Thyroid Disorders

Hypothyroidism refers to patterns where thyroid hormone activity is reduced. “Overt” hypothyroidism usually shows clear laboratory changes, while “subclinical” patterns may show borderline shifts with symptoms that are very real to the patient.

• Common symptoms may include fatigue, weight gain, constipation, cold intolerance, and hair changes.
• We look at trends over time, not just a single result, and how your symptoms align with those trends.
• Our focus is on understanding how thyroid activity interacts with stress, nutrition, sleep, and other systems.

Hyperthyroidism refers to patterns where thyroid activity is higher than the body can comfortably manage. This can occur gradually or more suddenly and may require careful monitoring and co-management.

• Common symptoms may include palpitations, anxiety, heat intolerance, weight loss, and tremor.
• We consider how lab patterns, symptoms, and heart rate or rhythm changes relate to one another.
• When appropriate, we coordinate with endocrinology and other specialists as part of a team-based approach.

Hashimoto’s thyroiditis is an autoimmune pattern in which the immune system targets thyroid tissue. It can contribute to fluctuating labs and variable symptoms over time, even before clear hypothyroidism appears.

• Symptoms may wax and wane: some days feel “hyper,” others feel “hypo,” especially in early stages.
• We pay attention to inflammation, immune triggers, and how stress, infections, and environmental factors may interact.
• Our care is trauma-informed and acknowledges the emotional impact of autoimmune conditions.

Graves’ disease is an autoimmune condition in which antibodies stimulate the thyroid, often creating hyperthyroid patterns. It requires careful monitoring and collaboration with specialists when indicated.

• May present with significant anxiety, heart racing, heat intolerance, and weight loss.
• Eye changes or neck fullness can sometimes be part of the picture.
• We help track symptoms, coordinate labs, and integrate lifestyle support alongside specialty care.

After pregnancy, some individuals experience a thyroid pattern called postpartum thyroiditis. This may move through hyperthyroid and hypothyroid phases, adding to the complexity of early parenthood.

• Symptoms may be misattributed to “just being tired” or “postpartum hormones.”
• We look at timing of symptoms relative to delivery, lactation, stress, and existing thyroid history.
• Support often includes nervous system care, nutrition, sleep strategies, and close monitoring.

Some people have adequate T4 on paper but struggle to convert it into active T3 efficiently. Stress, illness, inflammation, nutrient status, and liver function may all play a role.

• Symptoms may resemble hypothyroidism even when TSH and T4 look acceptable.
• We pay attention to Free T3, Reverse T3, and the overall clinical picture.
• Our focus is on understanding the “why” behind conversion slowdowns, not just the numbers alone.

In some cases, lab values may appear adequate but the body behaves as if thyroid hormone signaling is not getting through properly. This may be influenced by inflammation, receptor sensitivity, chronic illness, or other endocrine interactions.

• We look at how symptoms, vitals, and labs line up — or don’t.
• Our approach emphasizes reducing physiologic stressors and supporting overall hormone communication.

Ultrasound findings such as nodules, goiter, or other structural changes often raise understandable concern. We help you track how structure and function interact over time.

• We review imaging reports in the context of your symptoms and lab patterns.
• When needed, we coordinate with endocrinology, ENT, or radiology for further evaluation.

TSH is produced by the pituitary gland and acts as a signal telling the thyroid how much hormone to produce. It is often used as a first-line screening marker.

• Higher TSH values may be seen when the body is asking for more thyroid hormone.
• Lower TSH values may be seen when thyroid hormone levels are elevated or in some pituitary patterns.
• We pay attention to TSH trends over time and how they relate to symptoms, not just a single number.

Free T4 represents unbound thyroxine available in the bloodstream. It is the main hormone produced by the thyroid and is converted into T3, the more active form, in various tissues.

• We look at Free T4 alongside TSH to better understand thyroid output.
• Patterns where Free T4 is technically “normal” but symptoms persist may prompt deeper evaluation.

Free T3 is the more active thyroid hormone that binds to receptors in cells and drives metabolism, temperature regulation, and many aspects of energy production.

• We consider how Free T3 levels align with symptoms such as energy, mental clarity, and body temperature.
• Conversion from T4 to T3 can be affected by stress, illness, nutrient status, liver function, and inflammation.

Reverse T3 is an alternate form created when the body converts T4 into an inactive isomer rather than active T3. This can be influenced by stress physiology, acute or chronic illness, and inflammatory states.

• Elevated Reverse T3 may be seen in periods of physiologic stress or recovery.
• We pay attention to the relationship between Free T3 and Reverse T3 as part of the bigger picture.

Several types of antibodies can provide information about autoimmune activity involving the thyroid.

• TPO antibodies (TPOAb) and thyroglobulin antibodies (TgAb) are commonly associated with Hashimoto’s patterns.
• TSI and TRAb can be associated with Graves-like patterns and immune-driven hyperthyroidism.
• We view antibodies as one piece of the puzzle and consider what may be influencing immune activation.

Understanding thyroid health often involves looking beyond thyroid-specific labs. We may consider markers that influence hormone production, conversion, and signaling.

• Iron studies and ferritin
• Vitamin D and B12 status
• Liver function tests
• Cortisol patterns and stress physiology
• Markers of inflammation and metabolic health

• Difficulty losing weight or unexplained weight gain
• Unintentional weight loss with appetite changes
• Changes in cholesterol or blood lipids

• Persistent fatigue or low stamina
• Needing more sleep but not feeling rested
• Afternoon crashes or difficulty getting going in the morning

• Cold hands and feet or overall cold sensitivity
• Heat intolerance, feeling overheated easily, or excessive sweating
• Heart rate changes, palpitations, or feeling “revved up” or “slowed down”

• Brain fog, slowed thinking, or memory changes
• Anxiety, irritability, or low mood
• Difficulty falling or staying asleep

• Hair thinning or increased shedding
• Dry or coarse skin
• Brittle nails or slower growth

• Constipation or slower digestion in lower thyroid patterns
• Loose stools or more frequent bowel movements in higher thyroid patterns
• Changes in menstrual cycles, fertility, or libido

• Chronic infection and immune activation can influence thyroid hormones and antibodies.
• We consider history of Lyme disease, viral reactivation, and other complex-illness patterns.

• Water-damaged buildings and mycotoxins may influence inflammation, immune patterns, and energy.
• We consider thyroid function within the broader context of environmental stressors.

• Iron, B12, iodine, selenium, zinc, and other nutrients support thyroid hormone pathways.
• We explore nutrition and absorption patterns as part of the big picture.

• Chronic stress can impact conversion, Reverse T3, and how thyroid hormones are perceived by the body.
• We prioritize nervous system regulation as a core pillar of endocrine health.

• The liver plays a key role in converting and clearing thyroid hormones.
• Gut inflammation and microbiome imbalance can also affect immune activity and nutrient status.

• Plastics, pesticides, solvents, and other chemicals can influence hormone signaling.
• We discuss realistic, sustainable ways to reduce exposure where possible.

• Prioritizing sleep, nervous system regulation, and recovery
• Addressing nutrition, digestion, and blood sugar balance
• Exploring inflammation and immune triggers that may impact thyroid patterns

Some people benefit from thyroid medication as part of a comprehensive plan; others may not need it. We do not make blanket recommendations online.

• Treatment decisions are made between you and your clinician after a thorough evaluation.
• We consider your history, current symptoms, labs, co-existing conditions, and goals.
• Any prescription therapy is monitored and adjusted over time based on your response.

• Time to share your full story, not just isolated symptoms
• Review of prior thyroid labs, imaging, and related testing
• Discussion of energy, mood, sleep, digestion, cycles (if applicable), and long-term patterns
• Development of an individualized plan that may include further testing, foundational support, and, when appropriate, medication conversations
• Your care may be provided by Allison, APRN; Stella, APRN; or Dr. Georgia, APRN — all of whom practice under the direct supervision of Dr. Penni, APRN, and follow her ILADS-informed framework for complex illness care.