Home: Tired of being Tired, Depressed, Constipated,
Can't Sleep or Think?
Cancer, Depression, Hair Loss, Vertigo, & Infertility Correlate
with Low Thyroid Levels
TSH Levels Fluctuate and often
do not Reflect Thyroid Levels
Osteoporosis, Gum Disease &
Bad Teeth are not from Low TSH
High Blood Sugar & Insulin Resistance Correlate with High T3
Thyroid Blood Tests to Diagnose a
Thyroid or Hormone Imbalance
Thyroid Lab Results are Affected
by the Time of your Last Dose
Thyroid Reference Ranges are too Broad; What is Healthy / Optimal?
Thyroid Hormone Medications:
T4, T3, or Desiccated (T4 + T3)
Thyroid Hormone Requires
Iron, Cortisol, Selenium, Iodine
Hyperthyroid Symptoms (Anxiety, Tachycardia), Hypothyroid Labs
Adrenal Fatigue or Low Cortisol: Hydrocortisone (HC) Side Effects
Reverse T3: Side Effects of T3-only
(or why you need T4 too)
Insomnia, Incontinence, &
Vaginal Dryness Resolve with BHRT
Low Testosterone in Aging Men:
TRT for Andropause
Saw Palmetto, Stinging Nettle, and OTC Men’s Supplements
Asthma, Eczema, Allergies, Hives, and Yellow #5 (Tartrazine)
Antithyroid drugs + Levothyroxine
High Altitude Sickness: Headache, Insomnia, and Hypothyroid?
Books I Recommend
Who Writes TiredThyroid?
Donations to defray web hosting costs appreciated.
Tired of being Tired, Depressed, Constipated, and Can't Sleep or Think?
Welcome to TiredThyroid.com, a website for those who are tired all the time, and not getting the help they need to restore their health due to thyroid problems. This site was specifically written for patients to share with their doctors. Therefore, it is essential that one understand thyroid physiology terms. Here, in great oversimplification, are the terms one needs to know.
The hypothalamus is located in the brain and is about the size of an almond. It sends signals to the pituitary gland, also located in the brain, to create hormones that stimulate other organs. One of these is Thyroid Stimulating Hormone, more commonly known as TSH. TSH tells your thyroid to produce thyroid hormones such as thyroxine, which is more commonly called T4. The “T” stands for tyrosine, which is the amino acid that 4 iodine atoms are attached to. A healthy person produces around 100 mcg T4 and 6 mcg T3 daily. T3 or triiodothyronine, which is tyrosine with 3 iodine atoms attached, is the biologically active thyroid hormone that gives one energy, when it fits into a T3 receptor site in a cell. This is analogous to a key fitting into a lock. Without sufficient T3, the body doesn't function well, and in extreme cases, one may lapse into a condition called myxedema coma. In a healthy person, T3 will be converted from T4 as needed, by an enzyme that strips one iodine atom off a T4 molecule, resulting in a T3 molecule. A different enzyme will convert a T4 molecule into a reverse T3 (rT3) molecule, by removing an iodine atom from a different position. Both T4 and rT3 have little energy-producing effects, though they do have other essential functions. A healthy body has T4, T3 and rT3 in the correct proportions, with T4 being the dominant hormone.
The hypothalamus and pituitary work off of feedback loops, similar to a thermostat in a house. If you turn the heat on in a home, a thermostat will sense the air temperature, and when the temperature drops below a certain level, the heat will turn on, warming the house until the temperature reaches the desired level. Then the system automatically shuts off, until the temperature again drops below the set level. The heater only turns on when the thermostat indicates it’s too cold. This is a simple feedback loop, and similar to how the TSH works. TSH will rise when the body senses that thyroid levels are too low. A high TSH is a signal to make more thyroid hormone. Severely hypothyroid patients have reported TSH levels in the 100s, while a healthy TSH is closer to 1.0. A very low TSH (near zero) may indicate hyperthyroidism or too much thyroid hormone in the body, but many on replacement thyroid medications have a suppressed TSH with normal T4 and T3 levels.
In the same way that thermostats can break and become unreliable, so can a damaged hypothalamus, pituitary, and the resulting TSH signal be unreliable gauges of thyroid levels. A hit to the head from a sports injury or car accident can damage either the hypothalamus or pituitary, resulting in what is called tertiary or secondary hypothyroidism. Severe blood loss from an accident or childbirth can also damage the pituitary, again resulting in a broken feedback TSH signal. For this and multiple other reasons explained in another section, TSH is not a reliable indicator of thyroid levels.
To review: thyroid hormone is produced in the thyroid gland in one’s neck, acting on the TSH signal produced by the pituitary gland in the brain. In a similar fashion, cortisol is a hormone produced in the adrenal gland located above one’s kidneys, in response to an ACTH signal produced by the pituitary gland in the brain. ACTH stands for Adrenocorticotrophic Hormone. Thyroid and cortisol work together in a healthy person, so lack of either hormone creates health problems. Normally, thyroid and cortisol will rise and fall in tandem, so as thyroid levels fall, so do cortisol levels. Likewise, raising thyroid levels slowly can raise cortisol levels. Interestingly, if someone is suspected of having low cortisol or adrenal fatigue, a cortisol lab is run first. ACTH, the pituitary hormone, would only be run later to determine if a deficiency in ACTH is the cause of the abnormal cortisol lab. This is in direct contrast to thyroid testing, where the pituitary hormone TSH is run first, and actual thyroid hormones (T3 and T4) may not even be checked. As stated earlier, a normal TSH does not necessarily mean that thyroid levels are healthy. This is the major flaw with current thyroid treatment: TSH is a pituitary hormone, not a thyroid hormone, does not fit into a T3 receptor site, and therefore excessive or deficient TSH levels cannot cause one to be hyper or hypothyroid. Only excessive or deficient T3 (and T4) levels can cause hyper or hypothyroidism. One can be severely hypothyroid and have a normal TSH.
More terminology for the case study that follows:
Thyroidectomy – surgical removal of one’s thyroid
Goiter – enlarged thyroid, often from an iodine deficiency or Graves’ disease, an autoimmune thyroid condition which causes hyperthyroidism
Desiccated thyroid – a natural medication made from freeze-dried pig thyroids that contains all the components of a thyroid: T4, T3, iodide, and tyrosine
Armour, Nature-Throid, Erfa's Thyroid, NP Thyroid – some brands of desiccated thyroid
Cytomel, liothyronine – some brands of T3 medication
Synthroid, Levoxyl, Tirosint, levothyroxine – some brands of T4 medication
A Typical Thyroid Patient's Doctor Visit
Nearly everyone who is hypothyroid will relate to this real-life forum post from a male thyroid patient (four years after total thyroidectomy at age 38 due to compressive, non-toxic, multi-nodular goiter, and still suffering from multiple hypothyroid symptoms on Synthroid):
Re: First Endo Appt
doctor about switching to desiccated
thyroid or adding T3 to your
So don’t put too much
stock into this appointment. The first thing you need to
After his thyroidectomy, this patient was prescribed 150 mcg Synthroid, which was slowly raised to 175, 182, 200, back down to 175, then up again to 200. His last adjustment up to 225 mcg still did not rid him of all his symptoms, which are the usual hypothyroid symptoms: weight gain (25lbs), inability to lose weight no matter what, brittle fingernails (they broke easily, all the time), constipation, mood swings, fatigue, muscle and joint aches, lower back pain, high cholesterol (went from 175 to 310), lack of motivation, depression, memory problems, foggy brain, trouble concentrating, inability to get mentally organized, scatter-brained, and trouble sleeping.
The following are his own words, which have sadly been repeated by too many:
complained of muscle aches, they said exercise more and stretch out
Hind sight is 20/20. If I could do it all over again, I would have left my thyroid in and dealt with having a big goiter on my neck and looked like a freak instead of dealing with this nightmare. It has turned my life upside down for the worse. I have gone thru 3 primary care doctors and am on the fourth one now after firing the last one.
The messed up part is, no one ever treated the symptoms as a thyroid problem . . .
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