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Why Thyroid Disease is Often Undiagnosed

Updated: Jan 14, 2022

January is Thyroid Awareness month! Thyroid disease affects one in five women and one in ten men, yet 50 percent of people with thyroid disease go undiagnosed. Many who are diagnosed become treated inadequately with medications such as Synthroid®


The thyroid gland is a small butterfly shaped gland that rests just below the center of the neck. It regulates everything metabolic in the body. When I say metabolic, I don’t just mean weight gain or loss. I mean the cellular energy that makes you go swiftly each day. It’s what makes you maintain your life! What a huge task by such a small gland!





It impacts the digestive system, mood and emotions, mental clarity, skin health, immune function, how well our body's utilize cholesterol. It even helps to synthesize other hormones like progesterone, which are needed for fertility and cortisol, which is needed for immune function and stable blood sugar.


When the thyroid is working properly we feel energized and happy! When the thyroid is working suboptimally, we may feel sluggish, depressed, and experience constipation, dry skin, feeling cold, infertility - just to name a few!


Many times, folks are undiagnosed with hypothyroidism because of a couple factors:

  1. Only TSH lab marker is run during blood work

  2. Because the lab test results land in the reference range, the doctor says “they’re normal/fine!”


However, there are some big factors that are missed!


How Your Thyroid Gland Functions


TSH is a brain hormone NOT a thyroid hormone. The brain tells the thyroid to make more or less thyroid hormone by increasing or decreasing TSH. By running TSH alone, we are not actually seeing what’s going on with the thyroid.


So what bloodwork markers do we need to look at to understand the thyroid? Thyroid hormones! There are 3 main hormones we want to be looking at:

  • T4: T4 (about 93 percent) is the inactive form of your thyroid hormone that, if everything works as designed, your body will convert into T3.

  • T3: About 7 percent of your thyroid hormone is T3, the “active” hormone. While we want enough T3, we also need enough T4 to be able to convert to T3.

  • Reverse T3: T3 hormone is like the gas peddle, but Reverse T3 is like the brake. It forces the body to slow metabolism… often due to high levels of stress.



Additionally, we want to look at thyroid antibodies. Thyroid antibodies include Thyroid Peroxidase antibody and Thyroglobulin antibodies. When there’s a presence of antibodies, it can indicate that the body is attacking the thyroid gland (mistaking it for a stranger danger substance) and reducing it’s ability to make T4 and T3. So in Functional Medicine, we very much want to know if there are antibodies being produced against the thyroid. If there are, then our primary focus will not be on the thyroid gland itself, but it will be on balancing and regulating the immune system so it stops attacking the thyroid gland.






What about those reference ranges?


The last thing to address here is whether “normal” labs always mean normal or optimal thyroid function. The conventional lab ranges are, in many cases, based on a sample of people that have received those tests, and then they simply make a bell curve of the results. Anyone who is in the middle of that bell curve is deemed as being normal. As a result, these ranges are based on what the average values are in a population, rather than what the optimal values are.


Additionally, the conventional reference range for TSH is quite large, typically being .5 - 4.5. This means that if you go to your doctor and your TSH is 4, they’re going to tell you that you have a normal functioning thyroid gland. However, studies have shown that a normal TSH was more like 0.5 to maybe 2 or 2.5. Anything above 2 - 2.5 should be further investigated for hypothyroid dynamics.



A Full Thyroid Panel

To receive a comprehensive look at your thyroid these are the lab markers you’ll want to run


  • TSH: Thyroid Stimulating Hormone

    • Brain hormone that tells the thyroid to make more or less thyroid hormone

  • Total & Free T4: Thyroxine

    • Weak thyroid hormone. T4 can be converted to T3 or Reverse T3

  • Total & Free T3: Triiodothyronine

    • Active thyroid hormone. It competes with Reverse T3

  • Reverse T3:

    • Blocks the action of T3

  • Anti-TPO Ab: Anti Thyroid Peroxidase Antibody

    • Antibodies that destroy the creation of T4 thyroid hormone

  • Anti-Tg Ab: Anti Thyroglobulin Antibodies

    • Antibodies that interfere with the creation of T4 thyroid hormone


Finally, thyroid dysfunction is often NOT due to the thyroid being broken. It can actually be a symptom of something deeper going on within the body. We will want to explore your nutrient status, your gut health, and your liver health to name a few.



If you'd like to learn more about thyroid health, watch our free 30 minute class!





January is Thyroid Awareness Month. Get your thyroid checked by requesting a full panel. If your medical provider won't order one, you can order labs for yourself or contact us at info@sagebrushwellness.com and we can help you with that process. Speak up for your thyroid!




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This blog post is for informational and educational purposes. It’s not meant to treat any health condition or to be prescriptive for anyone.

Always be sure to work with your healthcare practitioner before implementing new recommendations and/or supplements.






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