A Normal Thyroid Test Result Can Still Mean Something Is Wrong

“Your thyroid is normal.” If that sentence has ever made you feel crazy while you’re running on empty, we get it and we’re not letting it slide. Today we walk through why a single screening lab can look fine while you still deal with fatigue, brain fog, weight gain, feeling cold, mood shifts, digestion changes, and hair loss that won’t quit.

We start with the basics of thyroid function and then get very specific about testing. TSH is important, but it’s a pituitary signal, not the actual thyroid hormone your cells use. We explain the difference between free T4 (largely a storage form) and free T3 (the active, usable hormone that often matches how you feel day to day). You’ll also hear why conversion from T4 to T3 can stall with chronic stress, inflammation, nutrient deficiencies like selenium, zinc, and iron, and even gut issues.

Then we zoom out to the autoimmune side of thyroid health. Thyroid antibodies (TPO and thyroglobulin) can be elevated for years before TSH ever moves, which matters for people with Hashimoto’s who want earlier clarity. We also touch on reverse T3 as a potential “brake pedal” when symptoms persist. Finally, we talk about normal versus optimal lab ranges and why your lived experience deserves to be taken seriously, plus a word-for-word script to ask for a fuller thyroid panel: TSH, free T4, free T3, and antibodies.

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Transcript

Why TSH Alone Misses So Much

SPEAKER_00 0:00

If I had a dollar for every woman who sat across from me and said, but they told me my thyroid was normal, with a completely abnormal thyroid, I would be running this practice from a beach in Italy and not Arizona in the middle of summer. Every single time I ask the same question, normal according to what exactly? What did they actually test? And almost always the answer is one number. TSH. If you have spent any time following me or listening to me, you know what I am about to say next. That one number is simply not enough for us to know what your thyroid is actually doing. And today I'm going to show you why. Welcome back to Unshakable and Unfiltered conversations on healing hormones and being human. I'm Dr. Jordan Trapp, naturopathic doctor and founder of Unshakable Wellness here in Scottsdale, Arizona. Today our conversation is all about the thyroid, what it does, how it works, and specifically why the standard way it gets checked leaves so many of you feeling terrible while your lab report says everything is fine. Let's start with the basics. What is your thyroid? Your thyroid is a little butterfly-shaped gland in your neck. And for something that small, it has a wild job. It sets the pace of your entire metabolism, your energy, your temperature, your heart rate, your digestion, your mood, your menstrual cycle. And near and dear to my heart, your hair. When it's sluggish, it's not subtle. But the symptoms are so general that they get blamed on everything else. Tired, you probably have a busy life. Brain fog, probably your stress. Gaining weight, you gotta fix your diet. Losing hair, change your shampoo. Meanwhile, the gland that's actually running the show never really gets fully checked. Here's why. When someone says we'll test your thyroid, that test they usually order is a TSH. This is called thyroid stimulating hormone. And here's where people get confused. TSH is not made by your thyroid, it's actually made by your pituitary, a little gland in your brain. TSH is basically a text message from the brain to the thyroid that says, hey, we need to make more thyroid hormone. If the body wants more hormone, it sends more texts, your TSH goes up. If we have plenty of hormone floating around, the brain stops sending text messages and TSH goes down. And before anyone clips this and puts it on social media and says, Jordan's anti-TSH, I'm not. I order a TSH on literally every single patient. But think about what it actually is. It's the message, it's not the product. It tells you what your brain is asking for. It doesn't tell you how much usable hormone is actually reaching your cells or whether your cells can even use it properly. Here's how I explain it to patients. Think of the thermostat on your wall. Its whole job is to read the request for heat and then send a signal to turn on. You set it to 70, the house gets cold, the thermostat says call for heat. That's the DSH, the call for the heat. But look at everything that thermostat doesn't know. It doesn't know if the furnace actually kicked on. It doesn't know if a vent got closed in a back room and the bedroom is now freezing. It just tells us that the house needed heat and that that request went through. Not if the house is actually heating. The reading on the thermostat is normal, but the house is cold. That gap is the whole reason we don't stop just at a TSH. Let me give you what a fuller

Free T4 And Free T3 Explained

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panel would look like. Not so you can self-diagnose on the internet at 11 p.m. Please don't. I do not encourage that at all. But I want you to be able to walk into your doctor's office and ask for what you deserve. TSH we covered. That's the first step. The message from the brain. From there, the thyroid gland creates free T4. T4 is the main hormone that your thyroid pumps out. But here's the thing: it's mostly a storage form. I equate this to you getting paid and putting money into your savings account. You have money, it counts, it's yours, but you can't hand the cashier your savings account. It would have to be converted into something spendable first, cash. That spendable form is free T3. This is the big one, and most frequently the one that does not get checked. T3 is the active hormone that walks up to your cells and says, let's make energy, let's stay warm, let's keep your brain going. So much of how you feel lives in this hormone. And here's the piece that a lot of people miss. You can have a perfectly fine TSH and T4, but if your body is not converting it into T3, you're walking around feeling terrible, tired, cold, foggy. That conversion rate can get blocked by a bunch of different things: chronic stress, nutrition gaps like selenium, zinc, iron, inflammation, gut issues, because believe it or not, a chunk of that conversion happens in your gut. That's a whole episode for another day. So when we are only measuring TSH and maybe a T4, you completely miss whether the active hormone is actually showing

Antibodies Hashimoto’s And Reverse T3

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up. Next on our list is gonna be thyroid antibodies, specifically TPO and thyroglobulin. These tell us whether your immune system is mistakenly attacking your own thyroid, which is the hallmark of Hashimoto's. I get asked quite often what the benefit to running antibodies are without knowing that there's any problems with the thyroid. The reason is your antibodies can be elevated for years before your TSH ever drifts out of range. So you can have a totally normal TSH and your immune system is already quietly going after your thyroid gland. If no one checks it, no one sees it coming. Elevated antibodies are an early signal. Knowing that they are elevated does not mean you have to panic, but it does mean you're not going to get blindsided when your thyroid starts to get a little wonky in a couple of years. And seeing it coming changes everything about how we can treat you moving into that phase. And sometimes we look at something called reverse T3. The simplest way I can put this is it's a brake pedal. It's a version of the hormone that fits the lock, but it doesn't open the door. Think of free T3 as the gas in the tank and think of reverse T3 as the brake. If you're flooring the brake, it doesn't matter how much gas is in the tank, you're not gonna go anywhere. In certain cases, this can be the extra clue we need as to why you feel funky even though your TSH is normal. I know that was a lot of letters and numbers. If your eyes glazed over, that is fine. Here is the thing that I want you to take away. One number, TSH, is the message from your brain. The fuller panel tells you whether the hormone is being made, converted, delivered, and whether your immune system is involved. That is a wildly different amount of information.

Normal Versus Optimal Lab Ranges

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The other thing I would like to touch on why your labs are normal doesn't mean you feel good. Your results are getting compared to a reference range built from a big population of people who got tested at that lab. And the issue with that is the general population is not a bunch of thriving, well-rested humans. A lot of them don't feel great either. So that range is very, very wide. Being inside of it means you are not in a medical emergency. It does not mean you've landed where you feel like yourself. That is the difference between normal and optimal. Normal is the whole bell curve. Optimal is the narrow zone where people actually feel their best. A number can technically be in range and nowhere near where you'd feel good. So when someone says it's normal, a fair follow-up question is great, but is it optimal and is it optimal for me? If

Advocacy Script And Next Steps

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you have been continually told that there is nothing wrong with you because your labs are normal, I want to talk directly to you for a second because I can 100% relate to that both as a patient and as a provider. I know you have probably been told it's probably just stress or you're just a busy mom, or this is normal for your age. So many times that you have started to maybe believe it's actually in your head. Maybe you've even stopped bringing it up at your appointments because the last few times you walked out feeling like you wasted everyone's time, including your own. I see you. Not only as a provider, but as someone who has sat in that chair. The exhaustion of not being believed is its own kind of tired and it is so heavy. So here's what I need you to hold on to. Feeling unwell is data. It's not dramatic, it's not weakness. Your body is giving a report, and I feel terrible is a legitimate finding. When your lived experience and a lab value are in a fight, we don't automatically side with the lab and tell you that you're wrong about your own life. You've lived your life. Me telling you you're wrong about your symptoms would be absolutely insane, and I'm sorry that someone has done that to you in the past. A normal number does not erase your symptoms and your lived experience. It just means we haven't finished looking yet. I want to make this a practical tool for you because I don't want to just leave you with a pep talk about your thyroid and no plan. So here's your takeaway and your next action step. Next time your thyroid gets checked, or if you want to look back at old labs, find out exactly what was tested, ask for the actual numbers, and if all you see is TSH, here's a script that you can borrow word for word. What are we gonna say? You're gonna say, I'd love to understand my full thyroid picture a bit better. Can we check a free T4, a free T3, and my thyroid antibodies in addition to the TSH? That's it. Calm, informed, completely reasonable. You're not being difficult, you're being a participant in your own care. And if the answer you get is no, that's good information too. It might be time to find someone who's willing to explore a little bit further

Personal Story And Closing Encouragement

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with you. This episode got me really emotional. And I want to share why. I have been the patient. I had to fight for a leukemia diagnosis. My primary care doctor did not want to send me to a hematologist. She actually laughed at me when I asked for further exploration of some lab values, but something like that teaches you very, very quickly that the most informed person in the room about your body needs to be you. I was lucky. I learned all of this in school. I knew what to look for. So when I got told no, I continued fighting, and I think she just got tired of me. This is why you need to educate yourself. No one is going to care about your health more than you. Listening to this podcast was a great start, and this is why I'm such a big advocate about getting education out there for people to consume. You have literally nothing if you don't have your health. Anyways, sorry, got a little heavy there. Let's wrap this part up. Your thyroid does an enormous job, and it deserves more than one number. Remember, TSH is the message. Free T4 is the storage, free T3 is the active, usable form where so much of how you feel actually lives. Antibodies tell us if your immune system is involved, often years before anything changes. And normal just means in range, which is not the same as optimal. If you've been collecting a pile of normal results and feel anything, but I would genuinely love to look at your whole picture with you. I offer a free 15-minute consult, no pressure, just a conversation to see if we are a good fit. The link will be right in the show notes, or you can text my office at 602 842 2106. This has been Unshakable and Unfiltered. I am Dr. Jordan Trapp. Thanks for spending a part of your day with me. Be kind to yourself this week. Drink some water and remember you're not crazy, you're not lazy, and you are absolutely not making it up. We'll see you next time. Bye.