We look at the full thyroid picture, not just TSH. Understanding how hormones are being produced, converted, and used helps us find patterns that standard testing tends to miss.
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TSH measures what the brain is asking for. It does not tell us how much hormone the thyroid is producing, how well T4 is converting, or whether the cells are responding. Standard panels stop at TSH. We do not.
We look for the root cause rather than defaulting to replacement hormone without investigation.
An immune condition affecting the thyroid. We address the immune drivers, not only the hormone deficiency.
Symptoms are meaningful even when TSH is only mildly outside range or sitting at the high end of normal.
Adequate T4 production does not always mean adequate Free T3. Conversion is a distinct step that we test directly.
When conversion favors Reverse T3, it blocks receptor sites and produces hypothyroid symptoms regardless of what standard labs show.
Cortisol dysregulation directly affects thyroid conversion and receptor sensitivity. We assess both systems together.
Hypothalamus
Signals the pituitary to release TSH based on the body's perceived metabolic need.
Pituitary
Tells the thyroid to produce T4. This is the only point in the cascade that most standard panels test.
Thyroid Gland
An inactive storage hormone. It requires conversion to Free T3 before the body can use it.
Liver & Tissues
Chronic stress, gut dysfunction, and inflammation can push conversion toward inactive Reverse T3 instead of usable Free T3.
Every Cell
Free T3 drives metabolism, energy, and cognition at the cellular level. Receptor resistance can blunt this effect even when T3 levels look sufficient.
A Closer Look
Hashimoto's is an immune condition that happens to target the thyroid. Most people receive a diagnosis, a prescription, and little else. The immune process driving antibody production is rarely part of the conversation.
We look for the triggers sustaining the immune response and work to address them directly. The goal is lower antibody levels and better thyroid function over time, not just hormone replacement.
Gluten sensitivity, intestinal permeability, EBV, H. pylori, and environmental toxin burden are each assessed as potential immune drivers
Intestinal barrier integrity directly influences immune activation. Restoring it reduces the antigenic load sustaining antibody production
Selenium, vitamin D, omega-3s, and select botanicals have clinical evidence for meaningful TPO antibody reduction
Specific dietary triggers are identified and removed. Anti-inflammatory nutrition supports a calmer immune environment
Cortisol burden is both a trigger and a perpetuating factor in autoimmune flares. HPA axis function is always assessed
When replacement is indicated, type, dose, and timing are optimized based on the full lab picture and how the patient is feeling
Diagnostics
We test the full hormone cascade and read results against optimal ranges. Each marker tells us something different about where in the process things may be breaking down.
Discuss Your TestingTSH
Interpreted against an optimal range of ~1–2 mIU/L, correlated with symptoms
Free T4 & Free T3
Unbound, bioavailable forms of both hormones: T4 for production and Free T3 for the active form at receptor sites
Reverse T3
Identifying disproportionate conversion to the inactive blocking form, which is commonly missed by standard panels
TPO & Thyroglobulin Antibodies
Screening for Hashimoto's, which is often detectable years before TSH becomes abnormal
Nutritional Cofactors
Selenium, iodine, zinc, ferritin, and vitamin D, all essential for hormone production and conversion
Adrenal & Cortisol Panel
DUTCH panel evaluating HPA axis function, which directly modulates thyroid conversion
TSH alone does not tell us whether T4 is converting well, whether Reverse T3 is interfering, or whether early Hashimoto's antibodies are present. A single marker cannot answer those questions. A full panel can.
Levothyroxine provides T4. The body still needs to convert that T4 to Free T3 for it to have any effect, and conversion can be impaired by stress, gut dysfunction, nutrient insufficiency, or adrenal burden. We look at each of these specifically.
Often yes. Gluten elimination, selenium, vitamin D, and gut healing have clinical evidence behind them for reducing TPO antibody levels over time. Lower antibodies correlate with slower glandular damage and better overall function.
It depends on how much tissue has been affected. When Hashimoto's is identified early and immune drivers are addressed, dose adjustments are sometimes possible over time. When damage has accumulated, ongoing support is likely necessary. In either case, the goal is feeling well, not just a number in range.
A free discovery call is a good starting point. We will review what testing you have had, listen to what you are experiencing, and talk through whether this approach makes sense for you.
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