My Thyroid Is Low But My Doc Doesn’t Know

Based on reader feedback from my last article (Love and Marriage) I thought I needed to clarify an issue. My wife isn’t a zombie. She only occasionally acts like one and that behavior is usually provoked by a certain someone in her life. She is an excellent physician and her obstetric and gynecology patients need not fear any irrational behavior (unless I’m around).

My anti-aging and wellness practice includes medical weight loss. As such, I see quite a few patients that have experienced the “middle age spread”. Not familiar with the term? According to, middle age spread is defined as “an increase in bulk, especially in the waist and buttocks, associated with the onset of middle age and the body’s decreasing ability to metabolize calories efficiently.”

Why does the body have a decreased ability to metabolize calories efficiently? One of the main reasons is a decrease in hormone levels. Most of my patients have a similar story. They were able to maintain a healthy weight when they were younger; but kids, work, and decreased time for exercise began to show on the scales and the clothing rack. Typically they have tried to lose weight through diet and exercise and come to see me when the avenues that worked previously are no longer effective.

Many have seen their primary care doc, their thyroid level has been checked and come back “normal”, and they have been told that they just needed to eat less and exercise more. How do we define a normal thyroid level? We compare the patient’s TSH (thyroid stimulating hormone) level, not against the patient’s baseline blood levels drawn when they were younger, but against other people in their age range who likely had their blood drawn because they were experiencing similar symptoms.

The TSH test is a screening test developed to detect very high and very low levels of thyroid production. Thyroid stimulating hormone is produced by the brain, not the thyroid, as part of the metabolic feedback mechanism. The TSH test’s broad range doesn’t do an adequate job in detecting early decreases in thyroid production. Free T4, free thyroid hormone released by the thyroid gland, is a much more accurate test that shows the level of thyroid hormone circulating in the bloodstream.

Typical Western medical education now centers more around looking at test results on paper than looking at the patient’s symptoms. It’s easier to treat the paper than the patient! After all, why should we trust that the patient knows their body better than we do?

What are the symptoms of low thyroid? Fatigue (Chronic Fatigue Syndrome), depression, weight gain, changes in hair, skin, and nails, increased cholesterol, cold intolerance, fibromyalgia, constipation, forgetfulness, and low sex drive to name a few. Don’t recognize any of your symptoms on this list? Visit for a more complete list. Though not written by a doc, I haven’t seen anything yet with which I don’t agree.

My patients? I will typically start with a baseline TSH and free T4. If the patient has any of the above symptoms and the TSH is on the higher end of normal with a lower end of normal free T4 I’ll start them on natural thyroid supplementation (Armour/ Naturethroid/Westhroid). What about Synthroid/levothyroxine (synthetic T4)? I have quite a few patients that have had poor response to Synthroid that have great response to natural thyroid such as Armour. Do I follow TSH? Long enough to see that it comes down to the low normal or low range as long as the free T4 (and sometimes free T3) are in the normal range with good symptom control. TSH was never designed to track the effects of thyroid replacement. My job is to listen to my patients and work with them to reach their goals and help make their lives better.


Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He firmly believes that thinking inside the box doesn’t work and that zombies aren’t really real (other than his wife). Comments or questions? His email address is: