You’re on levothyroxine. Your TSH is “in range.” And you’re still exhausted, still gaining weight, still losing hair. The number on the lab isn’t the whole story.
Most conventional visits check TSH and stop. Functional-medicine practitioners look further upstream: are you converting T4 to active T3? Do you have antibodies (the “Hashimoto’s” in Hashimoto’s)? Is gut inflammation — H. pylori, low stomach acid, food triggers — blunting absorption and conversion? Is iron, selenium, or zinc the missing cofactor?
Fatigue that sleep doesn’t fix · weight gain despite effort · hair thinning · cold hands/feet · brain fog · constipation · low mood · irregular cycles.
Beyond TSH: free T3, free T4, reverse T3, TPO and thyroglobulin antibodies, plus the upstream drivers — ferritin, vitamin D, a gut workup when symptoms point there. Your practitioner decides what’s worth running for you.
A long-time Hashimoto’s patient with “in-range” TSH was still exhausted. A deeper workup found an H. pylori infection driving inflammation and blunting conversion. Address the upstream driver, and both the labs and the symptoms finally moved.
Work with a practitioner who looks at why — not just the prescription.
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