How to Assess Thyroid Health (Part 1 of 3)

While over 20 million people are currently being treated for clinical and subclinical hypothyroidism, there may be as many as 13 million more Americans suffering the ill effects of an undiagnosed thyroid problem–making it one of the most under-diagnosed health conditions in the United States. At the same time, because the thyroid is intimately intertwined with the other glands of the endocrine system, supplementing with thyroid hormones may be counterproductive if the problem is rooted in adrenal fatigue, dietary and lifestyle factors, and stress. Many factors affect thyroid health, including common stressors such as inadequate sleep, exposure to environmental toxins, or minor illnesses. Even the normal physiological changes associated with aging are stressors that are detrimental to thyroid function.


The health and function of the thyroid gland has long been considered to be an accurate indicator of vitality, and for good reason. In more than 25 years of seeing thousands of patients, I’ve observed that many health problems share the common denominator of an overload on the neuroendocrine and nervous systems, manifesting as adrenal-thyroid insufficiency, imbalance, or dysfunction. Thus, when evaluating thyroid function, I always consider the relationship of the HPAT (hypothalamic–pituitary–adrenal-thyroid axis.) Because the thyroid produces hormones that influence essentially every organ, tissue, and cell in the body, even relatively minor deviations in function can have far-reaching negative health consequences. Furthermore, if thyroid disease goes undiagnosed or is not treated, serious problems can arise, including cardiovascular disease, cognitive impairment, depression, and elevated cholesterol, estrogen, and insulin levels–which in turn can lead to further biochemical imbalances.

Unfortunately, current medical practices don’t recognize or treat the nuances of sub-par thyroid function. Most conventional doctors rely on TSH levels alone to evaluate thyroid function, but this is not the most accurate method for determining thyroid health. Many physicians today assume the thyroid is an isolated entity, akin to regarding its function as a soloist without an orchestra. Because of this, it is not usually considered as a contributing factor to poor health or the plethora of symptoms a patient presents. Just as frequently, physicians assume that anyone with even a slightly elevated level of TSH (thyroid stimulating hormone—a pituitary hormone that signals the thyroid to make T-4) is suffering from an underactive thyroid and needs medication. In the long run, medicating solely based on TSH and/or over-medicating are the wrong approach, and can lead to many more serious health problems or diseases including osteoporosis, heart disease and even cancer.1

I view any thyroid issue within the context of the entire endocrine, nervous and circulatory systems. For this reason, I always provide general botanical support to the HPAT (energetically, I refer to this as the Vital Essence), often focusing first on the nervous system, with targeted thyroid support secondary. Key nutrients such as iodine (in the form of whole sea vegetable powder, not an isolate), vitamin D, zinc, and selenium, are keystone nutrients for thyroid support. For general support I recommend an adaptogenic formula (not a single herb), a Kidney Essence formula for Inward (Yin) Essence, and/or one for Kidney Outward (Yang) Essence.

My approach is to provide the building blocks the body needs, lending a helping hand so that the body is the driver of the healing process—this approach may be slow in showing results, but is truly therapeutic. If the person still suffers from hypothyroidism, natural thyroid medication, such as Armor thyroid, at the lowest dosage that improves symptoms, may be helpful.

It is important that physicians not regulate the dosage solely based on blood tests. Firstly, these blood tests are very volatile and fluctuate day-to-day and even throughout the day. For instance, thyroid function and circulating thyroid hormone (TH) levels change in response to varying conditions such as reduced food availability, decreased environmental temperature, and illness.2  Secondly, every human being has a unique range of “normal.” One person’s TSH might be 4, and their free T-3 might be 2.5 and their health is perfect in every way; while another person might not feel well with the same numbers and need a slight boost in their HPAT.

The bottom line is the regulation of the HPAT axis occurs at multiple levels and is highly integrated with the internal milieu and the external environment. For this reason, most thyroid health problems would be best served by a holistic approach, nourishing the HPAT axis as well as the nervous system with botanical, nutritional and life-style tools.

Assessing Adrenal-Thyroid Axis Deficiency

A comprehensive assessment of adrenal-thyroid axis deficiency should include the following:

  • Careful review of presenting symptoms. Symptoms of hypothyroidism include fatigue (with or without depression or anxiety), increased sensitivity to cold temperatures, menstrual irregularities, infertility, calcifications (tartar on teeth, bone spurs, breast calcifications), muscle aches, painful joints, and urinary frequency. Hyperthyroidism is a less common condition characterized by heart palpitations, nervousness, weight loss, and restlessness.
  • Physical signs. Symptoms include dry skin, thin or missing outer third of eyebrow, brittle nails, dry hair, excess weight, or very low blood pressure.
  • Basal metabolic temperature (BMT). The temperature is taken upon awaking and should be between 97.8 and 98.6 degrees.
  • Blood Tests. Blood tests for assessing the adrenal-thyroid axis should include:
    • DHEA sulfate
    • Morning cortisol
    • TSH (thyroid stimulating hormone)
    • T4 (total & free)
    • T3 (total & free)
    • Reverse-T3
    • TPO (Thyroid Peroxidase)
    • TBG (Thyroid Binding Globulin)

It’s obvious that thyroid function is complex and cannot be effectively diagnosed or treated without a correspondingly comprehensive approach. In my next post, I’ll share the herbs, supplements, and general protocol that I’ve found best support healthy thyroid function.


  1. Hercbergs AH, Ashur-Fabian O, Garfield D: Thyroid hormone and cancer: clinical studies of hypothyroidism in oncology. Curr Opin Endocrinol Diabetes Obes 2010, 17:432–436; Thanh D Hoang, Cara H Olsen, Vinh Q Mai, Patrick W Clyde, Mohamed K M Shakir. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013 May ;98(5):1982-90. Epub 2013 Mar 28. PMID: 23539727
  2. Ricardo H. Costa-e-Sousa and Anthony N. Hollenberg, Minireview: The Neural Regulation of the Hypothalamic-Pituitary-Thyroid Axis, Endocrinology. 2012 Sep; 153(9): 4128–4135.
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