This is for those of you who struggle to find a diagnosis for your myriad common for women at the midpoint but oh-so-real symptoms that rob your energy, focus, and feeling like you-ness.

Symptoms like weight gain, poor sleep, loss of hair, feeling cold, fatigue, and general malaise.

You may have even had a doc recommended blood test to check your TSH (thyroid stimulating hormone) level only to be turned away with “Your TSH is within range. I can offer you an anti-depressant…”

You are not alone. I understand how frustrating this situation is. What follows is information you can take to your doc to go further with testing, some of the common myths about hypothyroidism, and recommendations for more info and support.

You’d think, after reading the stats below, that with so many cases of un-diagnosed thyroid illness, more docs and practitioners would get educated about this critical piece of the health puzzle.

According to the American Thyroid Association,

  • Up to 60 percent of those with thyroid disease are unaware of their condition.
  • Women are five to eight times more likely than men to have thyroid problems.
  • One woman in eight will develop a thyroid disorder during her lifetime.
  • One in four adults over 65 have some sort of thyroid dysfunction.
  • The majority of these patients have hypothyroidism — too little hormone production — while a small percentage suffer from hyperthyroidism (too much hormone production).

Your thyroid

Shaped like a tiny butterfly, your thyroid gland is located in the throat. I refer to it as the unsung heroin of the healthy, happy human. (Men as well as children can experience thyroid disfunction.)

The thyroid’s role in the body is to regulate the body’s metabolism and calcium balance.

According to Dr. Chris Kesser,Every cell in the body has receptors for thyroid hormone. Thyroid hormone directly acts on the brain, the G.I. tract, the cardiovascular system, bone metabolism, red blood cell metabolism, gall bladder and liver function, steroid hormone production, glucose metabolism, lipid and cholesterol metabolism, protein metabolism, and body temperature regulation.”

Thyroid health and your brain

What Dr. Kesser does not include his list but I believe should be on it, is the effect that thyroid function has on mental health. According to Drs. Richard and Karilee Shames, in their book, Thyroid Mind Power, The Proven Cure for Hormone-Related Depression, Anxiety, and Memory Loss, “Thyroid imbalance is a medical condition that often carries with it a variety of well-studied psychological symptoms. Millions of people face emotional havoc due to simple untreated or poorly treated thyroid imbalances.”

Dr. Ridha Arem, MD author of The Thyroid Solution says, “It is time for thyroid hormones to be recognized as key brain chemicals, whose actions and effects are similar in many ways to serotonin and other neuro-transmitters.”

When there is too little or too much thyroid hormone, you can see from the above list that every cell in the body, including the brain, can be impacted. Too much thyroid hormone, called hyperthyroidism, results in nervousness, heart palpitations, excessive sweating, unexplained weight loss, and feeling hot. Too little does the opposite. Hypothyroid sufferers will be cold, are prone to weight gain, become listless or foggy brained, and constipated. It’s usually these quality-of-life issues that send us to the doctor for tests.

“The” test

The most common test given by general practitioners is the TSH test. This test measures the hormone produced by the pituitary gland that stimulates thyroid hormone production. It does not give you a picture of how effective the body is at using that hormone. Is it getting into the cells?

Unless you are obviously on the high or low sides of this basic test, you risk going un-diagnosed.

Using one “normal” standard range for everyone is an archaic way of determining an individual’s status.

Dr. Google

Google your symptoms and you might come across an article on a well-known, trustworthy site like the Harvard Health newsletter like I did. (I’m not linking to the article because I believe it’s got inaccurate information and it won’t help you if you are looking for answers.)

I respect the training that this MD has, and that there are always two sides to every argument. Her thesis — that too many people are being tested and treated for hypothyroid symptoms — and her reliance on the TSH test results as the gold standard, will leave millions of women suffering with quality of life symptoms and put them at risk of serious problems like heart disease.

(Yes, untreated hypo or hyper thyroid problems are not just annoying, the can lead to serious disease.)

Her final prognosis, “According to most guidelines, a TSH below 10 provides good reassurance that a person does not have hypothyroidism.”

Whose guidelines I don’t know, but I know countless hypothyroid patients who don’t feel well until their TSH is below 2! Me included.

In defense of docs

Most docs are not educated in the treatment of thyroid problems. Our medical model is one of specialty. If you are a GP you won’t learn much about nuanced thyroid care. You wouldn’t expect them to.

“Ah, let’s find an endocrinologist”, you say.

Not so fast. Many endos are experts in the endocrine system, a complex system of organs and glands. Common diseases like diabetes, PCOS, even osteoporosis all fall under their umbrella of care. So do thyroid imbalances. In my experience, these docs shine if you have thyroid cancer, goiter, or nodules to treat.

The subtle art of thyroid balancing, not so much.

For that you will have to find a functional medicine or alternative specialist.

Don’t insult our intelligence

What frustrates me for those of you who may have all the classic symptoms of hypothyroidism but a “normal” TSH result is that you are likely to  get sent home with either an anti-depressant or a suggestion for lifestyle change such as eat less, exercise more, if you are cold put on a sweater. Lifestyle does play a role in thyroid health,but first let’s diagnose the problem.

Being dismissed is demoralizing. For some women it is enough to get them to quit the search for relief and healing.

Don’t give up til you get the help you need.

I didn’t give up and feeling like myself, being able to stay at a weight that feels good, sleeping, seeing my skin and hair improve — priceless.

Where are you on this quest?

Let’s say you have a doc who agrees that based on your symptoms, your TSH # may not be telling the whole story. Ask this doc if they will run a full thyroid panel. This will reveal how well your pituitary gland — the gland that produces actual thyroid hormone — is responding to TSH — thyroid stimulating hormone, and how well this hormone is being used by the body vs bound up and not getting to the cells where it should be.

Once you have a complete picture, your doc — if he or she is fluent in thyroid health — will prescribe thyroid replacement therapy and lifestyle changes.

My experience tells me it won’t be easy to find such a doc, but you might. You might already have someone in your village of care experts who is willing to work through this with you.

If not, here are my trusted resources for information, testing, and support.

They won’t be able to prescribe medication, but you will be able to go to your doc with information supporting your request to try their suggestions. You’ll make it easy for them and they might even thank you for bringing this kind of information to their attention.


Dr. Chris Kresser for information on all things functional medicine but specific to this post, he has a great ebook on why people get thyroid disease, what stresses out the thyroid, testing, meds, herbs, etc.

Mary Shomon is a lay person but decades long thyroid health advocate and coach for those struggling with hypothyroidism. She has books, runs classes, and offers coaching including reading thyroid labs. I interviewed her for the podcast. Find it here.

Izabella Wentz specializes in Hashimotos thyroiditis which is the autoimmune form of hypothyroidism. She recommends lifestyle, natural foods and supplements for healing and dealing with Hashi’s.

Dr. Richard Shames, as mentioned above, is a thyroid expert who offers virtual consultations after testing. He was the first doc I consulted after interviewing him for a summit and I’m forever grateful for his insights and recommendations. You might want to start with his book, Thyroid Mind Power, The Proven Cure of Hormone-Related Depression and Memory Loss.


It’s a haven for those who can’t get treated satisfactorily or who need ammo to take to a doc when the drug prescribed isn’t working. You’ll find alternatives and recommendations for dosing based on severity of symptoms. You feel heard here and will get answers.

Do not give up if you’ve been told you are “fine” after blood work and still feel poorly, can’t lose weight, etc. Hormone balance is a complex aspect of health and it may take time to get back to fully functional, but so worth every moment it takes to arrive there.

If you do warrant thyroid medication the first stab at the right dose may or may not be “it.” But just knowing you are on the road to recovering your old self will start the process of feeling better.

I’m here if you want to chat

Please let me know if you want to chat about this — there’s no charge — I will listen to what’s going on and give you next steps. Maybe even help you realize you are not crazy and this is not just a function of aging.

Grab a spot on my calendar.