Your thyroid creates hormones that affect almost every cell in your body to help control heart rate, weight, strength, cholesterol, and and so much more.
There are a lot of hormones that go into making your thyroid work as it should. Let's think of the hormones as ingredients for your fluffy pile of delicious thyroid pancakes.
TSH is the flour. (Sure, almond flour) It's the start of a great, healthy cake. After the flour, you're going to need the sugar (T3) and eggs (T4). Of course, there are more ingredients that go into the cake, but let's start with these.
If you're missing the flour, you're going to know quickly that something is wrong. You, the baker, can see that something is clearly not right. However, you could have the correct amount of flour, but missing the sugar. (Yes, I know. I said sugar is bad. Stay with me.) That cake is still not going to be right. You may not be able to see it initially (as in a TSH test), but when you taste the pancake batter, it's not nearly a delicious as it should be. Even though you have the necessary flour, you need all of the ingredients to have the best cake. Without all of the ingredients to work together as they should, you end up with a flat, tasteless, shell of a pancake.
Other factors go into mixing up the best pancake, as well! You need the right temperature (inflammation, trauma, infections), pure ingredients (diet, toxins), and cookware (handling stress) to put everything together. If your eggs are too cold, the pancake will be dense, heavy, and sluggish.
As you can see, there are so much more to look at in your thyroid function than TSH levels. TSH signals the release of T4, an inactive thyroid hormone, and a little T3, the active thyroid which can be made later from T4. Even though you're producing enough TSH to signal that you need these ingredients, you may still not have the right stuff to convert T4 into T3.
Stress, infections, diet, inflammation, toxins, and medication [point out of IFM's Factors that Affect Thyroid Function page] can keep T4 from converting to T3. It's important to get enough selenium and zinc to keep that processes flowing smoothly.
T4 can also turn into reverse T3. When all of this is working correctly, RT3 balances T3 out, keeping your body from hyperthyroidism. When you're overloaded with negative factors, such as stress or inflammation, RT3 can beat out T3, causing hypothyroidism.
Now, just because the hormone is reaching the cell, doesn't mean the cell will accept the change. Getting sufficient vitamin A, exercise, and zinc keep your cell sensitivity to thyroid hormones in tip-top shape.
There are so many things that could make you feel bad, even though your TSH levels came back normal. If you are fatigued, weak, intolerant of cold, constipated, irritable, losing memory, have rough and dry skin or nails, and gaining weight, looking into all of the factors that affect your thyroid will be beneficial.
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