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.

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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.

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.

Thyroid Medication

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.

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