The first thing we will talk about is Hashimotos Thyroiditis, This is a condition that is grossly under diagnosed in this country, I have read estimates that show this condition effecting 1/2 of diagnosed hypothyroid condition. According to the American Association of clinical endocrinologist there are 27 million people in the US with this condition and more than 1/2 go undiagnosed. So if 1/2 go undiagnosed and 1/2 of the diagnosed have Hashimotos that’s a lot of sick people. I believe that those estimates are conservative and a much greater number of individuals are suffering with Hashimotos and don’t know it.This is a crime because if you have Hashimotos you have and auto immune condition not a thyroid condition so you are being treated for the wrong thing. let me say that again but differently, you do have thyroid problems but they are due to the fact that your thyroid and thyroid enzymes are being attacked by your immune system. This needs to be handled completely different than a traditional hypothyroid condition, and that’s why so many patients as well as doctors are frustrated with these cases.The reason this autoimmune condition goes undiagnosed is #1 your lab values may look normal this is where a practitioner of functional medicine is needed you need to look at functional levels as opposed to traditional lab values. Functional medicine is a cutting edge approach to many chronic conditions. Functional medicine practitioners are like medical detective looking to restore function not just treat your symptoms or diagnosis. #2 if your doctor gives you thyroid medication and your thyroid stimulating hormone or TSH level return to normal then your doctor feels the treatment was effective. So why do you still feel like crap? Because you still have the autoimmune condition that caused the thyroid symptoms.Running the appropriate testing can detected Hashimotos Thyroiditis. One such test is a thyroid antibody test to see if you are making antibodies to your thyroid.So the 1st hidden cause of you thyroid condition is Hashimotos Thyroiditis.The second factor is estrogen. Excess estrogen will increase thyroid binding globulin. thyroid binding globulin will prevent your inactive thyroid hormone from converting to the active form T3 when this happens your TSH might look normal your T4 might look normal and you doctor might tell you everything is fine but why do you still have symptoms. This is why it is so important to run a complete thyroid panel in this case the marker we are looking for is T3 uptake T3 uptake is inversely proportional to thyroid binding globulin, if we find that you low T3 uptake and have high thyroid binding globulin we need to look at estrogen and that is a whole other topic, but very important to the true resolution you thyroid problem.So the 2nd hidden cause of you thyroid condition could be estrogen.Now remember I said hidden causes because many times the doctor you are seeing will not pick up on these causes, and there are two main reasons for this. #1 not running the proper test and in your doctors defense this is all about training when you are trained in drug treatments and the experts you rely on for training are experts in drug training that’s why we’ve seen patients from the mayo clinic that could not be help until they found us. So not running the test from a functional perspective as opposed to drug treatment perspective. #2 the lab ranges they are comparing to are pathological ranges comparing you to sick people we look at functional ranges comparing you to healthy people. This is why your test are normal but you know you are not normal you feel bad.So back to cortisol. Cortisol is produced by the adrenal glands and they sit right on top of the kidneys your adrenal glands are your stress glands and have a few functions but when you are exposed to long term chronic stress the gland can get overwhelmed and production of cortisol an indication of the function of the adrenal glands. One of the problems that can happen is excess cortisol this can result in the production of excess cytokines this can inhibit the pituitary from producing TSH thyroid stimulating hormone.One of the test I run for my patients is called an adrenal stress index test to determine adrenal function. Now when you have adrenal dysfunction it can cause other problems so a nice side effect is not only do you get your thyroid better but other areas like you adrenal glands get better in the process.So the 3rd hidden cause of you thyroid condition could be cortisol.Remember when I was talking about cortisol I talked about how the pituitary makes thyroid stimulating hormone and that this is many time the only marker many doctors look at to determine how much medication to give you. One of the factors in the pituitary function is dopamine if dopamine production is off that can affect the TSH production of the pituitary, I think you are starting to get the picture that our bodies are made up of many inter related functions that need to work together, it’s a team effort.The big question is not if your TSH is low in the functional range or the traditional pathological range by why is it low and it could be dopamine. Let’s not forget that low dopamine can have its own symptoms like feeling of worthlessness or lake of focus your doctor may have you on other medications for those symptoms like antidepressants or Ritalin. The beauty of functional medicine in getting to the underlying cause of your thyroid problem we will likely correct other underlying problems all at the same time, I think that is really cool and that’s why I love this unique approach t thyroid conditions.So the 4th hidden cause of you thyroid condition could be Dopamine.Serotonin is a neurotransmitter and serotonin problems can give symptoms like depression, anxiety, it is interesting to note that there can be many causes of thyroid problems just like many causes of depression and sleep disorders so treating any of these by just using the symptom as a guide does not make sense you must be a detective and do many test to find the underlying dysfunction.With serotonin we may do a number of things, one of which is a neurotransmitter assessment form and a comprehensive metabolic profile.So if you are having symptoms of anxiety, depression, sleeping disorders, symptoms like PMS and carbohydrate cravings it could be a serotonin problem.So the 5th hidden cause of you thyroid condition could be serotonin.Prolactin is another hormone that can affect your pituitary if you remember earlier we talked about how the pituitary makes TSH or thyroid stimulating hormone. So if you have increased prolactin that will suppress the pituitary and suppress the production of TSH.Remember that as long as your TSH is within the pathological reference range your doctor will not pick this up and that’s because he is not trained to look for functional ranges. I want to stress for all of you who love your doctor, he/she is doing the right thing for which they were trained. It’s all about training and that is why I have done extensive training in functional medicine and that is what enables me to help people who could not previously be helped.So what is causing prolactin to be elevated? It could be low dopamine and progesterone. Anything that suppresses dopamine and progesterone function can increase prolactin and suppress TSH this is where the real doctoring comes in do the testing. If you’ve been told your labs are normal or even if you’re on thyroid hormone and its helps why do you need it?So if prolactin is an issue you could have symptoms such as difficulty getting pregnant and leakage from the breast for men you may have decreased libido since prolactin suppresses testosterone the male sex hormone. And yes we have treated patients for thyroid and in the process they got pregnant once we restored proper prolactin levels, really cool and again why I love doing this type of work.So the 6th hidden cause of you thyroid condition could be prolactin.Cytokines are chemicals in the body that are produced in response to stress and or inflammation. If you have high levels of stress and by stress I mean emotional as well as chemical. Many people will say I’m not that stressed but they are and hove no idea how chemically its reeking havoc on their bodies. You can have toxic exposure to chemicals like some of my patients that work in nail salons or dry cleaning facilities, if you have a condition called leaky gut you can have food proteins stressing your immune system. The point is there are many hidden stressors in today’s world and if your cytokines are elevated it can suppress thyroid stimulating hormone, sometimes not enough to show up on the pathological lab ranges but enough to show up on the functional ranges.In order to find out if cytokine elevation is contributing to your thyroid problem you need to do the testing. We look at markers such as interleukin 6 interleukin 10 to evaluate cytokine function. Once again this is not standard testing with your typical thyroid specialist, remember we are looking at function and trying get to the underlying cause of your condition not just trying to figure out how much TSH to give you.So the 7th hidden cause of you thyroid condition could be cytokines.