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WisconsinChristianNews.com
Volume 26, Issue 4
Your Thyroid Health
By Dr. David Lange, Genesis Primary Care August 2025 The thyroid gland. Who knew that such a small organ (it is even smaller than the tongue) could cause so much confusion and chaos. This butterfly- shaped gland at the base of the neck,
these hormones. However, in the process of convert- ing T4 into T3, the wrong iodine atom is removed about 40% of the time. This is normal and expected. This creates something called reverse T3 (RT3) which is not biologically active since it doesn’t fit into the T3 receptor. Having measurable RT3 is not a dis- ease state. Testing for RT3 seldom results in a
T4 and T3 help us come to a diagnosis? Maybe. But for the most part, does it matter how one got to the abnormal state when the treatment is always the same? For hypothyroidism, one needs to be taking hormone replacement. The discussion about which medication is best for replacement is again outside of the scope of this article. For hyperthyroidism, one
testing? To make an argument as to why the only test needed for checking your thyroid health is the TSH. I suspect there will be those who wish to debate this conclusion, and they have that right, but in the end the prescriber is only trying to get the TSH into a normal range which indicates that the body is happy with the amount of T4 and T3 present. Trying to target a T4 or T3 level when someone is on re- placement doesn’t make the body any healthier. Monitoring antibody levels doesn’t change the fact that the patient will become hypothyroid at some point and as of now, there aren’t any autoantibody suppression therapies to stop that inevitability. You are watching for the TSH to start to climb indicating that your thyroid gland is having a hard time keeping up with T4 and T3 needs and the pituitary gland is pushing it harder to get those values in the normal range. Depending on your lab, these tests are expensive. In a corporate health care clinic, getting these four tests can easily exceed 500 dollars. Getting them done through an independent lab will already bring that cost down substantially, but getting the only test that really means anything brings the cost down to under 50 dollars. Since I am making the argument that the only test needed is the TSH, is there a target value to shoot for? Generally speaking the optimal replacement value is from 0.5-2.5. There is little benefit going lower than 0.5. Lower rather than higher? This test is an inverse test. The lower the TSH the more T4 and T3 that are present. The pituitary gland does not need to work at stimulating the thyroid gland if there is more T4 and T3 present. While no doubt some people feel better a bit on the over replaced side of things (this is why mild hyperthyroidism is recognized less often than hypothyroidism), it is hard on the body. Osteoporosis, high blood pressure, palpitations and heart attacks are just a few of the potential com- plications of excessive thyroid hormones. Since the TSH value is slow to change in light of daily circumstances, it does not need to be monitored frequently. With any dose adjustment, the next test should be no sooner than 6 weeks later, 8 weeks may be even a bit better. Once the dose is dialed in, unless there are significant changes like weight loss or weight gain, annual testing is generally adequate. In the next few issues, I will be reviewing other test- ing recommendations. These will likely be less con- troversial than thyroid testing, but we will see what I can do to stir the pot, so to speak, to help the reader be better informed about one of the sacred cows of medicine, lab testing, and get the most value out of their relationship with their healthcare provider. GenesisPrimaryCare.com Please see the display ad on Page 20 of this issue of Wisconsin Christian News).
weighing less than an ounce, is ascribed numerous symptoms important for our sense of well- being. And while the physiology is actually quite well worked out, it is still widely misunderstood in healthcare. This ar- ticle is not going to be a comprehensive look at the gland, but a review of testing and what is needed when managing a thyroid condition. Thyroid hormone plays a role in the function of many parts of the body. I think this is why so many people think their symptoms are thyroid related. It is essential during childhood and adolescence for growth. It acts on the heart, lungs and muscles. It is key to metabolism. When the thyroid hormone is low, one may feel cold, weak, have muscle cramps, pain, stiffness, weight gain, constipation, dry skin, slowness of think- ing and slow heart rate among many other symp- toms. These symptoms are all too common. They are also very nonspecific as many conditions leave peo- ple feeling this way. Too much thyroid hormone is thought about less often as it generally only draws attention when it is “really” too much hormone. Those symptoms are rapid heart rate, palpitations, high blood pressure, weight loss, rapid thinking, poor sleep, tremor and in a milder form of chronic hyper- thyroidism, a bulging of the eyes as the tissues be- hind the eyes swell and push the eyeballs forward. The thyroid gland produces two hormones. Thyroid hormone and calcitonin. The calcitonin function does- n’t seem to go awry too often and is not the subject I want to spend time on. Thyroid hormone production is based on a feedback loop. You can think of this a bit like your furnace and thermostat. As the house cools off, the thermostat senses that and sends a sig- nal to the furnace to kick on and bring the tempera- ture back up to the set point. Once reached, the furnace shuts down until needed again. When look- ing at the thyroid “cycle,” it probably doesn’t matter where we start in the loop of hormones as it always circles back to wherever we start. The main product of the thyroid gland is thyroxine (T4), which has 4 iodine atoms in it. This is converted to triiodothyronine (T3), which has 3 iodine atoms in it. T3 is the active hormone that the body needs. T4 and T3 have very specific configurations and fit into their respective receptors precisely in order for them to function correctly in the various tissues that require
meaningful diagnosis or change in the medications prescribed. T3 and T4 levels circulating in the blood find their way to the pituitary gland at the base of the brain. These levels influence the secretion of thyroid stimulating hormone (TSH). There are several other measurable hormones in this loop but they are not really used in clinical practice and will not be dis- cussed. The only other thyroid test I will mention right now is actually not from this loop, but influences thy- roid function when present and that is antithyroid an- tibodies. More on this later. The majority of T4 and T3 are bound to various pro- teins in the blood with only about 0.1% of each being free in the circulation. Being free, or unbound, is re- quired for them to be biologically active. T4 and T3 are fairly short lived in the circulation and are very sensitive to what is happening to the person (i.e. stress and illness). TSH is not short lived. TSH is more stable and longer lasting and is therefore less sensitive to illness and stress. TSH is a better meas- ure for the overall health of the thyroid gland. I see a lot of patients come in with tests done else- where or asking for a long list of tests that they have been told are the necessary tests to check on thyroid function. There are times that checking all of these labs may provide some additional information, but generally speaking, if the TSH is where it should be, then your T4 and T3 will be where they should be. If the TSH is not where it should be, then the T4 and T3 won’t be where they should be. Does knowing the
needs to control the body’s response to the overstim- ulation until the thyroid gland burns out and the hy- pothyroid state develops. Thyroid antibody testing may be valuable in some instances. An autoimmune disorder is the most com- mon reason that one becomes hypothyroid. Some- times it is more obvious, most of the time it is not obvious at all. The need to test for antibodies is really pretty infrequent. Someone may have symptoms of hypothyroidism and maybe have family members that have it and the person wants to know if they are at future risk of de- veloping hypothyroidism. Maybe then it is ok to test and if positive, let them know that it should happen at some point in time. But once the test is positive, it will always be posi- tive. It really never needs to be checked again. If the value is changing from a lower number to a higher number, one isn’t more sick and there are no addi- tional health risks to the patient. The numerical value is technically meaningless. The only meaningful part of the result is positive or negative. And then, as long as the TSH is in the normal range, everything is good. If the test is negative and someone isn’t at risk an increased risk of developing hypothyroidism, the antibody test is not likely to be needed in the future. If they are at risk of developing hypothyroidism, re- peating the test someday may have some value, but I doubt it. So why go through all this explanation about thyroid
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