Normal Thyroid Tests, But Still Exhausted? Here’s What May Be Missing
You finally get your results back, “Good news” every thing is looking fine, thyroid is fine and so is your iron and B12…. And yet you’re still exhausted, flat and foggy. We’re not talking “a bit tired” we’re talking:
Deep bone heavy fatigue
Brain fog
Feeling cold when others are warm. First to put on a jumper vibes.
Hair shedding
Low motivation
Hard to shift weight, no matter what you do
Trouble concieving
Irregular periods
Low mood
Dry skin
Constipation
It’s confusing and can often be disheartening, commonly left thinking is this just how I feel now?!
If you’ve ticked off at least 2 of these symptoms let’s talk about what might be missing.
What Most Thyroid Tests Actually Measure
Thyroid screening usually includes TSH (Thyroid stimulating hormone) and T4 if you’re lucky.
TSH is a brain to thyroid signalling hormone. This tells us how loudly your brain is needing to talk to your thyroid for it to work. It’s helpful, but it doesn’t show the full picture.
What TSH isn’t telling us:
How well your thyroid hormones are being converted into their active form
If early autoimmunity is developing
If your thyroid hormones are being shunted into an unusable form
And this is often where the missing pieces lie.
Spoiler: TSH Can Be “Normal” While You Still Feel Awful
Thyroid function is a bit more complex that a single number.
Without giving you a full biochemistry lecture here is what you need to know: The thyroid hormone T4 is converted into T3 within the body, this is the active hormone that powers energy, metabolism, mood and temperature regulation.
If you aren’t converting your T4 into T3 well you can experience classic Hypothyroid symptoms even if TSH looks “fine”.
But Why Does This Happen?
Chronic Stress:
Your body starts to prioritise survival over optimal metabolism.
Inflammation:
Whether it’s from gut issues, chronic infection or stress this can all impact thyroid hormone conversion.
Nutrient Deficiencies:
Zinc
Selenium
Iodine (In appropriate amounts - too much and this could cause a thyroid autoimmune flare)
Iron - Low iron alone is going to cause hair shedding and fatigue
Early Autoimmunity:
This is a biggie which I see commonly in clients. Thyroid autoimmunity can develop slowly, these antibodies that develop can be evelated for years before it shifts TSH levels out of range. This is where intervention needs to happen, please do not wait until symptoms become severe or until TSH becomes out of range.
So if you have:
A family history of autoimmunity (Coeliac, Lupus, Crohns, Rheumatoid Arthritis, Psoriasis, Sjogrens, Type 1 diabetes)
Have these thyroid symptoms and have recently been pregnant
Other autoimmune symptoms (Gut symptoms, food allergies, joint pain and stiffness)
It’s worth checking thyroid antibodies
Remember: If You Don’t Feel Right - Trust That
You know your body better than anyone else and when something isn’t right. Your symptoms are your body giving you information, listen to that information and dive deeper into the root cause.
If you’d like support exploring your thyroid function and symptoms more comprehensively, I offer detailed thyroid testing that looks beyond just TSH and consider the wider picture of your health. The Comprehensive Thyroid Panel shows everything I need to know about the way your thyroid is functioning.
You deserve to feel well and energised again.
