Thyroid disease is a prolific problem that can cause daily dysfunction and difficulty. Sadly, many of those afflicted by a thyroid disorder are not even aware of it. A primary component of this problem is that many doctors are unwilling or unable to run the appropriate tests to properly assess individual thyroid function.
To combat the frustrating issue of undiagnosed thyroid disorders it’s important to understand why doctors or not running the right tests, what proper testing looks like, and why thorough testing is necessary for resolving thyroid disease.
The Testing Roadblock
In an ideal world, patients would have access to the best testing and treatment possible. Unfortunately, there are multiple factors in the structure of modern medicine that inhibit this goal. Larger medical forces, specifically insurance companies and healthcare providers, have overthrown patient and doctoral authority in deciding what is best for patients. Because of this patients and doctors now have less control over testing and the quality of their care.
Typically, doctors want to provide the best care possible for their patients, but insurance companies can impede or completely obstruct such care. A prominent component of this problem is that insurance companies focus on cost, rather than patient wellness, when establishing guidelines for care. This strategy often limits options and lowers treatment quality because it incentivizes doctors to use the most cost-effective testing and treatment rather than what is best for the patient.
Patients with a chronic condition are often the one’s suffer most in the current system. Complicated diseases are frequently not evaluated thoroughly simply because healthcare companies pressure doctors into using the most cost-effective testing rather than the most accurate. This has resulted in TSH testing becoming the primary method of assessing thyroid health. However, this metric is insufficient on its own and provides minimal information regarding actual thyroid activity.
The Problem with TSH Testing
TSH is widely and wrongfully considered to be the most sensitive marker of tissue levels of thyroid hormone. Most endocrinologists and medical practitioners are also incorrectly taught that a TSH within the “normal” range is clear evidence that the thyroid is functioning properly. Currently, a “normal” TSH is considered to be anywhere between 0.5 and 4.5. Patients are only considered to be at risk of thyroid disease if their TSH is in the top or bottom 2.5% of the lab’s testing curve. This means that only the worst cases of dysfunction are diagnosed. Therefore, many thyroid patients are left to suffer from their condition with little hope of being diagnosed until they reach a severe level of dysfunction.
The widespread use of TSH testing is based on the understanding that it is inversely correlated to pituitary levels of T3. This belief is accurate. However, most practitioners are unaware or intentionally disregard the fact that physiological stress caused by chronic disorders such as diabetes, CFS, obesity, and others, can increase pituitary T3 levels (which raises TSH) while reducing tissue levels of T3 elsewhere in the body. Such stressors also increase the levels of Reverse T3 which further inhibits thyroid function. This means that patients experiencing physiological stress that impacts the pituitary may present nominal TSH levels even though the thyroid and the rest of the body is experiencing a thyroid hormone deficit.
Reliance on TSH testing frequently results in misdiagnosis. When TSH-only testing is done, it is common for patients to be informed that their thyroid is functioning fine even though they continue to experience a worsening of thyroid related symptoms – get a full list of thyroid disease symptoms here. TSH testing alone is clearly not enough to properly identify thyroid dysfunction.
What Tests Should be Done to Assess Thyroid Function
To accurately gauge thyroid function, multiple factors must be tested. Many different hormones and substances influence thyroid function. To get a more complete image of how well the thyroid is working, each are should be tested. A full thyroid panel should include the following:
- Free Triiodothyronine (T3) – the active form of thyroid hormone
- Reverse-triiodothyronine (RT3) – the mirrored and inhibitory form of T3
- Free T3 to RT3 Ratio – measures tissue levels of Free T3 in relation to RT3
- Free Thyroxine (T4) – the inactive or storage form of thyroid hormone that is converted to T3
- Thyroid Antibodies (TPOAb antibody) and Antithyroglobulin Antibodies (TgAb) – elevated levels may indicate the presence of a thyroid autoimmune disorder such as Hashimoto’s thyroiditis and Graves’ disease
- Thyroid Stimulating Hormone (TSH) – the hormone used to relay information between the pituitary and thyroid
Even though TSH on its own cannot be used to reliably assess tissue levels of thyroid hormone outside the pituitary, it is an important component of thyroid communication. Therefore, it should still be considered when testing thyroid activity but must not be the only one used to assess thyroid function.
How Do I Get the Testing I Need?
Doctors who believe a patient may have a thyroid condition typically use a TSH test to assess thyroid function because insurance and healthcare companies pressure them into using the most cost-effective assessments. Unfortunately, this method is grossly inadequate in assessing thyroid function if it is the only test used. To accurately gauge thyroid function, a thorough examination of all markers of thyroid activity must be administered.
Take control of your wellness back from insurance and healthcare companies by getting the tests you need to properly assess thyroid health.