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Hormone Health: The Thyroid Paradox

by Karan Y. Baucom, MD, FACOG, FAAAM
October 1, 2009

What Is Thyroid Paradox?

Most physicians are trained to approach low thyroid or hypothyroid disorders with one test. The TSH or Thyroid Stimulating Hormone is considered the gold standard as reflecting thyroid gland function. The thyroid range for this test varies per laboratory, but in general the range is .045 – 4.50 uU/ml. To be considered low thyroid, the TSH result must be over 4.50 uU/ml, some consider low thyroid to be at least double that amount.

The paradox is the TSH is not the only true reflection of thyroid health.Those with Hashimoto’s Autommune disease can have a normal TSH. Iodine deficiency can cause a goiter, yet still show a normal TSH and T4. A normal TSH can show in spite of non-conversion of T4 to T3. Adrenal issues causing thyroid symptoms can stop conversion of thyroxin (T4) to the active thyroid hormone, triiodothyronine or (T3). None of these is picked up by TSH levels alone.

The normal physiology of thyroid function is as follows:

The manufacture of T4, or thyroxine, requires iodine, zinc, selenium and tyrosine. Without these nutrients the gland can not produce the hormones T4 or T3. The master gland, the pituitary is located right between the eyes in the space in the middle of the forehead. Thyroid releasing factor, or TRF, is asking the pituitary to stimulate the thyroid gland to make thyroid hormone. Obviously a pituitary tumor may not be ascertained by TSH, yet thyroid issues may be caused by pituitary malfunction.

The thyroid gland will respond to TRF (thyroid releasing factor) and produce eighty percent (80%) thyroxin and twenty percent (20%) T3 or triiodothyronine. The thyroxin or T4 is the pro hormone. The T3 is the active hormone that the receptor sites of the cells in the CNS (central nervous system), muscle, bone etc. respond to.

Most physicians ignore T3 assuming that the T4 or thyroxin will automatically convert to T3. This is not the case. Stress, low or high cortisol will prevent conversion. Insufficient zinc, selenium or tyrosine can stop conversion. Diabetes, low protein, heavy metals can all affect conversion. These are factors not connected to the pituitary-thyroid axis. The conversion is based on liver and kidney functions as well. Therefore people with kidney or liver disease can alter conversion ratios, without affecting the TSH level.

One out of five females and one out of ten males will have a thyroid problem. As women enter menopause and get fluctuations in their estrogen levels, their thyroid binding globulin (TBG) may increase and hold on to the T3 rather than release it. Thyroid symptoms can mimic the change of life - fatigue, hair loss, dry skin, weight gain are a few of the symptoms that are shared by both syndromes.

Oprah Winfrey’s thyroid problems were missed by some physicians who failed to do the screening TSH. Ms. Winfrey’s adrenal stress blocked her T4 to T3 conversion, and compounded her menopausal symptoms, which were missed for sometime.

This scenario is typical. “All your thyroid studies came back in the normal range.” A statement commonly heard by many patients. Unfortunately the screening for this common disorder is in many cases only a TSH, or a TSH and free T4. Conventional doctors do not routinely screen for Hashimoto’s thyroid disorder or nutritional deficiency. Tests for antibodies, to the thyroid gland itself or to the peroxidase enzyme or even to the thyroglobulin binding protein are rarely ordered; yet these antibodies influence the wellbeing of the individual.

How should one approach diagnosing thyroid disorders? Of course the TSH is part of the workup. But a complete thyroid assessment may not be reimbursed by medical insurance.

The following tests can evaluate thyroid function:

  1. TSH
  2. Total T4, Free T4
  3. Total T3 Free T3
  4. TPO antibody
  5. TBG antibody
  6. TSI antibody
  7. Reverse T3
  8. Cortisol assessment
  9. Thyroid ultrasound

The bare minimum would be as follows:

  1. TSH
  2. Free T3, Free T4
  3. TPO antibody
  4. Thyroid ultrasound
  5. AM Cortisol

There must always be an assessment of adrenal health. When the adrenal gland is stressed or hypo functional, it can mimic hypothyroidism or low thyroid.

When the TSH is three (3.0) or greater, but less than 4.50, a condition called sub-clinical low thyroid is present. Many agree the disorder should be treated. Many conventional physicians will say the level is in the “normal range”, and will not treat the disorder. Even if the patient has clinical symptoms, they will be ignored in favor of the test results being in the normal range. The symptoms are more important than the equivocal laboratory data.

These ranges are based on results taken from sick as well as normal patients. The results are thus skewed. Some well patients may be in lower or higher “ranges” and still be normal. All results must encompass both clinical history and physical signs and symptoms.

In summary, thyroid disease can be difficult to diagnose and treat. The function of this vital gland in energy, bone, brain and heart for physical well-being is greatly undervalued. It is always one of the first glands that should be investigated when fatigue, weight gain or loss, depression, and body aches are complaints.

Recommended reading:

  1. Thyroid Power by Richard Shames, MD and Karilee Halo Shames, RN, PhD
  2. Hypothyroid, the Unsuspected Illness by Broda Barnes, MD and Lawrence Galton
  3. Iodine: Why You Need It, Why You Can’t Live Without It by David Brownstein, MD
  4. Wilson’s Temperature Syndrome by E. Dennis Wilson, MD
  5. Adrenal Fatigue 21st Century Syndrome by James L. Wilson, ND, DC, PhD and Johnathan Wright, MD
  6. The Thyroid Sourcebook by M. Sara Rosenthal, PhD


For more information visit the website of
Karan Y. Baucom, MD, FACOG, FAAAM
Fellow American College of OB-Gyn
Fellow American Academy of Anti-Aging Medicine


Previous Hormone health articles by dr. baucom:







Adrenal Glands and Cortisol: the Stress Hormone
Male Andropause








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Updated 09/29/2010