Thyroid Thursday Episode 12: Thyroid Hormone Dysregulation Disorder
Hi, its Dr Eric Balcavage and I’m back for another edition of Thyroid Thursday and today I want to clear up some of the confusion regarding hypothyroidism and a term that I use, Thyroid Hormone Dysregulation Disorder. In the last episode of Thyroid Thursdays, we talked about a number of hypothyroid patterns. In allopathic medicine there is really only one form hypothyroidism. What doctors are looking to determine in the allopathic model is if the patient is in a hypothyroid state. Only two tests are needed to identify this, TSH and T4. There is not a big concern about running the rest of the thyroid panel or running thyroid antibodies because they are only looking to identify hypothyroidism.
Hypothyroidism technically is a situation where the thyroid gland is just not making enough T4. Remember, we said that when the cells need thyroid hormone, the pituitary gland releases something called thyroid stimulating hormone that goes to the thyroid gland, kicks the thyroid gland into gear to make thyroid hormone. The clear majority of thyroid hormone produced (93% of it) is T4, which is an inactive form of hormone and it needs to go off to the peripheral tissues, the liver, the gut, muscle , and other peripheral tissues, to make T3. The T3 then needs to bind to receptors on cells and once the thyroid hormone is in the cell and bound to the receptor, then it can help regulate metabolism.
Primary hypothyroidism is really what is being measured for most people when they do a TSH and T4. You only need those two markers to diagnose (glandular)hypothyroidism, and what they are looking for is, is the thyroid gland making enough T4? If it’s not, then you’re diagnosed as hypothyroid and you are given thyroid hormone.
The problem with this model is that it assumes that once you give thyroid hormone, everything downstream is going to work, and we know that that just isn’t the case. There are so many places where thyroid physiology can break down or get bogged down. Just because you put thyroid hormone (T4) into the system doesn’t mean it’s going to be converted to T3. Just because I tell my kids to do their chores or to do their homework, doesn’t mean they are going to go up in their room and do it. They could be watching videos on their iPad or on their iPhone instead of doing their homework. I wouldn’t assume that just because I told them to do it that they are going to do it.
Doctors can’t assume that just because They dump T4 into the system that it’s all going to be converted into T3 and everything is going to work the way it should, that all the hormone is going to get to the cells, and it’s all going to work. There are cofactors, enzymes, multiple steps that must occur and there are a lot of places where thyroid hormone physiology can break down and often does.
What I term Thyroid Hormone Dysregulation Disorder is a situation where TSH is maybe normal, T4 maybe normal, but there are problems with their physiology. If you remember from the segments I have done in the last couple of weeks, we talked about the hypothyroid patterns 2-7. These were all Thyroid Hormone Dysregulation Disorders, where the TSH and T4 values may have been okay, but the steps past T4 were breaking down for some reason or the other. If you don’t run a full thyroid panel, you will never see the rest of these Thyroid Hormone Dysregulation Disorders.
You just won’t see them. What gets measured gets managed. When only TSH and T4 get measured, then that’s all you manage. There is plenty of research at this point, plenty of documentation, to say that there are multiple ways thyroid physiology can break down and we need to look well beyond T4. Many allopathic doctors are following a 30-old year model of understanding our thyroid physiology.
What do you need to do when you talk to your doctor? Don’t get mad. Traditional medicine says that really all you need is a TSH and T4 to diagnose hypothyroidism and that’s all they’re diagnosing when they run those tests. You really want to push for a full thyroid panel that we’ve talked about on other Thyroid Thursday videos. You’ve got to run TSH, T4, free T4, T3, free T3, reverse T3, T3 uptake and the thyroid antibodies. You want a full thyroid panel.
You also need to find a functional medicine practitioner who understands the whole thyroid physiology pathway and all the things that could compromise it, like micronutrient deficiencies, B-vitamin, selenium, and zinc deficiencies. We need to understand immunity and gut physiology because, as I said in one of the previous videos, autoimmune thyroid disorder is the number one cause of hypothyroidism symptoms in the United States.
If you are struggling and you’re really frustrated with trying to get your doctors to run full panels and they are not talking about the rest of these Thyroid Hormone Dysregulation Disorders or patterns, it’s just because for many of them it’s not what they’ve been taught. What I’m explaining doesn’t fit the medical model of the thyroid physiology. Is the gland is either working or it’s not. In primary hypothyroidism, the thyroid gland is not working. In the Thyroid Hormone Dysregulation Disorders, the thyroid gland is working, but somewhere else in the pathway is disrupted.
One last point, even if the person is hypothyroid and their gland is not making T4, a doctor can give them T4. This will provide them with the T4 that their thyroid gland isn’t making. But we should be asking one more question, and that is, why is the thyroid gland not working? It’s not just because you’re older. It’s not because you turned 40. There is a reason for it and that’s why functional medicine practitioners tend to dig into it a little bit more because we want to know the underlying reasons why the thyroid is dysfunctional, not just diagnose that it is dysfunctional and give thyroid hormone.
We want to understand the reason why its dysfunctional in the first place and see if we can fix the reason why it is dysfunctional. Maybe there is tyrosine steal going on, where tyrosine is not getting to the thyroid gland. Maybe there is an iodine deficiency. There are multiple reasons why there could be breakdown in the thyroid glands ability to make thyroid hormone and in functional medicine that is really what we are looking for.
So, I hope this has helped. If you are struggling with your thyroid condition and you need help, you can always give my office a call, its 610-558-8920, and you can always leave comments below and I’ll get back to you as quickly as possible. I look forward to giving you some more information on next Thursdays Thyroid Thursday. Take care.
