Consultants in Metabolism

Consultants in Metabolism I am a board certified physician with a practice focused on optimizing thyroid, hormone management and wellness.

05/07/2026

Do all Hashimoto’s patients really need to eliminate gluten and dairy?

In this episode of Beyond the Thyroid, Dr. Dana Gibbs discusses the growing trend of increasingly restrictive elimination diets in thyroid disease — and why the outcome is not always positive.

Many patients begin by removing one or two foods in hopes of reducing inflammation, but over time the diet can become so limited that it contributes to inadequate nutrition, elevated stress physiology, worsening fatigue, impaired thyroid conversion, and metabolic dysfunction.

Dr. Gibbs also explains an important practical issue regarding gluten:

If you are considering long-term gluten elimination, it is important to be tested for celiac disease BEFORE removing gluten from your diet for weeks or months, because standard testing can later become falsely negative.

This reel is a short excerpt from the full conversation.

Watch or listen to:
Beyond the Thyroid – Episode 49:
“Do You Really Need to Cut Gluten & Dairy in Hashimoto’s?”

Available on YouTube, Spotify, Apple Podcasts, and Buzzsprout.

05/05/2026

Do you really need to cut gluten and dairy if you have Hashimoto’s?

You’ve probably heard:
“Go gluten-free.”
“Cut dairy.”
“Try AIP.”

But here’s the truth: it doesn’t work the same for everyone.

In this week’s episode of Beyond the Thyroid, I explain:
• Why elimination diets are not one-size-fits-all
• When gluten elimination is actually necessary
• Why overly restrictive diets can backfire
• The 3-layer framework I use with patients
• How to evaluate food without guessing

Food matters—but it’s rarely the first place to start.

🎧 Episode 49 is live now
📍 https://youtu.be/1iWEqWzlFvw

05/02/2026

No single thyroid lab explains the full picture. TSH tells you what the pituitary sees. Free T4 tells you what is circulating but neither tells you how well thyroid hormone is being activated at the tissue level.

That is where T3 and reverse T3 come in. Looking at both, and especially their relationship, helps you understand whether T4 is being converted into active hormone or diverted into inactive pathways.

This is often the missing piece in patients who remain symptomatic despite normal labs and while this panel is sometimes seen as unnecessary, in the right setting it can reduce trial-and-error treatment and repeated visits.

The key is not one value. It is how they relate to each other. I break this down step by step in a full clinician training.

Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

05/01/2026

Insulin resistance is often missed in routine care. It does not always show up on basic labs and often has to be inferred through markers like triglyceride to HDL ratio or HOMA-IR.

In Hashimoto’s, it is much more common than most clinicians realize. Estimates suggest up to 70% of patients may have underlying insulin resistance.

This matters because metabolic dysfunction contributes to inflammation and can worsen symptoms. GLP-1 therapies can be helpful in the right patients, improving weight and glucose control. But their primary benefit is metabolic. They are not a treatment for thyroid autoimmunity.

And overly aggressive calorie restriction can actually worsen T3 conversion. This is where nuance matters. If we are not evaluating metabolic health alongside thyroid function, we are missing part of the picture.

I break this down in a full clinician training. Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

04/30/2026

When you suspect Hashimoto’s, ultrasound can be more informative than labs alone. It shows you the structure of the gland.

In Hashimoto’s, you often see a heterogeneous texture and increased vascularity, reflecting inflammation.

This can be diagnostic, even when antibodies are negative. And that matters, because not all patients with autoimmune thyroid disease test positive on labs.

Diagnosis should not rely on a single marker. It should integrate symptoms, exam, imaging, and labs.

For straightforward cases, TSH and antibodies are enough. But many symptomatic patients do not present that way.

In those cases, you need a broader panel, including T3, the active hormone at the tissue level. This is where standard workups often fall short.

I break this down in a full clinician training. Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

04/28/2026

Thyroid hormone levels fluctuate in Hashimoto’s. As autoimmune activity rises and falls, hormone levels shift.

At the same time, inflammation and stress change how thyroid hormone is used at the tissue level. This creates a pattern that is easy to miss.

Patients with normal TSH and normal T4 who still have impaired thyroid signaling. Clinically, this often looks like low T3 activity. And the symptoms are broad.

Fatigue, brain fog, mood changes, sleep issues, weight gain, cold intolerance, irregular cycles, GI symptoms. Individually nonspecific. But together, they form a pattern.

Too often, these symptoms are attributed to stress or lifestyle. And patients feel dismissed.

If we are not looking for this pattern, we miss it. I break this down in a full clinician training.

Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

Still not feeling right on thyroid meds? It might not be your thyroid… It might be your dose.Or the type of medication.O...
04/28/2026

Still not feeling right on thyroid meds? It might not be your thyroid… It might be your dose.

Or the type of medication.
Or how your body is actually using it.

In this week’s GoodTalk Live, we’re breaking it down: 🎙 How to Tell If Your Thyroid Dose Is Too High, Too Low… or Just Wrong for You

We’ll cover:
⚖️ Symptoms of over- vs under-treatment
🧠 Why labs don’t always match how you feel
📉 Conversion issues and Reverse T3
🔍 What to look at next

📅 Tuesday, April 28
🕧 12:30 PM CT
📍 Live on the Goodself App
https://www.goodself.com/chat/Z93osbKa3Cmfr39I1cua

Bring your questions—this is one everyone needs.

04/27/2026

Many Hashimoto’s patients develop symptoms long before TSH becomes abnormal. If we rely on TSH alone, we are often identifying disease late.

This is why so many patients are symptomatic but do not meet standard lab criteria. A more useful model is to think of Hashimoto’s as two processes.

First, autoimmune activity causing inflammation and gradual damage to the thyroid. Second, the downstream effects on thyroid hormone function.

The thyroid operates under a high oxidative load, making it particularly vulnerable to damage when antioxidant systems are overwhelmed. And this autoimmune activity is not constant. It can flare, quiet down, or even appear to resolve.

This helps explain why symptoms and labs often do not match. I break this down in a full clinician training.

Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

04/26/2026

Normal TSH does not always mean normal physiology. Many patients treated with levothyroxine still have adverse metabolic markers and persistent symptoms.

One reason is that T3 levels may remain low, even when T4 is normal or elevated. This reflects how T4 is being processed in the body.

Most T3 is produced through peripheral conversion. And that conversion can go in two directions. Toward active T3 or toward reverse T3, an inactive pathway.

This balance is regulated and can shift based on stress, inflammation, and other factors. When it shifts, patients can have impaired thyroid signaling despite normal labs.

This is why reverse T3 matters. It helps us measure what is happening beyond TSH.

I break this down in a full clinician training. Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

04/24/2026

Hashimoto’s is influenced by more than just the thyroid gland. Gut health, nutrient absorption, and stress all play a role.

Malabsorption can worsen deficiencies in iron, B vitamins, and vitamin D, all of which impact thyroid function. At the same time, impaired thyroid physiology can worsen gut function, creating a cycle.

Stress further disrupts immune regulation and hormone metabolism. But even after addressing these factors, many patients remain symptomatic.

Including those with normal TSH. The reason is simple.

TSH reflects what the pituitary sees in the bloodstream. It does not tell us what is happening at the tissue level. If we rely on it alone, we miss part of the picture.

I break this down in a full clinician training. Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

04/22/2026

Standard thyroid care is built around TSH and levothyroxine. It has simplified care.

But it has also left many patients symptomatic despite “normal” labs. Most of these patients are women, and many have Hashimoto’s.

When we cannot explain their symptoms, they do not stop searching. They lose trust and often seek answers elsewhere, sometimes in settings that are not safe or evidence-based.

In practice, it can be easy to attribute persistent symptoms to stress or burnout. But unexplained symptoms often reflect gaps in our framework, not problems with the patient.

This is what led me to look more closely at thyroid physiology beyond standard models.

I break this down in a full clinician training! Watch full training here: https://thyroidclarity.com/new-endo. The New Endocrinology starts May 3, enrollment is now open!

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Southlake, TX
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