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Limits of Liability/Disclaimer of Warranty The author, Brad Shook has made their best effort to produce a high quality and informative reference. The author makes no representation or warranties with respect to the accuracy, applicability, fitness or completeness of the contents of this program. They accept no liability of any kind for any losses or damages caused or alleged to be caused directly or indirectly, from using the information contained in this book. This book is not intended for use as a source of any legal or medical advice. The publisher wants to stress that the information contained herein may be subject to varying international, federal, state and/or local laws or regulations. The purchaser or reader of this publication assumes responsibility for the use of these materials and information. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness or dietary supplement regimen. Page 0 of 14
The Office of Dr. Brad Shook Hi, and welcome to this special edition guide, The 29 Non-Thyroid Labs You Need, That No One Has Ordered. Hopefully you already have my 9 Tests Required to Understand Your Thyroid, but if you don t, don t worry, this special guide will cover the thyroid related labs, just not in as much detail. As a quick and easy way to give you a general idea of the potential problems that could be causing your thyroid symptoms, I have developed this patient based guide that walks you through the labs you NEED to have done so that you can start working on getting to the root cause of your thyroid symptoms. Why do you need 29 different labs? Here s why you can have 10 people with low thyroid symptoms you know, tired, fatigued, can t lose weight, depressed, hair falling out, weak nails, constipation you know what I m talking about. Now here is the interesting thing, and a VERY important point every one of those 10 people, could have a different problem causing the exact same symptoms! Yes, you read that correctly, 10 different problems, causing the same low thyroid symptoms. So what do 99.9% of doctors do? Well they do everything they can, they prescribe thyroid hormone replacement therapy (even though most people don t have a thyroid quantity problem), or they give antidepressants you know what, they are trying, but I m sorry, that is unacceptable! People deserve better! It s my mission to help people with Hashimoto s and thyroid problems get their health back. So this is what I did I put this guide together so that you can: - Fill in your lab values and read my comments on what could be going wrong - Learn how lab values outside the optimal ranges may contribute to your symptoms - Get an idea of what you may want to consider doing about it All you need to do is get a copy of your most recent labs, and transfer the values of your laboratory markers to this color-coded form a little further down in this guide. If your laboratory ranges are outside of the optimal ranges I use, or outside the lab high and low ranges, read some of the potential problems associated with each marker. This is not a comprehensive list of possible problems that can cause thyroid symptoms, and only the most common physiological breakdowns that I see on a regular basis are mentioned. I would be very difficult to expand my explanation of possible laboratory findings beyond what I have done, simply because of the shear amount of time and information required to detail each marker and all of the Page 1 of 14
possibilities. This form is in no way a substitute for medical care, and is not provided to you to treat, diagnose or cure any condition, but rather is information in nature. In functional medicine, we seek to identify the drivers of disease processes, so that we can work to begin a program of supportive care, to help your body heal by addressing the root problem. We use more sensitive laboratory test ranges, called functional ranges. These values compare you to what is believed to be a healthy normal population of people, rather than just comparing you to the laboratory average range, which is based on an unhealthy population. We want to detect potential problems before they become a diagnosis, and work to be preventative, and restorative. Functional Medicine takes the opposite approach of traditional medical care, which is primarily based on symptomatic treatment once you are sick. If you have a symptom or problem, you can be treated under the traditional model, but that system of healthcare does not focus on a true preventative or restorative approach to most chronic health problems. All of your doctors care about you, and mean well, but they are tied to a system that approaches healthcare from a reactive, rather than proactive perspective. Before reading through, and trying to utilize these lab markers make sure you watch my video on how your body makes and uses thyroid hormone. This video explains the process of thyroid hormone creation, and follows it as it passes through your body until it is finally used by the cell. There are about 24 known physiological patterns of thyroid dysfunction that can cause hypothyroid symptoms, and thyroid replacement hormone is only a solution for 1 of those 24 patterns, primary hypothyroidism. Once you finish with my first video on thyroid physiology, view his presentation on thyroid dysfunction, and then watch his presentation on autoimmunity if you have Hashimoto s, Graves disease or any other autoimmune condition. Understanding autoimmunity is critical if you have an autoimmune thyroid condition, because the autoimmune condition is usually the primary reason for your symptoms, not low thyroid hormone levels. If you are interested in working with me, you must watch all of these videos before an appointment can be scheduled. Your understanding of my approach to supporting your health is the starting place for you to begin your journey of taking your health back. Your health has to be a top priority, and it is our goal to educate you so that you can become empowered, and be your own advocate. Page 2 of 14
What are Functional Ranges? Page 3 of 14
Watch my first video and follow along using this diagram. If you understand this diagram, you will know more than 99% of the healthcare providers that you will see. Knowledge is power, be your own advocate! Here is the link to the video. *The following values follow adult reference ranges, and have been derived from numerous sources including clinical observation. Please be aware that lab ranges for most laboratory values are different depending on the lab you go to. That s right, lab values are different around the country, and are based on averages of people that visit that lab, not based on a standard value for everyone! If your lab says that for TSH to be lab high, the value must be over 5.5, then for you to be diagnosed as hypothyroid your TSH must be above 5.5. The lab high value in my area is 4.45, but you have to go by the values from your lab when diagnosing a condition. For this very reason, in Functional Medicine we use Functional Ranges, or optimal ranges that compare you to healthy people, and not just to the lab ranges which are considered to be associated with poor health. Page 4 of 14
29 Marker Lab Guide *This guide is not comprehensive. It is not focused on, nor intended for the identification of pathology, but is intended to be information only. Functional Range Your Result These markers are not the cause, but rather markers reflecting altered chemistry. Hemoglobin A1C (blood sugar 3 mths) - Above 5.7 indicates blood sugar spikes and dips Ideal is less than 5.7 5.7 to 6.4 prediabetes >6.5 is considered diabetes RBC (red blood cells) (F) 3.9-4.5 (M) 4.2-4.9 - Number of RBCs per liter of blood. - Low levels suggest anemia, but why? Hgb - (F) 13.5-14.5 (M) 14-15 - Number of iron containing oxygen transport proteins in RBCs. - Low levels suggest anemia, but why? Hct - (F) 37-44 (M) 40-48 - % of RBCs in blood - Low levels suggest anemia, but remember, always ask why, and work on getting to the root of the problem. MCV - 85-92 - Measures average volume of RBCs - Large size suggests B12 deficiency, but why? - Small size suggests Iron deficiency, but why? MCH - 27-32 - Measures the average mass of hemoglobin per RBC MCHC - 32 35% - Measures average concentration of hemoglobin in a volume of packed RBCs RDW - < 13 - Indicates variation in size of your RBCs. - Elevation can indicate anemia. WBC (white blood cells) 5.0-8.0 - Suppressed suggest a chronic condition - Elevated suggests infection Neutrophils - 40 60% - Elevated suggests bacteria Lymphocytes - 25-40% - Elevated suggests viral involvement and/or chronic autoimmunity Monocytes - < 7% - Elevated suggests Epstein-Barr Virus Mono Eosinophils - < 3% - Elevated suggests parasite Basophils - 0-1% - Elevated suggests large, allergic, histamine response TSH (thyroid) 1.8-3.0 - TSH is (Thyroid Stimulating Hormone) it is produced by the pituitary gland in the brain - High suggests hypothyroidism - Low suggests hyperthyroidism Total T4-6 - 12 mg/d (Total Thyroxine) Total T3 100-180 ng/dl (Total Triiodothyronine) Free T4 1.0-1.5 ng/dl - T4 is approx. 93% of the thyroid hormone produced by the thyroid, and it has to be converted to T3, to be used. - Low suggests primary hypothyroidism (the gland not producing enough hormone) - Low suggests poor conversion of T4 to T3 in the liver and GI tract. - Low suggests increased thyroid binding globulins from Page 5 of 14
Free T3 2.0-3.0 pg/ml Reverse T3 25-30 ng/dl T3 Uptake - 28-38 mg/dl Thyroid Peroxidase Antibody (TPO) Above Lab Range Antithyroglobulin Antibody Above Lab Range SGOT (AST) 10-26 U/L (Liver) SGPT (ALT) 10-26 U/L GGTP 10-26 U/L LDH 140-180 U/L increased estrogens - Free T3 is the most physiologically active thyroid hormone - Low suggests increased thyroid binding globulins from increased estrogens - Normally produced, but elevations suggest extreme stress, major trauma, surgery, chronic stress, elevated cortisol, and due to inability to clear it from the body. - It can compete with T3 and cause hypothyroid symptoms. - Low suggests increased thyroid binding globulins from increased estrogens - High suggests decreased thyroid binding globulins from increased testosterone. - Levels above the lab range indicate an autoimmune process against the thyroid. - Levels above the lab range indicate an autoimmune process against the thyroid. - Elevated with liver inflammation - Marker involved with liver function - Commonly increased with low thyroid function, birth control - Decreased with hypoglycemia 25 (OH) Vitamin D 70-100 - Critical for immune system regulation. Vitamin D helps your immune system produce regulatory T Cells. These regulatory cells help to balance the immune system. C-Reactive Protein (Inflammation) < 1 Homocysteine (Inflammation) < 7 - A marker of active inflammation - Elevations mean that you have an active source of inflammation that you HAVE TO DETERMINE! You cannot have chronic inflammation; it will cause problems with multiple systems in your body. It is a HIGH priority! - An inflammatory marker - Elevations can be an indicator of methylation problems, and could mean that you have a genetic SNP snip. Page 6 of 14
TSH TSH (Thyroid Stimulating Hormone or Thyrotropin): Stimulates the enzyme TPO to manufacture thyroid hormones through the recruitment of iodine and hydrogen peroxide. TSH is used to confirm or rule out suspected hypothyroidism. It is produced by the pituitary gland, and as its name implies, it stimulates thyroid hormone production. It is often used alone to infer whether or not thyroid hormone (T4) is low. When TSH goes high, T4 should be low if the feedback loop to your brain is working normally. As an individual marker, it is my opinion, and the opinion of other experts in the field of Functional Medicine that this is not adequate to best determine the mechanism behind hypothyroid symptoms. Clinical Adult Range: 0.450-4.500mlU/L Optima, or Functional Adult Range: 2.0-3.5mlU/L Common Causes of TSH Increase: Thyroid hypofunction Common Causes of TSH Decrease: Thyroid hyper-function, anterior hypofunction T3 T3 (Triiodothyronine): T3 is a thyroid hormone produced mainly from the peripheral conversion of thyroxine (T4). T3 contains three molecules of iodine, and is the primary thyroid hormone used by your body. Most of your T4 to T3 conversion occurs in the liver and GI tract. If your liver is not functioning properly you may have a difficult time converting T4 (which is mostly inactive in the body) to T3 (the active for of thyroid hormone). Without enough T3 hormone you will have hypothyroid symptoms. Optimal liver function and a healthy GI tract are critical for conversion of T4 to T3. Clinical Adult Range: 71 180 ng/dl Optimal Adult Range: 100 180 ng/dl Common Causes of T3 Increase: Hyperthyroidism Common Causes of T3 Decrease: Hypothyroidism T4 T4 (thyroxine): T4 is the major hormone secreted by the thyroid gland (93%). Thyroxine is a combination of 4 iodine molecules and the protein thyroglobulin. T4 is mostly inactive in the body. T4 is bound to the carrier protein Thyroid Binding Globulin (TBG) and transported throughout the body until it reaches its destination, where T4 is released by the protein (becoming free T4) to be used by the tissue. Clinical Adult Range: 4.0-12.0 mcg/dl Optimal Adult Range: 6.0-12 mcg/dl Common Causes of T4 Increase: Hyperthyroidism Common Causes of T3 Decrease: Hypothyroidism, anterior pituitary hypofunction Page 7 of 14
Free T3 Free T3 is non-protein bound Tri-Iodothyronine that is available for the cells of your body to use. A common clinical presentation is increased or decreased thyroid binding globulins (transport protein for thyroid hormones) from increased estrogens or testosterones that will lower or raise Free T3 levels. Clinical Adult Range: 2.0 4.4 ng/dl Optimal Adult Range: 3.0 4.0 ng/dl Common Causes of T3 Increase: Hyperthyroidism Common Causes of T3 Decrease: Hypothyroidism Free T4 Free T4 is non-protein bound thyroxine that is available for the cells of your body to use. A common clinical presentation is increased or decreased thyroid binding globulins (transport protein for thyroid hormones) from increased estrogens or testosterones that will lower or raise Free T4 levels. Clinical Adult Range: 0.82 1.77 ng/dl Optimal Adult Range: 1.0 1.5 ng/dl Common Causes of T4 Increase: Hyperthyroidism Common Causes of T4 Decrease: Hypothyroidism Reverse T3 Of the 93% of thyroid hormone made by your thyroid gland is T4. The majority of the T4 made in your body is converted to T3 in your liver. Of the T4 that is converted in you liver, 20% of it is converted into Reverse T3 (rt3). Reverse T3 is an inactive isomer of T3. Reverse T3 levels fluctuate for numerous reasons, but the most common I see clinically is elevation due to inflammation or high T4 levels that drive more T4 through the reverse T3 conversion pathway in the liver. Though Reverse T3 is inactive, if it is present in high levels it can compete for thyroid hormone receptor sites on the surface of every cell in your body. Adult Range: 9.2 24.1 ng/dl Optimal Adult Range: 9.2 24.1 ng/dl T-3 UPTAKE T-3 Uptake T-3 uptake measures the unsaturated binding sites on the thyroid binding proteins (TBG), these are the transport proteins for thyroid hormones. If the T3 Uptake is low, it could indicate that you have an increased number of TBGs that are holding onto your thyroid hormones and not letting go of them for the body to use, lowering your ability Page 8 of 14
to uptake the hormone. This pattern is frequently seen when using birth control or estrogen hormone replacement therapy. T3 Uptake is often high, when there is a decrease in TBGs, and that pattern is commonly seen with increased testosterone levels. Increased testosterone levels are frequently seen in women with PCOS, and that get accidental exposure to testosterone cream. **Testosterone creams have been shown to get passed onto children by fathers and grandfathers with very serious side-effects. Make sure that this is not happening to you or any children in your life. Clinical Adult Range: 22-36% Optimal Adult Range: 27-37% Common Causes of T-3 Uptake Increase: Thyroid hyperfunction Common Causes of T3 Decrease: Thyroid hypo-function Thyroid Peroxidase (TPO) Antibodies TPO Antibodies are used to determine if your immune system is attacking the enzyme TPO that is located inside the cells of your thyroid gland. If these are positive, you have an autoimmune process against your thyroid gland. If you are over 19 y.o. the normal range is 0-34. If your levels are over 34 you have an autoimmune process against TPO. Thyroglobulin Antibodies (TgAb) Thyroglobulin Antibodies are used to determine if your immune system is attacking the thyroglobulin protein located in your thyroid gland. Reference range is <4.0 IU/mL for all ages. Thyroid-Stimulating (TSI) Antibodies TSI antibodies are antibodies against the TSH receptors on the cells (thyrocytes) of your thyroid. When these antibodies attacked the TSH receptor they stimulated the thyroid cells to produce massive quantities of thyroid hormone. This increase in thyroid hormone can create hyperthyroidism and lead to a life threatening increase in thyroid hormone that can result in stroke and heart-attack. This hyperthyroid states are often referred to as a thyroid storm. Any person with TSI antibodies, or that is diagnosed with Graves Disease must be medically managed by someone so that in the event you have an autoimmune flare, you can be immediately treated with medications to suppress the thyroid storm. Reference Range = < or = 1.3 TSI index. This range applies to all ages. Page 9 of 14
Let s look at the complete lab testing I recommend Has your doctor specifically checked for an autoimmune disorder or Hashimoto s disease? There are two parts to your immune system, TH1 and TH2. IF one of these parts is dominant, you could have an autoimmune disorder. An autoimmune disorder is where your immune system is attacking your body causing your thyroid condition. The first part, called our "T"-Helper 1 System (TH-1 System), is our immediate immune response system. It is responsible for an immediate attack against foreign invaders like bacteria, viruses, mold, fungi, or parasites. The cells involved in the TH-1 system are called macrophages, natural killer cells, and cytotoxic T- Cells. It is our front-line defense. The other part of our immune system is our T-Helper 2 (TH-2) system. It involves the production of antibodies to "tag" onto invaders so our TH-1 system can more easily destroy the invaders. It is our B cells that are responsible for producing the antibodies. The balance between these two sides of our immune system is very important to look at with many thyroid patients. IF one of these parts is dominant, you could have an autoimmune disorder. An autoimmune disorder is where your immune system is attacking your body and it could be causing your thyroid problems. You are just about guaranteed to fail using medications alone. WHY? 90% of the time the primary mechanism is your immune system attacking your thyroid, which is also known as an autoimmune attack. Medications alone do nothing to slow or stop the auto- immune attack. Since the autoimmune mechanism is the most common cause of hypothyroidism in the United States, you would think that it is commonly screened for by all doctors. Unfortunately, autoimmunity is rarely if ever, checked. The reason is that doctors are too hung up on treating thyroid problems with medications only. Why would they run extra tests if they are not going to alter the treatment based on the test results? Has your doctor specifically checked you for any food sensitivities? Each time that you eat a food that you are sensitive to such as gluten, dairy, eggs or soy, it can cause your immune system to attack your thyroid. These foods can destroy your body, SILENTLY, and you may not have any symptoms! These absolutely have to be checked Page 10 of 14
Has your doctor run a complete thyroid panel like I showed you? Your thyroid CONTROLS your body metabolism so if you suffer from thyroid conditions it must be checked! I m not talking about a simple test for TSH (Thyroid Stimulating Hormone), I am talking about the complete set of thyroid tests I listed above all 9 of them! Your thyroid is critical to your health, and it must be thoroughly checked. Did you know that many doctors consider TSH levels from.45 to 4.5 to be normal. Optimal or functional TSH levels should be 1.8 to 3.0. What is YOUR TSH level? If it is not 1.8 to 3.0, have you had all the thyroid tests I mentioned? Has it ever been checked? If not, why? Has your doctor checked your adrenal glands? Your adrenal glands are your stress glands and they are very important in successfully improving your thyroid health. An adrenal test needs to be done, that will check your cortisol levels at 4 times throughout the day. Has your doctor checked you for blood disorders such as anemias? Anemia simply means you can t carry enough oxygen to the tissues of your body. There are different kinds of anemias such as iron, B12, Folic acid, anemia of chronic disease, autoimmune anemia, and the list goes on. We have the ability to test for each one. Anemia is very important to find and correct. Without oxygen available for your brain and nervous system, most likely, no treatment will work! No supplement will work. No nutritional program will work. Has your doctor ever checked you for sex hormone (testosterone or estrogen) imbalances? If you are female and post-menopausal has your doctor ever assessed your risk factors for developing uterine or breast cancer? How are you eliminating estrogens from your body? Are you breaking them down into carcinogenic forms like 4OH? What about estrogens that drive tissue growth and proliferation, like 16OH? You should be clearing out estrogens through the 2OH pathway through the liver we can, and do check for this! Your hormone levels are critical for healthy thyroid function! If you answered NO to any or all of these questions then there is a good chance that your thyroid condition is not being managed properly, and that is a fact. You need to have these tests to get to the bottom of your thyroid problem. There is no way around it! Page 11 of 14
What to do next: If you have previous lab results, enter them into the Lab Guide above, and see if you can determine some of the potential drivers of your thyroid problems. If you want help getting answers, or you want a shortcut to help you figure out the drivers of your thyroid problem, I m here to help. I work with clients across the world helping them figure out what is driving their thyroid and autoimmune problems. My primary role is helping them to investigate the driving factors or causes, and then coming up with a short and long-term plan to help them support their health naturally. We can get blood drawn at LabCorp office across the US, and if you need specialized testing, we can mail you the specialty collection kits just like we do with patients seen in the office. If you are interested in saving time and getting to the root of the problem faster, you may want to consider distance coaching, or traveling to our office in Hickory, NC to become a patient. Either way, our goal is to help you get to the root of the problem so that you can get your health back! You can visit our website here if you are interested in scheduling an appointment. You can also call our office at (828) 324-0800. If you are sick and tired of living with your symptoms and slowly watching them get worse over time, and if you would like to take a natural approach to help improve your health and feel great again, then call us at (828) 324-0800 and schedule your complete case review and consultation, or click here now. We will get you scheduled and send out our new patient history and questionnaires. The cost for the initial consultation will cover the review of your history, review of past medical records, and our consultation. A few things to really consider 1) How have your thyroid symptoms affected your job, relationships, finances, family, or other activities? 2) What has it cost you in time, money, happiness, sleep? 3) Where do you picture yourself in the next one to three years if your thyroid problem is not taken care of? 4) What is your health worth? What if we could improve your condition? I am here to help you as much as I can, but you have to ask for help Yours in Health, Dr. Brad Shook, DC, BCIM Page 12 of 14