What’s your New Year’s resolution? To lose 10 or 20 pounds or more? If you have an underactive thyroid gland, this may be almost impossible. You may begin eating healthier and exercising on Jan. 1 and give up in frustration by Jan. 30 after failing to lose the weight you wanted, or in fact gaining weight, despite all your valiant efforts.

As a women’s health nurse practitioner caring for thousands of women every year, I always encourage my patients to eat a healthy, balanced diet and exercise 30 minutes or more, five to six times per week. Unfortunately, for my patients who are suffering from thyroid or other hormonal imbalances, this usually is not enough to promote weight loss and good health.

Do you suffer from any of the following?

  • Tiredness and sluggishness
  • Dryer hair or skin
  • Gain weight easily
  • Weaker muscles
  • A constant feeling of cold (fingers/feet)
  • Frequent muscle cramps
  • Poorer memory
  • Depression/mood changes
  • Slower thinking
  • Puffier eyes, face, hands or feet
  • Difficulty with math
  • Hoarser or deeper voice
  • Constipation
  • Coarse hair/hair loss/brittle hair
  • Muscle/joint pain
  • Low sex drive/impotence
  • Unsteady gait (you bump into things)
  • Thinning of the outer third of eyebrow
  • Irregular periods
  • Heavier periods (more clotting or periods that last more than three days)
  • Carpel tunnel syndrome
  • Sleeping more than usual

If you have many of the above symptoms, consider seeking treatment from a functional medicine provider who is trained to identify multiple causes and treat many hormone imbalances, including hypothyroidism. A functional medicine approach is very comprehensive and may include the following tests:

  • Free T3
  • Free T4
  • TSH
  • Reverse T3
  • Estrogen
  • Progesterone
  • Testosterone
  • DHEA
  • 2 or 4 point cortisol
  • B12 and folate
  • TPO antibodies
  • TG antibodies
  • Ferritin
  • Vitamin D 25 OH

Hypothyroid symptoms may seem nonspecific. They may overlap with symptoms related to other conditions, such as food allergies, adrenal dysfunction, iron deficiency and hormonal imbalances. Careful evaluation of your symptoms, lab results, physical exam, deep tendon reflex speed, diet, medical and family history and toxin exposure should be used to create a personalized treatment plan for you. This is important because each person may have different contributing factors that need to be addressed, such as:

  • Poor diet — one that is low in iodine, L-tyrosine, zinc and selenium — vital components that the body needs to manufacture thyroid hormones. I recommend a pharmacy-grade, well-formulated multivitamin and mineral supplement along with eating a well-balanced, nutrient-dense diet to every patient in my practice.
  • Hashimoto’s thyroiditis, a condition where the immune system starts to attack the thyroid gland. This patient may have elevated thyroid antibodies and may experience swings between hypothyroidism and hyperthyroidism (i.e., heart palpitations, fast heart rate, insomnia, hand tremors, sweating, nervousness, etc.) symptoms until their thyroid eventually is not able to function. This person’s treatment would include thyroid medication and education about ways to decrease the inflammation in their body.
  • Food and chemical sensitivity testing may be helpful to identify substances that may be causing low-grade, chronic inflammation. Reaction to gluten (the protein in wheat, rye and barley) may cause systemic inflammation for many and choosing to eat gluten-free for life may be necessary.
  • Disrupted gastrointestinal (GI) flora can also contribute to malabsorption, poor detoxification of toxins and poor conversion of T4 to the biologically active hormone T3.
  • Stress can cause high cortisol and estrogen levels, which prevents ovulation and is common in times of hormone transition such as perimenopause. Female hormone testing and prescription progesterone therapy may be helpful. Certain supplements, foods and more fiber may be prescribed to help increase the clearing of excess hormones from the body.
  • Low vitamin D levels affect the cellular thyroid receptor response.
  • Low ferritin decreases the transport of thyroxine into the cell nucleus.

Did your doctor say your thyroid is working “just fine” because he/she only tested your thyroid stimulating hormone (TSH) level and the result was in the “normal” range? Or are you taking a T4-only thyroid medication (i.e., Synthroid) but your symptoms persist? I prefer my patient’s lab values, including many thyroid levels, vitamin D and ferritin, to be in the optimal end of the lab normal ranges. I have also found many patients respond better to a combination of a prescription T4 and T3 hormone medication.

As you can see, a TSH test alone may not properly diagnose hypothyroidism and it may take more than Synthroid medication to help you feel your best.


At our wellness center we offer a specialized, computerized assessment of the speed of your deep tendon reflex in your arm along with thorough physical and symptom assessments and personalized treatment plan. This information is invaluable to determine if you need to start prescription thyroid medication or have your current level of medication adjusted. We understand that thyroid-driven weight gain is stubborn but we can help you stop it!

Randi Mann, WHCNP-BC, NCMP, is the owner of Wise Woman Wellness LLC, an innovative wellness center in De Pere. She is a functional medicine provider offering natural treatments and prescription medications for thyroid and hormone imbalances including custom-dosed, bioidentical hormones. Please attend the seminar End Hormone Havoc — Stay Slim, Sane and Sexy, offered monthly.