Why Do I Have Hypothyroid Symptoms If Labs Are Normal?

Why Do I Have Hypothyroid Symptoms If Labs Are Normal?

Why Do I Have Hypothyroid Symptoms If My Labs Are Normal?

By far, this can be one of the most frustrating feelings: being dismissed by your doctor who says your labs are normal, regardless of the hypothyroid type symptoms you experience everyday.

The question is, what’s going on?

Common Symptoms Associated With Hypothyroidism

Here are some of the most common symptoms associated with hypothyroidism:

  • fatigue
  • depression
  • slow metabolism
  • dry skin
  • thinning hair or hair loss
  • mental dullness
  • physical slowness
  • inability to tolerate the cold
  • muscle weakness or cramps
  • orange pigmentation in the skin, most noticeable on the palms
  • recurrent infections
  • yellow bumps on the eyelids (fat deposits)

Thyroid Labs (Testing for Hypothyroidism and Hashimoto’s)

Most of the time, a doctor will run labs that only show TSH levels without providing a full thyroid panel. It is important that you request a full thyroid panel that normally includes the following:

  • TSH
  • Free T4
  • Free T3
  • rT3
  • TPO Antibodies
  • TBG
  • TAA (antibodies)
  • TSI

The issue with knowing only your TSH is twofold:

  1. TSH is a pituitary hormone, not a thyroid hormone. Your TSH goes off of a negative feedback mechanism based off of what your thyroid gland communicates. This does not help with addressing the thyroid.
  2. Often, conventional medicine uses a wider range of referenced TSH levels. The slightest increase or decrease of TSH can have a very prominent effect on how you feel. I find that a TSH reference range between 0.5-2.0 works best with my clients.

Do You Have Hashimoto’s?

When I hear people say that they have hypothyroidism, but don’t know if they have Hashimoto’s, it immediately concerns me. As stated above, many doctors will test just TSH in a typical thyroid lab to help with a diagnosis. If you have high TSH, you will be hypothyroid, if you have low TSH you will be hyperthyroid. Then, you will be given synthetic thyroid hormone like levothyroxine or Synthroid to help get you back to a “healthy” range. If you fall into the conventional reference TSH range, you will be dismissed, even though you feel crummy (fatigue, weight gain and depression being the most common symptoms).

Sometimes you may have TSH levels that are just outside of the reference range and are not technically “hypothyroid.” However, you may have prevalent thyroid antibodies. This can show a state of autoimmunity, even without hypothyroidism. Again, always request a full thyroid panel. If you have positive antibodies (Hashimoto’s), you will need to take steps that address your immune system before your thyroid gland gets progressively attacked. There are specific dietary recommendations for Hashimoto’s that can be followed in order to help stabilize your thyroid and control your immune system response.

Your Thyroid Panel

Your thyroid labs come back “normal.” But, you realize only your TSH was tested. You go back and request a full thyroid panel. It comes back with high rT3 (reverse T3). Elevated rT3 signify increased stress – this can range from any type of stress from starvation (trying to lose weight in an extremity or intermittent fasting) to physical, emotional and/or environmental. Your rT3 can be reversed depending on how you manage your stress (again, all types of perceived stressors); however, elevated rT3 impacts your thyroid causing T4 to be converted to rT3 instead of the needed, active form, free T3. Sometimes from this state alone, symptoms of hypothyroidism occur; namely fatigue, mental dullness/brain fog and the potential onset of depression.

Other Factors That Can Effect The Thyroid (Triggered Towards Hashimoto’s and Hypothyroid)

There are other factors that can ultimately effect the thyroid. Even if your thyroid labs come back so called “normal” you may be impacting your thyroid health unknowingly.

  • Genetic predisposition or family history: do you have a family history of thyroid illness or other autoimmune diseases?
  • Nutritional deficiencies: particularly iodine and selenium. Are you eating enough of these foods regularly (although still in moderation). Sea vegetables, seafood, nuts and seeds are good options; all if well-tolerated.
  • Stealth, viral, bacterial or yeast infections. EBV being one of the most common viruses in those with Hashimoto’s.
  • Foodborne bacterial illness. Another underlying cause that impacts thyroid health.
  • Chronic stress (that causes adrenal insufficiency)
  • Adrenal Fatigue
  • Trauma
  • Hormonal or immune system changes (including pregnancy)

Steps To Take If You Have Normal Thyroid Labs But Feel Crummy

I recommend registering for my free thyroid balancing guide. It has many useful tactics that help you address how you are feeling (chronic symptoms) and how to improve the health of your thyroid. It is most suitable for those with Hashimoto’s, hypothyroidism or if you are experiencing hypothyroid symptoms.



  1. Address adrenal fatigue
  2. Modify diet to best support the thyroid.
  3. Support your gut (whether antibodies are present or not)
  4. Decrease inflammation

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