Thyroid Thursday Episode 56: Thyroid Allostasis and TSH
Hi everybody, it’s Dr. Eric Balcavage. We’re back for another edition of Thyroid Thursday. Today I want to talk about TSH again. I’ve been beating this drum, but TSH is not a valid marker of thyroid physiology in the body. I talk about cellular hypothyroidism and the fact that lack of thyroid hormone in the cells is really what triggers the symptoms, and you can have this cellular hypothyroid state going on, even though the gland is working fine. This is why people can have fatigue, have all the hypothyroid symptoms, they go to their primary care physician or an endocrinologist with all the symptoms of hypothyroidism, and they’re told that their thyroid gland is fine, they don’t have a hypothyroid condition because their TSH levels are normal or low.
What most conventional medicine doctors, including endocrinologists, are looking for is thyroid disease, but symptoms don’t necessarily occur when there’s glandular disease. They occur because we’re getting insufficient thyroid hormone into the system. This paper in 2017 on thyroid allostasis in Frontiers in Endocrinology talks all about what I’ve been talking about int the last 50-some videos. That different stresses and strains on the body create changes in thyroid physiology that can occur in the absence of glandular disease. You do not have to have damage or disease to your thyroid gland, and you can still have changes in thyroid physiology, which is why a comprehensive thyroid panel is important and why we just can’t use TSH to evaluate somebody’s thyroid hormone state.
We can’t even just use it as a marker of thyroid hormone disease because in strained states where we have different stresses and strains on the body, TSH levels can be modified or can adapt or change as the result of these stressors in the absence of disease. In unstrained situations where there’s no stress, no strain on the body, the body’s at rest, there’s no major challenges going on, you could use TSH as in indicator of thyroid disease, but that’s really not who’s coming to see most doctors. Most of the people that are coming to see us are people who are chronically stressed, chronically strained, and have chronic healthcare problems. This is another reason why we just can’t use TSH only as an indicator of thyroid hormone physiology, and we can’t always use it as an indicator of thyroid disease.
A couple questions answered.
- Is TSH a valid marker of thyroid hormone physiology in the body? The answer continues to be no, and it’s expressed again in this paper.
- Is TSH a valid marker of thyroid disease, which is what most conventional medicine doctors are looking for? The answer is, it depends. If you’re in an unstrained situation; you’re at rest, you have no major stress or strain on the body, no physical stress, no chemical stress, no emotional stress, no microbial stress, then yes, TSH may be a good indicator that if it’s elevated or low out of lab range, that you may have thyroid disease. But, most of us aren’t going to doctors feeling fantastic, feeling great, and having unstressed or unstrained conditions. It is not necessarily a valid marker when you have stressed or strained situations.
What are those types of situations? They’re things I’ve talked about in the past; physical stress, chemical stress, emotional stress, or microbial stress. In this paper, they talk about starvation, exhausted, physical exercise, depression, pregnancy, obesity, endurance exercise, cold adaptation, and post traumatic stress, emotional stressors can all drive TSH to vary and thyroid hormone levels to vary in the absence of glandular disease. These are the type of people who may have TSH elevations or normal TSH and be told there’s nothing really wrong with them, and yet they have low thyroid hormone and the symptoms. They don’t have glandular disease. They don’t necessarily need a thyroid hormone support. You have to get to these root things that are triggering the change in physiology.
In this paper they say that concentrations of thyroid hormones maybe altered in other physiologic and pathologic situations in the absence of any dysfunction of the thyrotrophic control system, the thyroid gland and what helps make thyroid hormones, or any of its elements. Explaining this, it says that thyroid can work fine, the gland itself, but the thyroid hormone regulation beyond the gland can be altered. I.e. what we call decreased thyroid hormone in cells, or cellular hypothyroidism. This is what drives symptoms.
TSH in strained situations could be high, could be low, it could be normal. The gland may not be diseased at that point, but you may be symptomatic. What we have to do is look at the person’s history, we have to look at the stressors in their life, we have to look at a full, comprehensive lab panel, and we have to look at other indications of stress on the body. A comprehensive metabolic panel, maybe a GI stool test. All the testing that needs to be done to identify the stressors is really based on your timeline, on your history, and that’s what a good physician should help you identify.
Today’s Thyroid Thursday is on TSH and thyroid allostasis, and the question I was asking and answering is, is TSH a valid indicator of thyroid hormone physiology in the body? No. Is TSH a valid indicator of thyroid disease? Maybe. It depends on your state. If you’re under stress and strain in your body and your life, then no, it’s not a good indicator of thyroid disease because those values may shift as a normal mechanism of something called allostasis, the body’s adaptation process to try and regain a normal physiology in the body.
If you’re in an unstrained state where there’s no stress on your body, no stress in your life, then yes, it may be an indicator of thyroid disease, but that’s not when most people are going to the doctor. Most people are coming to the doctor already symptomatic, already struggling with challenges, dry skin, fatigue, brain fog, and not feeling well. They’re already under stress with chronic inflammatory conditions. Hopefully this one helped. This is TSH thyroid allostasis. Is TSH a good valid marker for thyroid hormone physiology in the body? The answer is no.
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