Thyroid problems can mimic disease throughout the body. This makes it sneaky and hard to detect without a high index of suspicion. It also makes sense since thyroid hormone is key to regulating the metabolism of every cell in the body. Everything from fatigue to constipation or irregular menstrual periods can be from an underlying thyroid problem.

The body has a hierarchy of how hormones work:

  • Cortisol and Adrenal Hormones
  • Thyroid Hormones
  • Sex steroids like Estrogen and Testosterone

It makes sense to fix things in this order as well. If a person has adrenal crisis and their body is not producing enough cortisol type hormones their thyroid might be a little off. Fixing the adrenal problem will often let the body bring the thyroid hormones back into balance without separately treating the thyroid.  The same is true for thyroid hormones and sex steroids. Fixing a thyroid hormone problem may often the body normalize testosterone or estrogen when they are slightly out of balance. Irregular menstrual periods may normalize from fixing the thyroid issue or a low testosterone may come back into the normal range.

There are three main actors in the realm of thyroid hormones:

  • TSH – Thyroid Stimulating Hormone – which is secreted by the pituitary gland in the brain to signal the need for more thyroid hormone to be produced and released by the thyroid gland
  • T4-Thyroxine – T4 is the main hormone made by the thyroid gland and released into the circulation
  • T3 – Triiodothyronine – T3 is the active form. Most is derived from conversion of T4 into T3 which happens inside of cells
  • Thyroid Autoantibodies – Microsomal and other antibodies directed against the thyroid gland signal an autoimmune process
  • rT3Reverse T3 Hormone – An inactive form of T3 that the body produces under stress or during illness that both shunts the available T4 into an inactive form and blocks the T3 receptors inside of cells

The most common thyroid problem in developed countries such as the United States is hypothyroidism – having too little thyroid hormone. Most of this is caused by an autoimmune mechanism where the immune system attacks the thyroid gland causing Hashimoto’s disease. When this happens, the thyroid gland is destroyed over time. Autoimmune phenomenon can also cause hyperthyroidism where there is too much thyroid hormone.


When the thyroid is under functioning because of problems at the level of the thyroid gland then the thyroid puts out too little thyroid hormone. The brain responds by increasing the TSH level to try to stimulate the gland to produce more thyroid hormone [whip it harder to try to get some kind of response].

The standard treatment for hypothyroidism is to prescribe T4 – levothyroxine to get the TSH back down into the normal range. For some people that’s all they need and they feel great. Their metabolic parameters go back to normal and all they need is to have their TSH checked every year or so once it has been stable in the normal range for a while.  That’s the standard of care I use when I teach Board Review courses for doctors to continue to maintain their Board Certification.

Some people however, just don’t feel great when they are treated with just T4. This is where it gets interesting and where Functional Medicine doctors think differently about thyroid treatment than most Traditional Western Medicine doctors. Most Endocrinologists know the other stuff I am about to talk about but it is not the standard of care and they don’t believe that the concerns are either relevant or common enough to worry about for most patients.


By adjusting therapy using only the TSH level it assumes that all tissues in the body respond essentially the same, and that the brain’s response to circulating T4 levels is the whole story


By assuming only TSH matters it means that levels of the T3 active hormone aren’t really relevant to how a person feels or functions


The normal range of TSH is the target range for optimal health


Nothing blocks the thyroid receptors inside of cells


Nothing prevents the conversion of T4 to the active T3 hormone


Autoimmune thyroid problems are irreversible. Once you have antibodies against your thyroid gland you will always have them and there is nothing to do about it.

Functional Medicine doctors think that most of these assumptions are not true. They believe both in treating thyroid problems more aggressively and that there are things that can be done to find and reverse the root cause of thyroid problems in some individuals.

When Hillary Clinton was running for President of The United States she released her list of medicines. She was taking a combination of T3 and T4. News sources from around the country interviewed prominent Endocrinology doctors who were perplexed as to why she would be taking a primitive therapy when purified T4 was available. As in interesting note, Bill Clinton’s personal physician is one of the best Functional Medicine doctors in the country. Seems likely he also treats Hillary and that he may be using more specifically targeted testing and therapy than just giving T4 and measuring only TSH.

From detailed study, we know that there are many steps and many micronutrients required to produce thyroid hormone. Deficiencies of any of these nutrients can decrease the production of thyroid hormone, impair the conversion of T4 into the active T3 form or keep the receptors from functioning normally. With all the endocrine disrupting chemicals, we have in our bodies it is no wonder we are challenged in all our hormone systems.

It also shouldn’t be incredibly surprising that if we raise our food on sterile depleted soil and douse the plants with chemicals that the plants we eat – and that we feed to the meat animals we consume – are lacking in micronutrients and full of chemicals that can cause such an array of changes in our bodies that they are not only unknown but virtually unknowable in the complexity and disruption they can cause the delicate biological systems we call our bodies.

Functional Medicine doctors use lower TSH targets and tighter ranges as well as measuring T4, T3, and rT3 when needed. They also believe that things like wheat and gluten sensitivity, even without full blown Celiac disease can trigger autoimmune processes that destroy the thyroid in some people.

When your body is challenged with fatigue, depression, fibromyalgia, or intractable headaches then fine tuning your thyroid status can lead to higher levels of function. If you want a higher standard of care or you are not satisfied with how you feel then consider working with a Functional Medicine doctor to investigate or treat your thyroid issues.