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Why Standard Thyroid Testing Doesn’t Tell the Whole Story

Your thyroid is a small organ with a huge impact on all aspects of your health. Thyroid hormone impacts every cell in your body, so even a small disturbance in thyroid hormone levels affects your digestive tract, brain, heart, metabolism, glucose, weight, energy, cholesterol levels, and much more.

Yet, despite its importance, thyroid problems are one of the most under-diagnosed conditions in the world. As many as 60% of people who have thyroid problems aren’t aware of it! By some estimates, up to one in 10 North Americans have a thyroid problem, and that number rises to one in eight for women. That’s a lot of people experiencing health issues that could be helped through naturopathic treatment!

picture of a woman's face and neck showing where her thyroid problem is located
Are you 1 in 8 who have a thyroid problem and don’t know it?

Symptoms of Low Thyroid Function or Hypothyroidism

For many people, low levels of thyroid hormone (a condition referred to as hypothyroidism) are the problem. Some of the symptoms of hypothyroidism include:

To further complicate matters, many thyroid treatments fall spectacularly short when it comes to improving a patient’s quality of life. Part of the problem is having inadequate diagnostic tools. Traditionally, conventional medical practitioners run two tests for thyroid hormone levels: one for Thyroid Stimulating Hormone (TSH) levels and one for the thyroid hormone thyroxine (free T4). Then they place patients on thyroid hormone replacement. In effect, this bypasses the thyroid and that doesn’t get to the root of the problem.

When blood tests show a dip in thyroid hormone levels, thyroid hormone replacement therapy drugs such as levothyroxine, are very commonly prescribed.

Growing evidence suggests thyroid hormone replacement is over-prescribed, and may even increase a patient’s risk of mortality.

Those that clearly have low thyroid levels (hypothyroidism) benefit from this medical treatment, however, the problem may lie in those who may have only a few, mild symptoms of hypothyroidism and come back with borderline test results, known as subclinical hypothyroidism. This may occur in older adults in particular.

Studies show that people aged 65 and over who have been given thyroid replacement therapy have an increased risk of death. Due to the many changes that naturally begin to occur in older adults such as sleep changes and increased inflammation, natural dips in thyroid levels may occur. Thyroid replacement medication in these cases may not be necessary and if taken may override said changes, therefore causing further complications.

Why thyroid medication may not be the best solution

Focusing solely on levels of TSH and T4, and then replacing thyroid hormone, ignores the fact that the most common cause of hypothyroidism is actually an autoimmune disease called Hashimoto’s. When someone experiences Hashimoto’s, their immune system erroneously attacks their thyroid, leading to damage to the tissue and a reduction in thyroid hormone secretion.

We haven’t yet determined the cause of autoimmune diseases, although evidence suggests genetic factors, inflammation, certain medications, and stress can all contribute. As well, studies have found possible connections between “leaky gut” syndrome, or increased gut permeability, and the autoimmune system.

Because of the vague causes for autoimmune disorders, traditional medicine tends to treat just the symptoms, without taking a holistic approach to address overall health. This is particularly true for Hashimoto’s, which is problematic. Without proper treatment, the immune system will continue to attack the thyroid gland, making it increasingly difficult to treat without addressing the autoimmune response. Once one autoimmune condition crops up, others may follow if you don’t address the underlying cause.

The problem with thyroid testing

As you can see, thyroid problems and treatments are much more complex than simply trying to fix a shortage of hormones as determined from testing TSH and T4. For better results, and a more holistic treatment plan, patients need more comprehensive assessments. Below are five causes of thyroid problems that won’t be detected by standard tests.

Pituitary problems

The production of thyroid hormone is controlled by a gland at the base of the brain called the pituitary gland, which releases TSH. Elevated cortisol levels can damage the pituitary gland, which in turn reduces the amount of TSH, and consequently the amount of thyroid hormone (free T4).

Poor conversion of T4 to T3

In order to be used by your body, T4 must be converted to another hormone, triiodothyronine, commonly called T3. If this process doesn’t run smoothly, your body won’t have its optimum amount of T3, even if your T4 test results look good. An excess of the stress hormone cortisol in your body can impact this process.

High TBG levels

Thyroid hormone travels through your bloodstream thanks to a protein called Thyroxine Binding Globulin (TBG). High TBG levels can lower the amount of active thyroid hormone since T4 is inactive when bound to TBG. Excess estrogen can result in elevated TBG levels, which can lead to hypothyroidism, even if the results of the traditional tests are within the normal range.

Low TBG levels

Paradoxically, low TBG levels can also lead to hypothyroidism. That’s because low levels result in an excess of free T4 in the blood, which causes cells to develop resistance. The result is hypothyroidism since, although there is enough thyroid hormone in the blood, the body’s cells aren’t receptive to it. Common causes of low TBG levels include high testosterone levels and insulin resistance.

Thyroid resistance

The receptors in your cells can be damaged by high levels of T4 or T3, or high levels of cortisol. As well, chronic stress can lead to HPA axis dysfunction, which is also harmful.

Optimum thyroid performance depends on a tightly woven interplay of processes, and, as shown above, just one imbalance can throw the whole thing off.

Traditional tests aren’t always going to recognize the various factors that contribute to thyroid problems. If you want to take a deeper dive into your thyroid health, give me a call at 416-481-0222!

By Dr. Pamela Frank, ND

Thyroid Testing Information Sources

Stoll K. Disparities in Thyroid Screening and Medication Use in Quebec, Canada. Health Equity. 2019;3(1):328-335. Published 2019 Jul 11. doi:10.1089/heq.2018.0051

Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017;8:598. Published 2017 May 23. doi:10.3389/fimmu.2017.00598

Stratakis CA, Chrousos GP. Neuroendocrinology and pathophysiology of the stress system. Ann N Y Acad Sci. 1995 Dec 29;771:1-18. doi: 10.1111/j.1749-6632.1995.tb44666.x. PMID: 8597390.

Bernadette Biondi, David S. Cooper, The Clinical Significance of Subclinical Thyroid Dysfunction, Endocrine Reviews, Volume 29, Issue 1, 1 February 2008, Pages 76–131,

Enoch Joseph Abbey, MD, MPH, Eleanor M Simonsick, PhD, John McGready, PhD, Jennifer Sophie Mammen, MD,PHD, OR18-05 Thyroid Hormone Use and Survival among Older Adults – Longitudinal Analysis of the Baltimore Longitudinal Study of Aging (BLSA), Journal of the Endocrine Society, Volume 4, Issue Supplement_1, April-May 2020, OR18–05,

Picture of Toronto Naturopath Doctor Dr. Pamela Frank, Best Naturopath in Toronto many times over
Dr. Pamela Frank, BSc(Hons), Naturopathic Doctor

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.

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