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It’s Not Your Thyroid. Or is it?

Mar 9, 2023 | Blog, Hormone Health

By the age of 40 who doesn’t have some of the symptoms of hypothyroidism?  The most common symptoms are tiredness, weight gain, depressive symptoms, slowing of movements/ thoughts, constipation, and/or dry skin.  


I had almost all of those and I was convinced my thyroid was low.  I didn’t feel bad, but I didn’t feel great either.  And I was putting a lot of effort into my health.  Surely, something was up.  


But my doctor did exactly what conventionally trained doctors do and checked my TSH (thyroid stimulating hormone).  


It was normal.   I was told, “It’s not your thyroid.”  


I was offered an antidepressant.  That’ll make you feel better or at least, make you not care that you feel so bad. 


Now I know that even when the TSH is normal, it IS often the thyroid.  The thyroid is a small butterfly-shaped gland in your neck and it’s main job is to control your metabolism.   The TSH gives a nice assessment of how much overall thyroid hormone your body is making.  This is good to know but, an equally if not more important question is what TYPE of hormone is being produced?  


You see, TSH is made in the brain (in the pituitary gland). The brain sends a signal to the thyroid gland prompting the gland to produce T4.  T4 is a pro-hormone that gets further converted to either free T3 or reverse T3.  


Many patients have a picture that looks like this:  Normal TSH, low normal T4 and T3, and high normal reverse T3.  All normal, but this “normal” picture does not equal optimal thyroid function.  There is a difference.  A big difference.  


Reverse T3, to put it simply, is a “worthless” thyroid hormone.  Well, it isn’t really worthless, it’s just worthless in most current modern-day situations.  Let me explain.    Reverse T3 is a hormone your body makes when it perceives too much stress.  Reverse T3 is a signal to slow down metabolism and save fuel for later use because the body senses danger.  So, it isn’t worthless if you are in a life-threatening dangerous situation.


But, my guess is you are a lot like me.  Thankfully I was never chased by a tiger or in a similar acute life-threatening situation.  I was stressed because  I was just pushing hard to do it all.  I was trying to be the perfect mom and wife with the perfect body.  I tried to be the person who remembered everyone’s birthday and bought amazing gifts wrapped with beautiful bows and had an immaculate house and . . . . . blah, blah, blah.  It’s a lot.  It’s impossible.  Your body is smart and it senses it’s way too much (and it’s right) and slows your metabolism to protect you because it senses you are in danger.  Slow metabolism leads to more fat storage for fuel for later use.  Your body is trying to keep you alive.  That’s great when the focus is on survival.  But you can’t truly thrive and feel great when your body is just focused on keeping you alive. 


As a former conventional doctor, I checked the TSH.  If it was normal I told the patient your thyroid is normal.  Now as a functional doctor, I check a lot more. The thyroid is normal if the TSH, Free T4, Free T3, Reverse T3, and thyroid antibodies are not only normal but optimal.  I look at both the absolute number and the ratio of these hormones.  If they aren’t optimal we replace the hormones or the nutrients necessary to get them to the optimal range for YOU.  


In addition, we work on fixing the root problem. Why is your body responding the way it is?  Why does it think it’s in danger?  HINT–it’s often the adrenals and other hidden stressors.  Fixing the adrenals is one of the keys to balancing thyroid and sex hormones.  They are a root problem for so many of us in our modern-day stressful world! 


On top of fixing the root problem, it is also critical to look at your lifestyle.  The definition of insanity is doing the same thing over and over and expecting different results. No amount of intervention can create lasting change unless you break the stress cycle you are in.   Your body needs to know it isn’t in danger.  This takes some work. It means prioritizing yourself.  I promise you’ll be a better spouse, parent, and friend if you prioritize yourself.  Self-care isn’t selfish.  It’s critical for optimal health and you, my friend, are worth it. 


Conventional medicine says the TSH is all you need.  The accepted belief is that reverse T3 has extremely limited utility for conventional medical practitioners in assessing hypothyroidism.  Although some studies show benefits, conventional medicine touts that for the vast majority of patients with hypothyroidism, it is suggested not to use combination T4-T3 therapy.   


I understand that this is what the studies show.  But here’s what I know.  Over the past 20 years, I’ve had tens of thousands of patient visits.   Countless patients asked, “could it be my thyroid?”  Now that I’ve opened my mind to be a little less “by the book” and a lot more focused on how I can best help this unique individual sitting in front of me who isn’t a number in a study, patients are finally passing the line of fine and shifting from ok to amazing.


My TSH was normal but my thyroid was not. I fixed the root cause. I learned to stop pushing so hard and began taking care of myself in addition to others. I regained my energy and my health.    I was told my thyroid was normal, that it wasn’t my thyroid.  But it was. I fixed it.  It’s not your thyroid- a lie I learned in medical school that I no longer believe. 

There is hope.  If your intuition tells you something is off, you are right. Don’t give up till you find the answer.  I have a passion for helping people like you find the answers.  Conventional medicine will get you to the line of fine.  Some people are content with that.  Others, like me, are not.  You deserve to feel amazing and when you don’t there is a reason.  Maybe it is your thyroid even if you’ve been told it is not.  


  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Bunevicius R, Prange AJ. Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. Int J Neuropsychopharmacol 2000; 3:167.
  7. 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.

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