There are a few things at play when this is going on:

1. You haven’t figured out or addressed the root cause of your thyroid dysfunction.
2. Your doctor gave you medication but no guidance on the lifestyle changes needed to thrive.
3. Your labs are incomplete or are based on sub-optimal numbers (also known as conventional ranges that are - unfortunately - the standard of care).

This particular episode is going to focus in on that last one, but let’s chat about the first two briefly.

1. You haven’t figured out or addressed the root cause of your thyroid dysfunction.

The body is incredibly intelligent. It doesn’t just stop working for no reason.

A hypothyroid diagnosis is a downstream effect of an upstream problem. Think about it like there’s an oil leak upstream, the doctor is down at the bottom of the stream going, “yep, you have an oil problem, here’s a bucket to just keep scooping it out of the water.”

But oil still is going to be in the water until you scoop it out. Read: symptoms.

On the other hand if you go upstream and stop the leak, we stop the problem at the source. For some people this means they’re able to actually get off their thyroid medication completely.

Others have too much damage to their thyroid from the autoimmune disease hashimoto’s to ever fully come off their medication. But even for them, the stream is cleaner and they can go back to at least feeling like themselves again.

What are the potential root causes of hypothyroidism? There are many.

But the most common ones I’ve seen in my practice are gut dysbiosis and leaky gut, a high toxic load (meaning the liver is overburdened), chronic stress, infections, and food sensitivities.

If you want to find out your specific root cause, you can head here for more information on how I help my hypothyroid clients and to fill out a consultation form (it’s totally free). But basically I combine an in depth health history, a symptoms score card, and functional lab work to give my clients answers and a clear path forward.

2. Your doctor gave you medication but no guidance on the lifestyle changes needed to thrive.

Again this goes back to our stream analogy. The thyroid medication is the bucket you’re using to scoop out the oil, but it’s the lifestyle changes that are going to actually fix the leak.

As a bonus for my Club members who are listening to this, I’m going to share the 3 lifestyle changes that I made that completely fixed the chronic fatigue, stubborn weight, and digestive issues that my thyroid medication did nothing for.

3. Your labs are incomplete or are based on sub-optimal numbers (also known as conventional ranges that are - unfortunately - the standard of care).

Most doctors start by testing only TSH, and only if that number is off will they test T3 and T4. And usually that’s where they stop. This is borderline medical negligence in my book.

I’ll explain why in a minute, but first I want you to have an idea of what a full thyroid panel should include, what the lab markers mean, and what the optimal ranges of those lab markers are.

Note: Conventional ranges are based on population averages (including sick people). Optimal ranges represent optimal health and are much more narrow. Sadly you’ll be hard pressed to find a doctor who takes optimal ranges into account.

TSH:

This is your thyroid stimulating hormone and it’s like the gas gauge in your car. When there isn’t enough T4 in the bloodstream, your pituitary registers that and releases TSH to let the thyroid know it needs to produce more hormones.

Conventional Range: 0.35-5.5 mIU/L (milli-international units per liter)
Optimal Range: 1-2 mIU/L

Free T4:

Think about this like the driver turning the engine on, getting your body ready to go… but you’re not going anywhere yet. It’s mostly inactive and has to be converted into T3 to become active.

We prioritize free T4 over total T4 because most of the T4 that’s produced is bound to proteins, making it unable to enter into the cell and perform its function. Free T4 is what’s actually available for the cells to use.

Conventional Range: 0.7-2.4 ng/dL (nanograms/deciliter)
Optimal Range: >1.25 ng/dL

Free T3:

This is like the gas pedal that actually gets your car from a to b. It’s the active form of thyroid hormones. It’s converted from T4 mainly in the liver and gut.

Conventional Range: 2.3-4.2 ng/dL
Optimal Range: >3.2 ng/dL

Reverse T3 (optional):

If Free T3 is the gas pedal, reverse T3 is the brakes. It blocks thyroid receptors and slows down thyroid function. You may wonder why we even have reverse T3; as is the case with most mechanisms in our body… it’s there for survival.

When your thyroid is humming along producing enough T3 to power your body, your metabolism is revved up. During times of famine, you would want your metabolism to slow down so you could hold onto more of the calories you consume.

These days reverse T3 can be triggered by inflammation, gut dysbiosis, restrictive dieting, too much fasting, and infections, just to name a few.

Conventional Range: 9-25 ng/dL
Optimal Range: <15 ng/dL

TPO Antibodies:

These are the antibodies your immune system produces when it starts to see your thyroid tissue as an enemy it needs to fight against. Think of these and your thyroglobulin antibodies (see below) as emergency lights, signaling that something is wrong in the body.

Conventional Range: <35 IU/mL (international units per milliliter)
Optimal Range: <10 IU/mL

Thyroglobulin Antibodies:

These are the antibodies your immune system produces when it starts to see your thyroid tissue as an enemy it needs to fight against. Think of these and your TPO antibodies (see above) as emergency lights, signaling that something is wrong in the body.

Conventional Range: <1 IU/mL
Optimal Range: <1 IU/mL

So back to the incomplete testing most of us experience. You’ll be lucky if your doctor tests you for TSH, free T3, and free T4, let alone antibodies and reverse T3.

I can’t explain how much of a disservice this is to us as thyroid patients. (It’s an even bigger disservice to those who are dismissed before getting to the labs that would show they have a thyroid problem.)

There are multiple scenarios where only testing TSH, free T3, and free T4 - or worse, testing only TSH - could have you missing a glaring problem with your thyroid.

1. Over 90% of hypothyroid cases are caused by the autoimmune disease Hashimoto’s where the body attacks and destroys thyroid tissue.

If we tested antibodies at the beginning, we could potentially catch the autoimmune attack before enough damage occurred to affect your other thyroid markers. Imagine if we did that, you might be able to stop the autoimmune response early on, preventing you from ever even developing hypothyroidism.

2. You could have a conversion issue.

Maybe your thyroid produces enough T4 and therefore your pituitary produces enough TSH, causing your doctor to say you’re fine.

But what if you have issues in the liver, the gut, or you have hashimotos making it harder for your body to convert T4 into T3 (the active hormone that actually makes you feel better). You would never know if your doctor stopped at a TSH test.

A similar situation happened to a client of mine. While she already was diagnosed hypothyroid and hashimoto’s, her doctor had her on levothyroxine (which only contains T4).

But in looking at her labs, while her T4 was doing ok her T3 was quite low, indicating a potential conversion issue. So while we worked on her gut and liver health to help with the conversion, I told her to ask her doctor about switching to a combination T3/T4 medication. She did and the numbers speak for themselves:

Or maybe your TSH, free T3, and free T4 all come back normal, but your body is also producing too much reverse T3, rendering the T3 you do have useless.

All of these scenarios end the same way: you being led to believe you’re crazy for feeling like crap. I literally had a client recently tell me that when she told her doctor the symptoms she was experiencing despite being on medication her doctor told her to just go to a therapist.

It’s enough to make your blood boil.

This is why I wanted to write this episode. We all know knowledge is power and I want you to have the knowledge and the power to have informed conversations with your doctor, to walk away when someone is dismissive, and better understand your body and your condition so you can make the right decisions for yourself and your health.

Now to be fair, while I absolutely can blame doctors for not giving comprehensive enough tests and for settling for conventional ranges, I really can’t blame them for not working to get to the root cause or for not teaching people the lifestyle changes they need to make for their condition. They simply weren’t trained for it.

It would be like asking a heart surgeon to fix your broken bone, that’s not their specialty.

Which is why the most successful hypothyroid cases I know (myself included) includes both a medical provider they trust for labs and medication and a functional nutrition practitioner who can guide them on the other stuff.

If you’re looking for the latter, I would love to be on your team and support you in living symptom free.

But of course we both want to make sure we’re the right fit. To do that again just go to katspangler.com/functionalnutrition and fill out the form to set up a complimentary consultation and we’ll take it from there!

------------------------------------