Clues That Your Thyroid Isn’t Working Optimally, Even When Tests Are ‘Normal’

Just because your standard thyroid tests come back in the normal range, it doesn’t always mean your thyroid is working optimally.

Fatigue, unexplained weight gain, and brain fog can all be symptoms of an underactive thyroid—or hypothyroidism. When you’re not producing enough thyroid hormones, other hormones in your body (including insulin and cortisol) can all be affected. This disruption can impact all parts of your body, including your mental health.

In this episode, we take a look at hypothyroidism manifestations you might not be aware of, how to get the thyroid tests that will give you a more accurate picture of your thyroid health (spoiler alert: these are not the standard tests your doctor ordered), and how to get the help you need to get your thyroid hormones back to optimal balance.

How does The Virgin Diet impact the thyroid? Gut health is a common factor in autoimmunity, and what you eat directly impacts your risk of developing certain conditions, including thyroid issues. Tune in to find out how I use diet and lifestyle habits to keep my thyroid in optimal working health!


0:02:41 – Warning signs of hypothyroidism and associated symptoms
0:04:19 – The impact of Hypothyroidism on mental health and hair loss
0:06:16 – Low thyroid function and mental health
0:12:44 – Hypothyroidism’s impact on heart health, joint pain, and swelling
0:14:49 – Understanding the need for comprehensive testing
0:17:27 – Diet, supplements, and stress management strategies to boost thyroid health

Mentioned in this episode:

Watch the FULL VIDEO on JJ’s Youtube Channel 

Vitamin D Plus is critical for thyroid health

I use Extra Fiber to keep my gut, and thyroid, happy

Study: The evidence for a narrower TSH reference range

Order your own thyroid labs through Your Lab Work and get the information you need

Click Here To Read Transcript

ATHE_Transcript_Ep 546_10 Warning Signs of Hypothyroidism (Signs of Low Thyroid)
JJ Virgin: [00:00:00] I am JJ Virgin, PhD Dropout. Sorry, mom, turn four time New York Times bestselling author. Yes. I’m a certified nutrition specialist, fitness Hall of Famer, and I speak at health conferences and trainings around the globe, but I’m driven by insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information that I uncover with as many people as I can.
And that’s why I created the Well Beyond 40 podcast to synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode we’ll talk about what’s working in the world of. From personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness, join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100.[00:01:00]
You just don’t feel quite right. Your energy is low, you’re a little cold, and you just can’t work out like you used to. Your doctor says your labs look fine, but your symptoms say otherwise. Now, just because your thyroid lab tests come back in the normal range doesn’t mean everything’s working smoothly and you.
Because you can feel it. I could too. I remembered the changes that came on practically overnight. I went from always running hot, being a little sweaty to feeling cold all the time. My LDL cholesterol, which was always ideal, shot up. I got constipated. Honestly, that was the worst, and my weight started going up.
Okay. That was bad too. And I started losing hair outer third of my eyebrows. And even in my. My head, [00:02:00] so I had my labs done and my ts h. My thyroid stimulating hormone was 2.4. Now the normal lab range was 0.4 to 4.5, but thankfully I was working with an integrative doc who didn’t just manage my lab values.
He also had me check thyroid antibodies and pre T3 and t4. We’re gonna talk about what labs you need. But first, let’s go over the warning signs of hypothyroidism. Now, some you may know about, but there are a few surprises out there for you to watch out for. And the first one like this is the obvious is this unexplained weight gain.
When the thyroid gland is not functioning properly, your metabolism can slow down and that leads to weight. This is really one of the first key signs of hypothyroidism. Now, other piece here is when the thyroid gland is not producing enough hormones, other hormones in the body can also go out of balance, which further contributes to weight gain.
Among them is cortisol. Now hypothyroidism is [00:03:00] associated with higher cortisol levels. Likewise, high cortisol levels are associated with. Thyroid stimulating hormone levels. The other one that can go sideways is insulin, because people with hypothyroidism tend to have higher insulin resistance than people who don’t.
There was a study that showed that subclinical hypothyroidism increases the risk of insulin resistance and associated disorders, such as metabolic syndrome and cardiovascular issues. And then finally, besides cortisol. Besides insulin is estrogen. Estrogen levels are significantly lower in. With low thyroid, there was a study that showed low estradiol and low testosterone levels in hypothyroid women.
Next sign is just that feeling tired and sluggish. So when the thyroid gland doesn’t produce enough thyroid hormones, your metabolism can slow down and that lowers your energy levels and increases those feelings of. Tiredness of fatigue. Hypothyroidism can also cause low levels of [00:04:00] iron in the blood leading to anemia, which can contribute to feelings of fatigue and weakness too.
Now, I had this, which then led to my hair falling out. In fact, I had to do iron shots for a year to get my iron back up to optimal levels, and I could actually start to tell where my iron was purely by the state of my. Hormonal imbalances caused by hypothyroidism can also disrupt the normal functioning of other hormones like insulin and estrogen, and cortisol, and this can lead to symptoms such as depression and decreased motivation and can further leave you feeling sluggish and tired.
I know everything’s back to, I’m tired. Next one, and I still remember this. I had a client, this was years ago. Who just like overnight became depressed. She became depressed, no reason for it, and her hair started falling out and I’ve been working with her on some of her, her diet and lifestyle stuff, and her doctor at the time wanted to put her on Prozac.
And I’m like, okay, wait a minute. [00:05:00] Like depressed out of the blue hair starting to fall out. I sent her over to my integrative doc, Dr. Alan Christensen, and sure. , it was a thyroid issue causing depression, not a Prozac deficiency. Go figure. Research shows that people with thyroid disorders are more prone to develop depressive symptoms and depression.
So why is that? Well, here’s what happens. The hypothyroidism impacts serotonin, which obviously is gonna influence your mood. And then you have these imbalances in this neurotransmitter, and that’s linked to, of course, mood changes, carb cravings, digestive issues, sleep issues. And more low thyroid hormones lead to decreased serotonin levels and an increased turnover of serotonin in your body, which means you have low serotonin levels, and then what you do actually have is quickly eliminated.
So serotonin helps the release of TSH from the pituitary. If you have low serotonin, you have this whole vicious cycle where you have less TSH from the pituitary, which [00:06:00] reduces thyroid hormone levels, which then reduces serotonin levels, and then the deficiencies or breakdowns in serotonin pathways impact.
Thyroid health too. They stall the conversion of T4 into the active t3. They slow down the brain’s communication with the thyroid. So major problems here with serotonin, and it’s not just serotonin. You got a similar problem happening with dopamine. And dopamine is that motivation neurotransmitter. It’s your drive transmitter.
So there’s a two-way street between dopamine and thyroid hormone. Dopamine stimulates the brain to release T s H and impacts both the production of T3 in the thyroid gland and the conversion of t4 to T3 in the brain itself. Now that conversion to T3 is mission critical. It allows thyroid hormones to get into brain cells and keep them active.
So you are mentally alert and have a keen memory. Thyroid hormones stimulate the production of dopamine in both the brain and the kidneys, [00:07:00] cuz the kidneys synthesize neurotransmitters to be used by the body. So low thyroid function decreases the release of dopamine from the mid-brain, which makes it hard to maintain thyroid function.
So again, another vicious cycle, and that vicious cycle is gonna leave you feeling brain foggy and just unmotivated. Next thing you might notice is difficulty concentrating. Now, if you’re struggling to stay awake during afternoon meetings, you can’t focus on that novel you’re reading. It may be your thyroid, because when your thyroid is low, it can reduce the amount of oxygen energy available to the brain, and now as a result, less energy to the brain.
You’ve got issues with memory and concentration and overall brain function, and of course, all leading to what we think of as brain fog when thyroid hormone levels are. The body’s metabolism slows down, which reduces the amount of energy available to the brain. Now, the brain has to have a constant supply of oxygen to [00:08:00] function properly.
If there’s low oxygen, decrease oxygenation, it’s going to limit the brain’s ability to function well. Also low levels of thyroid hormone can impair the brain’s ability to use glucose, which then further reduces the energy available to the brain, which makes it even more difficult to concentrate and pay attention.
Skin problems. So thyroid hormones play a role in regulating the production of semen, and that’s semen is the oil produced by the skin to keep it moisturized. When the thyroid gland is not producing enough T3 and T4 sebum production can slow down and as a result, Your skin becomes thin and dry. Also, when thyroid is low, it also slows down skin cell turnover.
So you’ve got a buildup of dead skin cells on the surface of the skin, more dull, more dry, more thinning skin, and. , like we talked about earlier. Low thyroid can also impact other hormones and especially things like [00:09:00] growth hormone growth hormones critical cuz it helps regulate skin cell growth and repair.
And if you have low levels of growth hormone, then you’ll also have dry scaly skin. Now, I talked earlier about estrogen and how low thyroid can lead to low estrogen. While estrogen is super important for skin hydration. So if your estrogen is low, your skin will get dry too. And there’s one other piece, and this is one I started to notice too, is one of the things you see in hypothyroidism is this yellow tinge the skin.
This is a sign of jaundice caused by a buildup of a yellow pigment called bilirubin. This happens because the low thyroid function slows down the liver’s ability to process bilirubin, so it builds up in the blood and causes yellowing of the skin and the whites of the eyes, brittle and weak nails. Now I know how frustrating breaking a nail can be, and I’m not talking chipping your nail polish, I’m talking about when your nails like split right down the middle or along the side.
You cannot have strong, [00:10:00] healthy nails without having good thyroid function. If the thyroid gland isn’t producing enough hormones, you’re not gonna be making enough keratin. And keratin is that protein that you need for healthy hair and healthy nails. And if you don’t have it, you are gonna have those brittle, weak nails.
And lower thyroid hormones also slows down the rate of nail growth. So look at your nails. If you’ve got ridges, splits, discoloration, your nails are splitting. This could all be a sign that your thyroid is not functioning. This increased sensitivity to cold. Now we all get chilly sometimes, but if all of a sudden you’re in the room and everybody else is like in their tank tops and you’re like sitting there with a big sweatshirt and a hoodie on, you gotta start wondering if your thyroid may be not functioning quite up to snuff.
Because if your thyroid gland’s not producing enough hormones, your body’s overall metabolism and energy production, obviously nose dive, and it makes it just impossible to keep normal internal [00:11:00] body temperature up, right? Remember, your thyroid is a chief regulator of metabolism, so when it slows down, so does your metabolism.
And a slow metabolism makes it harder for your body to warm up so you feel cold, even in warm environments where you wouldn’t normally have felt. And low levels of thyroid hormones can also reduce the production of body heat. So if you’re feeling cold inside when everybody else confirms it, no, it’s just great out.
Check your thyroid. Okay. Constipation. Apparently this is the most common gut complaint with hyperthyroidism. Okay, so why does this happen? Thyroid hormones play a role in regulating the digestive systems metabolism and overall function. And when you’re not making enough thyroid hormones, your digestion slows.
A slow digestive system can lead to decreased contractions of the muscles in the gut. That is gonna make it more difficult for the stool to move through the digestive tract, which [00:12:00] then results in constipation and heart health. heart health is the leading cause of death among women. You may not know that, you might think it’s breast cancer.
Nope, it’s heart health. 50% or more of women, this is what is going to be the thing that takes them. Now, if you’ve got high or low blood pressure, if you’ve got unhealthy cholesterol levels, I know this is when I noticed that my LDL shot up. If you’ve got elevated LP little, a lots of small dents, LDL or HDL particles, or your heart rhythm’s erratic.
all potential red flags for thyroid problems because your thyroid plays several important roles in heart health, including regulating heart rate and rhythm. Including keeping your blood sugar balanced and your cholesterol levels. One study showed that hypothyroidism has profound effects on heart function.
It can impact your cardiac contractility. This is the ability of your heart muscle to contract, and as a result, your heart is a harder time pumping blood. It can impact your blood pressure, your [00:13:00] heart rhythm, and it can increase small dense LDL cholesterol. All of these things increase your risk of heart.
Hypothyroidism can also lead to the development of atherosclerosis. That’s where your arteries become narrow and hard, which is then, of course, gonna increase your risk of heart attack and stroke. Next one, joint pain and swelling. So hypothyroidism may lead to muscle aches, tenderness and stiffness, especially in the shoulders and hips.
And then swelling of the small joints in your hands. And. I still remember being at the gym and doing the regular workouts I did, and I just could not recover. I felt sore and achy for days afterwards and literally went on thyroid hormones and bam, it vanished. So low production of thyroid hormones can decrease the amount of synovial fluid in the joints and the synovial fluid’s critical.
It’s the what lubricates your joints and helps keep them flexible. So if you do not have enough of that, you’re going to start having joint pain and swelling. The other [00:14:00] challenge is the joints also tend to thicken while the bones are thinning. And that can lead to even more joint pain. This can happen anywhere, but the most common places are your knees, your ankles, your foot, and your hand joints.
And it turns out that joint pain is one of the most common complaints with hypothyroidism, but a lot of people don’t associate it. They don’t realize that this is one of the issues. So the big question for you going through all of those is how many of these are you struggling with? And I’ll tell you, if you answer yes, even one of these you’re gonna wanna test, but you are gonna really wanna go beyond the traditional lab tests.
Here’s what you’re gonna wanna have tested, and also where the ideal ranges should be. So first of all, obvious is thyroid stimulating hormone TSH. The TS H test is gonna measure the amount of TSH in the blood, which is produced by the pituitary gland to stimulate the thyroid gland to produce hormones.
According to my buddy, Dr. Isabella [00:15:00] Wentz, the thyroid pharmacist, most people are gonna feel best somewhere between 0.5 and two. Now, I personally. Point five to 1.5 seems to me a sweet spot. And remember, the ranges are like four to 4.5. They’re ridiculous. Disregard those. But remember, TSH is only one piece of the puzzle.
This only reflects the overall level of thyroid hormones. It does not reflect the levels of the active hormones, T3 and T4. Turns out your TSH
levels can be normal, even when levels of T3 and T4 are low, which those alone can also indicate hypothyroidism. Also, TSH alone can’t detect thyroid hormone resistance, which happens when cells are unable to allow thyroid hormone inside cuz their receptor sites are malfunctioning.
So you gotta go beyond just testing tsh. and you wanna get a complete thyroid panel, which is gonna include free t4. Free T4 is measuring the amount of [00:16:00] free or unbound T4 hormone in the blood, which is the active form of the hormone that regulates metabolism. And a total T4 test, which measures the amount of total T4 in the blood, including both bound and unbound form.
So the hormone. . Next, you wanna get a free T3 test, which measures the amount of free unbound T3 hormone in the blood, which is the active form of the hormone that regulates metabolism, and also a total T3 test, which is measuring the amount of total T3 hormone in the blood, including both bound and unbound forms of the hormone.
Then you will do reverse t3. This is a non-active form of T3 that’s gonna help you identify that thyroid resistance I just talked about. And you’ll wanna do thyroid antibody tests to measure the levels of antibodies that attack the thyroid gland, which can indicate autoimmune disorders like Hashimoto’s thyroiditis, because most of hypothyroidism is Hashimotos.
And by the way, you do not wanna. Any of that [00:17:00] elevated there, so where they might say, oh, it’s okay. You’ve got your antibodies a little up. No, you don’t want your antibodies up. You don’t wanna watch your antibodies. You wanna get those things back down to normal. Now, if you have hypothyroidism, if you have anything irregular with anything I just said, you’re gonna wanna work with a functional doc.
that functional doc is gonna help you determine if thyroid supplementation is what’s needed, and if so, what’s the combination that you need? Some people just need t3. Some people just need t4. Some people need a combo. But remember that’s a piece of the puzzle because there’s also several key diet and lifestyle strategies that can make a big impact because the goal is always use as little medication as possible.
Now, first off diet, you’re gonna wanna remove any of the potential autoimmune triggers. You identify your hidden food intolerances. So use My Virgin Diet, right? That’s either Virgin Diet or Breakthrough Food Intolerance online program that is gonna help you with this. And ideally, you’re gonna be pulling dairy, gluten, soy out on an ongoing basis.
Virgin Diet Plan’s [00:18:00] gonna help you incorporate more fiber, more anti-inflammatory, gut healing in as well, because those are super critical. Now, there’s also a variety of supplements that can help your thyroid function better. Selenium, B Vitamin, zinc, vitamin A. And omega-3 fatty acids. You can get those from a well designed daily pack like my Reignite Wellness Daily Essentials, and you’re gonna wanna work with the functional Medicine doc and test your iron and vitamin D levels and supplement if needed.
Now beyond diet and supplements, you’re gonna wanna address stress cuz you cannot fix your thyroid issues if you have chronic stress because chronic stress is going to really get in there and inhibit that conversion from T4 to active t3. So if these warning signs of hypothyroidism resonate with you, Go and get the test from your doctor so you can accurately assess where you are.
In the meantime, you’re gonna wanna watch this next video on simple tips to boost your thyroid health.
For more info on this and other health [00:19:00] topics I cover, or to rate and review, find me on Instagram, Facebook, and my website, and don’t forget to subscribe to my show so you won’t miss a single episode. Go to Thanks again for being with me this week.
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