You're exhausted. Your hair is thinning. You're gaining weight no matter what you eat. You finally convince your doctor to test your thyroid, and the result comes back: TSH 2.8. "Perfectly normal," they say.

But you don't feel normal.

Here's what your doctor isn't telling you: TSH is just one piece of the thyroid puzzle — and it's often the least helpful one.

TSH (thyroid stimulating hormone) measures how hard your pituitary gland is working to tell your thyroid to produce hormones. The "normal" range is typically 0.5 to 5.0 mIU/L. But functional medicine research shows that optimal TSH is between 1.0 and 2.0 — and many women experience symptoms when their TSH creeps above 2.0.

Even more importantly, TSH doesn't tell you what's actually happening with your thyroid hormones. It doesn't show:

• Whether your thyroid is producing enough T4

• Whether your body is converting T4 to active T3

• Whether Reverse T3 is blocking your thyroid function

• Whether your immune system is attacking your thyroid

You can have "normal" TSH and still have significant thyroid dysfunction. That's why comprehensive testing is critical.

The Tests Your Doctor Isn't Running

Most doctors stop at TSH. But a comprehensive thyroid panel reveals what's really happening in your body.

Free T3 (Triiodothyronine)
This is the active thyroid hormone your cells actually use for energy, metabolism, and brain function. You can have normal TSH and T4 but low T3 — which means your body isn't converting thyroid hormone into its usable form. This is one of the most common causes of persistent fatigue despite "normal" labs.

Free T4 (Thyroxine)
Your thyroid produces T4, which then converts to T3. Low T4 means your thyroid isn't producing enough hormone in the first place. High T4 with low T3 suggests a conversion problem.

Reverse T3 (rT3)
This is an inactive form of T3 that blocks active T3 from working. When you're under chronic stress, dealing with inflammation, or have nutrient deficiencies, your body produces more Reverse T3 as a protective mechanism. High rT3 can cause severe hypothyroid symptoms even when TSH and T4 look perfect.

TPO Antibodies (Thyroid Peroxidase)
Elevated TPO antibodies indicate Hashimoto's thyroiditis — an autoimmune condition where your immune system attacks your thyroid. You can have Hashimoto's for years before TSH becomes abnormal. Catching it early allows for intervention before permanent damage occurs.

Thyroglobulin Antibodies
Another marker for autoimmune thyroid disease. Some people have elevated thyroglobulin antibodies but normal TPO, which is why testing both matters.

Why doesn't your regular doctor test these?

Insurance companies typically only cover TSH testing unless TSH is abnormal. Conventional medicine is designed to diagnose and treat disease — not optimize wellness. By the time TSH becomes abnormal enough to trigger further testing, you've often been suffering for years.

Why Women's Thyroid Issues Get Dismissed

If you've been told "your labs are normal" while feeling terrible, you're not alone. Women's thyroid dysfunction is systematically dismissed in conventional medicine.

Here's why:

Insurance-driven testing protocols
Doctors follow guidelines that prioritize cost containment over comprehensive care. TSH-only testing is cheap. Comprehensive panels cost more. Unless TSH is flagged, insurance won't cover further testing.

Training focused on disease, not optimization
Medical schools teach doctors to treat overt disease. Subclinical hypothyroidism — where you have symptoms but labs are "borderline" — often gets ignored. You're told to wait until it gets worse.

Women's symptoms blamed on stress or hormones
Fatigue, weight gain, brain fog, and mood changes are frequently attributed to stress, anxiety, depression, or "just getting older." Women are prescribed antidepressants or told to exercise more — while the underlying thyroid dysfunction goes untreated.

Lab ranges based on sick populations
The "normal" TSH range of 0.5-5.0 was established by testing people who already had thyroid problems. It's not a range for optimal health — it's a range that includes early-stage dysfunction. Functional medicine uses tighter, evidence-based ranges that reflect true wellness.

The result? Women suffer for years with preventable symptoms because standard testing isn't designed to catch thyroid problems early.