Are You Truly Hypothyroid?  Caution for Those Seeing a Functional Medicine Provider

The field of functional medicine has become too liberal with labeling someone as ‘hypothyroid’.  This might sound appealing, “Yes, I finally have a diagnosis”.  However, the hidden danger is that taking unneeded thyroid medication can make your symptoms worse.  Let’s detail how to know if you are truly hypothyroid.


Dr. Michael Ruscio, DC: Hey, this is Dr. Ruscio.  Let’s discuss if you’re truly hypothyroid. This is something that I discussed in the past but I just got out of a visit with someone who was told they were hypothyroid and they were put on Armour thyroid, and they felt terrible the entire time. Actually gaining weight, losing hair, becoming more fatigued, having lower moods and having trouble with sleeping.

Now, why might this happen? Perhaps you’ve heard me comment before that while I appreciate much of what the field of integrative and alternative medicine does, unfortunately, as someone who practices in that field, I think the liberal use of thyroid medication and doling out a diagnosis of being hypothyroid, has increased to the point now where we really need to call attention to it and amend this problem.

[Continue reading below]

Dr. R’s Fast Facts Summary

Why might this happen?

  • Functional Medicine (and alternative medicine) use ranges that are a bit more narrow than conventional medicine.
    • This results in practitioners doling out a diagnosis of hypothyroid and liberal use of using thyroid medication
    • Downside – patients can be treated with treatments that they don’t actually which makes them feel worse
  • The problem emanates from the educational model of functional and alternative medicine – might be a bit too progressive

What can you do?

  • Get a second opinion
  • Check the labs yourself
    • If your TSH is not flagged high by the lab, and correspondingly your free T4 is not flagged as low then you most likely do not need thyroid hormone
    • The lab would have “high” next to it, or “bold”, or “out of range”

What if you want to try thyroid hormone to see if you feel better?

  • For someone who may have non-optimal levels, a trial on a thyroid hormone medication to see if they feel better is not a bad idea
  • After 4 to 12 weeks, if someone is not clearly feeling better, then that is likely not the right treatment

What else could it be?

  • Look to your diet and lifestyle and look to your gut health
    • Improving these aspects often times improves symptoms

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DrMR: Now what happens here? Well, in functional medicine, we will sometimes use ranges that are a bit narrower than conventional medicine will use. This, in some cases, has merit. However, we have to be careful with being too liberal in how tight of a range we use because the downside is we can start diagnosing people with a condition who actually don’t have it and therefore patients can be treated with treatments that they don’t actually need. This is exactly what is happening more often than not. I would say now I probably see a case of this a month, and I just got done with one. And so it is something that needs to be called attention to. And I don’t think it’s the fault of the provider, I think the providers are trying to do the best they can, and I think the problem emanates from the fact that the educational model and functional and alternative medicine might be a bit too progressive.

TSH Chart

So what happens is, someone is told they have hypothyroid when they actually don’t.  The short story is, if you’re seeing a natural provider or even a conventional provider who’s operating in more of an integrative, functional and progressive model (again, that’s a good thing) to safeguard against the fact that the person you may be working with might be operating under a model that’s way too progressive with the use of thyroid hormone, I would get a second opinion.

Now, there’s a fairly easy way to check this even if you can’t get a second opinion. If your TSH is not flagged high by the lab, and correspondingly your free T4 is not flagged low by the lab (not by the clinician); the lab would have a high next to it, or bold, or out of range, if you don’t see both of those, then you most likely do not need thyroid hormone. Now, for someone who is suffering and not feeling well, I understand someone telling you, oh, these thyroid levels aren’t where they should be, and this could explain your fatigue, your depression, your constipation, your loose hair. I understand how attractive that is, but it’s important that we don’t fall prey to a promise that does not have the appropriate substantiation attached to it. And unfortunately, I think this is happening more often than it should be in the realm of integrative and functional medicine care for thyroid.

We have to be careful with being too liberal in how tight of a range we use because the downside of that, is we can start diagnosing people with a condition who actually don’t have it and therefore patients can be treated with treatments… Click To Tweet

Now, on the other side of the coin, I’m not fully in opposition to someone who may have non-optimal levels of thyroid hormone performing a trial on a thyroid hormone medication to see if they feel better. But I would say after four to 12 weeks, one to three months, if someone is not clearly feeling better, then that is likely not something to be used and that I think is the most progressive statement that we can make. So if you are told by a progressive minded provider, doesn’t matter if they’re an MD, or a DC, or an ND, or what have you, if you’re told by a provider that you have hypothyroidism, I would inquire if it’s true hypothyroidism, or if it’s non-optimal thyroid function but not hypothyroid, and try to discern that in the conversation with the clinician. And I would also either get a second opinion or look at the labs yourself and if you’re not seeing flagged high TSH paired with flagged low free T4, then you may want to be a bit more cautious before you jump on a thyroid hormone.

Thyroid Hormone Infographic

I understand the appeal is there, but if you’re given a hormone and you don’t need it, you can actually have an exacerbation of your symptoms and feel worse. Now there’s a time and a place for considering a trial of thyroid hormone, yes, but I would first recommend going through a protocol to improve your lifestyle and your diet, and your gut health because this can be the source, in fact, in the particular case I’m referring to, this gal clearly has digestive symptoms that are likely driving her fatigue, and as we get her digestion better, she’s less bloated, less constipated, and has less abdominal pain, I am very confident her fatigue will improve.

I would make one of the first couple maneuvers to look to your diet and lifestyle, look to your gut health, my book Healthy Gut, Healthy You, lays out a plan for both of these in case you’re in need for that, but before you jump to the thyroid hormone, whatever plan you do, I would take steps to improve your diet and your lifestyle and your gut health, then re-evaluate your symptoms because the need for this thyroid hormone may not be there and make sure you are crystal clear in knowing that you actually need the thyroid hormone before you go on it. Because, while yes, often times thyroid hormone level optimization is typified as being this holy grail of wellness, unfortunately when you are not hypothyroid and you are given hormone, the hormone can actually make you feel worse. And that, of course, is counter-productive and something we want to avoid. This is Dr. Ruscio, hopefully, this information helps you get healthy and back to your life. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

36 thoughts on “Are You Truly Hypothyroid?  Caution for Those Seeing a Functional Medicine Provider

  1. What about autisum and gut health? I’ve read and witness gluten free , dairy free and yeast free helping autisum also vitamins which are methylated particularly b12 …

    I take low dose armour my tag very low and my t4 low and t3 but I do feel anxious at certain times of the day with it but freezing if I don’t take it and low mood etc …

    What about cortisol could that be why don’t feel well too?

    Thankyou

    I will buy the book would visit you if u were in the uk

    I have sibo and Candida since antibiotics but think had something going on all my life … 40 years now

    1. Hi Mandy,

      I’ll pass your question about autism on to Dr R to hopefully answer in a future Q+A episode of the podcast.

      I’d definitely recommend picking up a copy of Dr Ruscio’s book, but if that’s not enough, he does see patients virtually. You can apply to become one here: https://www.drruscio.com/gethelp

      Good luck!

  2. What could be causing extreme attacks of nausea and diarrhea about every 10 days, especially in the mornings. (dairy free, gluten free)

  3. My lab report does not flag thyroid antibodies as high at 60. It seems to me that any level of antibodies attacking one’s thyroid is abnormal. Am I wrong?

  4. What about autisum and gut health? I’ve read and witness gluten free , dairy free and yeast free helping autisum also vitamins which are methylated particularly b12 …

    I take low dose armour my tag very low and my t4 low and t3 but I do feel anxious at certain times of the day with it but freezing if I don’t take it and low mood etc …

    What about cortisol could that be why don’t feel well too?

    Thankyou

    I will buy the book would visit you if u were in the uk

    I have sibo and Candida since antibiotics but think had something going on all my life … 40 years now

    1. Hi Mandy,

      I’ll pass your question about autism on to Dr R to hopefully answer in a future Q+A episode of the podcast.

      I’d definitely recommend picking up a copy of Dr Ruscio’s book, but if that’s not enough, he does see patients virtually. You can apply to become one here: https://www.drruscio.com/gethelp

      Good luck!

  5. What could be causing extreme attacks of nausea and diarrhea about every 10 days, especially in the mornings. (dairy free, gluten free)

  6. My lab report does not flag thyroid antibodies as high at 60. It seems to me that any level of antibodies attacking one’s thyroid is abnormal. Am I wrong?

  7. If taking thyroid medication for years and lab results indicate TSH moving towards low end of reference range and T4 high, what is the safest way to decrease meds to avoid going hyperthyroid?

    Also if lab results are normal for TSH, T3 and T4, is this an indication to try reducing meds ever so slightly or do we have to include antibody results to come to that conclusion?

    1. Hi Ann,

      You’ll want to work closely with your doctor to decrease your dosage slowly while closely monitoring your labs.

      If lab results are normal (on meds), then all it likely means is that the meds are working. It’s not until things are trending toward hyper that you’d need to think about reducing the dosage.

      Hope this helps!

  8. Hi T-sh Can’t tolerate any thyroid med due to 3 fundoplicatioms gp sibo re herniated spine. Single mom disabled bankrupt going homeless known as crazy. Puke all thyroid med. I’m not surviving.

    1. Hi Nancy,

      I’m so sorry to hear you’re going through all that. There are some good free resources on here about thyroid health: https://drruscio.com/thyroid-disorders/ We can’t give personalized medical advice on this site, but potentially working on healing the gut can be very helpful with thyroid issues, so that could be an avenue to explore if you can’t take thyroid meds. Also, you may want to use this HRSA directory of health centers (assuming you’re in the US) – these health centers provide care on a sliding fee scale so it is affordable for anyone. You can receive care even if you are uninsured or cannot pay https://findahealthcenter.hrsa.gov/ Good luck!

  9. If taking thyroid medication for years and lab results indicate TSH moving towards low end of reference range and T4 high, what is the safest way to decrease meds to avoid going hyperthyroid?

    Also if lab results are normal for TSH, T3 and T4, is this an indication to try reducing meds ever so slightly or do we have to include antibody results to come to that conclusion?

    1. Hi Ann,

      You’ll want to work closely with your doctor to decrease your dosage slowly while closely monitoring your labs.

      If lab results are normal (on meds), then all it likely means is that the meds are working. It’s not until things are trending toward hyper that you’d need to think about reducing the dosage.

      Hope this helps!

  10. Hi T-sh Can’t tolerate any thyroid med due to 3 fundoplicatioms gp sibo re herniated spine. Single mom disabled bankrupt going homeless known as crazy. Puke all thyroid med. I’m not surviving.

    1. Hi Nancy,

      I’m so sorry to hear you’re going through all that. There are some good free resources on here about thyroid health: https://drruscio.com/thyroid-disorders/ We can’t give personalized medical advice on this site, but potentially working on healing the gut can be very helpful with thyroid issues, so that could be an avenue to explore if you can’t take thyroid meds. Also, you may want to use this HRSA directory of health centers (assuming you’re in the US) – these health centers provide care on a sliding fee scale so it is affordable for anyone. You can receive care even if you are uninsured or cannot pay https://findahealthcenter.hrsa.gov/ Good luck!

  11. You did not mention the case (like mine) where TSH and Free T4 are normal, but Free T3 is below the normal range. My doctor prescribes T3 medication (Cytomel), on the assumption that there is poor T4 to T3 conversion of unknown cause. Also no evidence of Hashimoto’s. I did get a second opinion before starting T3, but still wonder if it is something I should continue with for the long term. Thanks.

  12. You did not mention the case (like mine) where TSH and Free T4 are normal, but Free T3 is below the normal range. My doctor prescribes T3 medication (Cytomel), on the assumption that there is poor T4 to T3 conversion of unknown cause. Also no evidence of Hashimoto’s. I did get a second opinion before starting T3, but still wonder if it is something I should continue with for the long term. Thanks.

  13. Hi Dr. Rusico,

    My lab from last month showed a TSH of 6.6 uIU/ML and a Free T4 of 0.6 ng/dL TPO (Microsomal) Antibody result of 568.4 IU/mL. (This is the first time I have ever had my TPO Antibodies checked).

    The thing is I actually felt in an incredible well state of being going into these tests. All my other blood tests outside of my thyroid and in there normal clinical ranges. (It’s been my first comprehensive check up in over 9 years since I just got insurance again six months ago). An I am a young guy in my 30’s.

    The doctor started me on 0.088mcg of levothyroxine. I have been on it for three weeks. Since starting I have had trouble sleeping (normally I sleep soundly and usually get around 9 hours of rest per night). This past week I started having episodes of bruxism too. Other than those two issues I feel as well now as I did before I started the medicine.

    Any further detailed advice you and your team have is certainly much appreciated.

    1. Hi Jason,

      We can’t offer personalized diagnosis or medical advice on this forum, but as Dr Ruscio said in the video, it’s sometimes worth going through a diet + lifestyle protocol (i.e. the Great-in-8 plan from his book Healthy Gut, Healthy You) to see if that helps irons things out.

      He also has a helpful article here about how to lower antibodies: https://drruscio.com/three-simple-tips-to-lower-thyroid-antibodies-and-prevent-hypothyroidism/

      And lastly, if you’re not feeling well on the meds, it’s definitely worth mentioning it to your doctor, because the whole point of going on them is to feel better, not worse 🙂 Hope this helps.

  14. Hi Dr. Rusico,

    My lab from last month showed a TSH of 6.6 uIU/ML and a Free T4 of 0.6 ng/dL TPO (Microsomal) Antibody result of 568.4 IU/mL. (This is the first time I have ever had my TPO Antibodies checked).

    The thing is I actually felt in an incredible well state of being going into these tests. All my other blood tests outside of my thyroid and in there normal clinical ranges. (It’s been my first comprehensive check up in over 9 years since I just got insurance again six months ago). An I am a young guy in my 30’s.

    The doctor started me on 0.088mcg of levothyroxine. I have been on it for three weeks. Since starting I have had trouble sleeping (normally I sleep soundly and usually get around 9 hours of rest per night). This past week I started having episodes of bruxism too. Other than those two issues I feel as well now as I did before I started the medicine.

    Any further detailed advice you and your team have is certainly much appreciated.

    1. Hi Jason,

      We can’t offer personalized diagnosis or medical advice on this forum, but as Dr Ruscio said in the video, it’s sometimes worth going through a diet + lifestyle protocol (i.e. the Great-in-8 plan from his book Healthy Gut, Healthy You) to see if that helps irons things out.

      He also has a helpful article here about how to lower antibodies: https://drruscio.com/three-simple-tips-to-lower-thyroid-antibodies-and-prevent-hypothyroidism/

      And lastly, if you’re not feeling well on the meds, it’s definitely worth mentioning it to your doctor, because the whole point of going on them is to feel better, not worse 🙂 Hope this helps.

  15. My mother, 85, has a TSH of 4.55 and Free T4 of 1. These values have moved in the last 4 months from TSH of 3.26 and Free T4 of 1.1. She had a hysterectomy about 1.5 yrs ago. I believe reading the info you’ve published, she would be hypothyroid, correct? She has some foot swelling, all of a sudden has high blood pressure, and has a benign (tested) growht on her thyroid as well. Any recommendation on additional testing before they declare her hypothyroid and give her thyroid medicine? thank you!

    1. Hi Linda,

      Unfortunately, we’re unable to evaluate labs or offer personalized medical advice on this forum.

      If you’d like a little more info on hypothyroid, these videos may help:

      https://drruscio.com/what-is-hypothyroid/

      https://drruscio.com/tips-for-hashimotos-thyroiditis-hypothyroid-symptoms/

      You may also want to ask for a thyroid antibodies test. Thyroid medication isn’t necessarily a bad thing, if needed. Looking at gut health can also help resolve thyroid symptoms in many cases. Dr Ruscio’s book “Healthy Gut, Healthy You” walks through a DIY protocol to optimize gut health. https://www.drruscio.com/getgutbook

      Hope this helps.

  16. My mother, 85, has a TSH of 4.55 and Free T4 of 1. These values have moved in the last 4 months from TSH of 3.26 and Free T4 of 1.1. She had a hysterectomy about 1.5 yrs ago. I believe reading the info you’ve published, she would be hypothyroid, correct? She has some foot swelling, all of a sudden has high blood pressure, and has a benign (tested) growht on her thyroid as well. Any recommendation on additional testing before they declare her hypothyroid and give her thyroid medicine? thank you!

    1. Hi Linda,

      Unfortunately, we’re unable to evaluate labs or offer personalized medical advice on this forum.

      If you’d like a little more info on hypothyroid, these videos may help:

      https://drruscio.com/what-is-hypothyroid/

      https://drruscio.com/tips-for-hashimotos-thyroiditis-hypothyroid-symptoms/

      You may also want to ask for a thyroid antibodies test. Thyroid medication isn’t necessarily a bad thing, if needed. Looking at gut health can also help resolve thyroid symptoms in many cases. Dr Ruscio’s book “Healthy Gut, Healthy You” walks through a DIY protocol to optimize gut health. https://www.drruscio.com/getgutbook

      Hope this helps.

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