Should You Have Your Thyroid Tested?

By Dr. Brooke Kalanick

Sometimes you just know that something is off. You can call it women’s intuition — or chalk it up to the fact that when your hair falls out, you’re too tired to get to the gym, and, when you do manage to get in workouts, you can’t seem to drop a pound — it’s pretty obvious that things aren’t right.

doctor-and-patient-looking-at-report-450x340For one in eight American women, hypothyroidism is what’s wrong. This is a condition in which the thyroid, a butterfly-shaped gland found in the neck, doesn’t produce enough hormones. Hypothyroidism can cause a litany of side effects with a slowed-down metabolism.

Unfortunately, about half of those suffering from hypothyroidism don’t know that they have the common endocrine disorder. After all, symptoms of hypothyroidism aren’t always as apparent as fist-fulls of hair. Here’s a list of just some of the symptoms women commonly experience as an effect of low thyroid function:

  • Fatigue, with particularly low energy around 2 to 4 pm
  • Waking up tired, even after 7 or more hours of sleep
  • Brain fog
  • Hair loss
  • Dry skin
  • Thinning eyebrows, particularly at the outer edges
  • Constipation
  • Feeling cold, especially in the hands and feet
  • Sensitivity to certain foods (bloating, gastric distress, inflammation, skin rashes, etc.)
  • Gallbladder issues
  • Problematic menstrual cycles (irregular, heavy, etc.)
  • Infertility or miscarriages

So, if you have any or all of these symptoms, does it mean you have a thyroid disorder? Not necessarily.

Weight gain and bloating could just be due to a poor diet. Fatigue could come down to anemia or adrenal issues. And that bloating could be a result of low levels of digesting enzymes or stress. How would you know if your thyroid is really the issue? Simply put, you have to get tested. (Here’s a look at the thyroid tests you may need.)

What If It’s Not Plain Ol’ Hypothyroidism

tired-depressed-woman-350x375Women rarely just have a low thyroid levels. After all, your body is an intricately woven web, so if you’ve got a thyroid issue, every organ system in your body will also suffer. You probably also have low levels of vitamin D, B12, and iron, digestive imbalances, adrenal issues, blood sugar problems, and elevated levels of inflammation in your body. That’s a big reason why many diets and workouts that are aimed at helping those with low thyroids are ineffective: they don’t treat all of the health issues going on inside your body. In order to truly feel better, you and your doctor need to address any thyroid problems and then tackle whatever other health issues you have going on. It’s a lot to do, I know. But it is doable, so hang in there.

To complicate matters, it’s important to realize that as many as 90 percent of people with hypothyroidism also have Hashimoto’s disease (autoimmune thyroiditis). A condition in which the immune system attacks the thyroid gland, Hashimoto’s is the most common cause of hypothyroidism in the United States. While some women with low thyroid function do not have Hashimoto’s, those who do may not only suffer from hypothyroidism, but hyperthyroidism (or overactive thyroid) as well. So if, at times, you find yourself experience symptoms of low thyroid, but, at other times, you experience any of the below hyperthyroid symptoms, you should talk to your doctor about Hashimoto’s:

  • woman-hand-on-throat-thyroid-450x340Hot flashes and night sweats
  • Heart palpitations
  • Anxiety
  • Feeling puffy in general
  • Swelling or tight sensation in the throat
  • Waking achy and stiff
  • Difficulty recovering from exercise
  • Diagnosed hypothyroidism
  • Low estrogen levels
  • Low libido
  • Easily bruised skin

Because Hashimoto’s symptoms wax and wane as your immune system flares up and calms back down, it’s not uncommon to have a mix of hypothyroid symptoms (like fatigue or depression) and hyperthyroid symptoms (like anxiety or a fluttering heart). Typically in Hashimoto’s, hyperthyroid symptoms are transient and last no more than a few days, but it does create an odd and sometimes confusing picture for both doctors and patients.

A Negative Hashimoto’s Test Doesn't Mean You're In The Clear

Yes, even if your test results say you are the picture of health, Hashimoto’s could still be at play. Could this be any more confusing? Well, we’re actually just scratching the surface…

Many women with diagnosed hypothyroidism have all the above signs of Hashimoto’s, but their lab work, determined through levels of antibodies (TPO and TG), have never come back positive.

So if it walks and talks like Hashimoto’s, is it? Possibly. If you think you have Hashimoto’s disease, but have normal levels of antibodies, you should pay attention to the below health markers:

  • Your White Blood Cell Count: Remember that when we’re looking for antibodies, we’re looking at a response from your immune system. If your immune system is wiped out, it may think that your thyroid does not belong to you, and is actually an invader that needs to be attacked (the crux of autoimmunity). However, the levels of antibodies may not be high enough that we can detect them through standard lab work. This is often the case in women whose total white blood cell count is below 4.5. Often, when we get the immune system healthier — by combatting things like stress and chronic infections — the woman’s white blood cell count goes up. Only then do we antibody levels that are indicative of Hashimoto’s.
  • Your Levels of Inflammation: Immune system activation can trigger inflammation, leaving you puffy, fatigued, depressed, and cloudy headed. This is one reason why I insist that women get screened for Hashimoto’s even if their thyroid panels look fine. Inflammation shouldn’t be ignored. In fact, it’s a predictor of future thyroid disease. It’s always best to be proactive, rather than reactive. And, more immediately, why not deal with your inflammation so that you can feel better?
  • Your Levels of Other Antibodies: Even if your thyroid is indeed holding up OK, it isn’t uncommon for women with Hashimoto’s to produce other antibodies such as transglutaminase (Celiac disease) and intrinsic factor (pernicious anemia/B12 issues). In short, it’s important to know if you have any autoimmune conditions. If you suspect it or feel hypothyroid, yet have normal labs, get screened.

Did you get tested?

What’s more, your antibodies can be positive for years before you become hypothyroid. It is incredibly common for a woman to have every hypothyroid symptom, yet have thyroid bloodwork that looks normal.

blood-test-tube-350x375So, if you either take meds and don’t know if you’ve been tested for Hashimoto’s, or you have low thyroid symptoms but normal blood work, ask for your TPO and TG antibodies to be tested.

So many women who have been diagnosed with hypothyroid and who take thyroid hormones for treatment have no idea if they’ve ever been tested for Hashimoto’s. That’s largely because apart from taking hormones, there’s not much conventional medicine can do for Hashimoto’s. If you have the disease, other than the hormones you’re already taking, there’s no specific drug that’s recommended for managing the condition.

While requesting bloodwork from your doctor is a great first step in pinpointing any thyroid issues, it’s important to remember that current testing is not perfect. For example, some women may have antibodies that indicate hypothyroidism for years before they ever develop symptoms. And, on the flip side, some women have every hypothyroid symptom in the book, but their thyroid blood tests still come back negative.

For that reason, if the blood work doesn’t seem to match the symptoms you are experiencing, you doctor may perform a thyroid biopsy, which is highly accurate. However, doctors are hesitant to perform the more invasive procedure. That’s because, in the end, the biggest issue isn’t getting a firm diagnosis, but helping you feel better. After all, if you’ve previously been diagnosed with hypothyroidism, you are probably already taking the only commonly prescribed medication for Hashimoto’s: thyroid hormone.

Above that, an ongoing relationship with a doctor you can trust, and who takes a broad look at your entire health, is going to make the biggest difference in helping you get and stay better.

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About the author:  Dr. Brooke Kalanick

Dr. Brooke Kalanick earned her Doctorate in Naturopathic Medicine from Bastyr University. Known as “The Hormone Whisperer,” Brooke's balanced approach to health, using both conventional and alternative therapies, allows her to successfully treat patients with Hashimoto’s Hypothyroidism and PCOS as well as other female hormone imbalances. Learn more about Dr. Brooke on her website and connect with her on Facebook and Twitter.

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