01/12/2026
Most people get a TSH checked once a year…
and as long as it falls “in range,” they’re quickly sent on their way.
But here’s the truth: TSH alone is not enough to evaluate thyroid health.
TSH is simply a signal from the brain asking the thyroid to make hormone. It does not tell us how much hormone is actually being made, how much is active, or whether your cells can even use it. You can have a “normal” TSH and still struggle with fatigue, weight gain, brain fog, hair thinning, constipation, anxiety, or feeling cold.
Most thyroid hormone is produced as T4 (inactive) and must be converted into T3 (active) in the liver, gut, and other tissues. Stress, inflammation, nutrient deficiencies, gut issues, insulin resistance, and hormonal shifts (hello perimenopause and menopause) can all block this conversion — and TSH will not catch that.
TSH also does not show autoimmune activity like Hashimoto’s, which can quietly damage the thyroid for years before TSH ever changes.
This is why I always encourage a complete thyroid panel, ideally including:
• TSH
• Free T4
• Free T3
• Reverse T3
• Thyroid antibodies (TPO + thyroglobulin)
Yes, sometimes doctors face insurance pushback on ordering comprehensive labs. I get it. But if you are still symptomatic, it is reasonable to advocate for deeper evaluation.
Because thyroid health is not about one number.
It’s about how your entire system is functioning.
You deserve more than “your labs are normal.” 💛
