Beyond TSH: Understanding Hypothyroidism Through a Functional Medicine Lens

Thrive Collective
Sep 26
3 min read

Hypothyroidism is one of the most common yet misunderstood health concerns, especially among women. Fatigue, weight gain, brain fog, hair thinning, and low mood are often dismissed as “just stress” or “getting older.” In reality, your thyroid is a powerful regulator of metabolism, hormones, and energy—and when it’s underactive, every cell in your body feels the impact.

At Thrive Collective, Dr Susan Ward approaches hypothyroidism through a functional medicine lens—asking why the thyroid is underactive and not just prescribing medication. By exploring nutrient status, gut health, immune triggers, hormones, and lifestyle factors, we can address root causes and restore balance- which can result in lowering medicine needs.

Getting to the Root Causes of Hypothyroidism

Functional medicine looks deeper than thyroid hormone levels alone. Why? Because when we take steps to address the underlying root cause, we often see a significant reduction in the amount of thyroid hormone replacement needed, the duration/type of treatment and sometimes, we can even eliminate the need for hormone replacement completely!

Common contributors include:

Autoimmune conditions (Hashimoto’s thyroiditis) often triggered by gut permeability (leaky gut), chronic stress, or infections.
Gut infections and imbalances such as H. pylori, parasites, candida, or mould exposure.
Viral triggers like Epstein–Barr Virus (EBV) .
Toxins and heavy metals can disrupt directly with how your body produces and uses thyroid hormone.
Nutrient deficiencies—iodine, zinc, selenium, and iron are essential for converting thyroid hormone to its active form
Hormonal imbalances including perimenopause, insulin resistance, and adrenal dysfunction that exacerbate thyroid symptoms.
Stress and trauma—long-term high cortisol (stress hormone) interferes with thyroid regulation.
Genetic predispositions that make some people more vulnerable to thyroid autoimmunity.

Why Standard Testing Often Misses the Full Picture

A typical thyroid test looks only at TSH (thyroid-stimulating hormone). But TSH alone doesn’t tell us how well the thyroid is functioning at a cellular level.

A functional medicine approach measures:

TSH, Free T4, Free T3 – to see both production and active hormone availability.
Reverse T3 – which can block thyroid receptors when the body is under stress.
Thyroid antibodies (TPO, TgAb) – to identify autoimmune thyroiditis.
Nutrient markers (iodine, zinc, selenium, iron).

Treatment is guided by both test results and symptoms—because thyroid health is individual, and the “normal range” isn’t the same as optimal health.

Restoring Balance – A Functional Medicine Approach Management of hypothyroidism is personalised and comprehensive:

The Management of hypothyroidism as a whole-body imbalance, not just a thyroid problem, is comprehensive and tailored to you:

Nutrition: Optimising your intake of protein, healthy fats, and micronutrients; identifying food intolerances.
Gut healing: Treating infections, rebalancing the microbiome, restoring digestive health.
Detoxification support: Actively helping your body deal with heavy metals, mould, and other toxin exposures.
Hormone balance: Supporting perimenopause, insulin resistance, and adrenal adaptations.
Lifestyle medicine: Prioritising stress management, sleep, and exercise tailored to your energy.
Targeted supplementation: Using high quality supplements like selenium, zinc, vitamin D, B vitamins, and adaptogens where your body needs them.
Individualised thyroid medication (if needed): Carefully adjusted using T3/T4 balance, with doses guided by symptoms and labs, not just TSH.

Conclusion/ The result?

Hypothyroidism is not just a thyroid problem—it’s a whole-body imbalance. By addressing root causes and supporting every layer of health, functional medicine gives patients the chance to feel energised, clear-headed, and resilient again.

Ready to find out the root cause of your thyroid symptoms?

✨ To learn more or book an appointment with Dr Susan Ward during her upcoming visit to Hong Kong (13–18 October 2025), contact us at +852 9177 1562 or Book Here