Thyroid Testing - Hypothyroidism & Hyperthyroidism

Rashmi Gulati Head Shot

The thyroid is responsible for the production of hormones that play a central role in metabolism and energy production.

If the thyroid is low one can have a deficiency in energy production in virtually every organ.

The symptoms one will experience depend on which organ is most affected. If the brain can’t produce enough energy one will feel tired, depressed and likely to complain of brain fog and other unexplained symptoms. A low thyroid is manifested in the gastro-intestinal tract as constipation, cramps, poor digestion and at times reflux. Low energy production in the muscles can cause muscle pain. Frequently people are diagnosed with fibromyalgia but what they really have is a low thyroid missed by routine thyroid tests.

What causes a low thyroid?

One of the most common cause is toxic compounds and heavy metals. We are exposed on a daily basis to various toxins that can directly damage the thyroid and affect the immune system. Heavy metals such as mercury, lead, arsenic etc. is becoming a major health threat and the thyroid is the organ that seems to be most susceptible.

At Patients Medical we evaluate for the underlying causes - we look beneath the tip of the iceberg!!! Frequently people complain of many of the typical symptoms of a low thyroid and all the routine tests come out normal. Sometimes doctors just prescribe an anti-depressant, or tell patients you’re tired because you are getting older. We don’t accept this way of thinking.

We believe we can evaluate how well the body and organs are functioning, we can look beneath the tip of the iceberg and evaluate ones metabolic state and make the necessary changes. This is the beauty of the TRH stimulation test-It is a challenge test that evaluates how well ones pituitary and thyroid gland is FUNCTIONING...By using the TRH stimulation test we frequently pick up the low thyroid missed by so many doctors.

The doctors at Patients Medical are one of the few centers in the country who use this test. We have tested many people and have changed the lives of so many because of it.

Understanding the TRH Test

To understand how the TRH Stimulation Test works, it's first helpful to quickly review how the various brain hormones interact with the thyroid.
  • Your hypothalamus is a gland in your brain that secretes thyrotropin releasing hormone (TRH).
  • When TRH is released, it stimulates your pituitary gland -- also in the brain -- to release thyroid stimulating hormone (TSH).
  • TSH stimulates the thyroid itself to make thyroid hormones.
Most practitioners consider the best test of thyroid function to be the TSH test, which measures the circulating level of TSH in the bloodstream at one point in time. The TSH test results are then interpreted; levels higher or lower than a so-called normal range are considered evidence of potential thyroid disease. TRH is known generically as protirelin (pronounced proe-TYE-re-lin).

The TSH test is just a blood test.

The TRH test is different. A baseline TSH test is done. Then you are given an injection of TRH, which stimulates the pituitary to release TSH. A second blood sample is drawn 20 to 30 minutes later, and the TSH level is retested.

The TSH test is a picture in time of circulating levels of thyroid hormone. But by challenging the thyroid, the TRH Stimulation Test evaluates the thyroid's actual ability to function in real life.

How Does the TRH Test Differ from the TSH Test?

One way to look at it is to consider the difference between the TRH Stimulation Test and the TSH test, much like a cardiac stress test is compared to a cardiogram, or a glucose tolerance test is compared to fasting glucose level. In a stimulation test, the challenge may reveal an impairment in the thyroid.

Routine TSH Thyroid Blood Tests are Often Inaccurate... your TSH can be normal because the range for normal is so wide ... but you can still feel fatigued and not right. That is why we like the TRH test - it is much more accurate.

Routine Blood tests for thyroid function measure the amount of TSH, T4, and T3 in the bloodstream. But thyroid hormones don’t operate within the bloodstream; the action takes place in the cells themselves. Blood tests are measuring how much thyroid hormone is swimming around in the blood stream, but not what is in the cell. This is why the TRH test is so important.

Traditional medical professionals know that thyroid blood tests are less than perfect.

The Journal of Clinical Psychiatry has reported: Laboratory blood tests for thyroid may be inaccurate for many who get tested for hypothyroid disorder.

Compounding the problem of using standard blood tests to diagnose hypothyroid is the inability of doctors to agree on the laboratory parameters. According to the American Association of Clinical Endocrinologists (AACE) guidelines, doctors have typically been basing their diagnoses on the "normal" range for the TSH test. The typical normal TSH levels at most laboratories, has fallen between the 0.5 to 5.0 range. Those with a TSH below .5 are considered to have too much thyroid hormone (hyperthyroid). Those whose test results are above 5 are considered to have too little thyroid (hypothyroid). However, it’s not uncommon to find doctors, including endocrinologists (thyroid specialist), who withhold the diagnoses and treatment of hypothyroid until a patient's TSH tests read considerably above 10. While some doctors believe that anyone who has a TSH above 2 and complains of hypothyroid symptoms (depression, fatigue, brain fog, etc.) should be placed on thyroid hormone. While doctors often debate which parameters or numbers are correct, millions of low thyroid patients are not properly diagnosed and treated.

Frequently the routine TSH Thyroid tests miss the diagnosis. This is the reason why so many people have unexplained fatigue.

This is why physicians tell their patients frequently....

You have all the symptoms of hypothyroid but your blood work looks fine.

Patients often relate that they, and sometimes their doctors, suspect a thyroid problem only to have their blood work return normal.

Doctors are typically reluctant to prescribe thyroid replacement therapy without a definitive test that reveals true hypothyroid. They’re afraid that by doing so, they would jeopardize the health of the patient. And true, excess thyroid can cause several unwanted health problems, including elevated heart rate, rapid pulse, and accelerated bone loss. However, millions suffer with symptoms far worse then these when prescription therapy is withheld.

Certainly the dangers of thyroid replacement therapy should be a concern. But, if you weigh the pros and cons of administering thyroid replacement therapy to a patient with normal blood tests, yet all the symptoms of hypothyroid, fatigue, anxiety, depression, achy diffuse pain, weight gain, etc., it's easy to see that withholding therapy should be considered malpractice. This is especially true in light of the fact that many of these patients are taking numerous, potential dangerous drugs, to cover-up the symptoms of hypothyroid; Provigil or Aderall to increase energy, antibiotics for chronic sinus infections, a laxative for constipation, NSAIDs for pain, SSRI medication for depression, Neurontin for tingling in the hands and feet, and perhaps a benzodiazepine like Ativan or Xanax for anxiety. All of these drugs may cause side effects that may cause further symptoms (poor sleep, fatigue, depression, etc.). It’s not uncommon for my patients to be able to drastically reduce or eventually wean off these very medications once their thyroid disorder is corrected.

New Developments

To complicate matters, the parameters for determining who has a thyroid disorder, and who doesn’t, has recently been changed. The new guidelines narrow the range for acceptable thyroid function; the AACE is now encouraging doctors to consider thyroid treatment for patients who test the target TSH level of 0.3 to 3.04, a far narrower range. The AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder but have gone untreated until now.

Self-test for Low Thyroid

Dr. Broda Barnes was the first to show that a low basal body temperature was associated with low thyroid. His first study was published in 1942 and appeared in JAMA. This study tracked 1,000 college students and showed that monitoring body temperature for thyroid function was a valid approach to other thyroid tests.

The test for low thyroid function, according to Dr. Barnes’s protocol, starts first thing in the morning. While still in bed, shake down and place the thermometer (preferably mercury; digital thermometers are not as accurate) under your arm and leave it there for 10 minutes. Record your temperature in a daily log. Women who are still having menstrual cycles should take their temperature after the third day of their period. Menopausal women can take their temperature on any day. A reading below the normal 97.8 degrees strongly suggests hypothyroid. A reading above 98.2 degrees may indicate hyperthyroidism (overactive thyroid).

Treatment for Hypothyroid, The Barnes Method

Dr. Barnes recommends patients take a desiccated glandular (derived from pigs) prescription medication known as Armour Thyroid, which was used before synthetic medications such as Synthroid were introduced. Armour Thyroid and other prescription thyroid glandulars (including Westhroid), contain both T4 and T3.

Synthroid and other synthetic thyroid medications contain T4 only. Since some individuals have a difficult time converting inactive T4 to active T3, these medications may not work at the cellular level. Individuals may take T4 medications for years and never notice much improvement. Their blood tests look good, but in the mean time they’re falling apart; gaining weight, having more aches and pains, battling one sinus infection after another, and becoming more and more fatigued, depressed, and withdrawn. Research is validating what many doctors including Dr. Barnes has been advocating for years, a combination of T4 and T3 therapy is superior to synthetic T4 therapy alone.

Low Thyroid and Depression

Several studies demonstrate that a combination of T4 and T3 or simply T3 therapy alone, may provide welcomed relief from a number of symptoms commonly associated with depression. Studies show that T3 therapy is more effective in reducing the symptoms associated with depression than SSRI antidepressants.

Overall Wellbeing

A study by the New England Journal of Medicine showed that patients who received a combination of T4 and T3 were mentally sharper, less depressed, and feeling better overall than a control group who received T4 only. The addition of T3 often helps with many symptoms of hypothyroidism that may not disappear with supplemental T4 only. It has improved or eliminated depression, brain fog, feeling cold, constipation, chronic fatigue, headaches, insomnia, muscle and joint pain, and chronic sinus infections.

Weight Loss

For some people it has helped them finally lose weight.


One study showed that all the symptoms associated with FMS could be eliminated while the patient was taking high-doses (120 mcg.) of T3.

Over the Counter Thyroid Supplements

The prescription thyroid glandular medications, Armour, Westhroid, and Nuthroid are the preferred method of treating low thyroid disorder. However, many of our patients have trouble getting their medical doctor to write them a prescription for one of these medications.

If you have trouble getting your doctor to prescribe one of these medications then you should come and see one of our physicians.

If you cannot come to our office in Manhattan, consider using the over-the-counter thyroid supplement we recommend to our patients.

Over-the-counter thyroid glandular supplements can also be used to correct low thyroid function. Since these raw thyroid tissue concentrates contain T3, they can be used as a first line of treatment for low to moderate hypothyroid, euthyroid disorder, or Wilson’s syndrome. Individuals taking synthetic prescription thyroid medicines (Synthroid, Levathyriod, etc.) may find that adding an over the counter T3 glandular supplement helps them feel better. A study by the New England Journal of Medicine showed that patients who received a combination of T4 and T3 were mentally sharper, less depressed, and feeling better overall than a control group who received T4 only. Potent, high quality thyroid glandular supplements are not easy to find.

Begin Your Journey to Wellness with Patients Medical

Our job at Patients Medical is to listen, to connect the dots between a patient's medical history, symptoms, and their underlying causes. Patients Medical is a superb place for women and men to secure integrative and holistic health care from providers who give personalized care, partner with the patient to focus on the root cause of their illness, support their recovery, and help them maintain good health.

To make an appointment with one of our physicians, please call us at 1-212-794-8800. We look forward to hearing from you.

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