A recent study confirmed an under-active thyroid and a "low normal" thyroid, puts people at increased risk of developing type 2 diabetes. Unfortunately, this news isn't a surprise. All too often, I meet patients being treated for a low thyroid as well as many who are undiagnosed or bypassed by routine testing, go on to develop disease states like type 2 diabetes, heart disease and a whole host of chronic health conditions. A low thyroid can drastically alter the normal function of every system of the body. This study validates what I as a physician have been seeing and saying for many years.
How is the thyroid connected?
The thyroid produces hormones and messenger molecules necessary to activate cells, produce energy and regulate biochemistry. T4 and the more active T3 are thyroid hormones that act as regulators for the body. Without them, cellular function is compromised including the ability to take in and use other hormones like insulin. Insulin resistance is a state where adequate amounts are released yet cells are unable to use it effectively causing glucose levels to build up in the blood. This process can go undetected for many years until ultimately, type 2 diabetes ensues.
Having the right amount of thyroid hormone is incredibly important. Low levels -- even those within a normal reference range -- may not be optimal or adequate to properly regulate the body.
Is the reference range a reliable indicator of health?
In diagnosing thyroid conditions, the reference range is the determining factor that delineates a healthy person from one requiring intervention and medication. Sadly, there are flaws with this system that often lead to people being missed and bypassed for needed treatment.
Reference ranges are created by studying seemingly healthy people and tracking their TSH levels to find a range of "normal." Today, these people may be fine or at least appear so but we must take into account the long term. What about ten years from now? Will this same group used to define health still be without disease and the bigger question -- are they really without disease at the time of the study? A deeper investigation may prove otherwise. The routine testing is often unsuccessful at correctly diagnosis low thyroid conditions so I can't help but wonder, how many of these "healthy" test subjects would actually test positive for hypothyroidism through a deep test like the TRH.
One of the key take-always of the aforementioned study, is that it is quite possible to have the biochemistry of disease without actually having the disease yet. Health is not merely the absence of overt disease. Nor is disease a thing with neat boundaries and lab values easily cut out or killed. This outdated ontological view underscoring the theory of medicine, misses the greater picture. Disease is actually a process that is happening, often silently, creating unhealthy body conditions that result in symptoms and illness often years later. We must dig deeper to effect change now.
The dangers of strict reliance on reference ranges
If patients with low-normal thyroid function are more susceptible to health conditions and major illnesses like type 2 diabetes, maybe low-normal isn't really normal at all and certainly not optimal. We must question the accuracy of thyroid reference ranges or at least understand that they are not the final word. Too many patients feel sick and suffer with symptoms yet have normal test results.
Additionally the study went on to find, those being treated with thyroid medication also run increased risk of developing diabetes. I speculate this is in great measure a result of the inadequate testing used to monitor progress combined with ineffective treatments. While test results can return to normal levels, standard thyroid medication does little to correct underlying metabolism for a large percentage of patients.
Deep testing for optimal treatment
We must look to deeper testing to gain a wider breath of information. The routine TSH just scratches the surface missing a huge percentage of cases. There is a wealth of knowledge waiting to be uncovered by running a full battery of comprehensive tests. Anyone suffering with the symptoms of low thyroid should demand a full panel including TSH, free T3 and T4, total T3 and T4, Reverse T3 and antibodies to thyroid tissue like TPO, TSI and Thyroglobulin Ab. Additionally I always use an extremely accurate test called the TRH. This method can detect low thyroid when all other assessments fail to find it. Whenever possible, I urge everyone to seek out and have this very telling test performed.
Finally, as I touched on earlier, standard treatment options often fail to correct the metabolism driving disease. Routinely, Synthroid or other T4 only medications are prescribed but they simply don't work for everyone. Many bodies also require T3 to correct imbalances. Frequently, patients are on inadequate doses of T4 because routine testing isn't deep enough to correctly assess and monitor progress.
Unfortunately, a large percentage of these mis-managed cases will go on to develop diabetes and other serious health conditions.
Good health is achieved by balancing the body on many levels to correct the process creating disease states. Inflammation and microbiome imbalances further add to this matrix causing dysfunction that can trigger diabetes, heart disease and many other conditions. As physicians, we must shift our perception to understand health in terms of function not just numbers. The practice of medicine must always include the lost art of listening to how patients feel and deeply exploring biochemistry to find their very unique optimal levels. This is the way to bring people back to wholeness, allow their bodies to have the necessary support to heal and prevent disease.