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Thyroid
Your report says normal. You don't feel normal.
A TSH inside the reference range tells you your thyroid is functioning. It doesn't tell you it's working well, and it doesn't explain why you're exhausted by 3pm.
Does this sound like you?
Tick whichever ones you recognise.
- Exhausted by mid-afternoon no matter how much you slept
- Weight that will not move on a diet that used to work
- Hair falling more than it used to, and thinning at the front
- Cold hands and feet when nobody else in the room is cold
- Constipation that's become your normal
- Brain fog, losing words mid-sentence
- You were told your thyroid is fine, but something clearly isn't
What's actually going on
TSH is one number in a system with several.
TSH is a pituitary signal, not a direct measure of thyroid hormone. It can sit inside the lab's reference range while your free T3, the active hormone your cells actually use, sits at the bottom of its own range. Most people feel considerably better with a TSH under 2 than at 4, even though both are printed as normal.
The other half of the picture is conversion. Your thyroid mostly makes T4, which is relatively inactive. It has to be converted to T3, and a large share of that happens in the gut and liver, and depends on selenium, zinc, iron and adequate protein. If conversion is poor, correct medication still leaves you feeling flat.
And if this is Hashimoto's, the underlying issue is immune, not glandular. Which means the gut is part of the conversation whether anyone has mentioned it to you or not.
The approach
What we'd actually do.
We look at the full panel, not just TSH
Free T3, Free T4 and anti-TPO antibodies alongside TSH. If you've only ever had TSH tested, I'll tell you exactly what to ask your doctor for and why.
We correct what's blocking conversion
Selenium, zinc, iron and protein intake, checked against your actual reports rather than assumed. Deficiency here is common and very fixable.
We sort out the goitrogen question sensibly
Raw cruciferous vegetables in large daily amounts can interfere with iodine uptake. Cooked, they're fine. You don't need to give up cabbage and cauliflower, you need to stop eating them raw every day.
We time food around your medication
Thyroid medication absorbs poorly alongside calcium, iron and coffee. Small timing changes here often make a noticeable difference on their own.
The order that flattens the spike
- Half the plate, vegetables. Sabzi, salad, whatever is cooked that day. Eat this first.
- A quarter, protein. Dal, curd, paneer, egg, chicken or fish. Eat this second.
- A quarter, carbohydrate. Rice or roti. Still there. Just last.
Same food, same kitchen, different order. This alone measurably lowers the post-meal glucose rise, which is where most of the damage happens.
What to expect
What changes, and when.
Rough guide, not a promise. Bodies differ, and anyone giving you exact dates is guessing.
Relevant training
IBD and gut training through Monash University. Since T4 to T3 conversion is substantially gut-dependent, thyroid and gut health are treated together here rather than separately.
Questions
What people ask me about this.
My TSH is normal. Is there even anything to do?
Often yes. Normal is a wide range, and a large number of women feel poorly in the upper half of it. We also look at free T3, free T4 and antibodies, which frequently haven't been tested at all.
Do I have to stop eating cabbage and cauliflower?
No. Cooking largely deactivates the goitrogens. The problem is raw cruciferous vegetables in large quantities every day, which is a salad habit, not an Indian cooking habit.
Can food replace my thyroid medication?
No, and I'd be cautious about anyone who says otherwise. Food improves conversion, absorption and symptoms. Your prescription is your doctor's decision and I don't interfere with it.
What about Hashimoto's specifically?
That's an autoimmune condition, so we work on the gut and on inflammatory triggers. Some people see meaningful antibody reduction over a few months. Not everyone does, and I'll tell you honestly which group you appear to be in.
Is soy actually a problem?
In normal Indian quantities, no. Very high soy intake close to your medication can interfere with absorption, so we just separate the timing.
Let's work out what's going on.
Bring your reports. One consultation and a straight answer on what will and won't work.
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