Stop Chasing TSH Only
Why “TSH NORMAL” can still feel like fatigue, coldness, mood swings & weight gain — and what to test + treat (dosha-wise).
Index
- Why TSH Alone Is Not Enough
- The Full Thyroid Map (TSH, Free T4, Free T3, Reverse T3)
- Key Labs That Decide Symptoms (Ferritin, Vitamin D, B12)
- When to Suspect Conversion / Reverse T3 / Deficiency Pattern
- Ayurvedic View: Agni, Rasa–Meda, Srotas & Ojas
- Dosha-wise Protocols (Remedies + Dosages + Supplements)
- Diet & Lifestyle Rules That Make Medicines Work
- Supplement Guide (Simple Dosage Table)
- Safety Notes & When to Refer
- Final Takeaway
Why TSH Alone Is Not Enough
Many patients hear: “Your TSH is normal.” Yet they still experience tiredness, cold intolerance, hair fall, constipation, mood swings, brain fog, and weight gain.
TSH is a brain signal. It tells how strongly the pituitary is “calling” the thyroid. But symptoms depend on what happens after hormones reach tissues: conversion (T4→T3), receptor sensitivity, inflammation, nutrient status, and stress physiology.
Key concept:
Normal TSH ≠ Normal cellular thyroid action.
Normal TSH ≠ Normal cellular thyroid action.
The Full Thyroid Map (TSH, Free T4, Free T3, Reverse T3)
1) TSH — “Brain Demand Signal”
- High TSH often suggests low thyroid output or poor thyroid response.
- Normal TSH can still coexist with low tissue thyroid action (conversion block, reverse T3, deficiencies).
2) Free T4 — The “Stored / Transport” Hormone
- Free T4 is largely a pro-hormone.
- If Free T4 is okay but symptoms persist, you must evaluate conversion to Free T3.
3) Free T3 — The “Active Worker”
- Free T3 enters cells and drives metabolism, temperature, mood stability, bowel motility, and menstrual rhythm.
- Low Free T3 = classic hypothyroid symptoms even with “normal” TSH.
4) Reverse T3 — The “Metabolic Brake”
Reverse T3 (rT3) is commonly elevated in survival states: chronic stress, inflammation, infection, under-eating, poor sleep, overtraining. It can block T3 activity at receptor level — the body chooses survival over speed.
Practical clue: If the patient says “I can’t tolerate fasting, I crash easily, I feel worse in stress,” think about reverse T3 / cortisol-driven block.
Key Labs That Decide Symptoms (Ferritin, Vitamin D, B12)
Ferritin
Ferritin (Iron Stores)
- Low ferritin reduces oxygen delivery and weakens T4→T3 conversion.
- Hair fall + fatigue + palpitations can be worse if ferritin is low.
Clinical tip: Many patients feel better when ferritin is optimized (not merely “within range”).
Vitamin D
Vitamin D
- Low Vitamin D increases immune dysregulation and autoimmune tendency.
- Deficiency can worsen mood, body ache, fatigue, and thyroid autoimmunity.
B12
Vitamin B12
- B12 deficiency mimics hypothyroid symptoms: fatigue, low mood, tingling, poor focus.
- Common in veg diet, gastritis, metformin/PPI use, malabsorption.
When to Suspect Conversion / Reverse T3 / Deficiency Pattern
- TSH “normal” + symptoms strong → check Free T3, rT3, ferritin, Vitamin D, B12.
- Free T4 ok/high + Free T3 low-ish → conversion issue (liver/gut/stress/nutrients).
- Symptoms worsen after dieting/fasting → survival physiology, possible rT3 dominance.
- Autoimmune symptoms (body ache, fluctuating energy, throat heaviness, family autoimmunity) → consider thyroid antibodies clinically.
Remember: the thyroid is not a single gland problem — it is a system problem (gut–liver–stress–nutrition–sleep).
Ayurvedic View: Agni, Rasa–Meda, Srotas & Ojas
In Ayurveda, many thyroid patterns reflect disturbance of: Agni (metabolic intelligence), Rasa (nourishment, fluid transport), Meda (storage tissue), and Ojas (vital resilience).
- Kapha–Meda dominance → heaviness, slow metabolism, weight gain, edema.
- Vata dominance → anxiety, insomnia, dryness, constipation, irregular cycles.
- Pitta dominance → inflammation, hair fall, irritability, autoimmune tendency.
Thyroid “healing” becomes easier when you treat Agni + stress physiology + dhatu nourishment, not only labs.
Dosha-wise Protocols (Remedies + Dosages + Supplements)
Clinical note: Dosages below are typical adult ranges used in practice. Adjust for age, pregnancy/lactation, comorbidities, and concurrent thyroid medication. Avoid self-medication in complex cases.
Vata-dominant Thyroid Pattern
Common picture: tired + anxious, cold hands/feet, constipation, dryness, insomnia, palpitations in stress.
Ayurvedic Remedies (Typical Dosages)
- Ashwagandha churna: 3 g at night with warm milk (or warm water) after food.
- Brahmi ghrita: 1/2 tsp in the morning (with warm water or milk).
- Kshirabala taila (101) abhyanga: 10–15 ml, 3–4 times/week (neck + chest + whole body as needed).
- Triphala (if constipation): 3–5 g at night with warm water.
Diet & Lifestyle Focus
- Warm, cooked, oily, grounding meals; avoid excess raw salads, cold smoothies, prolonged fasting.
- Sleep timing: target 10:30 pm–6:30 am.
- Daily 10 minutes: slow breathing (exhale longer than inhale).
Supplements (Typical Dosages)
- Magnesium glycinate: 200–400 mg at night.
- Vitamin B12 (methylcobalamin): 1000 mcg daily (or 1500 mcg 3–4x/week).
- Omega-3 (EPA+DHA combined): 1000 mg daily with meals.
Pitta-dominant Thyroid / Autoimmune Pattern
Common picture: hair fall, heat intolerance, irritability, acidity, skin inflammation, autoimmune tendency.
Ayurvedic Remedies (Typical Dosages)
- Guduchi satva: 500 mg twice daily after meals.
- Shatavari churna: 3 g once or twice daily with milk (or warm water if dairy not suitable).
- Praval pishti: 125 mg twice daily after meals (especially if burning/heat/palpitations).
- Amla rasayana (if available): 5–10 g daily in the morning.
Diet & Lifestyle Focus
- Cooling, anti-inflammatory routine; avoid excess chilli, alcohol, late-night work, very high caffeine.
- Hydration + mineral support; emphasize bitter greens and seasonal fruits.
Supplements (Typical Dosages)
- Vitamin D3: 2000–4000 IU daily with fat-containing meal (adjust to baseline level).
- Selenium (selenomethionine): 100–200 mcg daily.
- Curcumin (standardized): 500 mg daily with food (if gastric tolerance is good).
Kapha-dominant Thyroid / Weight-gain Pattern
Common picture: weight gain, heaviness, puffiness, lethargy, slow digestion, high cholesterol tendency.
Ayurvedic Remedies (Typical Dosages)
- Kanchanar guggulu: 2 tablets twice daily after meals.
- Trikatu churna: 1/2 tsp before meals (with honey or warm water) once or twice daily.
- Punarnava mandoor: 250 mg twice daily after meals (if edema/heaviness + low Hb tendency).
- Warm water sipping: 6–8 sips every 30–45 minutes for a few hours daily (kapha mobilization).
Diet & Lifestyle Focus
- Light, warm meals; reduce dairy (esp. at night), fried foods, bakery, sugary drinks.
- Breakfast should be protein-forward; avoid “only fruit” breakfast if it causes rebound hunger.
- Walk 10–15 minutes after meals.
Supplements (Typical Dosages)
- Zinc picolinate: 20–30 mg daily with food.
- Iron (only if ferritin is low): elemental iron 18–27 mg daily (monitor tolerance).
- L-Tyrosine: 500 mg in the morning (avoid if uncontrolled anxiety, palpitations, high BP).
High Reverse T3 / Stress-Block Pattern
Common picture: “TSH normal” but severe fatigue, crash after stress, worse with dieting/fasting, poor recovery.
Ayurvedic + Lifestyle Strategy
- Stop aggressive fasting & overtraining for 4–6 weeks.
- Stabilize meals: protein + fiber + fat (no long gaps if patient crashes).
- Prioritize sleep + nervous system downshift.
Ayurvedic Remedies (Typical Dosages)
- Ashwagandha extract: 300 mg twice daily after meals (or at night if daytime causes drowsiness).
- Anu taila nasya: 2 drops each nostril in morning (if suitable).
- Brahmi vati (gold-free): 1 tablet once or twice daily after meals (patient-specific).
Supplements (Typical Dosages)
- Phosphatidylserine: 100–200 mg at night (stress-cortisol support).
- CoQ10: 100 mg daily with meals.
- Electrolytes (no sugar): 1 serving/day (esp. fatigue + low BP + poor recovery).
Diet & Lifestyle Rules That Make Medicines Work
- Sleep is the thyroid amplifier: aim for consistent sleep-wake timing.
- Protein at breakfast helps prevent 11am crash and reduces stress-cortisol loop.
- Don’t skip minerals: sodium/potassium/magnesium matter for fatigue & mood stability.
- Movement: walking after meals improves insulin signaling and metabolic rhythm.
- Stress physiology: long exhale breathing (5–10 minutes/day) improves autonomic tone.
Simple breath practice: 4 sec inhale + 6–8 sec exhale × 20 breaths daily.
Supplement Guide (Simple Dosage Table)
Use supplements based on symptoms and labs. Avoid stacking everything at once—start with the most relevant 2–3.
- Vitamin D3: 2000–4000 IU/day with meals (adjust to level & follow-up).
- Vitamin B12 (methylcobalamin): 1000 mcg/day (or 1500 mcg 3–4x/week).
- Magnesium glycinate: 200–400 mg/night.
- Selenium: 100–200 mcg/day (often useful in autoimmune patterns).
- Zinc: 20–30 mg/day with food.
- Omega-3 (EPA+DHA): 1000 mg/day.
- CoQ10: 100 mg/day (fatigue + stress block).
- Iron: only if ferritin low; elemental 18–27 mg/day (monitor GI tolerance).
Safety Notes & When to Refer
- Pregnancy, lactation, arrhythmia, uncontrolled hypertension, bipolar disorder, and severe anxiety need individualized planning.
- If there is rapid weight loss, severe palpitations, tremors, or eye symptoms, rule out hyperthyroid causes urgently.
- If on thyroid medication, dose changes must be monitored with clinician supervision and follow-up labs.
- Mineral/herbo-mineral preparations should be used only with proper clinical indication and sourcing.
Final Takeaway
Don’t chase TSH alone. Thyroid recovery becomes predictable when you optimize: Free T3 action, reduce reverse T3 blocks, correct ferritin/D/B12, and balance Agni + dosha + nervous system.
CTA idea: “If your TSH is normal but symptoms persist — comment
THYROID. I’ll share the complete lab checklist + dosha-wise guide.”
