Guest Post – How can I have a problem with my thyroid if my doctor says it’s OK?

Are you tired or even exhausted much of the time?   Is your hair thinning? Are you gaining weight and unable to lose it even with regular exercise? Do you feel cold? Do you have poor circulation?

Perhaps you have presented these symptoms to your doctor and were told to get a blood test for your thyroid. Then, perhaps, your doctor received the results and said that your thyroid is fine and that you have no problems. If you protested that you still have the symptoms, maybe you were given a prescription for an anti-depressant.

Does any of this sound familiar?


The problem with this picture is too much emphasis is being put on a single blood test. Too often thyroid system imbalance is missed because a person’s Thyroid Stimulating Hormone (TSH) comes back “within normal range”. TSH is a hormone made by the pituitary gland, one of the hormonal command centres in the brain.

It stimulates the thyroid gland to make thyroid hormones. When the thyroid is making adequate levels of thyroid hormones, the pituitary is happy and TSH levels will be within range.   If the thyroid has trouble making its hormones, then the pituitary increases TSH to stimulate the thyroid to make more of its hormones. Once the TSH levels get above the normal range, your doctor will usually make a diagnosis of hypothyroidism (low thyroid function) and prescribe medication. If the TSH reading is considered “normal”, then your doctor is likely to assume that your thyroid is fine.

How can there be a thyroid problem if the TSH is normal?

Most doctors conclude, from normal TSH levels, that the thyroid is producing adequate hormones and, therefore, the thyroid is normal. Beside the fact that the reference ranges used to consider TSH levels “normal” are far from what we should consider optimal, there is a more important factor that is being missed. Thyroid Stimulating Hormone does not necessarily reflect the levels of thyroid hormones in the body’s tissues. So, TSH, and even the thyroid hormones themselves, may be at normal levels in the blood. This does not mean that they are normal in the tissues, where their effects take place. When tissue levels of the thyroid hormones get low, you start to feel the symptoms that I mentioned earlier.

What do these thyroid numbers mean?

The amount of TSH that is made by the pituitary gland is determined by the blood levels of two thyroid hormones – triiodothyronine (T3) and L-thyroxine (T4). These two thyroid hormones stimulate your body’s metabolism. That is, they tell your body how fast or how slowly to run. This determines, amongst other things, your energy, weight, hair growth, skin texture, mood, sex-drive, and, of course, your body temperature.

T4 is manufactured in the thyroid gland, using four atoms of iodine. T3 is identical to T4, except that it contains only three atoms of iodine. Some T3 is made in the thyroid gland itself by conversion from T4. Most of the T3 in your body is manufactured outside of the thyroid gland, in the so-called peripheral tissue (which just means outside of the thyroid), including the liver. The difference between T4 and T3 may seem trivial – it’s only one iodine atom, after all. To your body, however, the difference between T4 and T3 is huge. In fact, T3 is four times stronger in stimulating your metabolism compared to T4. Because of this, it is vitally important that your body is able to produce enough T3. When it cannot, the typical underactive thyroid symptoms, that I mentioned earlier, tend to crop up. So, how do you know if you are making enough T3?

Do I have enough T3?

There are two tests that can determine blood levels of the thyroid hormones – freeT4 and freeT3.   These are the best tests to tell you the active thyroid hormone levels in the blood. Unfortunately, they do not give an accurate reflection of the tissue levels of T3, which is the critical one. Another thyroid hormone, called reverse-T3 (rT3), helps give a better picture. Reverse-T3 tends to build up to higher levels when the body is unable to efficiently convert its T4 into T3. When rT3 builds up, T3 levels in the tissues tend to go down. The most accurate way to use blood tests to estimate your tissue levels of T3 hormone is to use the ratio of T3 to rT3. A low T3:rT3 ratio can indicate low T3 in your tissues – a metabolic disaster!

Body temperature is the measurement that most closely matches the symptoms that accompany low tissue T3. When your thyroid system is functioning perfectly, your average daily body temperature will be 98.6°F or 37°C. If your average daily temperature is much lower than that, you will start to feel the symptoms I mentioned earlier.

The best way to see if your thyroid system is working is by measuring your oral temperature three times a day at three-hour intervals, starting at three hours after waking. If, after a few weeks of measurement, your average temperature is low, you know that you need to see someone that can address your thyroid issue without relying on unreliable blood tests.

Now I would love to hear from you! What question do you have about your thyroid gland? Leave a comment below and I’ll be back next week to fill in for Dr. Durkin on another edition of Doctor as Teacher Tuesday.

About The Author

Dr. Patrizio Nardini ND

Dr. Pat Nardini, ND, is a licensed Naturopathic Doctor (licensed by the College of Naturopaths of Ontario) and a 2001 graduate of the Canadian College of Naturopathic Medicine (CCNM) in Toronto. During this time, he was the recipient of the Dr. Leo Roy/Dr. Joseph Boucher Award for Excellence in Clinical Nutrition. Prior to that, he obtained a Bachelor of Science degree from the University of Toronto and a Master of Science degree from the University of Guelph. Dr. Nardini’s practice focuses on promotion of the overall health of his patients through a wide range of naturopathic methods. Pat recognizes that each person is an individual, and that human health is not a “one size fits all” process. His methods revolve around achieving an optimal state of health by examining and treating the root causes of the problem, rather than simply addressing the symptoms. Dr. Pat Nardini, ND has more than a decade of clinical experience as a Naturopathic Doctor. His special interest lies in the health of the Thyroid Gland, as well as the entire Endocrine System in the body. He is certified in the diagnosis and treatment of Wilson’s Temperature Syndrome, a stress-related, usually reversible condition of the thyroid system. In addition, he has extensive experience with a wide range of issues that can impact your health. Pat draws from the naturopathic modalities of clinical nutrition, botanical medicine, Traditional Chinese Medicine and acupuncture, homeopathy, and lifestyle counseling in his holistic practice. He has treated people at all stages of life, male and female, those dealing with specific health concerns, and those who just want to be healthy. Amongst all of his years of study, he has found that the time that he has spent with his patients has taught him the most. He is extremely excited to be a member of the wellness team at Quinte Naturopathic Centre.

Comments from our readers


  • Sandra Carter

    August 22, 2017

    I have Hypothyroidism & Michelle just did blood tests & after 2or 3 years I still have it. I’m going to do the temperature test & see what happens. I sleep pretty good, but I get fatigued very easy. I’ve lost my eye brows & hair. My mouth is dry as are my eyes. Should I be tested to see if I’m taking the right vitamins. . Thanks

  • Patrizio Nardini

    August 22, 2017

    Hi Sandra. It’s possible that you have thyroid system problems with normal blood tests. Check your temperatures for at least 2 weeks and follow up with Dr. Durkin to find out if further testing is required.

  • Lisa

    August 23, 2017

    This is exactly why I sought out alternative care to my family Doctor. Years of the same symptoms, clean blood tests and only ever being offered anti-depressants (which I never took)
    The QNC has been a life changer. To finally be understood and also see immediate positive changes from the few changes in diet and supplements was such a relief after years of frustration and no results.

  • Patrizio Nardini

    August 23, 2017

    Great to hear, Lisa!

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