Why Your Thyroid Might Be “Normal” On Paper… But Not Working For You
- Dr. Jessica
- 4 days ago
- 6 min read
Updated: 3 days ago
You’re tired.
Not “I need a nap” tired… but the kind that seeps into your bones and makes everything feel heavier.
You feel cold when others don’t.
Your mind fogs up during simple tasks.
You’ve gained weight even though nothing’s changed.
So you do the responsible thing.
You go to the doctor. You get your blood drawn. You wait for answers.
And then you hear the one sentence that feels like a slap:
“Everything looks normal.”
If you’ve ever left that appointment confused, dismissed, and a little gaslit… you’re not alone.
Here’s what most aren’t told:
Your thyroid isn’t just a single number on a lab report.
It’s a delicate, layered system.
A chain of messages, activations, and hand-offs.
And when even one part of that chain is off… you feel it, even if your labs don’t.
In today’s post, I want to break this down in a way that’s simple.
Not just to explain the science…
But to finally validate the symptoms that so many women have been taught to doubt.
Because you’re not crazy.
And your body is never wrong.
TLDR
• You can feel hypothyroid even when your TSH is “normal.”
• T4 must convert into T3, the hormone that actually drives energy, metabolism, and mood.
• Stress and under-eating raise reverse T3, which blocks active thyroid hormone.
• Hashimoto’s can be active for years before TSH changes.
• Symptoms matter: fatigue, weight changes, brain fog, cold hands/feet, mood changes.
• A full thyroid workup (TSH, free T4, free T3, rT3, antibodies) gives a clearer picture.
• Supporting stress, inflammation, blood sugar, iron, and nutrient status is key.
• If you don’t feel like yourself, it’s worth looking deeper than standard screening.
The Real Thyroid Story (The Part Most Women Aren’t Told)
1. Your thyroid makes mostly T4… not T3
Your thyroid sits in front of your neck and stores a huge amount of T4, the inactive pro-hormone.
T4 itself doesn’t do much. It’s a storage molecule.
Your body has to convert T4 into T3, the active hormone that actually drives:
• energy
• metabolism
• mood
• temperature
• digestion
• brain function
• menstrual cycles
• weight regulation
If T4 is the “ingredient,” T3 is the “action.”
This conversion is controlled by enzymes called deiodinases. And this is where things get interesting, because…
2. Not all tissues convert T4 into T3 equally
Your brain, liver, muscles, and brown fat all manage thyroid hormone differently.
This means your blood T3 can look “fine,” yet certain tissues can still be hypothyroid.
This is why a normal TSH doesn’t always match how someone feels.
3. Reverse T3 rises under stress, fasting, or inflammation
Reverse T3 (rT3) is the “brake pedal.”
When rT3 rises, your body blocks active thyroid hormone from doing its job.
Fasting, illness, low calorie intake, inflammation, and chronic stress all push rT3 up.
Women living in survival mode often sit in this pattern:
• normal-ish TSH
• normal or low-normal free T3
• high rT3
• crashing energy
And they’re often told nothing is wrong.
4. TSH is slow to respond and not the first thing to change
TSH is the standard screening marker in conventional medicine.
But it:
• responds slowly
• doesn’t reflect tissue-level thyroid activity
• can be “normal” even when a woman has significant symptoms
• doesn’t pick up early Hashimoto’s
A normal TSH does not always mean normal thyroid function.
5. Hashimoto’s can be active for years before labs change
Hashimoto’s is an autoimmune attack on the thyroid.
It often starts with:
• positive TPO antibodies
• normal TSH
• normal free T4
• symptoms that don’t match the labs
Women are often told to “monitor” it until TSH rises enough to justify medication.
But symptoms can start long before that point. Click here to read more about Hashimoto's
What This Means for Women Who Don’t Feel Like Themselves
1. Your symptoms matter more than the lab range
Fatigue, brain fog, cold hands, hair changes, depression, anxiety, weight changes… these are not “normal.”
They are messages.
You deserve someone who looks at the pattern, not just the number.
2. You can have thyroid dysfunction even with a normal TSH
This happens when:
• conversion is low
• stress is high
• rT3 is elevated
• inflammation is present
• your body isn’t using thyroid hormone properly
Looking at the full picture - TSH, free T4, free T3, rT3, TPO antibodies, symptoms, stress load, and metabolic health - gives the truth.
3. The root cause lives beyond the thyroid
Your thyroid responds to the environment inside your body.
Stress. Blood sugar. Iron levels. Inflammation. Gut health. Autoimmunity (Hashimoto's). Nutrient status. Sleep.
If these aren’t supported, thyroid medication alone often doesn’t bring full relief.
4. If you’ve been dismissed… it’s not your fault
Most women I meet have been told some version of:
“It’s your age.”
“Your labs are normal.”
“Just exercise more.”
“Try eating less.”
But the science is much deeper, and conversations like this one are helping women finally understand what their bodies have been trying to say.
How I Approach Thyroid Cases Differently
You want clarity. You want a plan. And you want a doctor who sees the whole you.
Here’s how I support women who feel brushed off:
1. Full testing, not partial screening
I assess:
• TSH
• free T4
• free T3
• reverse T3
• TPO / thyroglobulin antibodies
• ferritin
• B12
• vitamin D
• fasting insulin
• glucose markers
• cortisol
• CRP and inflammation markers
Thyroid symptoms are rarely just thyroid.
2. I look at how your body is converting and using thyroid hormone
Your thyroid makes two main hormones, T4 is the storage hormone. T3 is the active hormone.
Your cells only respond to T3. That means you can have plenty of T4 on paper, yet still feel tired, foggy or slow because the conversion from T4 to T3 is not happening well.
Many things can disrupt this step:
Chronic stress shifts your body into protection and reduces T3 production.
Low ferritin (iron) makes conversion sluggish.
Low vitamin D, selenium or zinc can weaken the enzymes that activate T4.
Inflammation or gut issues can increase reverse T3.
Blood sugar swings and long standing calorie restriction can slow thyroid activation.
None of these will show up if your doctor only tests TSH.
3. I address stress physiology and metabolic health
Reverse T3 spikes under stress.
Free T3 drops with chronic dieting or under-eating.
Your brain downshifts metabolism when it doesn’t feel safe.
We rebuild that foundation.
4. I support the immune system when Hashimoto’s is present
Instead of “wait and watch,” we look at:
• gut integrity
• nutrient deficiencies
• inflammation
• emotional stress load
• lifestyle patterns that fuel autoimmune activity
Early support makes a difference.
5. You leave with a plan & not more confusion
Women often tell me:
“No one has ever explained this to me like this.”
“This finally makes sense.”
“This is the first time I feel hopeful.”
That’s the entire point.
Key Takeaways
• A normal TSH doesn’t always mean your thyroid is working well.
• You can have early thyroid dysfunction long before labs shift.
• Stress, inflammation, under-eating, and blood sugar issues deeply affect thyroid conversion.
• Hashimoto’s can exist for years before TSH rises.
• You deserve a deeper, more root-cause approach.
If you're tired of being told everything is “normal,” it might be time for a different kind of care.
Ready to explore what’s going on in your thyroid, energy, and hormones?
Book your free 10-minute discovery call and let’s figure out your next steps together.
If you have been diagnosed with hypothyroidism but your symptoms haven't changed
You would like a second opinion about your "normal" blood work
You have been told that your thyroid is normal, but you still feel like there is something off
During this call, I will explain how I would approach your particular concerns and outline the process of what it looks like to work with me over the first few appointments.
My goal is provide you with the information to help you feel empowered in your health journey.
Comments