top of page

Insights into Hypothyroidism and Essential Thyroid Testing

Did you know over 12% of the US population will develop a thyroid condition in their lifetime, and women are 5-8x as likely as men to develop a thyroid condition ?

More specifically the presence of hypothyroidism, or an under functioning thyroid has steadily increased in the United States since 2009, and many of those increased cases are subclinical. As Coaches, hypothyroidism or an under functioning thyroid and the symptoms associated do commonly come across our desk.


Some Common Symptoms of Hypothyroid Include: 

  • Feeling Cold/Cold intolerance 

  • Fatigue

  • Dry Skin

  • Hair loss 

  • Brittle nails

  • Facial Edema

  • Constipation 

  • Brain Fog

  • Anxiety/Depression

  • Difficulty losing weight

  • Elevated Cholesterol

  • Low libido

  • Menstrual Irregularities

As a refresher. you can think of your thyroid like your body’s master thermostat. When we think thyroid, many think metabolism. But metabolism is the sum of all reactions in the body that provide the body with energy for LIFE!  

We want that thermostat humming at the right temperature to keep the rest of your physiology running is best it can. 

You can have a thyroid that slows down and isn't functionally as optimally as it could be without having a hypothyroid diagnosis. We commonly see this with clients presenting with some of the above symptoms! Slow digestion, not responding to a cut like we thought and low energy are some tell tale signs we need to check on thyroid function. 

What Causes the Thyroid to Down Regulate? 

Inputs from the brain are driving the response of the thyroid gland. The brain receives feedback from the internal and external environment that influence the thyroid’s function.

Ultimately, any health imbalance is the result of the body compensating which has been triggered by a stressor. 

Acutely, we want these adaptations to occur! The body is adapting to put resources towards surviving, or allowing you to do something fun like training. It is when stress is chronic that issues develop due to the stress response never fully turning off. The body continues to compensate, altering organ function- you guessed it, thyroid included. 

If the thyroid is underactive, there is a reason. Identifying the reason involves considering your health history as well as current state of health and the totality of stressors on your body.

Chronic Stressors That Can Lead to Adaptations

  • Under-eating /Frequent dieting 

  • Over-exercising 

  • Nutrient deficiencies

  • Insulin resistance and Blood Sugar Dysregulation 

  • Autoimmune Conditions including Hashimoto’s thyroiditis And Graves Disease 

  • Infections 

  • Hormone Imbalances 

  • Gut Dysfunction 

  • Food Intolerances 

  • Medications 

  • Toxin Exposure

  • Mental/Emotional Stress

Low free thyroid hormone levels, hormone conversion issues and destruction of the thyroid gland itself can all lead to hypothyroidism signs and symptoms. 

Thyroid Testing- Beyond TSH

When evaluating the functioning of the thyroid gland, it is important to consider what other systems and factors are causing the thyroid gland to adapt the way it is to gain a better understanding of what’s going on internally contributing to the symptoms you may be experiencing. 

For this reason, we suggest pulling at least a CMP and a CBC along with a full thyroid panel to understand how the liver, kidneys, immune system, and potential nutrient deficiencies could be impacting the status of your thyroid. 

Many conventional doctors will look at Thyroid Stimulating Hormone (TSH) alone to assess thyroid function. However, TSH is a hormone secreted by the pituitary gland, a pea-size gland at the base of your brain. It does not tell us what thyroid hormone status is throughout your body. What TSH does tell us is how the brain is communicating with your thyroid, and works on a negative feedback loop in response to circulating levels of protein bound thyroid hormones. When TSH is high, it indicates hypothyroidism, or a lack of thyroid hormone. When levels are low, it indicates hyperthyroidism, or too much thyroid hormone. However, that is not the whole picture. 

TSH stimulates the thyroid gland to produce Thyroxine (T4) and a small amount of triiodothyronine (T3) hormones. T4 is largely inactive, whereas T3 is the “active” thyroid hormone and is converted from T4 in the peripheral tissues such as the liver, gut and kidneys. 

When levels of thyroid hormone are insufficient , the hypothalamus senses this and releases a hormone called thyroid-releasing hormone (TRH), signaling the pituitary gland to release TSH and start the process over again. 

Image from February 2013 Clinical Pediatrics 52(4)

As indicated earlier, T4 and T3 are protein bound hormones, which means they can be transported around the body. Free T4 and Free T3 are the unbound and what can actually travel into cells . Free T4 is a representation of the amount of thyroid hormone available for the cells and Free T3 is the active thyroid hormone available at the cell level.  It is Free T3, the unbound and free and available thyroid hormone that drives metabolism and all the metabolic processes.

T4 can also convert to reverse T3, which is inactive and produced in higher amounts during times of excess cell stress, or when liver or gut function is compromised.

Assessing Your Thyroid Health

A functional medicine approach (which we encourage at Fortify Health Coaching! ) looks at a full thyroid panel to assess what the thyroid is doing and gain a deeper understanding of thyroid function. For example, TSH and T4 can be “normal” according to the lab reference but you can be experiencing Hypothyroid symptoms due to low levels of free T3 which you would only know by looking at a full thyroid panel. This pattern indicates an under-conversion of T4 to T3 which could be caused by a myriad of factors including inflammation, high cortisol levels or nutrient deficiencies.

We would suggest talking to your provider about running a full thyroid panel if you are experiencing symptoms of a sluggish thyroid.

A Full Thyroid Panel

When we reference a “full thyroid panel” we are referring to:

  • TSH

  • Free and Total T4

  • Free and Total T3

  • Reverse T3

  • TPO and TG Antibodies 

If antibodies are found to be positive , it can indicate an autoimmune disorder at the root of the thyroid dysfunction such as Hashimotos or Graves disease. Detectable in ~ 95% of Hashimoto’s patients and 50 to 85 percent of Graves' disease patients. TPOAb attacks thyroid peroxidase, an enzyme that plays a role in the conversion of T4 to T3.

Keep in mind, a CMP,CBC, Vitamin D, fasted insulin, full iron panel, Lipid panel could be some of the labs you might also consider requesting to see what else is going on internally that could be causing the thyroid to adapt, or how those adaptations are impacting other systems. More testing, such a GI Map to evaluate Gut health may also be warranted.

We always encourage assessing your situation as a whole. This means considering your symptoms, health history, dieting history and medication history along with any lab work is imperative to better understand what may be going on internally - and create a path for moving forward.

If you have questions or would like to discuss a tailored approach to your health. Reach out to our coaches today. We have have several options between 1 on 1 coaching to consultation work. 

Disclaimer: This blog  is intended for informational purposes only and should not be considered medical advice. Always consult with a healthcare professional for proper diagnosis and treatment of thyroid disorders and sleep-related issues.


Recent Posts

See All


bottom of page