Proper and thorough thyroid testing along with a comprehensive symptom investigation by your doctor will tell you if you are hyperthyroid or hypothyroid. Hyperthyroidism will generally have very low markers of TSH, and hypothyroidism will generally have high markers for TSH. However, TSH can misrepresent the true thyroid state due to pituitary and hypothalamus problems. It is also not the only screening method for diagnosing thyroid disease. For instance, many patients have a “normal” TSH lab result, but have low levels of Free T3, indicating hypothyroidism. For more information regarding the types of thyroid disease, please visit my Conditions & Symptoms page and my Testing page.

Hypothyroidism is commonly caused by Hashimoto’s thyroiditis, but the two terms are not the same. Hashimoto’s thyroiditis is an autoimmune disease with an elevated presence of either of these antibodies: thyroid peroxidase antibody (TPOAb or anti-TPO) or thyroglobulin antibody (TgAb). These antibodies react against the proteins in the thyroid, causing gradual destruction of the gland. The gland then becomes unable to produce the thyroid hormones that the body needs, resulting in hypothyroidism. A patient does not need to have elevated levels of TSH to have Hashimoto’s thyroiditis.

Hypothyroidism is a form of thyroid dysfunction where there are low levels of thyroid hormone or an underactive thyroid gland. It is most often caused by Hashimoto’s thyroiditis. To test for hypothyroidism, a physician should administer the following labs: Free T3, Free T4, TSH, and Reverse T3. TPOab and TgAb should also be tested as well to screen for Hashimoto’s. Hypothyroidism and Hashimoto’s may have similar symptoms depending on the level of function of the thyroid gland itself. Some patients with Hashimoto’s also report fluctuating hypothyroid and hyperthyroid symptoms. Please visit my Thyroid Basics page to learn more about disorders, proper testing, and treatment options.

Graves’ disease is an autoimmune disease where antibodies attack the thyroid gland, causing hyperthyroid symptoms in most cases. It is the most common cause of hyperthyroidism. The thyroid stimulating hormone receptor antibody (TRAb) and the thyroid-stimulating immunoglobulins (TSI) tests can assist in the screening for Graves’ disease. With Graves’, the body starts producing these antibodies which overstimulate the thyroid gland, causing it to produce too much thyroid hormone.

Hyperthyroidism is a disorder in which the thyroid gland is producing an excess amount of thyroid hormone. This condition causes a wide range of symptoms due to elevated levels of circulating thyroid hormones. As with hypothyroidism, hyperthyroidism can affect many organ systems in the body and can cause a wide range of clinical symptoms. The condition can be usually detected by the results of the TSH, T4, Free T4, Free T3 and radioactive iodine uptake (RAI-U) tests. Please visit my Thyroid Basics page to learn more about the disorders, proper testing, and treatment options.

There are hundreds of symptoms of thyroid disease. Patients can have any number of these symptoms and each symptom can vary in degree from individual to individual. A common symptom of hypothyroidism is weight gain or the inability to lose weight. A common symptom of hyperthyroidism is weight loss or difficulty in gaining weight. However, not all patients will display these symptoms. If you are currently being treated for thyroid disease but are still having difficulties with weight, it might be due to your treatment type or dosage amount which may not be optimal for you. Your physician should be looking at all factors including optimal thyroid balance and other possible conditions to determine the cause of remaining symptoms.

Depression and anxiety are common symptoms of thyroid and adrenal dysfunction and many doctors miss this association. Proper thyroid treatment may be all that is needed to alleviate these issues. It is possible that you may not have optimal levels of thyroid hormone levels or that you have undiagnosed thyroid disease with these symptoms. Visit my Resource Library page to read more about the association. Please note that there may be other underlying conditions besides thyroid disease that could be the cause of depression or anxiety in patients.

Unfortunately, not every doctor is aware of the comprehensive methods for diagnosing and treating thyroid disease. However, you can show your doctor the information on ThyroidChange’s Testing page and Medication Options page to help explain why full thyroid labs and treatment options are necessary. You may wish to find a more knowledgeable doctor who has experience in diagnosing and managing thyroid disease in my Find A Doctor page.

Yes. Visit my Resource Library page that provides many credible sources of material that might be helpful as you speak with your doctor.

Unfortunately, finding a doctor willing to run comprehensive thyroid labs and provide treatment options in some countries can be challenging. However, resources are available on my website to help patients find help. Please visit my Find a Doctor page for tips and for a listing of doctors who have been recommended in countries outside the U.S. There is also a Patient Forum page of international support forums and groups that may help you find a doctor.

This will depend on the doctor, the laboratory, and your insurance company. Many patients find that they can submit an “out of network” claim to their insurance company and be reimbursed for partial expenses. It is a good idea to ask in advance. It’s important to note that many insurance companies place restrictions on the time and testing services that doctors can provide, such as with integrative or functional medicine doctors. Many patients are finding that they are finding the best luck with these doctors.

Diagnosis should be based on clinical presentation in conjunction with laboratory results that serve as a guide. Lab ranges provide a large range of what “normal” levels could be, however, these ranges do not account for what is optimal for each individual. Also, current research and a growing number of physician reports suggest that the TSH test is not a sufficient measure of overall thyroid function and can be unreliable in many cases. Many physicians are finding that their patients have normal, in-range TSH levels, but do not have optimal levels of Free T3, Free T4, or Reverse T3. Please see my Testing & Diagnosis page for more information on lab testing and optimal levels. It is also important to note there is a small sub-group of patients who are antibody negative for Hashimoto’s or Graves’ disease, but are displaying symptoms. Your physician should be looking at all factors including family history, symptom presentation, and the results of a comprehensive thyroid panel.

The thyroid stimulating hormone (TSH) lab test is often considered the diagnostic “gold standard” for thyroid disease among many physicians. A thyroid disorder is typically diagnosed if the TSH level is above the normal range (hypothyroidism) or if the TSH level is below normal range (hyperthyroidism). However, many patients continue to suffer from ongoing symptoms despite a “normal” TSH. Your doctor may not be aware of the comprehensive thyroid tests to get the full picture of how your thyroid is functioning. If your doctor is only testing TSH, please read the FAQs under “Finding a Doctor” on this page. For more information on testing, please see my Testing & Diagnosis page.

Please see my Testing & Diagnosis page for general guidelines about recommended tests and optimal ranges. Normal, in-reference range lab results may not be what is optimal for you. “Optimal” ranges provided by some of the top integrative thyroid practitioners are noted on this page. Keep in mind that lab results are simply guidelines and your doctor should be using them in conjunction with the patient symptom report and family history when making a diagnosis.

Adrenal dysfunction often accompanies thyroid problems. When cortisol levels are not optimal, thyroid hormone may not be utilized properly. Many physicians find that the sensitive 24-hour saliva cortisol/DHEA test to evaluate adrenal function is an excellent tool to detect suboptimal cortisol levels, particularly because it provides a more complete picture than a single cortisol blood test. While there is no large-scale research that confirms that “in normal range” cortisol and aldosterone make a significant health impact, a significant number of smaller studies and mounting anecdotal evidence from physicians point to the need for addressing adrenal function with thyroid patients. Many integrative doctors are savvy to the thyroid/adrenal relationship. Please see my Find a Doctor page to find an integrative doctor near you that may be able to help. Information on cortisol testing can be found on my Testing & Diagnosis page.

Levothyroxine is often considered the “gold standard” treatment option for hypothyroidism among many physicians. However, mounting evidence and physician reports indicate that thyroid dysfunction can be treated in different ways depending on the cause of your imbalance, how thyroid production and conversion is operating, and its severity. Your doctor may not be aware of the comprehensive concepts for the treatment of thyroid disease. If you continue to have symptoms on levothyroxine-only, please know that there are other treatment options such as T3/T4 combination (liothyronine/levothyroxine), T3-only (for specific cases), and natural desiccate thyroid medication. If your doctor is not willing to prescribe treatment options outside of levothyroxine, please read the FAQ under “Finding a Doctor” on this page. You might also wish to visit my Medication Options page for additional information.

While radioactive iodine (RAI) is the most widely-recommended treatment of hyperthyroidism, it is not the only option. The anti-thyroid medications methimazole and propylthiouracil (PTU) are options for patients with sustained forms of hyperthyroidism, such as Graves’ disease or toxic nodular goiter. These drug therapies prevent the thyroid from over-producing thyroid hormones. With RAI, the goal is to dampen or kill thyroid cells, thus creating less thyroid hormone circulating within the blood stream and into your cells and tissues. Many times, the patient is left hypothyroid and will need thyroid hormone replacement. Surgical removal of the thyroid gland with subsequent thyroid replacement hormone is sometimes an option. For more information on hyperthyroid treatment, please see my Testing & Diagnosis page.

It depends on the medication, dosage, and possible underlying issues that may be contributing to symptoms. It may take several weeks before you notice some improvement in your symptoms, so try to be patient and follow your healthcare provider’s directions. For others, it may take a few months. Some patients may not do well on their originally prescribed medication and their provider might choose to switch them to another treatment option. In this case, more time might be needed to evaluate the effects of the medication and the prescribed doses to observe how the patient is responding to the treatment. Speak to your physician about typical response rates and visit your brand name medication’s website for a listing of their frequently asked questions.

Mounting evidence and physician reports indicate that thyroid dysfunction can be treated in different ways depending on the cause of your imbalance and its severity. It is not as simple as giving a patient a single pill at a single dose. Every patient is different with regards to what their body needs for thyroid hormone replacement. Additionally, it is possible that you can have any number of the following issues:  

1.  Incorrect type of thyroid medication (i.e. T4-only, T3-only, combination methods, natural desiccated thyroid) for your body’s needs.  

2.  Incorrect dosage or balance of thyroid hormone medication for your body’s needs.

3.  Reaction or an intolerance to a filler used in the preparation of the thyroid medication.

4.  Other vitamin or mineral deficiencies such as iron, ferritin, vitamin D, vitamin B12, etc. 

5.  Other underlying diseases or disorders such as autoimmune diseases, adrenal dysfunction, PCOS, cardiac issues, chronic infection, Lyme disease, etc. 

If you still have symptoms, please visit that Testing & Diagnosis page for essential tests and to read about optimal ranges.

Thyroid medication should be taken with water 1 hour before meals or coffee, if taken in the morning. It should be taken at least 4 hours before or after mineral supplements (iron, calcium, iodine, magnesium). Some patients have success with taking thyroid medication prior to going to bed at night and others find that taking it before waking up is the most beneficial. The most important thing is to be consistent and take your medication at the same time every day. To avoid skewing test results, physicians have recommended to take your thyroid medication AFTER your lab testing which should be done first thing in the morning.

Treatment or supplementing depends on the severity of high or low cortisol and should always be monitored by your healthcare provider. In cases of more severe adrenal fatigue, low doses of bioidentical hydrocortisone (HC) or sustained-release compounded hydrocortisone is commonly used. In less severe cases, some practitioners may recommend taking an adrenal glandular preparation and/or some of the following supplements: vitamin C, pantothenic acid (Vitamin B5),  and adaptogens such as holy basil, ashwagandha, Siberian ginseng, or rhodiola. Phosphatidyl Serine (PS) may also be used to lower high cortisol.  Many integrative doctors are savvy to the thyroid/adrenal relationship. Please see my Find a Doctor page to find an integrative doctor near you. Recommended adrenal supplements can be found on my Supplement Options page. Always consult with your healthcare provider.

Physician reports and growing evidence reveal that thyroid disease is often concurrent with vitamin and mineral deficiencies such as low levels of vitamin B12, vitamin D, iron and/or ferritin. It is common to have any one of these deficiencies in thyroid patients, and a deficiency may impact the body’s utilization of thyroid hormone. For more information regarding vitamin and nutritional deficiencies that are common with thyroid disease, please visit my Testing & Diagnosis page and my Supplement Options page.

Many practitioners have discovered that adrenal dysfunction adversely affects the necessary conversion of T4 to T3. Adrenal dysfunction is extremely common in thyroid disease and may impact a patient’s ability to utilize thyroid hormone properly. Additionally, sex hormone abnormalities, celiac disease, diabetes, poly-cystic ovarian syndrome (PCOS), infections and other autoimmune disorders are commonly presented with thyroid disease. Your doctor should understand the interrelationship between thyroid disease and these conditions. For further reading on testing of these conditions, go to my Testing & Diagnosis page. For supplements that could assist some of these conditions, visit my Supplement Options page.

There are many nutritional factors that play a role in optimizing thyroid function, however, patients rarely reverse their thyroid disease with dietary changes or supplements alone. Both nutrient deficiencies and excesses can trigger or exacerbate symptoms. Please consult with your physician prior to taking any supplement considerations listed on this site. Additionally, many patients have reported that going on an anti-inflammatory diet for autoimmune-related thyroid disease helps to reduce the severity of symptoms. Many patients have reported that going on a gluten-free diet is beneficial in reducing antibodies. Gliadin (the protein found in gluten) closely resembles that of the thyroid gland and when gliadin enters the bloodstream, the immune system tags it for destruction. These antibodies to the gliadin protein can cause the body to attack the thyroid gland.