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Aug 27, 2019

Functional Medicine & Normal Thyroid Levels

by Dr. Dan Kalish

Determining normal thyroid levels is a far greater challenge than one would imagine. There are so many competing reasons to test thyroid hormones in the first place that each group of health care practitioners has staked out their own version of normal and we are left in a situation where it’s just crazy confusing to figure out what any of it means.

Functional Medicine Thyroid Lab Ranges

There are conventional medicine thyroid ranges your conventional MD/endocrinologist will swear by. There are functional medicine thyroid lab ranges (which of course are different) that your functional medicine doctor will swear by. The functional medicine doctors often throw in a wider range of test markers as well. Then there are sub clinical thyroid folks that don’t register on the functional medicine lab ranges or the conventional ranges but still have significant thyroid imbalances.

Functional medicine hypothyroidism differs from conventional medicine hypothyroidism. How could this be? Who is right? Isn’t a functional medicine thyroid exam similar to a conventional medical thyroid exam? How could two highly trained seemingly intelligent groups not agree on what normal thyroid levels are?

Well it’s complicated.

Conventional medical thyroid ranges have a unique and clear purpose; to determine if you have a sufficiently severe thyroid issue that will require you to take prescription thyroid medications to maintain normal thyroid levels. The kicker here is that these medications will over time shut down your own body’s production of thyroid hormones even more meaning you’ll be on them the rest of your life. It’s an important decision and one not to be taken lightly. To make matters worse some people test positive on the conventional medicine lab ranges, take the thyroid prescription and still don’t improve. Talk about frustrating!

Functional medicine thyroid lab ranges are much broader and meant to detect thyroid issues prior to the onset of more advanced thyroid disease. Functional medicine thyroid lab tests also typically include additional markers beyond the typical TSH and include T3, T4, reverse T3 as well as autoimmune markers. This too makes sense because a well-trained functional medicine doctor has many ways to treat thyroid disease aside from the typical thyroid medications. A basic premise of functional medicine is that the thyroid responds to inflammatory issues elsewhere in the body and many thyroid conditions have a root cause to be found outside the thyroid itself. Once this root cause is addressed the thyroid recovers, oftentimes it seems, miraculously. There are some fancy specifics here in that the conversion of thyroid hormones from the inactive to more active forms can be blocked by inflammation coming from various other non-thyroid places like the gut, the diet, toxins in the environment, even severe emotionally stress can create a thyroid imbalance, so once these root cause issues are addressed oftentimes thyroid problems clear up on their own.

And to make it even more complex there are people who have outright thyroid disease where the root cause IS the thyroid gland. These folks can best be treated with medications. And just in case you thought we were winding down here, there is a very interesting sub category of thyroid issues that are connected to problems with mitochondrial function.

To step back a second and clarify this last zinger a little bit, I’ll name a hormone and you name its action. Easy, right? If I say insulin you would say blood sugar regulation. If I say estrogen you’d say female reproductive organs and so on. Cortisol? Stress. You get it.

Well if I say “thyroid hormone” to any doctor trained in any field from any country the immediate response is “basal metabolic rate”. In other words, we all know WHAT the thyroid does, it regulates basal metabolic rate. But then, and I’ve asked this question literally hundreds of times to incredibly intelligent doctors and never gotten the right answer, then the next question is “How does the thyroid do that? What tissue, what cells, what structure in the body does it regulate metabolism through?” It’s such an overly simply question no one ever gets it right. But the lack of ability for any doctor to ever answer this question properly reveals a massive bias or blind spot in our education. We don’t in any significant way associate the thyroid gland with the mitochondria!

It’s off-the-charts nuts but totally true. We all know it’s insulin-blood sugar and cortisol-stress but no one is thinking thyroid-mitochondria; when in reality the way the thyroid works, it’s very mechanism for regulating metabolism is the mighty mitochondria. There is a point here and I’m about to get to it. If you make this (appropriate) connection then the next thought is, my unresponsive thyroid patients who I put on natural thyroid or plain old prescription thyroid or for whom I use every thyroid nutrient and herb on the planet but only get a partial response – maybe they have a concomitant mitochondrial issue. Blamo you got it!

Dr. Richard S. Lord, my mentor and teacher these last few years has written about the “hypometabolic state” wherein the sheer numbers of mitochondria are reduced leaving the thyroid unable to act. In this instance you can have the right amount of thyroid hormone circulating there’s just not enough mitochondria present for it to work. It would be like getting enough gas in a car and it’s just the exact right kind of gas but the motor isn’t turned on. There is nothing for the gas to do but sit there.

This low mitochondrial state can be detected using organic acids testing and one sees a series of low markers on the metabolic screening portion of the test. So now let’s try to summarize all this. You can have (1) a thyroid problem that is diagnosed based on abnormal thyroid levels and end up with either a traditional treatment (typical thyroid prescription medication) or (2) a functional medicine thyroid treatment, often times “natural” thyroid prescriptions or a combination of herbs and vitamins and diet changes, etc. combined with an investigation about the root cause of the problem. Or (3) you may have normal thyroid levels from the conventional perspective meaning the regular MD’s will say you are fine but you may fall into the functional medicine thyroid lab ranges that are seen as problematic and end up with a functional medicine approach. Or (4) you may have completely normal thyroid lab ranges from both a tradition and functional medicine viewpoint BUT STILL HAVE A THYROID PROBLEM, if your mitochondria are not present in sufficient numbers.

So, fear not. If you are already being treated by a conventional medical approach and not feeling better, then shift and try a functional medicine doctor and if you are already trying that and not getting the full benefit of a program from your functional practitioners then by all means have your mitochondrial function screened and look for this newly discovered “hypometabolic state”. It can be corrected with an intensive nutrient program and it complements other thyroid treatments well.

Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.