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  • Writer's pictureNicola Hodges Nutrition

Testing for optimal health with Hashimoto's & hypothyroidism

Many of us have heard of Medichecks- but what else is available and what will these tests tell me?

Firstly, sorry I've been so quiet lately- (ok- so you probably didn't notice). We've recently moved to Devon to see how we like it, (I can still see clients from all over the UK- no change there thanks to ZOOM).

Why Devon? Like many of us, we were looking for a slower, quieter pace of life these days that involves being around more nature, the sea, and green space. Also, my husband is a keen golfer -so Devon seems like a good choice as it looks like there are more golf courses than petrol stations here!

Those of you with thyroid issues will know that a huge upheaval like moving house can really take it out of us and set us back several months. The good news is I have bounced back pretty well if I say so myself. I know better these days, just because I think I feel ok does not mean that my body feels the same way. I have been prioritising sleep and basically not taking on too much since moving and have done everything I can to make life more simple and less demanding.

Another unexpected happy surprise since moving here is that we have super-fast fibre broadband - surprising since it was hard to come by in Bristol!

Anyway, I'm now refreshed and ready to get super focused on supporting as many people as I can who live with Hashimoto's & hypothyroidism and want a better life!

One of the key tools in my toolbox is testing.

So let's do a deep dive into thyroid testing and what it can tell us.

The standard thyroid test

A large section of my clients come to me with their GP blood test results when we start working together.

Often in an NHS setting the main test for thyroid function will be TSH- if that comes back with an abnormal result then Free T4 may be tested. Bearing in mind that the lab range for TSH is way too broad in my view. Any TSH over 2 raises a question mark for me when seen in conjunction with symptoms.

TSH stands for 'thyroid-stimulating hormone'. When this marker is out of range- the higher it is, the worse it is. TSH is a marker of how loud the brain needs to shout at the thyroid to get it working. I've seen results ranging from 3.5 to over 30! Here's the thing- I've seen clients just as symptomatic with a TSH of 3.5 as of 30! This is because there is so much more to thyroid function than TSH. I'll explain what I mean and why I don't think that TSH is an adequate measure of thyroid function.

By the way- thyroid antibodies are rarely tested by the NHS as it won't change their clinical approach. I meet many clients who had no idea that their underactive thyroid problem is actually an autoimmune disease.

Thyroid hormone conversion

The thyroid hormone that actually does the business of keeping us active, alert, and supports our mood, and contributes to keeping us at a healthy weight is T3. The thyroid makes a very small amount of this, the rest has to be converted from T4 which is the main hormone produced by the thyroid and the active ingredient in Levothyroxine medication. This conversion from T4 to T3 takes place at various sites throughout the body such as the liver, gut, kidneys and other tissues.

The conversion of T4 to T3 is a major port of call where things can go skewiff. We need adequate nutrients in our diet to make this conversion happen. Stress and illness/infection will also severely hamper this conversion by tinkering with our active T3 and turning into something called 'reverse T3'. Reverse T3 is inactive and also blocks T3 receptor sites. This is a protective mechanism because the body knows when to slow us down and force us to rest and store fat because it senses a danger to health or survival in some shape or form. (As you can imagine modern living with chronic stressors can cause this protective mechanism to upregulate when we don't want it to).

Full thyroid panel

So, when it comes to testing I like to consider a full thyroid panel. This will also include both types of antibodies that cause Hashimoto's - thyroid peroxidase antibodies and thyroglobulin antibodies. It's also helpful to see free T3 and free T4- (although free T3 is highly dynamic and changes from hour to hour). When I use the term 'free T3 or free T4' this means free hormone that is not bound up in a carrier protein called 'thyroid-binding globulin'. When thyroid hormone is bound up to thyroid-binding globulin it will render it unable to be used. The free amount is the amount that is free to do its thing.

Sex hormones such as oestrogen can increase the amount of thyroid-binding globulin proteins in circulation resulting in a lower T3 uptake and hypothyroid symptoms. TSH can show as normal in this situation. Whilst, elevated testosterone as seen in PCOS can lower thyroid-binding globulins resulting in a higher T3 uptake- which eventually causes T3 resistance resulting in hypothyroid symptoms. Measuring T3 uptake is a helpful indirect marker of thyroid-binding globulin levels.

So here is what a FULL thyroid panel will often include:






Thyroid peroxidase antibodies

Thyroglobulin antibodies

Reverse T3

T3 Uptake

I would recommend this panel for a client that is highly symptomatic but has a reasonable looking TSH and free T4. Or if a client already knows that they have Hashimoto's and wants to delve deeper into finding their root cause.

Genetic testing for thyroid function and Hashimoto's

I will be dedicating an entire blog/newsletter to this subject- stay tuned!

Thank you so much for reading my blog- sign up for my newsletter if you would like to hear more from me.

Below I have included a photo of beautiful Dartmoor that I took late into the evening this summer a few weeks back.

Stay healthy,

Nicola x


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