Some people try to blame their fatigue, low energy, weight issues, constipation, depression, menstrual irregularities, skin and hair problems to a low thyroid. They persist in this belief despite all thyroid lab tests remain in the normal range or when thyroid medicine doesn’t help.

While these are common symptoms of thyroid, they all can come from numerous other factors as well.

Poor sleep, stress, dietary issues, celiac disease, dysbiosis, toxins, deconditioning, liver and kidney disease and chronic inflammation can all affect our bodies and mood causing similar symptoms as low thyroid states. Supplementing thyroid hormone will not fix these and in fact increases risks of cardiovascular, mental and bone side effects.

A variety of nutritional deficiencies can affect thyroid function as well. These include selenium, vitamins A, B2, B3, C and D, iron, zinc and iodine. Such nutritional deficiencies and can mimic low thyroid states or prevent administered thyroid from being fully effective. Replacing these can improve function of the thyroid.

Additionally, if you are taking thyroid medicine and still experiencing the symptoms, be sure you are taking it as prescribed, on an empty stomach. Calcium, coffee, soy, grapefruit juice, antacids, iron, antibiotics and many foods reduce absorption of thyroid hormone. So even though you are taking it at the prescribed dose, it may not be getting into your system.

Thyroid hormone replacement is available in several common preparations. These are levothyroixine-T4, liothyronine-T3 and dessicated porcine thyroid-natural thyroid. Most physicians prescribe only the T4, but adding T3 or using the natural thyroid may be more appropriate for some individuals, especially those who have genetic mutations that enzymes converting of T4 to the active form of T3.

Hashimoto’s thyroiditis has become the most common autoimmune disease. This is often a prelude to a low thyroid condition and may occur even decades before full blown hypothyroidism postpartum thyroiditis is another common event in women leading to hypothyroidism. These can result in long standing antibody activity that affect the thyroid for many years. While preventive medicine guidelines do not support screening for thyroid disease, I recommend obtaining thyroid testing if you have any of the common symptoms, particularly in women 40 and older.

Remember though that not all fatigue, problems losing weight, low energy and other malaise are due to low thyroid. Changing the focus from thyroid myopia to the big picture is not always easy. I have seen many unfortunate souls who are so convinced their symptoms are due to low thyroid and jump from doctor to doctor looking for a replacement plan that would work for them. Often they have no thyroid problem or have subclinical low thyroid that may not need or respond to thyroid replacement.

So if you think you may have a thyroid problem, be sure you and your physician are excluding other issues listed above that could be masking as a low thyroid conditions. Essential to an integrative and holistic treatment plan is also to identify any other factors, or that might be impairing the full function of your thyroid such as excess stress, or that reduce the benefits of administered thyroid hormone replacement.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.