Do you have thyroid symptoms but “normal” lab results?


Functional Medicine provider, Dr. Blake Butler, DC,  explains why standard lab tests sometimes overlook symptoms of thyroid disease:


Thyroid Hormones, like most hormones, are commonly misunderstood. This is in part due to the complexity of their impact on how we function. Thyroid hormones impact every cell in the body and regulate our metabolism. Our metabolism impacts all the chemical processes occurring in our body. We are basically chemistry in motion. Therefore, thyroid function, or dysfunction, can have a positive or negative impact on approximately 30 trillion cells and can significantly impact our ability to regulate how we function and feel.

According to the American Thyroid Association, more than 12% of the US population will develop a thyroid condition throughout the course of their lifetime (1). This equates to approximately 40 million people. Most of these people will experience Hypothyroidism. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones. The common conventional treatment includes thyroid hormone replacement. However, many people still experience thyroid related symptoms even when their labs have “normalized”. This is typically because the root cause of thyroid dysfunction has not been identified.

Think about this! 90% of Hypothyroid cases are a result of an autoimmune “self-attack” referred to as Hashimoto’s (2). There are multiple potential immune triggers that promote dysfunction within our immune system. If we do not systematically uncover what the potential environmental, dietary, or lifestyle triggers are, it is unlikely that we will improve our thyroid function. Conventional management treats the hormone imbalance, but often fails to address the immune system component.

Commonly Discussed Symptoms

Thyroid dysfunction is commonly correlated with weight fluctuation, fatigue, heart palpitations, cold hands and feet, hair thinning, and a thinning of the outer aspect of the eyebrows. However, there are many additional symptoms associated with sub-optimal thyroid function that are overlooked.

Uncommonly Discussed Symptoms

Symptoms that are often overlooked include:

  • Anxiety
  • Depression
  • Dry Skin
  • Muscle Weakness
  • Infertility
  • Irregular Periods

Lab Interpretation

Most healthcare practitioners rely solely on Thyroid Stimulating Hormone (TSH) to screen for thyroid dysfunction. However, it is essential to consider downstream impacts on thyroid function. For example, the thyroid gland produces 93% T4 and 7% T3. T4 is an inactive thyroid hormone and must be converted to T3 to have an impact on how we feel. If we have a normal output of T4, our TSH may come back well within the lab reference range. But if we are not converting T4 to T3, our cells perceive low thyroid output, and we experience many of the symptoms outlined above. Stress, gut microbiome imbalances, and nutrient deficiencies all impact this conversion. Therefore, it is essential to look beyond TSH when determining the cause of thyroid related symptoms. Additional recommended testing includes:

  • Vitamin D
  • Zinc
  • Selenium
  • Vitamin B12/Folate
  • Homocysteine
  • CRP, High Sensitivity
  • Comprehensive Stool Testing
  • Cortisol “Adrenal” Testing

Functional Medicine for Management of Thyroid Disfunction

What does all this mean for you? Quite simply, if you experience any of the outlined symptoms yet have been told you have “normal” thyroid function, it would be beneficial to consider a Functional Medicine workup. There are multiple conservative strategies within our toolbox that allow us to support thyroid function using primarily diet and lifestyle intervention. Functional Medicine allows us to think outside of the box as it relates to your health. Comprehensive testing, beyond TSH, allows us to get to the root cause of your symptoms. To schedule an appointment or free consultation with a Functional Medicine provider, please fill out the form below.


About Dr. Blake Butler, DC

Dr. Blake Butler is a Functional Medicine Telemedicine provider at Aligned Modern Health and currently serves patients in Florida, Colorado, and Illinois. Graduating with honors from Logan College of Chiropractic, Dr. Butler has extensive postgraduate training in functional medicine, blood chemistry interpretation, brain chemistry, thyroid function, and functional endocrinology. He specializes in regulating blood sugar, thyroid dysfunction, GI imbalances, and adrenal dysfunction. Dr. Butler places a strong emphasis on patient education and believes that diet and lifestyle play an important role in achieving optimal health and promoting chronic disease prevention.

  2. Amino N. Autoimmunity and hypothyroidism. Baillieres Clin Endocrinol Metab. 1988 Aug;2(3):591-617. doi: 10.1016/s0950-351x(88)80055-7. PMID: 3066320.


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