Thyroid Thursday Episode 21: Tissue Hypothyroidism – It’s Not About the Gland
Today I want to talk about the difference between glandular and tissue hypothyroidism and when we talk about the difference between tissue and glandular hypothyroidism, we then have to talk about the difference between the functional medicine approach and the traditional medicine approach because they differ greatly on the labs we do, our concern about symptoms, history, and what the eventual treatment winds up being. So, let me back up a little bit and let me talk about the difference between tissue and glandular hypothyroidism.
Tissue hypothyroidism is when the tissues, the peripheral tissues; the skin cells, the muscle cells, the brain cells, all the peripheral tissues of the body away from the thyroid gland aren’t getting sufficient thyroid hormone to run their metabolism, and as a result of that, that’s why someone feels hypothyroid symptoms. It’s not the result of the gland going bad. I mean, eventually if the gland can’t make enough thyroid hormone then there won’t be enough circulating and it can’t get into the tissues, but ultimately the symptoms don’t occur because the gland doesn’t make enough thyroid hormone because if you give somebody a thyroid hormone, sometimes you can alleviate their symptoms even though the gland can’t make it.
Hypothyroid symptoms are the result of poor thyroid hormone levels or insufficient thyroid hormone levels at the tissue or cellular level and so there’s a big disconnect here between having the symptoms and having a dysfunctional gland. When the gland can’t make enough thyroid hormone, that’s what I call glandular hypothyroidism. The gland has become diseased, dysfunctional and it can’t make enough T4 and T3, and when it can’t make enough T4 and T3 to support the pituitary gland, which is what TSH represents, the saturation of T3 of your pituitary gland, then your TSH levels will start to go up and you’ll often see the T4 low.
When you see a medical doctor or an endocrinologist, what they’re looking for is glandular hypothyroidism, or disease or dysfunction of the gland. When you see a functional medicine practitioner like myself, what we’re concerned about is the earlier stage which is tissue hypothyroidism – is the patient experiencing symptoms of reduced thyroid hormone to their peripheral tissues. If they are, we need to intervene, we need to figure out why, and we need to help that person.
Now, hypothyroidism doesn’t start when the gland goes bad. Just like a cavity doesn’t start when your tooth hurts, or cardiovascular disease doesn’t start when you have the fatal heart attack. Those are processes that occur over days, weeks, months or years and the end effect is the cavity, the end effect is the heart attack or the stroke, or whatever the disease process becomes or the result of the disease process.
The same is true for hypothyroidism. Hypothyroidism starts at a cellular level. The gland can be working great. There can be plenty of T4 and T3 in your blood stream but hypothyroid symptoms are the result of decreased T4 and T3 getting into your peripheral cells to run your metabolism. So, everything can look good, all your labs can look good, but you can still have symptoms and symptoms start before the gland goes bad.
The difference between what your primary care or your medical endocrinologist are looking for is they are traditionally waiting to help you until the gland becomes dysfunctional and diseased. The problem with that is that you may struggle with hypothyroid symptoms for years before the gland actually goes bad.
The difference between the treatment is when we look at symptoms. Ultimately I’m concerned about symptoms because if you have the symptoms of hypothyroidism that we classically see when you do a Google search; you’ve got fatigue, you’ve got unexpected weight gain, you’ve got dry skin, you’ve got poor circulation, your hair is starting to thin, you’re depressed, you have low thyroid hormone in your tissues. You could have any number of symptoms that are classified as poor thyroid physiology, those concern me, but not only do those symptoms concern me but every secondary symptom or other complaints you have concern me as well.
From a medical model, they may be concerned about the symptoms but if your TSH and T4 values are normal, which are typically the only labs that are run, they may say that those symptoms are caused by other things, and they could be. But, the most likely cause of all of those symptoms is poor thyroid hormone at the cellular level. Unfortunately, due to insurance reasons and the standards of practice which are based on old models, there really is no treatment for tissue hypothyroidism in a medical model. They only typically start treatment when the gland finally becomes dysfunctional, when it finally becomes diseased enough that it can’t produce enough thyroid hormone to support the pituitary gland.
If we take a look at labs in a traditional medical model, they’ll typically only run a TSH and T4 and if the TSH is normal, maybe no other testing is done and they’re assuming that as long as TSH is normal that all the downstream steps of getting thyroid hormone into the cells must work as the gland is working to make enough. Well, that just doesn’t pan out. Most of you who are struggling with hypothyroid symptoms already know that because you can have plenty of thyroid hormone being produced but if it doesn’t get into the cells, you’re going to have symptoms, just like you could have plenty of gas in your car but if there’s a problem with the gas getting from the gas tank to the engine or you’re missing sparkplugs or you don’t turn on the ignition, the car’s not going anywhere, so they’re really concerned just about TSH and T4.
In a functional model, especially in my practice, we run a more comprehensive thyroid panel. We typically run a TSH and T4, a T3, a free T4, a free T3, reverse T3, T3 uptake, and thyroid antibodies. Not only do I want to do a comprehensive thyroid panel but I also want to run a comprehensive metabolic panel because I want to not just know that the person has tissue hypothyroidism or cellular hypothyroidism, I also want to see by looking at a more comprehensive blood panel what are the reasons why they may have that in the first place. One of the leading causes of decreased thyroid hormone transport into the peripheral tissues is inflammation. If nobody runs inflammatory markers, how would you know? That’s why I like to run a more comprehensive panel.
I also want to know your story. So many people go to a doctors’ office and just don’t think about writing down a good history on themselves, and many doctors’ don’t do a good history on a patient. But when we’re looking to find the underlying cause of your tissue hypothyroidism or cellular hypothyroidism, or even the reason that the thyroid gland has become dysfunctional, we need to understand your story from as far back as you can remember. Your history tells us, especially in a functional model, why you most likely have the problems you have, and without that story, we’re missing a big piece of what’s creating your problems. So, it’s critically important to me what your life story has been so that I can understand the life stressors that have created the person that I’m trying to help.
Lastly when we talk about treatment, in a traditional model, the treatment typically doesn’t occur until TSH levels go up and T4 levels come down and go below lab range, and at that point, you may have struggled with hypothyroid symptoms for years and years. Typically, it’s a T4 supplement or a medication that’s typically provided and sometimes some doctors who are a little bit more progressive may recommend a T3 support or a combination T4/T3 support.
In a functional model, not only do we think that thyroid hormone support may be important but a lot of times, we don’t want to just flood the system with thyroid hormone support but we want to understand the mechanisms that cause the cellular or tissue hypothyroidism to begin with. And, we also want to make sure that we address the factors that were decreasing transport into the cells or what other factors may have caused the thyroid gland to become dysfunctional in the first place. Which is why we want to do a more comprehensive workup.
The medical or traditional model is a little easier. There’s not a really big concern as to why the gland is becoming dysfunctional, just the fact that you can’t make thyroid hormone so we’re just going to give it to you and that’s going to be good enough. In a functional medicine model, we want to know why the gland became dysfunctional, why you couldn’t get thyroid hormone into your tissues, why you were over-converting to something called reverse T3 or wasted thyroid hormones, and how do we go about fixing that.
So, I hope that helps you understand the difference between tissue and glandular hypothyroidism, the difference between traditional and functional medicine when it comes in regard to trying to help somebody with hypothyroid symptoms from a detection standpoint and from a treatment standpoint. If you have some questions, there should be a button below where you can request a complimentary consultation over my lunch breaks but if you’re ready to get started, you’re looking for this non-traditional approach but a more comprehensive look at why you may have your hypothyroid symptoms or you really start to resonate with what I’m explaining with regards to a tissue thyroid problem versus this glandular issue that most medical doctors are working towards then call my office at 610 558 8920, schedule an appointment.
My staff will handle everything with you to get all of your information so that we can sit down, go over your history, understand your story, look at what treatments you’ve had to date, what other medications you’re taking, and I can unravel this web of dysfunction that’s going on so we can come up with a strategy to help you improve your thyroid physiology, to improve thyroid hormone getting into your peripheral cells so that your symptoms improve, you feel better and you get your quality of life back.
Look forward to another video in the coming weeks.
