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By Dr. Michael Veselak, D.C.

Today we are going to discuss the Thyroid Gland and the 6 Patterns of Hypothyroidism

In our office we see a lot of patient with Thyroid Dysfunction. We always ask the 3 basic questions.   When did you first notice you had symptoms? How long did it take to get Diagnosed? How often do you change your Dose?

Most of our patients have tried everything to get their energy back and to feel good again.

Thyroid Problems are often not diagnosed for 2 reasons. First doctors do not run enough markers. Secondly the lab ranges are too wide. We utilize functional ranges 1.8- 3.0 for the TSH.

The current medical model, which is a 50 -year old model falls short in fully identifying the cause of the thyroid condition. It is based upon a limited number of lab markers focusing on TSH and T4. How can you manage the thyroid without all the information?

As you will see in the next few minutes there are several other lab markers that need to be addressed to determine the actual cause of the thyroid problem. Our complete thyroid panel includes TSH, T4, Free Thyroxin index Free T4 l Free T3l; T3 uptake; Reverse T3; TPO and TBG antibodie; TSH, antibodies and TBG levels.

When necessary we will also run other labs to determine the cause. Proper testing is crucial.   A complete metabolic panel including all the thyroid tests described above along with liver function, anemia, blood glucose levels. Hormone tests, Salivary cortisol levels; Cyrex testing for gut permeability issues, stool testing looking for infections, yeast or parasites. We also at times will run an organic acids test.

Other testing we may recommend is genetic testing and the MTHFR gene, Hair analysis to evaluate copper and mercury toxicity and deficiency of essential nutrients.

To understand how to support the thyroid it is extremely important to know how the thyroid works. Then when we discuss the 6 patterns of hypothyroidism it will become clear where the problem arises.


  • Fatigue
  • Depression
  • Weight Gain
  • Hair Loss
  • Constipation
  • Morning Headaches
  • Muscle Cramps at Rest
  • Dry or Brittle Hair
  • Chronic Digestive Issues
  • Loss of Outside Portion of Eyebrows

The thyroid supports bone metabolism, immune system, brain and nervous system, endocrine system, GI function, liver and gall bladder, growth and sex hormones, fat burning, healthy cholesterol levels and proper stomach acid.



Overview of the thyroid gland and how it is converted.

It all begins in the Brain, The hypothalamus releases a hormone TRH (Thyrotrophic Releasing Hormone – to the Pituitary Gland. The Pituitary gland the signals the release of TSH thyroid stimulating hormone) this is what is tested on lab work.

The pituitary gland also regulates the release of other hormones- ACTH to the adrenal glands; You can see the Adrenal glands are responsible for the release of Cortisol, Progesterone, aldosterone, DHEA, epinephrine and norepinephrine.   Pituitary gland also releases Lutenizing hormone and follicle stimulating hormone to the ovaries and testes which helps control the menstrual cycle and testosterone

To make Thyroid Hormone the Thyroid gland needs iodine and Tyrosine. T4 is 4 molecules of iodine and one of Tyrosine and T3 is 3 molecules of iodine and one tyrosine. The thyroid produces 93% T4 and 7 % T3

To transport the molecules they hop on a taxi cab which is called TBG or thyroid binding globulin. This taxi cab transports it to the liver where T4 is converted to T3 the useable form of T3.

60% of T4 is converted to T3 in the liver.   Selenium is also extremely important in the conversion of T4-T3

20% in the gut and 20% in other tissues As you can see it is essential to have not only a healthy liver, gut, pituitary , adrenals, but we also need iron, iodine, selenium, zinc, magnesium and tyrosine to make it all happen.

Once again they bind to a protein TBG to carry it to the cells. Free T3 is the active form of thyroid hormone. EVERY CELL IN THE BODY HAS A RECEPTOR SITE. The cell is dependent on methyl groups, viamin A and iron for absorption.

The 6 major Thyroid patterns: 

1 The first pattern is PRIMARY HYPOTHYROIDISM

(High TSH)

If the pituitary gland senses the thyroid isn’t doing its job, it will pump out extra TSH, giving the thyroid a kick in the pants.

Primary hypothyroidism is a true dysfunction of the thyroid gland and is the only pattern of hypothyroidism that can be effectively managed with thyroid replacement hormone – unless its autoimmune Hashimoto’s. Then is an immune issue and needs to be supported as such.  If tissue destruction is severe, replacement hormones prevent complications due to deficient thyroid hormones.  However, if the health care practitioner detects primary hypothyroidism before the damage is too far gone and approaches it nutritionally, the condition can be reversed in the majority of the people delaying the need for medication, if its required at all. If the TSH does not come down to normal after the nutritional protocol the hypothyroidism may be so advanced that thyroid medication is the only recourses.

The lab range is .5-4.5, functional range is 1.8-3.0. anything above lab range of the TSH is considered Primary Hypothyroidism.


(Low T3, High Cortisol)

This is a very common pattern of functional hypothyroidism.  Here TSH will be low (below 1.8) although not as low as with primary hypothyroidism but you will still have symptoms. Chronic stressors are at the root of this pattern because they fatigue the pituitary gland at the base of the brain. Then the pituitary fails to signal the thyroid to release enough TSH to stimulate activity.  In other words, the thyroid gland may be perfectly fine but nobody is telling it to go to work because the pituitary is asleep on the job. Pituitary hypofunction is usually the result of one of four things.

An active stress response (poor diet, inadequate sleep, too much caffeine, high carbs   chronic inflammation, viral or bacterial infections are just a few factors which wear the body out

Postpartum depression.  It’s not uncommon for women to dip into a low thyroid state after pregnancy, because pregnancy amplifies the demands on all hormonal systems in the body, keeping the pituitary busy 24/7. 

The third pattern is THYROID T4 UNDER-CONVERSION

(Low T3, High Cortisol)

This is a common pattern associated with chronic stress and excess production of the adrenal hormone cortisol. Here the body makes plenty of T4 but too much cortisol prevents the body from being able to convert enough T4 to T3, the form of the thyroid hormone the body can use. An elevated cortisol level suppresses the conversion of T4 to the useable form of T3.

Another common cause is deterioration of the body’s cell membranes in response to chronic infection or inflammation. Cell membranes are in charge of multiple functions, including the conversion of T4 to T3. Chronic inflammation causes lipid peroxidation, in which harmful free radicals damage the cell walls. And damaged cell walls hamper thyroid conversion.  Finding the cause of the inflammation are keys to the support.


(High Free T3, Decreased TBG)

This pattern is found with insulin resistance and polycystic ovary syndrome (PCOS), since excess testosterone production accompanies these conditions. Reversing insulin resistance reverses hypothyroid symptoms.  This pattern also arises in those who already have developed Diabetes (DM) and are taking insulin. Gaining control over blood sugar, any insulin needs with diet, supplementation and exercise are critical.


(Low T3 Uptake and low or normal Free Thyroxine Index (FTI))

This pattern is often found with oral contraceptives or estrogen replacement therapy.

Thyroid hormones hitch a ride through the bloodstream on thyroid binding globulins (TBG). Since thyroid hormones in the blood bind to excess TBG’s, not enough free hormone is available to enter the cells.  Clearing the body of excess estrogen addresses hypothyroidsim.


(Thyroid panel WNL, Elevated cortisol)

This is another stress related pattern in which the pituitary and thyroid glands function normally and make the right amount of hormones but the hormones are not getting into the cells to take affect. Symptoms of hypothyroidism show up. Elevated  levels of cortisol, in response to stress, cause the cells to become resistant to thyroid hormones.

Functional Medicine Approach

Based upon our functional medicine lab findings we will offer support to the thyroid, adrenals, liver, gut, blood sugar, anemia or autoimmune regulation.

We must address nutrient deficiencies, food sensitivities, adrenal dysfunction, gut dysbiosis and liver detoxification issues.

I completely understand how you feel if you are frustrated and have no energy. A lot of our patients with thyroid issues felt the same way.

if you have any questions email me at [email protected],

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Hello, my name is Dr. Michael Veselak, and today we’re going to talk about functional medicine and why it is important to utilize functional medicine

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