Why So Many Thyroid Issues Are Missed and What That Means for You

Rheece Hartte

Jan 14 • Give Advice

If you have ever been told your thyroid labs are “normal” but you still feel

tired,
foggy,
stuck,
cold,
anxious,
constipated,
or unable to lose weight,

you are not alone

An estimated 20 million Americans have some form of thyroid disease, and nearly 60 percent of them do not know it.

Many spend years feeling off before anyone recognizes what is actually happening.

Part of the problem is how thyroid health is tested and interpreted.

Most doctors rely heavily on one number, TSH, to assess thyroid function.

But TSH is not a thyroid hormone. It is a signal from your brain telling your thyroid how much hormone to make.

It does not tell you how much hormone your body is actually using.

So it is entirely possible for TSH to be “in normal range” while your cells are functionally underpowered.

That is why so many women feel dismissed when their labs look fine but their bodies do not.

What does your thyroid actually do?

Your thyroid produces two main hormones, T4 and T3.

T4 is a storage form.

It circulates in the blood but does not do much on its own.

T3 is the active form.

It enters your cells and tells them how fast to run, how much energy to produce, how warm to be, how quickly to digest food, how well your brain functions, how your heart contracts, how your bones rebuild, and how easily you burn fat.

Every cell in your body depends on T3.

So having thyroid hormone in your blood is not enough.

You have to be able to convert T4 into T3 and actually deliver it into your cells.

Why do symptoms persist even on medication?

Synthroid and levothyroxine give your body T4.

Your body still has to convert that T4 into T3.

Under healthy conditions, that conversion happens mostly in the liver and the gut.

Are your Liver & Gut 100% Healthy 7 happy?

Under stress, inflammation, infection, calorie restriction, nutrient deficiencies, or poor sleep, the body often diverts T4 into reverse T3 instead.

Reverse T3 is an inactive form of thyroid hormone that blocks thyroid receptors. It acts like a brake on metabolism.

So you can have plenty of thyroid hormone in your blood, but not enough active thyroid hormone in your cells.

That is why many women feel tired, cold, foggy, anxious, or stuck even while taking thyroid medication.

It is not that the medication is wrong. It is that the environment inside the body is not allowing it to work.

Why does this matter for fat loss, mood, and bone health?

When thyroid signaling is low inside cells,

metabolism slows.
Fat loss becomes harder.
Digestion slows.
Cholesterol rises.
Energy drops.

At the same time, circulating thyroid hormone can still stimulate the nervous system and stress hormones, which can lead to feeling wired but tired, anxious, restless, or unable to sleep deeply.

Over time, this stress state also affects bone health, menstrual cycles, fertility, mood, and cardiovascular health.

So women end up in a confusing place where nothing feels quite right, but nothing looks obviously wrong on paper

What does a good thyroid evaluation actually looks like?

A meaningful thyroid assessment looks at more than TSH.

It includes-