All four books of Drs. Richard and Karilee Shames recommend saliva and blood spot testing as superior methods to evaluate thyroid and other hormones.
Hormone testing is useful, whether you are mildly affected by hormone imbalance, severely impacted and unable to function, or are simply wondering if the hormone issue is a factor in your everyday health.
Once you have submitted your samples to the lab, and have had the results sent back to you, it is now time for interpretation. What you want to find out is whether your results are in the normal range, or whether one or more is showing some abnormality. (The normal range for each test is at the far right hand side of the page, on the same line as your test result.)
Thyroid Hormone Levels
Start with your thyroid lab test report. (For example, the lower third part of the page for the Advanced Plus Panel.)
There are four separate thyroid determinations, each measuring a different facet of your thyroid function (and a Vitamin D level, if you ordered the Advanced Plus Panel).
FT4 (free Thyroxine — transport form of thyroid hormone)
This is the actual level of transport thyroid hormone that the thyroid gland makes and releases into the body. It is considered the "inactive" form, from which active thyroid hormone is eventually made. The ideal level is the middle or upper part of the normal range.
FT3 (free Triiodothyronine — active form of thyroid hormone)
T3 measures the amount of active thyroid hormone that has already been converted from T4 and is ready to go to work in your tissues. The ideal level is the middle or upper part of the normal range.
TSH (Thyroid Stimulating Hormone)
Measures how much your brain and pituitary are asking for more thyroid. A higher than normal number indicates that the brain’s is sensing a need for more energy, and is asking your thyroid gland to make more thyroid hormone. Conversely, if hardly any TSH can be measured, this usually means the amount of thyroid energy now in your tissues is plenty. (In other words, a higher than normal TSH often means low thyroid; while a lower than normal TSH often means too much thyroid.) The ideal place to be on this measurement is in the bottom quarter of the normal range.
TPO (Thyroid Peroxidase Antibody)
This measures whether or not your immune system is making antibodies against thyroid hormone production. A normal result here means, "No, it isn't." A high result means, “Yes, it is.” Making antibodies against the thyroid is a common underlying cause of thyroid hormone imbalance. If your antibody level is high, you could have a thyroid problem, even though your TSH, FT4, and FT3 are all in the normal range.
Vitamin D (D2, D3, and total)
Having your total vitamin D results in the upper third of the normal range is your goal here. This is known as being “replete” or “ample” as regards such an important vitamin. In fact, regarding thyroid function, vitamin D is much more of a necessary co-hormone, than a mere vitamin. Being at the lower end of the normal range, and especially if you are below the normal range, could hamper your metabolic function. Many people with vitamin D deficiency are tired and sluggish especially in the winter months when our natural levels of vitamin D from sunshine decrease.
Reproductive Hormones
Next, consider your reproductive hormone scores. Both men and women have estrogen, progesterone, P/E ratio, and testosterone levels. The ranges of normal reported on the results page differ for males & females.
Estradiol
Ideally, this estrogen score falls in the middle third of the normal range. The normals are listed depending on your gender, age, and special situation.
Progesterone
This is a hormone that is considered a balancer of estrogen levels, and a supporter of thyroid and adrenal function. It is interpreted depending on your gender, age, and special situation.
Pg/E
The progesterone/estrogen ratio, if abnormally low, is an indicator of “estrogen dominance”, a situation that is often uncomfortable, and detracts from optimal thyroid function. Examples of estrogen dominance include mood swings, heavy bleeding with menstruation, tender breasts or fibrocystic breasts
Testosterone
Measures an important androgen level in both sexes; you want to be ideally in the middle of normal range. Being in the upper end is not necessarily better than being in the mid-normal range. On the other hand, in some people, being in the lower end of the normal range feels for them like being too low.
Adrenal Hormone Levels
Now consider several adrenal determinations:
DHEA-S
This is an abundant adrenal hormone that is sometimes at too high or too low a level in the body, for optimal adrenal and thyroid function. Your levels are best well within the particular normal calibrated to how old you are. This is represented by the graph at bottom center of the page, finding your level as a single blue dot within the shaded curve or normalcy at various ages.
4-sample cortisol levels (8 am, noon, 4 pm, 11 pm)
The ideal would be to be in the middle of the listed normal range for each of the 4 times tested. Your score also shows as a dark blue line on the graph at the bottom right of the results page. A cortisol spike around 8 am followed by a smooth gentle continuous downward curve from noon to 4 pm to midnight being the lowest point, is generally ideal. Other kinds of curves are abnormal, like a "reverse curve" in which the highest spike of cortisol occurs at midnight and might be associated with insomnia or fatigue symptoms.
Weight Management Profile
Estradiol
Ideally, this estrogen score falls in the middle third of the normal range. The normals are listed depending on your age, gender, and special situation. High levels cause excess weight in hips, thighs, and breasts.
Progesterone
This is a hormone that is considered a balancer of estrogen levels and a supported of thyroid and adrenal function. It is interpreted depending on your gender, age, and special situation. It keeps estrogen levels in check and supports thyroid metabolism. Low levels increase obesity risk.
Pg/E
The progesterone-estrogen ratio, if abnormally low in women, is an indicator of "estrogen dominance", a situation that is often uncomfortable, detracts from optimal thyroid function and predisposes to weight gain.
Testosterone
Measures an important androgen level in both men and women. It increases lean muscle mass and metabolic rate. You want to be ideally in the middle of normal range. Being in the upper end is not necessarily better than being in the mid-normal range. High levels in women contribute to central obesity. In men, being in the lower end of the normal range often feels for them like being too low in energy for exercise.
DHEA
This is an abundant adrenal hormone that is sometimes at too high or too low a level in the body for optimal adrenal and thyroid function. Low DHEA leads to decreased muscle mass, with a resultant increase in adiposity. High levels can lead to insulin resistance and weight gain. Your levels are best well within the particular normal range related to your age.
Cortisol
This important hormone helps control blood sugar, appetite, and food cravings. Excesses help promote fat storage in abdominal tissue. This visceral fat is associated with insulin resistance and metabolic syndrome. Low levels reduce metabolic activity of thyroid hormone.
The ideal would be to be in the middle of the listed normal range for each of the 4 times tested. Your score also shows as a dark blue line on the graph at the bottom right of the results page. A smooth gentle continuous downward curve is ideal. Other kinds of curves are abnormal and might be associated with a higher likelihood of weight problems.
TSH (Thyroid Stimulating Hormone)
This standard screening test for thyroid balance can reveal a tendency for excess weight, even when the result is normal but at the upper end of the normal range. Such a situation is borderline hypothyroidism of sufficient severity to increase fat storage. The tendency for increased weight is greater when the TSH is actually in the high range.
Vitamin D (D2, D3 and Total)
Low Vitamin D is exceedingly common and highly associated with insulin resistance and increased abdominal fat, two symptoms of metabolic syndrome. Correcting vitamin D levels is known to improve insulin sensitivity. This also helps to normalize the low thyroid function that is another result of even borderline low vitamin D levels. Best is to have your level be not just normal, but be ample. Shoot for a level of 50 to 70.
Insulin (In)
A high fasting insulin level is a marker of insulin resistance, which leads to type 2 diabetes and its resultant weight gain. Also, increased levels are associated with metabolic syndrome and its tendency for increased abdominal adiposity. High blood insulin also can cause erratic swings in testosterone levels in both men and women.
Hemoglobin A1c (Hgb-A1c)
This is a measure of the average blood sugar over the last three months. Levels above 6% are associated with diabetes and metabolic syndrome, both of which can lead to increased adipose tissue and weight gain. Knowing your blood sugar level is frequently crucial in getting weight under control.
Optional Additional Tests (Add-ons)
If you have added the thyroid tests onto the Weight Management Panel, know that any abnormal levels in these metabolic indicators increase your risk of having hormonal weight gain.
If you have added on the cardiovascular lipid determinations, know that higher than normal levels of cholesterol etc. can indicate risk of metabolic weight gain, now or in the future. Moreover, high lipid levels are a major risk factor for heart disease and stroke, both of which are worse problems for those who are excessively overweight. Knowing your hormonal imbalances associated with weight can be of tremendous help in proper management of the situation.
Neurotransmitter Testing
Neurotransmitters are the brain chemicals that facilitate the transmission of signals from one neuron to the next across a synapse. Neurotransmitters work with receptors in the brain to influence and regulate a wide range of processes.
Your color-coded report lists the names of the tested-for neurotransmitters on the left side of the main results page. Just a bit to the right will be your numerical level of that particular neurotransmitter.
Further to the right will be a tri-color line representing the normal range in green, the too-low range in blue, and the too-high range in red. On each line will be a color triangle pointing to where on the range your own level was determined to be.
If your triangle for that line is green, then you are within the normal range. If your triangle is blue, then your level of that neurotransmitter is too low. If your triangle is red, then your level for that neurotransmitter is too high.
Further to the extreme right-hand side of the page is the actual numerical range of normal for that neurotransmitter.
Here are the names of the neurotransmitters tested:
Serotonin
Here we have a key neurotransmitter that is involved in the regulation of sleep, appetite, and aggression. Serotonin imbalance is a common contributor to mood problems. When serotonin is out of range, depression, anxiety, worry, obsessive thoughts and behaviors, carbohydrate cravings, PMS, difficulty with pain control, and sleep cycle disturbances can result.
GABA
This is the major inhibitory neurotransmitter found in the central nervous system. Good levels result in a ‘calming’ action, but high levels may contribute to sluggish energy, feelings of sedation, and foggy thinking. Low GABA levels can be associated with disregulation of the adrenal stress response, impulsive behavior, or anxiety symptoms.
Dopamine
This chemical is largely responsible for regulating the pleasure reward pathway, memory, and motor control. Caffeine and other stimulants often work by increasing dopamine release, although continual stimulation of this release can deplete dopamine over time. Low dopamine symptoms include loss of motor control, cravings, compulsions, and addictive behaviors. High dopamine levels may contribute to hyperactivity or anxiety.
Norepinephrine
Also called nor-adrenaline, it is an excitatory neurotransmitter produced in the central nervous system (as well as a stress hormone produced in the adrenal medulla). Nor-epinephrine is involved in a wide variety of actions including attention, focus, heart rate, blood flow, and inflammation. High levels are often linked to anxiety, stress, elevated blood pressure, and hyperactivity; whereas low levels are associated with lack of energy, decreased focus, and low motivation.
Epinephrine
Often better known as adrenaline, this excitatory neurotransmitter helps regulate muscle contraction, heart rate, glycogen breakdown, blood pressure, and is heavily involved in the stress response. Elevated levels of epinephrine are often associated with hyperactivity, ADHD, anxiety, sleep issues, and low adrenal function. Over time, chronic stress and stimulation can deplete epinephrine stores leading to difficulty concentrating, fatigue, depression, insufficient cortisol production, chronic stress, poor recovery from illness, dizziness and more.
Glutamate
This is considered to be the most abundant neurotransmitter in the nervous system. It is involved in cognition, memory, and learning. High levels of glutamate can cause excito-toxicity, a process where nerve cells are damaged by excessive stimulation. Elevated glutamate levels are commonly associated with panic attacks, anxiety, difficulty concentrating, and obsessive-compulsive disorder. Low glutamate levels may result in memory loss, insomnia, low energy levels, and depression.
Comparison of the Three Hormone Systems: Thyroid, Adrenal, Reproductive
Ideal levels are generally the middle of normal range (except for TSH and Vitamin D described above).
- If adrenal and reproductive testing was mostly normal, and only thyroid showed a significant abnormality, then you should immediately begin recommendations for thyroid re-balancing.
- If you were mostly quite normal in thyroid and reproductive hormones but showed glaring abnormals in adrenal testing, then you should start with adrenal rebalancing.
- If you were mostly quite normal in thyroid and adrenal levels, but reproductive hormones clearly showed glaring abnormalities, then you might need to initiate your re-balancing efforts in the reproductive system first.
The most abnormal system is the one you ought to re-balance first. Then, if still needed, you can re-balance the second and third most abnormal system later.
If you are working with a practitioner, simply share these results with that person and strive to get their best input. Remember that everyone's approach is slightly different. Some practitioners would use this information to start you on over-the-counter products, then suggest you move to prescription items if more help was needed. Others may want to start with prescription treatment first, then move to milder items for maintenance.
If you or your practitioner would like help in interpreting these hormone test results or in deciding on the best course of action based on these results, you may elect to have a coaching session with Dr. Shames. Click here to review the information related to telephone coaching sessions.
During the consultation with Dr. Shames, he can help by coming up with an effective treatment plan and offer other recommendations for further action, with over-the-counter remedies and supplements for optimal correction of any imbalance. He can also make suggestions about a more favorable prescription medicine intervention that you can talk over with your practitioner. We hope this information is helpful as you seek to reclaim your health!
