Untreated Thyroid Disease: Do You Feel Cold, Fat, and Tired?

By Susan E. Sklar, M.D.
Untreated thyroid disease is more common than you may think and affects thousands of women. For some it destroys their life. Feeling cold and exhausted diminishes the quality of your life. Many women feel sick. As a functional medicine doctor, Dr. Sklar knows how to interpret lab results. She wants your thyroid labs to be at “optimal” levels, not just in the “normal” range.

Despite these symptoms, doctors often say “your labs are normal”. The untreated thyroid disease and this “medical” rejection is for many women a slap in the face.  In this blog I share why this is happening and how to get help.  You will see why traditional medicine is unable to help women with thyroid disease. You will find out that help is within reach.

Woman in coat indoors cold due to untreated thyroid condition

Cold and Exhausted: Familiar Symptoms that Go Untreated

She sat there on a summer day in a wool coat, her face haggard and drawn from exhaustion, telling me how she had no energy, was steadily getting fatter, and felt cold no matter how many layers of clothes she wore. She retired early because she had difficulty functioning on the job. Gina couldn’t remember things and her brain worked so slowly that she felt like she was under water slogging her way through each day.

She had seen 8 doctors over 5 years without relief. I knew what the problem was before any lab results were back. When I told her, she looked stunned.

This is a story I have heard over and over since starting my restorative medicine practice. As a holistic medical doctor, I am able to put the pieces of the puzzle together and get people back to living their best lives.

Why does this happen? There are an estimated 20 million Americans with untreated thyroid disease. They occur far more often in women than in men. Yet, untreated thyroid disease is one of the most commonly misdiagnosed and mistreated health problems in America.

What is the trouble with a conventional approach to thyroid problems?

Gina’s doctor ordered the usual thyroid tests which didn’t effectively show whether her thyroid was working well. After ordering the test, they interpreted the results in a knee-jerk fashion by seeing that her results were in “the normal range.” The “normal range” is a spread from low to high of where 95% of the population’s thyroid levels are. Most of the patients I see are somewhere in the normal range but not at the best level to feel good.

Here’s how it works.  When your lab results are ready, the doctor has his/her staff send you a message that “everything is normal.” The low thyroid levels go untreated. You’re crushed by this information because you feel awful and know in your heart that something is wrong, but it never shows up on testing, like Gina and her story above.

Why is the thyroid gland so important?

Your thyroid gland governs your metabolism, which is your body’s equivalent to your car engine. If your engine is sluggish, you move slowly. The speed of your engine runs affects how your body functions. Every cell in your body is under the influence of the thyroid gland. The speed of the chemical processes in your body depends on instructions from your thyroid gland.

The less active your thyroid gland, the more sluggish your body. Protein production slows down. Finger and toenails become brittle. Your hair is dry, your skin flakes. This sluggishness can affect your intestine and cause chronic constipation.

Untreated thyroid disease affects the brain. It is harder to think. Everything slows down. Your energy decreases. You may feel like you are moving slowing and through a very thick liquid because everything is so difficult. Weight gain is out of control. No matter what you do—diet restriction or exercising—you continue to gain weight. The thyroid is the master regulator of your metabolic engine and when it is slowed down, your body and mind suffer.

What about thyroid testing?

Proper thyroid testing is the subject of a lot of confusion and so a lot of thyroid problems are going untreated. While doctors seem stuck in an old paradigm, patients are suffering. So, let’s take an expanded view of thyroid testing.

T3 is your accelerator.

T3 (triiodothyronine) is your active thyroid hormone. It is like putting your foot on the accelerator. The more T3, the faster you go. T3 has cellular receptors (a place to act) in every cell in your body. This means it can put the foot on the accelerator in every single cell.

Your regular doctor rarely orders this test.  Most of the time when it is, the healthcare provider does nothing about it when it is low. Low T3 has been linked to chronic fatigue.[1]

At the Sklar Center, we want to see levels in the optimal range, where you feel and function your best, not just somewhere in the “normal” range. It is the key to understanding your metabolism. When it is low, everything slows down. It is the most accurate and direct gauge of the speed of your engine.

T4 is your reservoir.

T4 (thyroxine) is an inactive thyroid hormone. Its only role is turn into T3. It is an available reservoir of hormone for when your body needs more T3. This is the hormone that your conventional doctor tests. If you have problems making T3 from T4, your T4 level can look fine even when you feel like you are exhausted. Using the T4 as the gauge of your thyroid health is misleading. We find this is what normally happens.

Is TSH a good measure of thyroid function?

TSH (thyroid stimulating hormone) is the most commonly ordered thyroid test by your conventional medical doctor. The brain produces TSH and regulates the thyroid gland. Again, like T4, it is an indirect test and does not show a low functioning thyroid gland much of the time. TSH levels go down with age so they are an even worse predictor of thyroid health in older people. Using this as the main test for thyroid activity is woefully misleading, but that’s usually what’s done.[2]

 Reverse T3 puts on the breaks.

Thyroid’s Twin, Reverse T3.  Reverse T3 is another thyroid hormone that we have not mentioned. It is the mirror image of T3. In the world of biological reactions this means that it can take up the place of T3, but it isn’t going to cause the metabolic changes we want to see. It is isn’t going to put the foot on the accelerator. It does exactly the opposite. It puts the breaks on.

Reverse T3 is useful during times of famine when we need to slow down body processes to conserve energy. Most of the time, we are not in a famine situation and Reverse T3 levels rise for other reasons. Reverse T3 levels rise when we become stressed and produce high cortisol levels. Levels also rise when we lack certain nutrients like selenium and iodine. The result of a high Reverse T3 is that we can have any or all the symptoms of low thyroid and still have normal T3 thyroid blood testing.

What does this mean for patients?

In Gina’s case, the doctor did not order the proper test for truly evaluating thyroid function. Her doctors only ever ordered free T4 levels and they were normal despite her extreme symptoms. They should have tested for the free T3 to properly assess whether the accelerator was working in her engine.

Sometimes doctors do order Free T3, but then interpret it as being in the normal range. Often, they don’t understand where the level needs to be for a person to feel well and function properly. So even when patients have pressured their unwilling doctors to order the free T3, usually the results come back “in the normal range” and patients are disappointed that they don’t qualify for treatment in the opinion of their doctor.

What is the functional medicine approach to thyroid treatment?

In the few times that your tests are outside the reference ranges, conventional doctors do diagnose low thyroid function. However, the medications that most doctors prescribed restore only one of your thyroid hormones, T4. These are the pharmaceutical products know as levothyroxine, Levoxyl™, or Synthroid™.

Once you begin treatment with one of these medications, your conventional doctor will use the TSH test to guide your treatment. Unfortunately, TSH is known to be a poor guide to restoring your thyroid hormone. So, millions of people are suffering with low thyroid symptoms. Doctors tell them everything is normal and there are no more treatment options.

What’s the history behind doing this?

For many years, drug companies processed porcine thyroid, derived from pig’s thyroid glands. Manufacturers formed pig thyroid into tablets for humans to use. It worked very well and was used for many years starting in the 1930’s. It contains T3 as well as T4 and some other minor thyroid hormones. It was the main thyroid replacement used until the development of Synthroid™ which is synthetic T4. By some sleight of hand and aggressive marketing, Synthroid became the biggest selling thyroid medication.[3]

The makers of Synthroid marketed their product as a superior one to doctors.  The Food and Drug Administration had grandfathered in Synthroid even though it had never met regulatory standards. The Journal of the American Medical Society finally published a study of effectiveness of Synthroid after the makers of Synthroid suppressed the results.  It showed that Synthroid was no more effective or consistent than other T4 preparations.[4] By then most doctors had converted from Armour thyroid to Synthroid thinking it was a more modern treatment. They felt that the use of Armour Thyroid was “old fashioned”.  Therefore, the use of Armour Thyroid and fell out of favor to the detriment of the public.[5]

Relief is here at last!

As expected, Gina’s Free T3 was one of the lowest levels I had ever seen. Her diagnosis was untreated thyroid disease.  When I showed her the results on her lab test, she began to cry—tears of anger that no one over the course of five years had figured out her problem—and tears of relief that finally she could feel better.

We started Gina on a low dose of Armour Thyroid while further evaluating probable causes of low thyroid function. Within the first month her energy improved, and she no longer needed to wear a wool coat to keep warm. Eventually, her brain worked better, and she was even able to go back to school for retraining. Gina knew that she would enjoy her retirement.

If you are experiencing unusual fatigue, coldness or have unexpected weight changes no matter how hard you try to eat properly, you may need a proper thyroid evaluation by a Thyroid Specialist at the Sklar Center. Give us a call today at 562-596-5196 to request a consultation.


  1. <id=”note1″>F Ruiz-Núñez B, Tarasse R, Vogelaar EF, Janneke Dijck-Brouwer DA, Muskiet FAJ
    Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case-Control Study.
    Endocrinol (Lausanne). 2018 Mar 20;9:97. doi: 10.3389/fendo.2018.00097. eCollection 2018.
    LINK: Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case-Control Study.
  2. <id=”note2″>EA McAninch
    New insights into the variable effectiveness of levothyroxine monotherapy for hypothyroidism
    Lancet Diabetes Endocrinology 2015
    LINK: New insights into the variable effectiveness of levothyroxine monotherapy for hypothyroidism
  3. <id=”note3″>Kenneth M. Lankin, MD, MC USN
    Bioequivalence of Levothyroxine Preparations: Issues of Science, Publication, and Advertising
    JAMA. 1997;278(11):897. doi:10.1001/jama.1997.03550110035024
    LINK: Bioequivalence of Levothyroxine Preparations: Issues of Science, Publication, and Advertising
  4. <id=”note4″>Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK
    Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study
    J Clin Endocrinol Metab. 2013 May;98(5):1982-90. doi: 10.1210/jc.2012-4107. Epub 2013 Mar 28.
    LINK: Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study
  5. <id=”note5″>Snyder S, Listecki RE
    Bioidentical thyroid replacement therapy in practice: Delivering a physiologic T4:T3 ratio for improved patient outcomes with the Listecki-Snyder protocol.
    Int J Pharm Compd. 2012 Sep-Oct;16(5):376-80.
    LINK: Bioidentical thyroid replacement therapy in practice: Delivering a physiologic T4:T3 ratio for improved patient outcomes with the Listecki-Snyder protocol.

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