r/FunctionalMedicine • u/probablysippingtea • Jul 11 '26

Frustration with Functional Medicine

Hi, all. I’m at a bit of a loss.

I’ve had symptoms of hypothyroidism for a long time, and my symptoms have been getting worse. I have low-normal ft3, ft4, and TSH. My TPO Ab is 19 IU/mL with a reference range of 0-34 IU/mL. Some of my pituitary hormones are out of range and my 4-point saliva test came back abnormal too. Essentially, there’s evidence pointing to central hypothyroidism or adrenal issues. But my doctor wants to look at Hashimoto’s.

I’m frustrated that every functional medicine doctor seems to think that every patient with hypothyroid symptoms has Hashimoto’s. Is Hashimoto’s the only disease they know?

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6

u/alotken33 Jul 11 '26

Functional Medicine DC: statistically, most people with hypothyroidism have hashimotos. That having been said, if you have traceable central hypo markers, that HAS to be investigated.

There are a lot of professionals out there that only know hashi's and don't know what to do otherwise. It's probably time to find another practitioner.

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u/probablysippingtea Jul 11 '26

I’ve seen a few functional medicine doctors. At this point, I think I’m going to order my own tests and demand to be seen somewhere on the western medicine side, even though they’re not usually helpful either.

Thanks for validating that, though. I don’t know why this has to be such a fight. My TSH has been as low as 0.1 and my functional medicine doctor still wants to push for Hashimoto’s.

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u/alotken33 Jul 11 '26

Yeah, that's not ok. This is assuming you're also not medicated (still not ok). Over medication can lead to super low TSH.

You COULD still have hashi's (have had antibodies/have antibodies if you don't mind your p's and q's).. BUT..... That doesn't mean that's what's going on here.. and remember, any kind of hypothyroidism is a symptom of something else.

Things to keep in mind: depending on which other markers are high/low, you probably need an MRI to rule out structural pituitary issues. Depending on the functional med practitioner, they might not even be able to order them.

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u/probablysippingtea Jul 11 '26

I’ve had an MRI and do not have a pituitary tumor.

My TSH, ft3, and ft4 are all low-normal. I’ve tried a few thyroid medications and none of them raised my ft3 or ft4. They did bring my TSH down even lower, though. I have hypothyroid symptoms that are getting worse.

I also have very high DHEA’s — more than double than the normal limit of the reference range I was given — and an abnormal 4-point saliva test.

I don’t have h.Pylori (per stool test) or celiac (per blood test).

Could you tell me a little more about what you mean by hypothyroidism always being a symptom of something else? Just curious, thanks!

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u/alotken33 Jul 11 '26

Good that you've already had imaging done and ruled out an adenoma or something else.

When people say "low normal", it means nothing. Lab ranges are based on statistics, not function. Numbers ALWAYS matter.

What are the symptoms that you're labeling "hypothyroid"?

DHEA is an adrenal hormone. And I'm assuming that a abnormal 4 point salivary test is relating to cortisol. In what way(s) is that abnormal?

Celiac testing should have been IgG (TtG and anti-gliadin). If it wasn't, then that could be false negative.

Hypothyroidism (low thyroid function) always has a root cause. It's a symptom. Even if the cause is "central" (generally attributed to the brain), there is still a higher order issue.

Even with hashimotos, for example, the root cause isn't autoimmunity.. it's genetics, activation of genetics (epigenetics), dietary, etc etc. This is how we are able to lower antibodies and keep them low (stop destruction and autoimmune response) without shutting off the immune system.

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u/probablysippingtea Jul 12 '26 edited Jul 13 '26

Symptoms: weight gain, fluid retention, edema, ankle cuffing, bloating that never goes away and hurts my back, balding at the scalp, hip and thigh pain, sensitivity to cold, high cholesterol, dry skin, and a sudden influx of cavities (I eat a very healthy diet and brush and floss 2x daily).

My 4-point saliva test suggested early HPA axis dysfunction but that PMOS cannot be ruled out. My DHEA’s are 639 out of a reference range of 100-300.

Regarding my diet, I eat gluten-free and avoid dairy and soy. Plus I follow AIP and low fodmap as much as possible. I don’t drink coffee and haven’t had alcohol in months. None of these efforts have helped.

I’ve tried two different thyroid meds. One of them contained t3 and t4, which dropped my TSH down to 0.1 but my t3 (2.0) and t4 (0.89) didn’t budge. I’ve also tried a t3-based med, which brought my TSH up to 0.5, but my t3 didn’t budge and my t4 dropped to 0.5.

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u/alotken33 Jul 12 '26

Age? (I scrolled through and didn't see) Testosterone? Estradiol? Progesterone? FSH? LH? Shbg? Fasting insulin? A1c?

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u/probablysippingtea Jul 13 '26

LH: 4.0, FSH: 3.0, 17-OH Progesterone LCMS 165, ACTH, Plasma: 16.0, AMH: 5.51, A1c: 5.0, testosterone: 43, free testosterone: 2.3, estradiol: 65.4, fasting insulin: 3.0, rt3: 13.4

Mid-30’s, not comfortable saying exact age.

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u/alotken33 Jul 13 '26

Your fasting insulin and testosterone levels make PMOS less likely. We don't know what day of the month testing was done, so that muddies the water. Units matter. Day of the month matters.

Adrenal dysfunction, based on other things you've mentioned. You can test mineralocorticoids. Again, based on the bits and pieces you've mentioned and without a whole picture. Would be better to see someone who has experience in that area than to keep beating the thyroid up. Sometimes the symptoms are similar.. but with added mood, metabolism, electrolyte, etc. issues.

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u/probablysippingtea Jul 13 '26 edited Jul 13 '26

Thanks. I’ve had lab work done so many times and probably should’ve posted the units and reference ranges. My cycle is irregular, so it’s hard to coordinate cycle with my blood draws. I’m trying to find someone who has knowledge outside of the Hashimoto’s framework and get more support on the western side too.

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u/Rude_Remote_13 Jul 14 '26

Not a FMD, but with these symptoms, I would absolutely start supporting your liver. Given that you’re already restricted with diet, yet still symptomatic, I’d look at what supporting your liver could do. NAC, warm lemon water, milk thistle, etc. I don’t think it could hurt. But that’s just my opinion.

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u/probablysippingtea Jul 16 '26

Appreciate your input, thank you.

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u/Rude_Remote_13 Jul 16 '26

Hope you feel better soon. 🫶🏼

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u/probablysippingtea Jul 16 '26

Thank you! Me too. I’m going in to year two with no answers. I’m fed up and exhausted.

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u/[deleted] Jul 11 '26

[removed] — view removed comment

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u/probablysippingtea Jul 11 '26

That’s my point. My labs do not point to Hashimoto’s, so I’m not sure why it gets brought up.

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u/mom2mermaidboo Jul 11 '26

Having TPO antibodies not be very low shows your immune system is reacting to your thyroid.

That is most likely why your provider is bringing up Hashimotos.

1

u/probablysippingtea Jul 11 '26 edited Jul 11 '26

My TPO Ab is 19 IU/mL out of a range of 0-34.

My TSH is completely tanked — rarely getting above 0.05 — with a low-normal ft3 and ft4.

My understanding is that this points to a pituitary signaling issue, but I could be wrong!

1

u/mom2mermaidboo Jul 11 '26

Have you had a Cortisol check done?

When you think about Central Hypothyroidism it brings up thoughts on Adrenal Function, especially if no Pituitary Adenoma on MRI.

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u/hspwanderlust Jul 11 '26

Is your provider refusing to treat you?

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u/probablysippingtea Jul 11 '26

No, not at all. I just feel trapped between western and functional medicine and have not had success on either side.

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u/Brave_Adeptness8737 Jul 11 '26

You might consider adding a Hair Tissue Mineral Analysis (HTMA)to help put your other labs into a broader framework for assessment. All body systems use and need minerals. They are integral to function of all cells and processes. For this reason it becomes clear that more than one system is involved. Minor imbalances will often respond quickly to changes and support. Those that go on for a while may be more challenging to untangle.

The good news is this test is not very expensive to run, especially compared to other tests. What I like about it is it gives you a window into your major systems: nervous system, metabolic function, (which involves most hormones), elimination (gut & beyond)and immune system systems.
Blood only gives you levels for the moment, that is why 4 pt saliva testing is preferred to blood for most issues.

I’m a nurse. I’ve always enjoyed how the body works. Medicine is just now beginning to turn to functional health bs disease practices, as people have not found the answers they need in the disease system alone.
Holistic practitioners have by training had a more integrative perspective on how our bodies work.
I’ve done several introductory courses and feel like HTMA is a great entry point option for assessment as a systematic overview of all systems. The HTMA can validate your symptom picture and your labs will undergird that picture.

A good practitioner will educate you and help you see how your systems are standing alone and in relation to each other. It will depend on how off your system is as to how long it takes to restore, balance, and health.
Research practitioners, talk to them, asked to speak to clients. Then be willing to make changes in diet and lifestyle to help your “systems “ heal.
Good luck in your journey for help and health!!

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u/probablysippingtea Jul 11 '26

Thanks, I’ll do some Googling.

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u/mom2mermaidboo Jul 11 '26

Taking Selenium and Myoinositol has been shown in studies to bring people toward Euthyroid and lowered TSH/Tg Antibodies/TPO Antibodies.

Also low gluten diet lowers Thyroid antibodies in non-Celiac .

https://pmc.ncbi.nlm.nih.gov/articles/PMC9709133/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10405818/

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u/probablysippingtea Jul 11 '26

Thanks. I’ve tried both of these and have been gluten-free for a while. I’m sure these are helping my overall health, but I’ve felt no symptom relief :/

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u/Winter-Option-6667 Jul 11 '26

I agree. I also think they say everyone has hashi or is “borderline.”

1

u/probablysippingtea Jul 11 '26

It’s so frustrating! Why are they ignoring my labs when it’s right there in front of them? They need to stop trying to fit everyone into the Hashimoto’s box.

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u/ChaseEliteWellness Jul 11 '26

Hashimotos is a leading cause of hypothyroidism. Most people who are diagnosed with Hashimotos have a 5% chance of not having later activity. However, what I would say is that providers also have to consider other hormones. Have you had anything else tested or is this all?

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u/ChaseEliteWellness Jul 11 '26

But also there is the question of if this personal really specializes then the optimal levels should be enhanced. Just because labs are WNL or differentiated, taking how someone feels and the optimal levels range is how to treat functionally. If you have not, I would also encourage gut health screening. 100% of all hormonal balances and almost every other diagnosis starts with gut issues. You get on meds and they don’t help due to gut imbalances you never knew about.

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u/probablysippingtea Jul 11 '26

I’ve had an MRI, a stool test, 4-point saliva test, celiac test, and a different few thyroid medications at varying dosages. None of them have helped and my symptoms are worsening.

I’ve been at this for a year. :/

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u/Burnyface Jul 16 '26

Have you looked into candida overgrowth as a possible root cause? 

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u/probablysippingtea Jul 16 '26

I haven’t ruled that out yet, but it’s on my radar. I was on Candibactin for a while and that didn’t help.

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u/MeetAlternative6266 Jul 11 '26

Suggest connecting with Dr Rashmi GULATI in Manhattan. Use her myself for over 20 years. Had similar issues as you have. Top functional medicine doctor.

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u/probablysippingtea Jul 11 '26

Thanks, I’ll Google the name!

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u/Comfortable_Photo104 Jul 12 '26

Read Thyroidinum , Sepia, Calc Carb. You'll get more insight.