What Metabolic Testing Needs to be done?
The testing needed is different for every patient based on your own unique health history, but there are
certain areas that must be evaluated. Traditional laboratory testing does not dig deep enough to find the answers you are looking for. They screen for basic metabolic markers and they use a very wide lab range to determine if you are normal or not. When Dr. Veselak runs testing (as discussed below) he is going to dig deeper and also realizes that there is a grey area on the way to disease, meaning that if the normal lab range says your TSH should be less than 5 and you are at 4.8 we know that you are trending towards a disease state. The more comprehensive tests, along with a more critical analysis, allows Dr. Veselak to identify areas of pathology as well as areas that are failing to function as optimally as they should.
In evaluating patients that are suffering with thyroid symptoms, a thorough thyroid panel must be performed! Most of the patients Dr. Veselak sees in his office have had their TSH and maybe a T4 tested, but this is simply not enough!
Why is a comprehensive thyroid panel necessary? Why isn’t your TSH level enough?
Your TSH tells you if you are hypo or hyperthyroid but it gives us no insight into where your thyroid problem is coming from. Being hypothyroid does not necessarily mean your problem is starting in the thyroid gland. For example you could have a problem in the pituitary gland causing you to be hypothyroid. You could have a problem in the liver or the gut that is blocking your ability to convert T4 to T3 and is causing your hypothyroid symptoms. When we run a comprehensive thyroid panel we will be able to better support you.
Here is a list of the thyroid markers I will want to see:
· Thyroid Stimulating Hormone (TSH): This is the hormone messenger that is sent from a gland in the brain (pituitary) to the thyroid.
· Free T3: This is a critically important hormone produced by the thyroid gland and it is considered to be the more biologically active hormone of the thyroid.
· Free T4: This is another important hormone produced by the thyroid gland. This will eventually be converted into T3 in the liver and the GI tract.
· Thyroid Binding Globulin (TBG): This test measures the amount of proteins in the blood that transport thyroid hormones to the cells. Elevated testosterone can lower TBG levels and elevated estrogen can raise TBG levels. Both can produce hypothyroid symptoms.
· Thyroid Antibodies (TGB & TPO): These are checked in suspected cases of autoimmune thyroid disorders (see below).
· Total T4: This is a reflection of how much total T4 hormone there is in the blood.
· Free Thyroxine Index (FTI): This is an estimate of how much thyroxine is in the blood.
· Reverse T3: In times of excessive or prolonged stress, your body may shift thyroid hormone conversion into reverse T3 creating hypothyroid symptoms.
The brain and your nervous system require two things to work properly:
To make sure the fuel supply for your brain is adequate you must ensure that these foundational areas are addressed:
(1) Blood Sugar – If you are diabetic, pre-diabetic, or hypoglycemic (too low of blood sugar) this will be a roadblock to healing your brain and stabilizing your immune system.
(2) Anemia – If you have any type of anemia you are robbing your brain and nerves of oxygen! Pernicious anemia is common form of anemia with thyroid disease.
(3) Vitamin Deficiency/Toxicity – Deficiencies in many vitamins and minerals can drive neurological deficits. At the same time if you are toxic with any of these elements it can also be a problem.
(4) Methylation – Methylation is a chemical process that takes place in your body which allows you to eliminate environmental toxins, reduce inflammation, and get essential nutrients to the brain and the nerves. There are genetic variants that can literally block your nerves, immune system and brain from receiving the nutrients that they need to work. It is estimated that 93% of people who suffer from neuro-immune disorders (like hashimotos) have a genetic defect in MTHFR. This genetic variant can literally be starving your brain!
(5) Auto-Antibodies – In my office I consider thyroid patients to be auto-immune until proven otherwise. Auto-immune diseases are diseases of the immune system where your immune system is attacking your own body! The most common cause of thyroid disease in America is hashimoto’s disease (an auto-immune disease). The important thing to understand is that if you are auto-immune the same attack going on against your thyroid can spread to your brain, your pancreas, your digestive system, etc. A common target in auto-immunity is the cerebellum. The cerebellum is the balance portion of your brain. If your cerebellum is being damaged not only can in trigger migraines but it also can manifest as balance disorders, tremors, and movement disorders.
If you are auto-immune the immune system must be stabilized in order for your thyroid health to be stabilized!
Many practitioners over simplify the idea of auto-immunity. They talk about the immune system like it is a see-saw between what is called the TH1 (natural killer cells) and the TH2 (the B-cells) systems but the truth of it is that the immune system is extremely complex. There is more to it than just the TH1 and TH2 systems. To work to balance the immune system the TH1, TH2, TH3, TH17, the GALT, and many other chemical interactions need to be evaluated and addressed.
In the case of auto-immunity it becomes extremely important to thoroughly evaluate gut and immune health. Many more of those tests are discussed in the section below.
Other lab testing that may need to be assessed include:
(a) Food Intolerance Testing – If your body has an abnormal response to a food you are eating on a daily basis you can be poisoning yourself without even knowing it. Food reactivities are not severe enough that patients can accurately identify if they are present. But when you continually expose yourself to a food that your immune system is reactive to it can trigger rampant inflammation and lead to brain and thyroid damage. This type of test is not an allergy test like what your medical doctor may have tested. This type of test can be performed through the saliva, the stool, or the blood but you must be evaluated for your IgA and IgG reactions. IgA and IgG food reactivities are delayed responses which can make it very difficult to determine what you are reacting to. This is why thorough testing in this arena is so important.
Common symptoms of food reactions can be:
– Fatigue after meals – Bloating after meals
– Heartburn – Headaches
– Rashes – Inability to lose weight
– Constipation – Eczema/Acne
– Increased post-nasal drip – Diarrhea
– Mouth ulcers or sores – Chronic pain
(b) Infections – Infections can stimulate the immune system leading to an elevated immune response which can result in attack on the thyroid gland. This is a common trigger for how auto-immunity can be developed. Parasites, bacteria, viruses, fungi, and yeast are all examples of infections that can wreak havoc on the body. Most patients I talk to feel like they would know if they had an infection. This is not true. Many times there are low-grade infections that don’t make a person acutely ill but do lead to a chronic inflammatory state, which gradually weakens the body.
Another example of an infection that can directly impact thyroid health is lyme disease. I will discuss Lyme disease below as there are many components to evaluating for lyme disease. We test for infections with serum testing, stool testing, and/or salivary testing.
(c) Adrenal Stress Profiles – The adrenal glands are your stress glands! Is your body under stress? This test measures the amount of cortisol being produced by your adrenals at 4 different times throughout the day. This is an important test because cortisol can be ruining your health in many ways.
Altered levels of cortisol may cause:
(1) Weight gain – Elevations in cortisol cause your body to store fat and decrease your ability to burn fat.
(2) Fatigue – Any time your cortisol rhythm dips during the day you will experience energy crashes.
(3) Insomnia – Altered cortisol rhythms causing too high or too low of levels at night lead to interrupted
(4) Brain Fog/Declining Memory– Cortisol is particularly toxic to an area of the brain called the hippocampus. The hippocampus plays a significant role in memory. Chronic elevations of cortisol are shown to damage this area of the brain and may even lead to conditions like alzheimers!
(5) Food Sensitivities – Elevations in cortisol causes elevations in antibody levels in your gut, which in turn leads to your immune system becoming abnormally reactive to foods.
(6) Hormonal Imbalances – The adrenals play a significant role in the regulation of testosterone, estrogen, and progesterone. When the adrenals are not healthy it can create imbalances in these hormones which can lead to infertility, anxiety, panic attacks, depression, irritability, water retention and weight gain.
(d) Immune Reactivity to Heavy Metals – Many practitioners refer to the need to eliminate heavy metals. There are many technologies to evaluate heavy metal exposure. The truth of the matter is that we live in an extremely toxic world. Everyone has heavy metals in the body. That is not the question. The question that must be asked is, ‘how is your body’s immune system reacting to the different heavy metals?’ Heavy metals can certainly trigger an immune response that can create nerve and brain inflammation and by testing your individual response to each heavy metal we can see what specific metals may be contributing to your thyroid disease.
(e) Immune Reactivity to Environmental Toxins – From pesticides, to plastics, to cleaning supplies, we are exposed to toxins on a daily basis. An individual’s exposure to these toxins is not the primary concern. If your immune system becomes hypersensitive to these environmental toxins it can wreak havoc on your thyroid and your body. We can run a comprehensive blood test to assess your individual response to these different toxins and to develop a specialized remediation plan for you.
(f) Iodine Testing – Iodine plays a key role in the production of thyroid hormones. Three molecules of iodine are used in T3 and four molecules of iodine are used to make T4. Insufficient levels of iodine can definitely play a role in the development of thyroid disease. There is much debate about whether iodine should be used to support thyroid patients. If you are deficient in iodine levels you will need iodine. The most important thing about iodine support is the timing. We don’t want to give you iodine when you have significant levels of inflammation in the body and the immune system. We can test iodine status in the serum or in the blood.