Normal Thyroid Levels But Still Have Hypothyroid Symptoms?

We get it. You have all the thyroid symptoms: fatigue, brain fog, mood changes, and weight gain, but your doctor told you that your thyroid is normal. You’re probably confused about where to go next and wonder what could be causing you to feel unwell. You might be tempted to think, “maybe this is just the way life feels for me.”

But, before you resort to feeling stuck with your symptoms with no answers, first, we have to ask what is being defined as “normal.”

Your thyroid was probably assessed by checking only a TSH (thyroid stimulating hormone) as the single lab screen, as is the case for the majority of people treated in conventional medicine. I know, because I used to feel limited with what I could order or evaluate for people myself when I practiced as a family medicine MD.

We’re taught in medical school and residency that the TSH is a very sensitive test for thyroid problems, that it will catch the vast majority of thyroid issues, and that it’s likely insurance won’t cover additional screening thyroid labs anyway. When I ordered anything other than the TSH to evaluate thyroid function, people often ended up with bills of over a thousand dollars when insurance did not cover the additional tests. That disappointment often falls back on the doctor who ordered the tests when people are upset. It’s no wonder doctors develop a resistance to ordering additional labs.

However, there are several problems with using only a TSH to assess thyroid function.

1. TSH comes from the pituitary and tells the thyroid to make more thyroid hormone in a feedback loop if the brain isn’t sensing there is enough thyroid hormone being produced. So, a higher TSH means the pituitary is signaling loudly at the thyroid to make more thyroid hormone because the thyroid hormone is low.

The first problem is that TSH is only one player in a multitude of hormones that make up thyroid function.

2. The next problem is that the range that is considered normal for TSH is usually quite wide ( ~0.5 – 4.5) because the studies used to determine this range were not personalized, and didn’t take into account that some people in the study population were already trending towards thyroid disease. In functional medicine we look at optimal ranges over normal ranges and we look at personalized levels. Our optimal range is typically between 1.0-2.25.

Using this functional perspective helps us find more thyroid problems and find them earlier, giving us a chance at more effective reversal of the thyroid disease process. Because most thyroid disease is auto-immune, we also screen by looking for antibodies that attack the thyroid so that we can intervene before more damage is done. The best thyroid antibody test to screen for Hashimoto’s Thyroid (which causes over 90% of hypothyroidism in the U.S.) is a Thyroid Peroxidase Antibody (often called TPO antibody).

3. The third major issue we hear from members who start to work with us is that their doctors told them in the past that there is nothing to do for Hashimoto’s if the TSH isn’t at a level yet that requires medication. Some are even told to just wait until enough of their thyroid has been attacked to need medication. We find this information very concerning. In our practice, we have effectively lowered the TPO antibody load, and thus the attack on the thyroid, to reverse hypothyroidism numerous times. When you evaluate and treat root causes, especially when Hashimoto’s is caught early, this is very possible to reverse hypothyroidism and at the same time, to restore feeling like your optimal self.

4. Lastly, using TSH only misses the mark because it’s not measuring actual thyroid hormone levels. TSH doesn’t tell us how well thyroid hormones T4 and T3 are being produced and then converted to its active form (T3) and then how well the tissues are using the thyroid hormone at the cellular level to drive metabolism.

For a full thyroid panel, what thyroid tests do I need?

When we assess thyroid from a functional level we check:

TSH
Free T3
Free T4
TPO antibodies.

You can now order your own advanced thyroid panel, without a doctor's visit, in the Root Access Membership.

Easy Thyroid Lab Ordering

Meet our Advanced Thyroid Panel - Now Available in the Root Access Membership

Biomarkers Tested: TSH, T4, Free T3, Free, Thyroid Peroxidase Antibodies, Reverse T3, Selenium

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When do you need a full thyroid panel?

You were told that your TSH levels are normal but you still have hypothyroid symptoms.

Such as:

Hormone imbalance (PMS, irregular periods, PCOS).
Infertility or Miscarriage
Daytime fatigue
Anxiety, Depression, or Mood Disorders.
Constipation
Hair loss
Aches in joints, muscles, hands
Difficulty concentrating or remembering things (brain fog)
Unexplained weight gain or difficulty with weight loss

Where do we go from here?

Not only do we assess the whole picture when it comes to how your thyroid is functioning, if it’s not functionally optimally, we want to know why – what are the root causes of thyroid dysfunction? Some common root causes we check for are: adrenal dysfunction, gut health (important for addressing thyroid antibodies)(1), nutrient deficiencies, inflammation, activity level, sleep and stress, infections, hormone imbalance, medication side effects and more.

We find root causes of thyroid disorders by listening to your story, by assessing possible causes of your symptoms, and by using advanced testing with functional medicine labs. We put the whole picture together.

So often in healthcare, medicine is artificially separated in silos. If you have a thyroid problem you see an endocrinologist. If you have a heart problem, you see a Cardiologist. This often leads to multiple medications for symptom control in each area and no one putting the whole picture together to address root causes and solve the problem at the cause.

With thyroid in particular, who is putting your whole picture together to optimize not only how you feel but the prevention of future problems?

Prevention of related problems

Nearly all hypothyroidism (>90%) in the U.S is caused by an auto-immune process (Hashimoto’s). We know that those with one autoimmune disease are more prone to develop another if we do not lower inflammation and address root causes. For example, a large number of patients with Celiac disease will develop Hashimoto’s.

Extra-thyroid symptoms

Thyroid disease affects nearly every body system. Those with thyroid disease or on thyroid medication are more at risk for bone loss. Many with thyroid disease also have sleep apnea (and often have sleep apnea with associated thyroid antibodies before being diagnosed with thyroid problems). Hypothyroidism can cause high cholesterol.

Thyroid hormone affects other body hormones

Thyroid hormone directly affects our female hormones. Thyroid hormone is essential for ovulation. Adrenal health and thyroid are interrelated. Hypothyroidism can alter glucose metabolism and lead to insulin resistance.

Simply replacing the end result (thyroid medication) isn’t enough. It doesn’t reverse disease or calm inflammation or address root causes. Plus, there is evidence that circulating thyroid antibodies do not only hurt the thyroid (2). A comprehensive approach to actually treating thyroid problems takes time and consistency, a partnership, the availability of the right labs, and nutrition knowledge. Treating the problem is different from simply managing the problem with medication.

If you’re interested in getting to the root of thyroid health, check out our functional medicine membership program.