By the age of 40, many people begin to experience symptoms of hypothyroidism. The most common include fatigue, weight gain, low mood, slowed thinking or movement, constipation, and dry skin.
I had almost all of those symptoms. I was convinced my thyroid was the issue. I didn’t feel terrible, but I didn’t feel great, and considering how much effort I was putting into my health, I expected to feel better. Something wasn’t right.
My doctor did what conventionally trained doctors are taught to do: check my TSH (thyroid-stimulating hormone). It came back normal. I was told, “It’s not your thyroid.”
Instead, I was offered an antidepressant. The goal was to make me feel better—or at least not care that I didn’t.
Now I know better. A normal TSH doesn’t always mean your thyroid is fine.
Your thyroid—a small, butterfly-shaped gland in your neck—plays a major role in regulating your metabolism. While TSH gives a general sense of thyroid hormone production, it doesn’t tell the whole story. What also matters is what kind of hormone is being made.
TSH is produced by the pituitary gland in the brain. It signals the thyroid to produce T4, a prohormone that later converts into either free T3 (the active form) or reverse T3 (a form that blocks the action of T3).
I often see Normal TSH, low-normal T4 and T3, and high-normal reverse T3. Technically, everything is in the “normal” range, but not optimal. There’s a big difference between normal and optimal thyroid function.
Reverse T3 is a hormone the body produces in times of stress. It slows your metabolism—helpful if a tiger is chasing you. Not so useful if you’re just trying to juggle work, family, and life.
My stress didn’t come from wild animals. It came from trying to be the perfect mom, wife, friend, and professional, with the ideal body and the perfect house. I was doing too much, and my body knew it. It slowed my metabolism to protect me, stockpiling energy just in case I really was in danger.
As a former conventional doctor, I used to stop at the TSH. If it was normal, I told patients their thyroid was fine. Now, as a functional medicine doctor, I dig deeper.
I check:
- TSH
- Free T4
- Free T3
- Reverse T3
- Thyroid antibodies
And I don’t just want them to be “normal”—I want them to be optimal, for you. If they’re not, we support your body by replacing hormones or nutrients to regain balance.
But even more importantly, we ask: Why is your body out of balance? Why is it acting like it’s under threat?
Spoiler: it’s often related to adrenal stress and other hidden stressors. Supporting adrenal health is key to restoring thyroid and hormone balance. In fact, it’s frequently the root cause.
And beyond labs and supplements, we look at your life. Because the definition of insanity is doing the same thing repeatedly, expecting a different result. If your lifestyle constantly puts you in survival mode, your body can’t thrive. You need to convince your body it’s safe.
This takes effort, and it starts with prioritizing yourself. You can’t pour from an empty cup. Self-care isn’t selfish; it’s essential. And you, my friend, are absolutely worth it.
Conventional medicine often stops at the TSH. It largely dismisses reverse T3. And while studies may not universally support combination T4/T3 therapy, here’s what I’ve learned from two decades and tens of thousands of patient visits: The textbook doesn’t always tell the whole story.
When I began treating each patient as a unique individual, not a statistic, people started feeling better, not just “fine,” but truly amazing.
My TSH was normal, but my thyroid was not. Once I addressed the root cause and gave my body what it needed, I regained my energy and health. I was told, “It’s not your thyroid.” But it was. And I fixed it.
So if your intuition tells you something is off, listen to it. Don’t give up. There is hope. I’m passionate about helping people like you find real answers.
Conventional medicine may get you to “fine.” But if you, like me, want more than just fine—you want to feel vibrant, energized, and whole—you deserve that. Maybe, just maybe, it is your thyroid. Even if you’ve been told it’s not.
Resources:
- Schmidt RL, LoPresti JS, McDermott MT, et al. Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory. Thyroid 2018; 28:842.
- Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ Jr. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 1999; 340:424.
- Walsh JP, Shiels L, Lim EM, et al. Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J Clin Endocrinol Metab 2003; 88:4543.
- Sawka AM, Gerstein HC, Marriott MJ, et al. Does a combination regimen of thyroxine (T4) and 3,5,3′-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J Clin Endocrinol Metab 2003; 88:4551.
- Clyde PW, Harari AE, Getka EJ, Shakir KM. Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. JAMA 2003; 290:2952.
- Bunevicius R, Prange AJ. Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. Int J Neuropsychopharmacol 2000; 3:167.
- Siegmund W, Spieker K, Weike AI, et al. Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14: 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Clin Endocrinol (Oxf) 2004; 60:750.
