Thyroid problems are so common I reckon if I could have a pound for every one I had identified, I would be a rich woman!
There are a ton of resources for you to read up on this. You can search for blog posts I've written over the years here, or just use the search on this site anyway, which will find them all for you. Here's one to start you off:
There is a good article here explaining the vagaries of thyroid testing:
And there are several useful forums to discuss thyroid issues. One of my faves is Thyroid Patient Advocacy in the UK. They provide good resources and advice.
In short, what you need to know is that it is very unlikely that a normal TSH/T4 test in mainstream medicine will diagnose a more hidden thyroid disorder. Sad, but so very true. I have lost count of the number of people who have been left with 'no problem found' and still feel completely on thier knees because of a thyroid disorder.
My own approach has been specifically to look for conversion problems - where someone shows enough TSH or T4 but it isn't converting into the active hormone - T3 - enough. Very common. See the iodine and selenium issues below - once you've identified this, it is relatively simple to solve and can save a lot of suffering!
Secondly, someone could be producing enough T3 but too much of it is being converted into Reverse T3, which is the inactive form of it. So, again, someone would look Ok but really hasn't got enough active hormone even though the surface situation on tests looks OK.
The third angle to look at is the autoimmune antibodies. If someone's thyroid has been identified with a problem, one of the major causes of that is autoimmune attack on the thyroid gland. Have your levels of peroxidase AND thyroglobulin been checked; often only one of them is and I have often found the other one high when I double-checked? Some docs do, some don't. I always check as sometimes it can be the only indicator of a developing problem - early identification means early heading it off! And you can. I regularly see antibodies reducing - just this morning, in fact. Always so nice to see.
The most common cause of autoimmune attack on the glands - adrenal or thyroid - in my clinical experience is a form of gluten related disorder - not necessarily coeliac disease. And PLEASE don't tell me you've had a coeliac test done and you were fine - this is another test that you simply cannot rely upon. See my Gluten Illness page for more on this and Gluten Tests here. In short, I have seen loads of people have seemingly intractable adrenal and thyroid issues helped by treating the gluten disorder. Don't shoot the messenger ;).
I have written quite a bit about the Thyroid-Gluten link on my specialist blog at TrulyGlutenFree so do search on there. Here's one post to start you off:
Finally, you need to consider what your adrenals are up to. I've touched on this more below for you, but so often a 'resistant' thyroid issue is hiding an underlying adrenal problem that has to be fixed first. I come across this quite a lot. Here is a blog post, for example, I wrote a while ago now but has some good tips for you on this:
I have written a full Adrenal & Thyroid Tests Overview on the shop for you and detail some of it here (there are more hints & tips etc there so do check it out fully).
Adrenal and thyroid glands are so interlinked and if one is having an issue, very likely so is the other. In most cases I come across, you have to treat the adrenal glands first before the thyroid will pick up so if your thyroid approach isn't currently working as it should be, then do bear that in mind.
There is, in fact, a whole chapter on thyroid and adrenal relationships (and higher up the chain - pituitary, hypothalamus and the connection with your steroid hormones oestrogen and progesterone too) in my Adrenal Plan which should help you understand these complexities a bit more and get a handle on what you need to do for your case.
I usually do the blood rather than urine because I often find antibodies and reverse T3 come up, which just don’t show in urine tests.
There is also now an Advanced Thyroid Test which includes the main Graves (hyperthyroid) thyroid antibody TRAb. It does all the same markers as the Thyroid Plus but also looks for hyperthyroid autoimmunity if you're not sure what yours is up to! Read the Adrenal and Thyroid Tests Overview for more on this.
You can also check your DI02 Deiodnase 2 Thyroid Gene for issues. This gene is responsible for the levels of T3 in the brain. T3 levels show fine in the body but these people tend not to do well on thyroxine treatment or need T3 with it even though their T3 body levels on tests look OK. You can read more about it here: DI02 Deiodinase 2 Gene Test.
First, start with the basal temperature test, which is the age-old way of finding hidden thyroid issues. Download the free factsheet on how to do it here.
When dealing with the thyroid, one thing crops up time after time and that is the need for iodine and selenium at different stages of the conversion processes.
Iodine and the Thyroid
The most suspect pattern here is if T4 is low with normal or high T3.
When I was trained, we didn't really do a lot about iodine deficiency at that time because it was assumed everyone had plenty. But that has not turned out to be the case in my clinical experience.
I started testing people for iodine deficiency using the Iodine Loading test about 8 years ago and it comes up positive a lot. There is then a protocol to use to correct it and retesting after 3-4 months usually shows not only has the iodine itself corrected, but so has the T4 if the iodine was a factor.
Anyway, I came across this really useful video on iodine recently which might be useful for you to watch. Some of the stuff he says is US rather than UK info, but it is all relevant. He likes the patch test; I find the loading test more accurate.
Have a look anyway. Iodine.
Symporter Iodine Transport Problem
A quick note on this one too. Some people can't transport the iodine to the receptors properly and, quite commonly, this is because the other halides that compete with it are too high: bromide and flouride. The best way to check this out is with a Halides Loading test. I've written a bit about this on the Nutrient Tests Overview and you can read a technical, if useful, factsheet on Symporter Transport Thyroid Problems here.
Selenium and the Thyroid
Selenium is specifically needed to convert the inactive T4 into the active T3. If you don't have enough of the selenium in the right place at the right time, it will impact your T3 levels. The most usual pattern to suspect is low T3 with normal TSH and T4.
The simple approach is to ensure enough selenium. You can check your levels using a Nutrient Test and I most often recommend checking all mineral levels if you can because one mineral deficiency can usually mean others are out too. For that, I would use the Toxic & Essential Elements test because it also looks for heavy metals, which we know can have a major impact on the thyroid. See all the Nutrients Tests here.
I've yet to write a full Thyroid Plan for you, but I have covered the adrenal-thyroid link and treatment quite comprehensively in the Adrenal Plan for you.
To be honest, thyroid treatment depends on what you find in tests. I'm not one of those who believes in a form of thyroid HRT unless absolutely necessary. Why? Because I have found that it is just too much for some people and, quite honestly, because identifying and correcting the following issues often renders it unnecessary. I'm not saying no-one needs HRT/thyroxine etc, of course they do - and it can be life-saving! - but I do wish people would consider these causes before going on lifelong medicine.
Correction of the iodine and selenium-based conversion problems are quite simple: correct the levels of the minerals, then re-test in 3 months to see what impact that is having. It might be only part of your answer, but often is enough to turn it around completely for you if that was the primary issue all along.
Quite often, actually, I have found in more mild cases certainly that giving a 'simple' thyroid boosting supplement is all that is needed. I have found the best are those that include the minerals and co-factors with tyrosine, the major co-factor for thyroid hormone production. In fact, I used to love it when people came in with thyroid problems because giving something like this usually helped a great deal - nice and simple (Ok, not always like that but often enough!).
This is a stronger booster type product that I rate - not with thyroxine please, of course - and here is the more standard version for longer-term use for you. Do work with your chosen health professional, of course.
Just one note: if you turn out to be grain sensitive (one of the gluten related disorders), you will need a TGF (trulyglutenfree) safe supplement so use the TGF Master List for specific safe supplements.
If you identify an adrenal problem, correct that first and sometimes that in itself is enough to trigger thyroid hormone production too, or it can open a doorway if you like for the thyroid hormone treatment to start getting in and doing some work. Use the Adrenal Plan here.
If you find an autoimmune issue, then it's a bit more complex. As I said above, the most common cause here is a gluten related disorder. Follow the Autoimmunity Protocol from the Gluten Plan - this will help whether it is gluten or not.
OK, of course it can be a lot more complex than that but actually I have found that the above approach to thyroid testing and treatment solves most issues. I hope it helps you, too. Good luck!
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