyroid hormone. As far as I'm aware. There's no diagnostic code for that. There's no particular name for it. I call it under conversion. I've heard it called low T3 syndrome. I've heard it called no lie Wilson's temperature syndrome. Dr. Wilson wrote a whole book about it. I think he wanted something named after himself and that the idea there was you had a low basal body temperature, but your thyroid hormone was normal, and that was because you weren't making enough T3, you weren't converting. It was sloppy. It was a poor attempt. It never caught on. So ignore that one, but it's there. But anyway, there really isn't an official name. It's not really a recognized condition. I don't know why, because it's probably one of the more common things that we see.

(11:54):

What else numbers? Lemme run through thyroid panel real quick and tell you what the numbers ought to be. These are numbers here in Houston, Texas or in the us. LabCorp is what I typically use. Quest isn't going to be all that different. If your numbers look very different than what I'm saying, they may be presenting it to you with a different unit of measure, almost like using metric instead of English. That won't be the problem, but it'll be a different unit of measure. So just look it up. If that's the case now, you'll be able to convert. So for TSH, the pituitary tucked up under the brain asking for thyroid hormone anywhere from one and a half to three is what I would consider normal. Now, if you're more aggressive about it, you'll cut that off at about 2.5, right? Remember, the higher it is, supposedly the lower the thyroid hormone or the lower the T four is.

(12:49):

I don't put much faith in it. I don't trust it much. It seems to be disconnected or what I call uncoupled from the T four levels pretty frequently in autoimmune cases. So I don't spend a whole lot of time with it. But to get really technical on the lower end, if your TSH is below 1.5, if it's 1.0 or 0.9 or 1.1, that would be lower than I would expect. But as long as you're making enough thyroid hormone, all it means is that with a minimal request, your thyroid is capable of doing a good job. I call that a win. So I don't worry much about it on the low end. As long as you're making enough hormone on the high end, whether you're making enough hormone or not, something's not right. It shouldn't be that active. It shouldn't require that much of a request.

(13:42):

So it's either uncoupled or you're really not making enough T4, but one and a half to three, one and a half to two and a half. I've seen some doctors go one to two. I think that's a little aggressive. I think if you're using that to make decisions, you'll be potentially treating a lot of people that might not really have a problem, but it's an aggressive number. So somewhere in there, you're going to have an issue. T4 coming out of the thyroid total T4 should be between six and 12. Most labs will go all the way down to four and a half or four. I think that's BS on the top end. They usually stop right around 12, maybe 12 and a half. So six to 12 is what I would look for. A little bit of wiggle room at the top 12 and a half. As long as you don't have symptoms of too much thyroid hormone, like being all caffeinated and jittery and anxious and all that. As long as you don't have that, I'm not going to worry too much about that.

(14:32):

Free T4, the stuff that's not bound to protein should be somewhere between one and 1.5. That's what's available to go into, say the liver and have one of those iodines removed. So one to one and a half for that. Once it comes out of the liver, that's total T3 total. T three should be somewhere between 100 and 180. Very common for that one to be low. But at the end of the day, free T3 is the active number we're looking for, and that should be somewhere between three and four. Some doctors go up to four and a half. Again, if you're not symptomatic of too much thyroid hormone, I'm cool with that. It doesn't bother me. But on the low end, it's pretty much agreed upon that. If you get much below three, you're not going to be feeling right. You're going to have some of the low thyroid hormone symptoms. So that's a normal thyroid panel antibodies, TPO antibodies. I think normally the cutoff is going to be around 34, 35, somewhere in the mid thirties. But if you have an autoimmune response, that number can go up into a thousand, 1100, 1200. Pretty common to see it between 300 and 800. Those are pretty active numbers. If you can get that TPO number predictably and consistently below 200, I would probably look maybe to get it below one 60. You're probably not doing enough damage at that point to be relevant. I would kind of consider that remission.

(16:06):

We'll talk about how to accomplish that in another video where I talk about how autoimmune conditions like this develop and how you would approach it. But anyway, those are the numbers. TPO or globulin or yeah, thyroglobulin, the TBG or TGB antibodies, those normally cut off at about one, maybe one and a half. Pretty common if people are active for that. To see them come in at one and a half to maybe three or four, you don't really see it generally a whole lot higher than that. But that'll typically get you the diagnosis of Hashimoto's as well. The same thing that brings down the TPO antibodies should bring down the thyroid globulin antibodies. They are variable, the same thing that triggered them to develop. If you get rid of that, if you get rid of the root cause and you stop triggering it, those numbers can go down and you can stop doing damage whether or not you can repair, that's a whole nother question.

(16:58):

It depends on how long you've had it, how young you are, how resilient you are, how well nourished you are. There're a whole bunch of things that go into that equation. But the doctors that say, once you've seen it and diagnosed it, you don't ever have to look at the antibodies again. I mean, I guess if you're just giving someone medication to replace their hormones and you don't care about the underlying cause, then that would be true. But if your goal is to revert this patient back to normal physiology so they're not attacking their own tissues, I think looking at the antibody levels would make sense. How else do you know if you're accomplishing that goal? I mean, if there was some magic pill that was supposed to get rid of Hashimoto's, you should look at the antibodies at some point. See if that magic pill's working.

(17:40):

Now, that magic pill could be all kinds of different treatments, but just to oversimplify it, I mean it would make sense to look at that. If you take a pill to lower your cholesterol, you take a look at the cholesterol later to see if you had that effect, right? So I don't know why doctors are so scared of repeating these. A full thyroid panel in an office like mine right now, I think is running about $110, maybe 115, something like that. It'll vary from office to office, and if they're putting it on your insurance, who knows what they're going to charge you. Full retail prices for labs like that, they can be eight to 10 times higher than what I just quoted you. Sometimes you'll see 'em within just a few bucks of that. So it's all over the place for charging for labs. But my point with that is not like go compare prices.

(18:23):

My point is it's not terribly expensive to look at this. It's not some $1,200 test or it shouldn't be. If they want to charge you something like that, find a functional medicine doctor near you. Call and ask. If you can't find anyone like that, contact me. We'll do it for you at whatever price we charge everybody else. Right now it's running in that range. The lab could change their prices whenever, so I can't guarantee that's the case, but call and check or email us and check. Anyway for this video, that's as far as I'm going to go. You now know how you make thyroid hormone, the definition of Hashimoto's. You know what hypothyroidism means. Those two don't have to go together, but they can. What should be in a normal lab panel and the numbers you're looking for and what each of those things does.

(19:11):

So that's a lot to cram into a video. I went quickly. I know you can rewind and go look at it again, but hopefully this helps you out pretty soon. I'll do another one on how do you develop an autoimmune thyroid problem and what in the world would you do about it if you wanted to affect some change there. So anyway, leave me messages. Let me know if you have other questions or if I just confused you more than you already were, and I'll see if I can do another one of these to clear all that up. Alright, otherwise, have a good one. I'll see you on the next video.