Thyroid Optimization
Your TSH is normal.
You still feel hypothyroid.
TSH alone misses a significant portion of thyroid dysfunction. At Meliora, we evaluate your full thyroid panel — TSH, free T3, free T4, and thyroid antibodies — and compare results to optimal ranges, not just “not sick” ranges.
The problem with testing only TSH.
TSH (Thyroid Stimulating Hormone) is a pituitary signal — it tells the thyroid how hard to work. A normal TSH means the pituitary is satisfied with the thyroid output. But it doesn't tell you whether that output is reaching your cells effectively. A patient can have a normal TSH and still be functionally hypothyroid.
The active thyroid hormone is T3 — specifically free T3. Your thyroid primarily produces T4, which must be converted to T3 in peripheral tissues (primarily the liver and gut). Conversion can be impaired by chronic stress, inflammation, nutrient deficiencies, and gut dysfunction — even when TSH is normal and T4 is adequate.
Additionally, Hashimoto's thyroiditis — an autoimmune attack on the thyroid — is the most common cause of hypothyroidism and is not diagnosed by TSH alone. Thyroid antibody testing (TPO) is required. Hashimoto's can be present for years before TSH shows any abnormality.
Full Thyroid Panel
Four markers. A complete picture.
TSH
Thyroid stimulating hormone. The standard marker. We evaluate against optimal range (1.0–2.0 mIU/L for most symptomatic patients) rather than the broader lab reference range.
Free T4
The main hormone your thyroid produces. Available T4 in circulation — not bound to proteins. Low free T4 with normal TSH suggests the thyroid isn't producing enough even when the pituitary is satisfied.
Free T3
The active thyroid hormone. Converted from T4 in peripheral tissues. Free T3 is what your cells actually use. Suboptimal free T3 explains hypothyroid symptoms even when TSH and T4 are normal.
TPO Antibodies
Thyroid peroxidase antibodies. Elevated levels indicate Hashimoto's thyroiditis — an autoimmune condition that progressively damages thyroid tissue. Present in most Hashimoto's patients, often years before TSH becomes abnormal.
Symptoms
Symptoms of suboptimal thyroid function.
These symptoms can all be driven by thyroid dysfunction — even when your TSH is “normal.”
Energy & Metabolism
- —Fatigue that doesn't respond to rest
- —Unexplained weight gain or difficulty losing weight
- —Feeling cold when others aren't
- —Constipation
- —Slow hair growth or hair loss
Cognitive & Mood
- —Brain fog
- —Poor memory
- —Difficulty concentrating
- —Depression or low mood
- —Anxiety
- —Poor motivation
Autoimmune Thyroid Disease
Hashimoto's thyroiditis: the most common thyroid condition you may not know you have.
Hashimoto's is an autoimmune condition in which the immune system attacks thyroid tissue. Over time, this destroys thyroid function — but it can exist for years or decades before TSH becomes abnormal. Many patients with Hashimoto's have normal thyroid function tests and are told their thyroid is fine.
Hashimoto's is diagnosed by measuring thyroid antibodies (TPO). If antibodies are elevated, the diagnosis is Hashimoto's — regardless of TSH level. Managing Hashimoto's involves addressing the autoimmune component (gut health, inflammation, nutrient support) as well as monitoring thyroid function over time.
At Meliora, we test for Hashimoto's routinely in patients with thyroid symptoms — particularly women, who are eight times more likely to develop the condition than men.
What to Expect
From labs to a personalized protocol.
01
Full thyroid panel
We draw TSH, free T3, free T4, and TPO at your initial lab visit. This is the minimum required to evaluate thyroid function comprehensively.
02
Consultation
Dr. Chua reviews your full thyroid picture alongside your hormone, nutrient, and metabolic results. Thyroid function doesn't exist in isolation — it's affected by everything else.
03
Treatment
If indicated, thyroid support may include thyroid hormone prescription (T4, T3/T4 combination, or desiccated thyroid), nutrient support (selenium, iodine, iron), or autoimmune protocol to reduce antibody load.
Common questions.
Can I have thyroid problems if my TSH is normal?
Yes. Suboptimal free T3, elevated thyroid antibodies, or impaired T4-to-T3 conversion can all drive hypothyroid symptoms with a normal TSH. This is one of the most common patterns we see.
What's the difference between T3 and T4 medication?
T4 (levothyroxine, Synthroid) must be converted to active T3 in peripheral tissues. Some patients do not convert adequately and feel better on a T3/T4 combination (such as desiccated thyroid extract or liothyronine added to T4). Dr. Chua evaluates conversion based on your free T3 and free T4 ratio.
Is Hashimoto's treatable?
Hashimoto's cannot be cured, but it can be managed. Reducing inflammatory triggers, supporting gut health (the primary site of T3 conversion), addressing nutrient deficiencies, and monitoring antibody levels over time can slow progression and reduce symptoms significantly.
Do you work with patients who are already on thyroid medication?
Yes. Many of our thyroid patients come to us already on levothyroxine — feeling partially improved but still symptomatic. We evaluate whether conversion is adequate and whether the current protocol is optimized.
Thyroid dysfunction is one of the most commonly missed diagnoses in conventional medicine.
Book a consultation. We'll run the full panel and evaluate against optimal — not just “not sick.”