Thyroid Hormones Are Crucial To Life Itself!  

Even if you no longer have a thyroid, you need thyroid hormones every day for many functions in your body. The key is to get the level of your hormones just right, specifically for you and your individual needs.

It’s important to understand that the “normal” lab reference ranges are calculated from a compilation of everyone who gets lab work, not just healthy people.  When you think about it, it’s usually sick people who go to the doctor and end up getting their blood drawn.  So, these “normal” lab numbers are more of a range for the total population, including lots of sick people.  Keep that in mind when you look at your thyroid blood lab results.


Which Thyroid Lab Tests Do You Need To Get For Optimal Health?

If you want to achieve optimal health without a thyroid, or with an under performing thyroid, you will want to get tested for all of the following:

  1.  TSH

TSH (Thyroid Stimulating Hormone) is actually produced by your pituitary gland, not your thyroid.  Usually, once you have had surgery to remove your thyroid due to thyroid cancer, the aim is to keep your TSH low.  This is because the TSH stimulates the production of thyroid hormone (it is like a “fertilizer” for your thyroid), and as such it helps thyroid cells to survive and to grow.  This is usually a good thing. But after you have thyroid cancer, and had your thyroid surgically removed, you will need thyroid hormone replacement medication, in the form of a pill, for the remainder of your life.  If there are any thyroid cancer cells left remaining in your body, (for instance in some of your lymph nodes,) then you definitely don’t want anything to encourage them to grow!

The goal is for those cancer cells to remain dormant, so as not to cause any future issues, so you don’t want to douse them with too much TSH “fertilizer”.   Instead, you want to intentionally keep your TSH level low, and this is accomplished by increasing your thyroid hormone replacement medication to a point where your pituitary registers that there is enough thyroid hormone, so it doesn’t activate the production of any more TSH.   You want your T3 and T4 levels to be slightly above the normal range, which will end up with your TSH being on the low side.  (It’s important not to become hyperthyroid, though, so it is a tricky situation that must be watched carefully by an experienced  practitioner.)  There’s a downside to having this low TSH, however:  This can start your bones to thin out and cause possible osteoporosis, and this causes weak bones that are prone to fracture.  Also, atrial fibrillation is a risk with too much thyroid medication.  One step you can take in this regard is to have enough Magnesium in your diet, which is essential for preserving your bones, and for heart health.

  1.  T4, Free T4 and Total T4  (Which test is best?)

T4 is the main thyroid hormone released into your bloodstream and several other areas in your body.  The T4 levels in your blood will tend to change slowly, and it’s helpful to know that T4 has a “half life” of about a week.  For those who don’t have a thyroid, as well as for everyone else, it’s advisable to take your T4 medication on an empty stomach, because T4 can bind to things that are in your gut when you ingest the medication (for instance, iron and calcium), and therefore the medication can’t get fully absorbed.  Consider nutrient absorption inefficiencies if your medication is not working as well as you feel it should.  Functional lab testing for malabsorption can be very helpful in this respect.

Most of your T4 is bound in your blood to a protein called Thyroid Binding Globulin.  Only a small amount of your T4 is free, and this Free T4 affects the tissue functions in your body, whereas the bound T4 does not.

Total T4 includes both bound and unbound (free) hormone. Free T4 is a more accurate read.  Free T4 is typically elevated if you are hyperthyroid, and you will find it too low if you are hypothyroid. Free T4 represents the level of hormone available for uptake, and therefore the level that is used by your cells.

  1.  T3 and Free T3

T3 (triiodothyronine) affects almost every physiological process in your body.  Usually, low T3 isn’t actually caused by a malfunctioning thyroid (and when you have no thyroid, there is all the more reason to have concerns with low T3.).  When something is off in your Hypothalamus-Pituitary-Adrenal Axis (HPA axis),  situations can arise that result in inflammation.  Sometimes your body cannot convert T4 into the usable thyroid hormone form of T3.  In this case, supplemental T3 can be helpful.

T4 is considered by your body as a storage hormone, and it is meant to be converted into T3.  This happens through the process of T4 losing one atom of iodine, and thus converting T4 into usable T3.  This important conversion happens in several areas of your body in addition to your thyroid;  It is also converted in your liver, your gut, your bones and your brain.

Your body really needs an optimal amount of T3 (it’s like the accelerator in the “engine” of your body).  Your Free T3 levels may be in “normal” range, but that does not mean they are optimal.  Get your T3 tested, and check your results – it should be in the upper quarter of the “normal” range.

  1.  Reverse T3

Reverse T3  (RT3) is like the brakes in the “engine” of your body.  Your body puts the brakes on the conversion of T4 to T3 if there is too much T3 being made.  If you have elevated reverse T3, you can experience a slower metabolism, constant weight gain without changing your eating habits, crushing fatigue, hypothyroid symptoms, chronic pain, depression, and anxiety.  Fortunately, some people with these symptoms report feeling much better once on T3 supplementation.

In addition to inadequate treatment, another cause of too much Reverse T3 can be attributed to chronic stress, where high Cortisol inhibits the conversion of T4 to T3 and instead favors the conversion of T4 into Reverse T3.

Insufficient iron levels can prevent your blood from being able to move your thyroid hormones throughout your body.  Chronic inflammation like Lyme disease, infections, parasites, physical injury, diabetes, calorie restriction, illnesses, liver cirrhosis, and heavy metals, all can contribute to an increase in Reverse T3.

Bottom line — too much RT3 means you are hypothyroid.

  1.  Thyroid Antibodies

You may have thyroid antibodies, even if you no longer have a thyroid.  Once your body starts creating antibodies to your thyroid, which could have started back when you still had a thyroid, and your body began a silent attack on your thyroid, believing it was “foreign”.  If your thyroid is gone now, you will still have those antibodies, and your immune system will choose a different area to attack.  Although this may seem like your body has gone haywire, this is all part of your body’s innate intelligence to survive.

Thyroid Peroxidase Antibodies (TPO Ab) can indicate a thyroid related autoimmune disease, such as Hashimoto’s Thyroiditis.  This is when proteins that are made by the immune system, and whose purpose is to bind to foreign substances so that they can be eliminated, bind instead to thyroid cells.  This starts the progression of thyroid autoimmunity.

Thyroglobulin Antibodies (Tg Ab) testing looks for antibodies made in your body that target a protein in the thyroid known as thyroglobulin.  Usually, elevated TgAb is evidence of autoimmune thyroid disease, such as Hashimoto’s Thyroiditis.   The presence of some antibodies is healthy and normal, since every human makes antibodies to cell tissue when your old tissue cells die, and your immune system tags these cells for destruction since they are no longer needed.  In thyroid autoimmunity, the antibodies start to tag healthy thyroid cells instead, and this begins the autoimmunity process.

If you do get tested and you have either of these antibodies (TPO Antibodies or TgAb), there are ways to improve your situation, even though you cannot be “cured” from the autoimmunity.  For instance, you can avoid gluten and dairy which have been identified as triggers to increased autoimmunity.  You can work with a skilled practitioner who can help you work out a healthy and beneficial food plan personalized just for you.

If you’ve had your thyroid gland removed, you want to make sure you are optimizing your hormones.  You may not feel your best on a certain medication, like levothyroxine, or any other T4-only medication.  You may benefit from a natural dessicated thyroid medication such as Armour, Naturethroid, WP Thyroid, or a medication made specifically for you from a compound pharmacy.  It’s important to get what you need, to make sure you are on the appropriate type of thyroid hormones for you.

Which is the best thyroid medication for you?

Types of supplemental medications used to reduce or treat the symptoms of your hypothyroidism can include:

  1.  Levothyroxine, which is the number one prescribed medication in the world as of this writing.  It is also known as Synthroid, Levothroid, Levoxyl, and Eltroxin, as well as many other names and formulations throughout the world.  This T4 – only medication is referred to as the “gold standard” among endocrinologists and other medical doctors.  It’s important to note for those with sensitivities that this medication (as Synthroid) contains corn starch and lactose.
  1.  Tirosint, which is a liquid inside a gel capsule, contains only 4 ingredients: levothyroxine, gelatin, glycerine and water.  There are no sugar, dyes, alcohol, gluten, lactose, or any other additives that can interfere with how your medication works, and therefore how you feel.
  1.  T3 (liothyronine), is best known as Cytomel, which is a synthetic T3 drug, and can be individualized by utilizing a compounding pharmacy, where they can even make this medication be time released. This medication usually contains modified food starch, as a filler, which means it contains gluten. A compounding pharmacy can eliminate this portion of the medication for those wishing to avoid gluten.
  1.  Natural Dessicated Thyroid (NDT), developed from the dried thyroid gland of animals, contains both T4 and T3, plus other elements found in a natural thyroid gland.  It is most popularly recognized as Armour (which, keep in mind for sensitivities, may contain dextrose and methylcellulose).  A compounding pharmacy will usually use this formulation or something close to it when creating your formulation, unless specified differently.  In addition to Armour, there is also Naturethroid, Westhroid, NP Thyroid, Thyrogen, Thyrolar, and generic NDT.   It’s important to note that even on Natural Dessicated Thyroid,  some people feel great, whereas others feel worse.
  1.  Another alternative is to go to a compounding pharmacy and have them create an individualized T4-T3 product made specifically for your needs.  The drawbacks to this option are the expense, and the need for the product to be refrigerated.  The benefits include the fact that it can be made without fillers, and essentially made from scratch, and it can help when other medication formulations have not helped.

If you have a problem converting T4 to T3, then Synthroid or other T4 medication is not going to be the best choice for you.  You will need to find out WHY are you not converting.  You may need a bioidentical hormone combination of T4 and T3, or at least a synthetic T3 that you can add to your T4 medication.  Inflammation is always something to consider and work towards reducing.  Also of importance is to look for an elevation of testosterone or estrogen, which will affect the level of your circulating free thyroid hormone.  For example, estrogen will increase the levels of thyroid binding protein, and if your hormone is bound to this protein, it will remain inactive.  Antibiotics and antifungals can also interfere with the absorption of T4.  It’s best to check with your pharmacy when you pick up your prescription to see if any other medications you are taking will block the absorption of your thyroid medication.

As far as nutritional support, try adding more essential fatty acids, in foods such as flax, dark leafy greens, olive oil, eggs, walnuts and almonds.  Remember to avoid raw goitrogens, but lightly cooked goitrogens are good for you and should be eaten regularly.  Also avoid the following foods in the raw state only (again, cooked is ok and beneficial!): unfermented soy, cassava, millet, mustard, and turnips.

Thyroid Optimization In Summary

Many endocrinologists offer great advice, but really have only the time and the skills to deal with the medical part of your thyroid situation.  They are less able to deal with the other issues that come hand in hand with a thyroid cancer diagnosis.  Psychological challenges, as well as the confusing maze of food and lifestyle protocols, will require the help of an experienced and compassionate health and wellness practitioner. Your motivation to get well and your self worth will help you decide how much time and money you should invest in your future wellness.  Sometimes you will have to go outside the realm of insurance and pay out-of-pocket for certain tests or practitioners.  Like everything else in life, you will need to weigh the benefits vs. the cost.  As a Functional Diagnostic Nutrition® Practitioner, I am fully trained in how to help you, and I have the compassion and understanding you are looking for.  If you would like to have a complimentary session to find out what I can do to help you, please sign up at the following link:

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