If you have ever been told your thyroid is “normal” while you are exhausted, gaining weight, losing hair, constipated, freezing cold, and barely making it through the day, this episode is going to hit a nerve.

Because the truth is, thyroid care is still failing women in a big way.

Too many doctors are only testing TSH, stopping there, and completely missing the full thyroid picture. And for women in perimenopause and menopause, this can be especially frustrating because thyroid symptoms often overlap with hormone changes, making it even easier to be dismissed or under-treated.

In this episode, I sit down with my friend Dr. Amie Hornaman, also known as “The Thyroid Fixer,” to talk about why thyroid treatment is still so broken, especially for women in midlife.

We go into one of the most important parts of this whole conversation: advocacy.

Because when it comes to thyroid health, no one is coming to save you. You need to know what to ask for, what labs to request, what patterns to look for, and how to push for better care.

If you have been told your thyroid labs are fine, but your body is clearly telling a different story, this episode will give you language, clarity, and a much better understanding of what may actually be going on.

Watch the Episode:

In This Episode, We Cover:

• Why thyroid care has not improved nearly enough for women
• Why testing only TSH is not enough
• The thyroid labs women need to ask for
• What free T3, free T4, reverse T3, TPO antibodies, and Tg antibodies actually tell you
• Why T4-only thyroid medication often does not work well for many women
• How reverse T3 can put the brakes on your metabolism
• Why thyroid dysfunction can affect blood sugar, insulin, fertility, and sex hormones
• The connection between perimenopause, menopause, and new thyroid issues
• Why many women are being under-medicated for hypothyroidism
• How to advocate for yourself and find a practitioner who actually understands thyroid care

Why TSH Alone Is Not Enough

One of the biggest issues in conventional thyroid care is that many women are only tested for TSH, which does not tell the full story of thyroid function.

TSH can be useful, but it does not show how much active thyroid hormone your body is actually using. That is why a more complete thyroid panel often includes free T3, free T4, reverse T3, TPO antibodies, and Tg antibodies.

These markers can help reveal whether your body is converting thyroid hormone properly, whether inflammation or stress may be affecting thyroid function, and whether Hashimoto’s or autoimmune thyroid disease may be part of the picture.

How Thyroid Symptoms Show Up in Midlife

Thyroid dysfunction can look a lot like perimenopause or menopause. This is one of the reasons so many women are told their symptoms are “just hormones” or “just aging.”

Common symptoms may include:

• Fatigue
• Weight gain
• Hair loss
• Constipation
• Cold intolerance
• Brain fog
• Low mood
• Poor motivation
• Sluggish metabolism
• Irregular cycles
• Fertility changes
• Blood sugar and insulin issues

And no, you are not crazy. Your body is giving you information. The problem is that too many providers are not looking deep enough.

Who This Episode Is For

This episode is for women who suspect they have a thyroid issue, have already been diagnosed with hypothyroidism or Hashimoto’s, or have been told their thyroid is “fine” even though they feel anything but fine.

It is especially helpful for women in perimenopause and menopause who are dealing with fatigue, weight gain, brain fog, low mood, constipation, hair loss, cold intolerance, or feeling like their body has suddenly stopped working the way it used to.

Listen to This Episode If You Want to Understand:

• Why your thyroid labs can look “normal” while you still feel awful
• Which thyroid markers to ask your doctor to test
• Why free T3 matters for metabolism, energy, and body temperature
• How reverse T3 can affect thyroid function
• Why T4-only medication may not be enough for some women
• How thyroid health connects to blood sugar, insulin, fertility, and sex hormones
• How to better advocate for yourself in the doctor’s office

This conversation is a must-listen for any woman who feels dismissed, under-treated, or stuck with symptoms that are clearly not “all in her head.”

Download in iTunes or on your favorite podcast platforms.

Dr. Amie Hornaman

Grab a copy of Dr. Amies NEW BOOK: The Thyroid Fix: The No-Nonsense Guide to Fix Fatigue, Fogginess, and Fat That Won't Budge on Amazon

FAQ Section

Why is testing only TSH not enough for thyroid health?

Testing only TSH does not show the full picture of thyroid function. TSH is a brain signal that tells the thyroid what to do, but it does not show how much active thyroid hormone your body is making, converting, or using. A more complete thyroid panel often includes free T3, free T4, reverse T3, TPO antibodies, and Tg antibodies.

What thyroid labs should women ask for?

Women may want to ask their provider about a full thyroid panel that includes TSH, free T3, free T4, reverse T3, TPO antibodies, and Tg antibodies. These markers can provide a more complete picture of thyroid hormone production, conversion, and possible autoimmune thyroid issues.

Why do thyroid symptoms get worse in perimenopause and menopause?

Thyroid symptoms can become more noticeable in perimenopause and menopause because hormonal shifts can affect metabolism, energy, mood, sleep, insulin sensitivity, and inflammation. Since thyroid symptoms often overlap with menopause symptoms, many women are told they are “fine” even when something deeper may be going on.

What are common symptoms of hypothyroidism in women?

Common hypothyroid symptoms may include fatigue, weight gain, hair loss, constipation, feeling cold, dry skin, brain fog, low mood, irregular cycles, sluggish metabolism, and difficulty losing weight.

Why does T4-only thyroid medication not work for some women?

T4-only thyroid medication may not work well for some women if their body is not efficiently converting T4 into T3, the more active thyroid hormone. Stress, inflammation, dieting, illness, low nutrients, and elevated reverse T3 can all affect thyroid hormone conversion.

How can reverse T3 affect metabolism?

Reverse T3 can act like a brake on thyroid function. When reverse T3 is elevated, it may interfere with the body’s ability to use active thyroid hormone properly, which can contribute to fatigue, weight gain, cold intolerance, and a slower metabolism.