Thinking About Your Thyroid? How "Standard" Blood Tests Miss the Real Hormone Info

If you read my blogs or have heard me speak, you know that I’m passionate about helping women get the hormones their bodies need to thrive at every age. I’m especially concerned about women getting the testosterone they need as part of their hormone therapy during perimenopause, menopause, and well into their later years of life, because providers often overlook that hormone. In fact, when I teach medical providers about hormone therapy so they can best serve their male and female patients, I always talk about the importance of testosterone for BOTH men and women.
In addition to being a testosterone advocate for women, I’m also a proponent for thyroid health.
More often than not, well-meaning, but undereducated providers misunderstand the importance of thyroid hormones during perimenopause and menopause. As is often the case with tests that attempt to assess fluctuating estrogen, progesterone, and testosterone levels, thyroid tests often appear to be in the “normal” range for many women. I’ll explain why in a minute. First, let’s look at some surprising statistics:
- One in eight women experiences a thyroid disorder in her lifetime.
- Women are five to eight times more likely than men to have thyroid problems.
- Nearly 60 percent of people with thyroid issues have no idea there's a problem.
- Undiagnosed thyroid disease may put women at risk for serious conditions, including cardiovascular diseases and osteoporosis.
You have to wonder, why are so many women suffering from thyroid disorders instead of getting the help they need? It could be largely a result of inadequate testing. Standard blood tests often miss the REAL thyroid information.
Why Should You Think About Your Thyroid in Perimenopause and Menopause?
Thyroid hormones play an important role in regulating the female reproductive system. During perimenopause, fluctuating estrogen levels directly impact how your thyroid hormones function. It’s a complex, intricate connection between the thyroid and your hormones. And, to make things even more confusing, symptoms of a thyroid disorder mimic and overlap some of the same symptoms of perimenopause, like hot flashes, anxiety, heart palpitations, and weight gain.
Typically, when a woman in her 40s or 50s conveys these symptoms to her provider, she gets “standard” testing for hormone levels and TSH (thyroid stimulating hormone). But, this is a limited approach, and doesn’t portray the complete picture of your thyroid function.
To fully understand whether or not your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), you need to have a more comprehensive thyroid test – one that evaluates T3, T4, and reverse T3.
All the T’s of Your Thyroid
When it comes to evaluating your thyroid, there are a lot of T’s involved! Let’s break them down:
- TSH is the thyroid stimulating hormone released from the pituitary gland in your brain
- T4 is thyroxine, an inactive precursor and the main hormone produced in your thyroid gland. It gets converted to T3.
- T3 is triiodothyronine, the active hormone
- Reverse T3 (rT3) is an inactive form of the thyroid hormone, after T4 is converted – a “byproduct” so to speak
Your body produces most of your T3 from your T4. T4 needs to be converted to T3 to perform optimally, and how well your body converts T4 into T3 is often a factor in thyroid disorders. T3 affects your heart rate, digestion, and metabolism.
With all these variable T’s in production and conversion, there are three ways your thyroid can run amok and cause symptoms like fatigue, weight gain/weight loss, hair loss, muscle aches, anxiety, and sleep problems. Here’s what typically goes undetected:
- Your thyroid doesn't produce enough T4
- Inactive T4 has trouble converting to active T3
- Active T3 can't get into the receptors because it's blocked by reverse T3
Request a More Complete Thyroid Picture
Most standard blood tests for thyroid only indicate TSH levels. Reverse T3 can be tested, but your provider needs to request that specific bloodwork. It helps if you have a practitioner who truly understands the thyroid connection to other hormones, including testosterone, estrogen, and progesterone.
“Unless all of the levels are tested, you can’t properly diagnose thyroid disorders, and hypothyroidism is the one most often missed. Luckily, hypothyroidism is usually not difficult to treat.”
– Angela DeRosa, DO, MBA, CPE
As someone who has treated more than 20 thousand patients in the last 30 years, and written about thyroid and hormone therapies, you might find my book,
A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You, a helpful tool in your perimenopause journey and beyond.
You can read more about thyroid disorders in Chapter 3.
The Doctor is in!
