Dr. Broda Barnes [1] spent 52 years of his life researching the human thyroid gland and its impact on health. Although he died in 1988, his work lives on through the Broda O. Barnes M.D. Research Foundation [2] as well as books and many in the alternative medicine community who believe he was on the right track regarding a hidden widespread epidemic of low thyroid functioning begin responsible for rising levels of metabolic related health problems. The 40% of the population affected by the rising epidemics of high cholesterol, type 2 diabetes, obesity, and metabolic syndrome interestingly approximate the 40% of the population whom Dr. Barnes suspected have hypothyroidism, the vast majority of whom have never been diagnosed with the condition. Among Dr. Broda’s many writings on thyroid disease and treatment, his book Hypothyroidism: The Unsuspected Illness [3]
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What is Hypothyroidism?
Hypothyroidism is a condition in which the thyroid gland produces insufficient thyroid hormones T3 and T4. This is often discovered when thyroid function is checked after long-term symptoms including fatigue, lethargy, low energy levels, heart rate abnormalities, headaches, memory loss, weight gain, depression, anxiety, irritability, panic attacks, dry skin, hair loss, constipation, and even infertility. Other symptoms include high LDL cholesterol, triglycerides, and blood glucose levels that don’t respond well to regular treatments.
The test most often used to find thyroid problems is the TSH test which examines blood for levels of TSH (Thyroid Stimulating Hormone) which is a hormone produced by the pituitary gland to tell the thyroid gland to increase its output of T3 and T4 hormones. Unfortunately, this is an indirect means to determine whether there are sufficient T3 and T4 levels. For instance, the pituitary gland could be dysfunctional in a way that does not cause elevated TSH despite a deficiency of T3 and T4.
Various Thyroid Hormones
TSH (Thyroid Stimulating Hormone) is the first hormone typically tested and is central to the control mechanisms for regulation of T3 and T4 hormones. T3 is the more widely active form of thyroid hormone. Most T3 is made away from the thyroid by cells in the liver and elsewhere converting T4 into T3 as necessary. If there’s not enough T4, it is likely there will also not be enough T3.
T3 has 3 iodine atoms, and T4 has 4 iodine atoms. There are tests to examine the total and free levels of T3 and T4 in the blood. There are also tests to examine levels of “reverse T3” which is the chemical mirror image of T3 but does not work like T3 does.
There are also tests to examine the levels of thyroid peroxidase (TPO) [6] which is used to obtain iodine atoms used to make T3 and T4 in the thyroid. TPO can be a target for autoimmune attacks in conditions such as Hashimoto’s thyroiditis [7]. There are also tests to look for antibodies to TPO to help diagnose autoimmune conditions that result in hypothyroidism.
There are also T1 and T2 hormones with 1 and 2 iodine atoms respectively. However, they are seldom discussed or researched and common thyroid tests do not detect them. It is not clear what role, if any, they have in the body. T1, T2, T3, and T4 are all present in desiccated thyroid products generally made from pig thyroid glands. Some believe that this may be why certain patients do much better on natural thyroid gland extracts than using synthetic versions of T3 and T4. (See The Desiccated Thyroid Story [8] for more information.)
Debate Over Thyroid Test Ranges
Hypothyroid patient activist Mary Shomon writes in her article The TSH Reference Range Wars: What’s “Normal?”, Who is Wrong, Who is Right… And What Does It All Mean For You and Your Health? [9] about the still-raging debate over how to interpret thyroid tests. Conventional doctors without expertise in endocrinology (hormone medicine) believe that a range from about 0.5 to 5.0 uIU/mL is “normal” for levels of TSH (Thyroid Stimulating Hormone) in health patients. However, in January 2003 the AACE (American Association of Clinical Endocrinologists) announced a formal opinion that 0.3 to 3.0 was a beter normal test range and that patients with a range between 3.0 and 5.0 should be checked for hypothyroid conditions via additional means.
Since then, other research has suggested that TSH levels above 2.0 are a sign of “subclinical hypothyroidism” which results in a variety of health problems including significantly elevated cardiovascular disease risk. But mainstream doctors without endocrinology expertise continue to widely ignore these findings, meaning that likely tens of millions of Americans are suffering from mild hypothyroid conditions and will not be diagnosed or treated despite the adverse effect on their health.
Although thyroid function tests such as free T3 and free T4 are very common tests and are not particularly expensive, unfortunately doctors are often unwilling to request anything other than a TSH test even though that test alone is not adequate to diagnose mild hypothyroidism.
What these doctors are doing is even more bizarre that it may first sounds. Their choice of tests is akin to trying to do a smog check on a car by putting the car into neutral and checking to see if the RPM gauge changes when the accelerator is pushed. Then they attempt to determine if the car is idling OK by observing if the RPM gauge is between 100 RPM and 7000 RPM when the car is idling. Sure you can show that the accelerator works, but it doesn’t prove a thing about whether the car will spit out smog or not. Any car using a 2009-vintage internal combustion engine that is idling at 5000 RPM is clearly broken, just as any TSH level above 3.0 is a strong sign that there is a problem and any level above 2.0 warrants further investigation.
If TSH is between 2.0 and 5.0 and there are signs of medical conditions related to thyroid issues, more tests are needed than TSH alone to be sure if the thyroid metabolic regulation system is working correctly. The doctors also need to be using realistic TSH test ranges, too. They are like the RPM gauge readings for the thyroid. There is significant evident that TSH levels above 2.0 uIU/mL are indicative of developing hypothyroidism. The American Association of Clinical Endocrinologists (AACE) stated in January 2003 that levels above 3.0 uIU/mL and below the older upper limit of 5.0 uIU/mL are indicative of mild hypothyroidism that may require treatment. Yet most labs and doctors are still unwisely using 5.0 uIU/mL or even 5.5 uIU/mL as the cutoff before they will diagnose hypothyroidism.
Do You Have Hypothyroidism?
Mary Shomon has put together a free online quiz to help people determine how likely it is they may have a hypothyroid condition. Visit it at Quiz: Could You Be Hypothyroid? [10]. After answering about 41 questions, you’ll be shown a percentage estimate for the risk of a hypothyroid condition in form that looks like this:
You answered 20 items out of 41 in a way that indicates hypothyroidism risks and symptoms.
Your score is 49%. You have enough risks and symptoms that you should have your thyroid evaluated.
One of the questions you will see in this quiz is one about having a low pulse or heart rate or low blood pressure. For typical adults, the resting pulse is between 60 to 100 beats per minute. Highly trained athletes can have pulse rates far below this, even well below 40 beats per minute. If you’re not clear on whether your pulse may be low considering your physical condition, it may help to read an article on human heart rate [11]. Typical resting blood pressure is around 115/75 in healthy adults, but this can vary widely. You may find it helpful to read an article on blood pressure [12] to understand whether your blood pressure is high, normal, or low.
Another free online quiz to initially evaluate the possibility of hypothyroidism is at the web page Women’s Health Center of Texas: Online Questionnaire for Thyroid Function (Hypothyroidism) [13]. This one encourages you to order a iodine supplement product from them, but it is not an overly aggressive pitch. The questions they ask appear appropriate and the score given might be slightly alarmist, but if this quiz helps you to decide to get appropriate thyroid blood tests (at least TSH, free T4, and T3) to evaluate the possibility of hypothyroidism then it was worth a few minutes of time.
Obtaining Thyroid Function Tests
If you have symptoms of hypothyroidism and can’t get your doctor to run a TSH test or he or she refuses to acknowledge that TSH above 2.0 warrants running additional tests, you might be well off to change doctors until you can find one who is more willing to be cautious with your health. If this is not going to be easy to do or you don’t have medical insurance or a regular doctor, your best bet may be to pay for your own thyroid test panel. This is really easy to do and can cost about $75.00 (if you’re already a Life Extension member) for the common set of TSH, T4, free T4, and free T3 that is enough to give a strong indication of whether there is anything wrong with your thyroid function (hypothyroidism, hyperthyroidism, or thyroiditis) that may need further investigation and/or treatment.
Listed below are two vendors from which you can obtain thyroid tests without involving a doctor. Either vendor will set up the test for you and send you the results. The collection is generally done at a local LabCorp facility located near a hospital or clinic and works just like the blood tests that your doctor would normally order, the difference being that you don’t get insurance coverage but you also can get a test done even with an obstinate doctor refusing to do it.
Life Extension Thyroid Tests
The Life Extension Thyroid Panel option is easier and less expensive since they bundle together the most common tests. At the time of this writing in July 2009, the thyroid test panel below which includes TSH, total T4, free T4, and free T3, costs $75.00 for Life Extension members versus $112.00 ordering the tests separately. Another benefit is that you can call a Life Extension health advisor after you get your test results for further consultation.
Life Extension: Thyroid Stimulating Hormone Blood Test – $31.00 [15]
Life Extension: Total Thyroxine (T4) Blood Test – $22.00 [16]
Life Extension: Free Thyroxine (T4) Blood Test – $28.00 [17]
Life Extension: Total Tri-iodothyronine (T3) Blood Test – $28.00 [18]
Life extension: Free Tri-iodothyronine (T3) Blood Test – $31.00 [19]
Life Extension: T3 Uptake Blood Test – $20.00 [20]
Life Extension: Reverse T3 Blood Test – $55.00 [21]
Life Extension: Thyroid Antithyroglobulin Antibody Blood Test – $66.00 [22]
PrePaidLab Thyroid Tests
Although the PrePaidLab tests are also performed by LabCorp, ordering is a little more complicated as you’ll need to select the thyroid tests individually. The price for the individual tests to match the Life Extension Thyroid Panel set of tests is $182.25 through PrePaidLab versus $75.00 through Life Extension, quite a lot more expensive. Of course you would have to join Life Extension as a member (typically $75.00 per year) to get the member price, but even then it would still be a savings.
As you can see, a few of the individual tests (such as Total T4 and Thyroid Antithyroglobulin Antibody Test) are less expensive via PrePaidLab than through Life Extension. I’ve listed the prices shown by PrePaidLab for July 2009 for reference and comparison.
PrePaidLab: Total T4 Thyroxine Test – $14.85 [24]
PrePaidLab: Free T4 Thyroxine Test – $40.20 [25]
PrePaidLab: Total T3 Triiodothyronine Test – $45.45 [26]
PrePaidLab: Free T3 Triiodothyronine Test – $90.00 [26]
PrePaidLab: Thyroid Antithyroglobulin Antibody Test – $48.15 [27]
[29]Ordering Individual Tests
Through either Life Extension or PrePaidLab you can order most of the thyroid tests individually. This gives you the option of ordering a TSH test alone and if that comes back looking very normal normal (around 1.0 to 1.5 uIU/mL) then you didn’t spend the money on the other tests that aren’t as likely to show a problem as if the TSH is straying from from the very normal 1.0 to 1.5 range. You can also follow-up on specific tests individually if you get back results with one test in particular looking unusual.
If you go the route of ordering individual tests, it probably would be especially helpful for you to read Mary Shomon’s article on the various common thyroid tests at Thyroid Blood Tests [30].
Life Extension Thyroid Test Panel is Good Initial Choice
I personally think your best choice if you can’t get your doctor to order more than just a TSH test is to order the Life Extension Thyroid Panel for $75.00 if you have any possible thyroid disorder symptoms. The savings in time (one lab trip versus multiple trips) and savings in money versus the individual tests is substantial. Also, even if your TSH number looks excellent, having the overall set of results gives you a set of useful baseline numbers and added confidence that there isn’t something unusual going on such as having TSH and T4 being in optimal ranges but T3 being low because of metabolic problems converting T4 to T3 when needed.
Using Your Thyroid Test Results
If you get your test results back and it looks like you may have abnormal thyroid hormone levels indicative of possible hypothyroidism, you should if at all possible then talk with a doctor to push for additional thyroid tests to determine if you may have an auto-immune disorder that causes antibodies to thyroid enzymes and hormones.
If you ordered the tests through Life Extension and are having problems understanding the results, a Life Extension health advisor may be able to give you some additional advice on what additional tests are appropriate. You can read more about the services they provide in the article Life Extension Health Advisors at your Service [31].
Living Well with Hypothyroidism: What Your Doctor Doesn’t Tell You… That You Need to Know (Revised Edition)
Mary Shomon is a hypothyroid patient who decided to become an activist for helping people with the problems of low thyroid function due to her personal experiences with how difficult it was to get adequate medical treatment. Although many endocrinologists understand hypothyroidism well, most other doctors do not. As Shomon explains in her book Living Well with Hypothyroidism: What Your Doctor Doesn’t Tell You… That You Need to Know (Revised Edition) [32]
, many people who have multiple symptoms such as weight gain, type 2 diabetes, hair loss, depression, low sex drive, anxiety, PMS, postpartum depression, infertility, high cholesterol that doesn’t respond well to diet or medication, poor sleep including insomnia and feeling exhausted even after a night’s sleep, and general problems with declining memory, concentration, and energy levels may actually have a hypothyroid condition. But when they go to their general practitioners with such complaints, many are wrongly told that there is “nothing wrong” with them or that they are just experiencing typical aging. Some will be prescribed medications to deal with depression and anxiety which may help but are band-aids on the the symptoms rather than treating the core problem of low thyroid function.
Reviews
“Hypothyroidism is a common, very treatable disorder that is also poorly managed by doctors. In this first-rate book by Mary Shomon…the disorder, its myths, and medicine’s successes and failures at dealing with it are thoroughly examined. This is not a book that rehashes old facts on thyroid disease. Shomon instead challenges patients and their doctors to look deeper and try harder to resolve the complicated symptoms of hypothyroidism…In a fascinating chapter, Shomon, who also has a Web site (http://thyroid.about.com [33]) and an online newsletter about the disease, explores recent evidence that the addition of the thyroid hormone T3 to the standard T4 (levothyroxine) may help some people feel better. In addition, the section on babies born with hypothyroidism, although brief, has the best advice on how to give medication to an infant that I’ve seen. As Shomon writes: ‘or years, thyroid problems have been downplayed, misunderstood and portrayed as unimportant.’ With her advocacy, perhaps no more.” –Shari Roan — Los Angeles Times, March 27, 2000
“If I could recommend only one book on thyroid problems for my patients, this would be it.” — Elizabeth Lee Vliet, M.D., Founder and Medical Director of HER Place Centers
“Vital for hypothryoid patients who want to get well, and for physicians who want to do so.” — Dr. John Lowe, Director of Research of the Fibromyalgia Research Foundation
Further Reading
Meaning and Interpretation of Medical Tests [34]
Thyroid Deficiency: Preventing a Metabolic Meltdown [35]
Thyroid Regulation [36]
Thyroid Deficiency [37]
Thyroid Blood Tests [30]
Obesity: Strategies to Fight a Rising Epidemic [40]
Thyroid Fast Facts [41]
A 7-Step Plan To Boost Your Low Thyroid And Metabolism [42]
The Colorado Thyroid Disease Prevalence Study [43]
These statements have not been evaluated by the Food and Drug Administration. The products mentioned in this post are not intended to diagnose, treat, cure or prevent any disease.
1 Comment To "40% of US Population May Have Hypothyroidism"
#1 Comment By Mr. D On July 31, 2009 @ 12:32 pm
My wife was suffering from what appeared to be hypothyroidism for over a year. Every early-AM fasting blood draw she went to for our primary care doc showed normal levels of TSH, T3 and T4. It wasn’t until her endocrinologist told her she could do a follow-up blood test any time of day that the low hormone levels appeared.
She got up that morning feeling OK, exercised a bit then volunteered at the school for a couple of hours – normal routine. By lunchtime, as usual, she was exhausted. It was then she went for the blood work. Two weeks later, the endo calls and says, “Your thyroid is failing. We’ve called in the synthroid script. Start it tomorrow!” After eight months on a low dose of synthroid, she is physically healthy.
I would think the TRH test would be the most accurate way to determine thyroid function but apparently nobody does it any more. Short of that, I would do what my wife did: wait until you are feeling ‘full-blown hypothyroid-ish’ then go have the blood work done.