Why Do I Have Thyroid Symptoms and Chronic Fatigue When My Doctor Says My Labs Are Normal?

by Dr. Susan Tanner, MD

There are many misconceptions and misunderstandings as to what the thyroid gland does and how and when it may be improperly functioning. Unfortunately, just as prevalent among traditional health care practitioners is an incomplete manner of testing to determine if the thyroid is doing its job and operating optimally for recovery and overall health. Thus, it would seem helpful to review exactly what the thyroid gland is and what it does in the body.

An Overview of the Thyroid Gland: Location, Function, and Role

The thyroid is located in the lower section of the front of the neck. It has three lobes and is spongy in texture. The thyroid has long been thought to be the gland for weight regulation, and while there is some truth to that, there are many other roles that it plays in the body; therefore, the importance of keeping the gland healthy cannot be overstated.

The role of the thyroid is to produce the hormone, thyroxine (T4) which is then converted within the cells of the gland to the active form of thyroid, Triiodothyroinine (T3). This conversion is dependent on the addition of iodine, zinc, selenium, the amino acid tyrosine, and other factors. It is the circulation of T3 through the body that actually expresses the activity of the thyroid. The traditional way of testing to see if the thyroid is within normal range is to look at a hormone called TSH, thyroid stimulating hormone. This is produced by the pituitary gland and is the hormone that tells the thyroid to work and produce T4 and T3. A simplified explanation is that the higher the TSH level, the lower the functioning of the thyroid gland, and the harder it is having to work to do its job. There are varying clinical opinions as to what the range of TSH should be; while many labs state that up to 4.0 is normal, in integrative medicine and for optimal functioning, evidence shows us that this level should be below 2.0.

Assessing Thyroid Function

TSH is simply not the best way to assess thyroid function. One really needs to look at the “free” levels of both T3 and T4. Free, means that they are not bound to another protein molecule. It is not uncommon at all to find that the TSH level is acceptable but the free T4 and free T3 levels are not optimal. Patients may experience many symptoms of low thyroid, such as low body temperature, weight gain, poor quality skin, nails and hair, and constipation, but are told that since their TSH is “normal” that they are fine.   Our preferred ranges for free T4 are 1.2-1.6 and free T3 3.2-3.8.

Another issue is that patients who have been diagnosed with low thyroid conditions are commonly prescribed Synthroid, (or the generic equivalent, levothyroxine). This is a synthetic thyroid which contains only T4. The problem with this type of treatment is that those patients who are unable to convert the T4 into the active T3, remain symptomatic of hypothyroidism even while on medication! This is much more common that would be believed, and illustrates the need for complete thyroid lab tests, not just a TSH value.

Mold and Its Impact on the Thyroid

In the world of the mold-injured patient, proper regulation and rebalancing of the thyroid is very important. One of the concerns is that when free T3 levels fall below 3.2, more glycogen, which is stored sugar, is released by the liver into circulation. Even these slightly elevated levels of blood sugar, which can fluctuate widely, feed yeast and molds in the system making them very hard to eradicate. It also makes it difficult for the patient to have regular blood sugar levels. This creates huge peaks and dips in energy levels and makes sugar and carbohydrate cravings worse, which also feed the yeast in the body. Additionally, the debilitating fatigue that accompanies mold injury is exacerbated by low thyroid.

Auto-Immune Thyroid Disease and Mold

Another category of thyroid illness is the autoimmune thyroid diseases, most notably, Grave’s disease (which usually presents as an overactive thyroid condition) and Hashimoto’s thyroiditis (which usually presents as progressive and/or heading toward low thyroid condition). Both of these diseases may be caused by multiple factors but, in my clinical practice, I have seen both improvement and exacerbation by exposure to environmental toxins, most notably mold. Mycotoxins are very dysregulating to the body’s immune system, thus causing one to react to their own tissues, and in this context, it is a reaction to the thyroid cells. When managing these situations acutely, especially in Grave’s disease, traditional medical therapies are necessary, but attention must be paid to the patient’s environment to effectively manage them long term. Even if thyroid removal or ablation is done, if environmental causes are not addressed, then body tissues or organs may be targeted as a patient’s body expresses an autoimmune overload.

Treating Thyroid Issues

Addressing this problem means several things for the patient. It is necessary to have a physician who is willing to order extra thyroid tests. They are not expensive. Secondly, if the circulating thyroid hormone levels are low, then treatment with a medication that contains both T3 and T4 is necessary. You may hear these medications referred to as “glandular formulas” and yes, they are derived from desiccated pork thyroid. For people who prefer not to use any animal product, then synthetic formulas containing both T3 and T4 hormones are available, but only from a compounding pharmacy.


Additionally, using thyroid support nutrients is very helpful. There are a number of these on the market that contain the necessary minerals and amino acids to help the thyroid gland be healthier and work more efficiently. Once the thyroid gland begins to function properly, many patients can decrease their use of supplemental medications, and sometimes, eliminate their use of it entirely—of course, this is completely dependent upon the severity of deficiency.   Some of my favorite thyroid support nutrients are Thyroid Support Complex by Pure Encapsulations, and Thyroid Response Complete Care by Innate Response. Either of these may be found on the Wellevate Portal.

When thyroid levels are restored and healthy, this also helps everything in the hormonal cascade work more efficiently as well. This includes adrenal hormones, sex hormones, and insulin/blood sugar cascade.

Have you experienced thyroid issues due to chronic illness and/or mold? Have you been tested, but told that your thyroid is fine or normal? We love hearing your feedback and comments. Write to us below or email us at newsletter@sinusitiswellness.com.