Everything You Need To Know About Hypothyroidism: Symptoms, Testing and Treatments

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Some studies estimate that up to one third of those with hypothyroidism are undiagnosed making it virtually impossible that they will be able to manage their condition. Resolving the problem of hypothyroidism requires that everyone have greater awareness and understanding of the thyroid and hypothyroidism.

Understanding the Thyroid Gland

To best understand hypothyroidism, it is important to first have a good understanding of the thyroid gland. The thyroid is a small butterfly-shaped gland located in the neck. Despite its size, it has a very large impact on virtually every bodily system and function. Some of the areas most impacted by the thyroid are metabolism, mood, and weight. However, the influence of the thyroid can be seen in a myriad of other areas throughout the body reaching from the heart, brain, gut, and beyond.

Find out how the thyroid affects the entire body here.

The thyroid exerts its impressive influence through the production of various hormones. Hormones act as one of the body’s primary methods of communication. Depending on the hormone, different types of information is relayed to control activity throughout the body. Thyroid hormones specifically regulate the speed in which bodily processes are carried out. For this reason, some liken the thyroid to a gas pedal that dictates how fast or slow the many systems throughout the body act.

The Thyroid Hormones

When discussing the thyroid, there are four hormones that must be discussed: Thyroxine (T4), Triiodothyronine (T3), Reverse Triiodothyronine (RT3), and Thyroid Stimulating Hormone (TSH). To sustain healthy bodily function, each of these hormones must be regulated and maintained at the appropriate balance. In part, this is because each influences the behavior and efficacy of the others.

  • T4 is the storage form of thyroid hormone that remains inactive until it is converted into either T3 or RT3. Without adequate levels of T4, the body may become deficient in other more influential thyroid hormones resulting in dysfunction.
  • T3 is the active form of thyroid hormones that upregulates activity. Too much T3 can result in dangerous acceleration of bodily processes while too little can lead to sluggishness.
  • RT3 is the mirrored form of T3 and effectively inhibits the efficacy of T3. This quality allows RT3 to act as a regulatory agent and protect against an overabundance of T3. However, excess RT3 can overly impede T3 resulting in an undesirable decline bodily function.
  • Although TSH is not technically a thyroid hormone, it does play an important role in thyroid function. TSH is produced by the pituitary gland and informs the thyroid that it needs to produce more T3 and T4. Disruption of TSH delivery, reception, or production can cause thyroidal disruption and contribute to hormone imbalances.  

The Basics of Hypothyroidism

When the thyroid is not working properly serious dysfunction may occur. One of the most common forms of thyroid malfunction is a condition called hypothyroidism. Hypothyroidism is defined as abnormally low or slowed thyroid activity. This typically results in a deficiency of thyroid hormones that prompt the development of many symptoms.

Common symptoms of hypothyroidism include:

  • Changes in skin and nail quality
  • Constipation
  • Depression
  • Difficulty thinking clearly or “brain fog”
  • Fatigue
  • Hair loss
  • Headaches
  • Insomnia or a reduction in sleep quality
  • Loss of libido
  • Menstrual irregularities
  • Pain and weakness
  • Sensitivity to cold
  • Weight gain or difficulty losing weight

Get a full list of thyroid disease symptoms here.

Because the symptoms of hypothyroidism are so disparate and often shared among multiple conditions it can be difficult to identify thyroid disease through symptoms alone. This means that effective and accurate testing is essential.

Learn more about hypothyroidism in this interview with Dr. Kent Holtorf.

Testing Practices for Hypothyroidism

One of the major contributors to the woefully underdiagnosed nature of hypothyroidism is a reliance on ineffective testing practices. The standard approach to assessing thyroid function is by measuring TSH values. However, TSH is only a metric for how well the pituitary is communicating with the thyroid and not the actual functionality of the thyroid or the prevalence of thyroid hormones. The ineffectiveness of this testing practice is exemplified by the fact that many thyroid patients who present TSH values within the “normal” range still experience significant thyroid-related dysfunction.

TSH does have value when assessing thyroid function. However, it should certainly not be the sole metric used in diagnosis. At minimum, a thyroid test should include TSH, T4, T3, and RT3. However, a more complete thyroid panel should also include:

  • Assessment of symptoms
  • Basal body temperature
  • Basal metabolic rate
  • Reflex relaxation phase
  • Sex Hormone Binding Globulin (SHBG)
  • The ratio between T3 and RT3
  • Thyroid antibodies

Get a FREE sample lab slip with a complete thyroid panel here.

Dr. Holtorf explains more about the importance of proper testing here.

Identifying the Cause of Hypothyroidism

Hypothyroidism may develop from a singular trigger, but it is far more likely that there are multiple contributing factors. Some of the most common causes of hypothyroidism include nutritional imbalances (specifically iodine deficiency), exposure to environmental toxins, pituitary malfunction, congenital predisposition, inhibited hormone signaling or transport, and various medications such as antidepressants.

Perhaps the greatest contributor to thyroid disease, including hypothyroidism is chronic illness. Conditions such as diabetes, insulin resistance, depression, chronic fatigue syndrome, and fibromyalgia can disrupt many factors relating to thyroid activity. The single most common cause of hypothyroidism is a chronic autoimmune condition known as Hashimoto’s thyroiditis. The disorder encourages the body’s own immune system to attack the thyroid gland resulting in an irreparable decline in thyroid function. Hypothyroidism caused by Hashimoto’s or other chronic illness cannot improve until the underlying contributors are treated.

Treatment Options for Hypothyroidism

When treating hypothyroidism, the primary goal is to normalize thyroid hormone values so bodily function can return to normal. Typically, this is done through hormone replacement therapy wherein synthetic or natural thyroid hormones are introduced into the body. The most common approach is a daily oral dose with a synthetic form of T4 called Levothyroxine. However, many hypothyroid patients do not see significant improvement of their condition with this specific form of thyroid hormone therapy.

Learn more about why Levothyroxine doesn’t work for many thyroid patients.

Studies suggest that patients often do better when their treatment is optimized to suite their specific needs. Therefore, effective treatment requires investigation of all thyroid hormone therapy options including combination T4 and T3 formulations, time-released T3, natural desiccated thyroid hormone, or highly customizable Bioidentical Hormone Replacement Therapy (BHRT). Each approach has their pros and cons meaning that patients should work with their doctor to find out which methods work best for them.

How You Can Help Combat Thyroid Disease

Thyroid disease, specifically hypothyroidism, is a common condition affecting many. To better identify, treat, and live with hypothyroidism it is essential that individual awareness and understanding of the condition be raised. You have taken an important step towards greater thyroid wellness by actively seeking out information on hypothyroidism. Now, take action by partnering with a qualified, thyroid-literate physician.

At Holtorf Medical Group, our physicians are trained to provide you with cutting-edge testing and innovative treatments to properly diagnose and treat your thyroid condition, optimize your health and improve your quality of life. If you have been diagnosed with hypothyroidism, but aren’t getting the treatment you need or if you have symptoms associated with thyroid dysfunction, call us at 877-508-1177 to see how we can help you!

Learn more about thyroid disease and how our practice treats it in this FREE Thyroid 101 e-book.

Click Here to Download Thyroid 101


1. Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).” https://www.nahypothyroidism.org/deiodinases/
2. Kent Holtorf, MD. “Thyroid Hormone Transport.” https://www.nahypothyroidism.org/thyroid-hormone-transport/
3. Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?” https://www.nahypothyroidism.org/how-accurate-is-tsh-testing/
4. Kent Holtorf, MD. “Why Doesn’t My Endocrinologist Know All of This?” https://www.nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/

How HMG Has Helped Others: Patient Testimonial

I would like to tell of my extremely positive experience with Dr. Holtorf. I was diagnosed with hypothyroid about 6 years ago. To make a long story short, I was originally placed on Synthroid and did not feel much better (still very fatigued, and poor memory). I have seen just about every doctor that is noted as a thyroid expert in the greater Los Angeles area, including numerous endocrinologists, internists, family practitioners, and alternative practitioners. I have been on Synthroid, Levoxyl, Armor Thyroid, Tyrolar, Cytomel (alone and with Synthroid), all with wide ranging doses (high to low). I would start to feel better on high doses but would then get anxious. It was never right. A friend of a friend who Dr. Holtorf really helped with her thyroid referred me to him. He stated that this situation is usually due to high reverse T3. He did an extensive thyroid panel when I was on 3 grains of Armour thyroid. My T3 was mid normal, TSH low, and reverse T3 extremely high. He said a timed release T3 would remedy this problem. I was worried because I felt horrible on Cytomel and did not expect that this would work. He then placed me on a timed release T3 and slowly increased it over 4 weeks. I finally feel normal (its been 3 months now), and I can go through my life without the fatigue, poor thinking or anxiety. He has my highest recommendation. – Lynda P.

Read more reviews here!

About Holtorf Medical Group

The Holtorf Medical Group specializes in optimizing quality of life and being medical detectives to uncover the underlying cause of symptoms, rather than just prescribing medications to cover-up the symptoms. We are experts in natural, prescription bioidentical hormone replacement and optimization, complex endocrine dysfunction, fibromyalgia, chronic fatigue syndrome and Lyme disease.

We’ve dedicated our practice to providing you the best in evidenced-based, integrative medicine that’s not only safe and effective, but provides measurable results.