Autoimmunity (Hashimoto's)
Thyroid antibodies can be raised long before TSH changes.
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Thyroid health
Thyroid symptoms, but told your results are normal?
Tiredness, feeling cold, weight gain, hair loss, low mood and brain fog are classic thyroid symptoms. Yet many people are told everything is fine because only TSH was checked. A full thyroid assessment often tells a different story.
Free, no obligation. First consultation £354, including a health coaching session. See fees
20+ years in clinical practiceIFM Certified PractitionerBritish Acupuncture Council member
The short answer
Can you have a thyroid problem with a normal TSH result?
Yes. TSH is a signal from the brain, not a measure of thyroid hormone itself. A normal TSH can miss poor conversion of T4 into active T3, and thyroid antibodies, as seen in Hashimoto's, can be raised for years before TSH changes. Charmaine Shepherd offers full thyroid testing (TSH, free T4, free T3, reverse T3 and antibodies) and looks at the nutrients, gut health and stress that affect thyroid function.
- WhoCharmaine Shepherd, IFM Certified functional medicine practitioner, 20+ years in clinical practice
- Where4 Albyn Place, Edinburgh EH2 4NG, or online by video
- CostFree 20-minute discovery call. Initial consultation £354, return visits £264
- ReferralNot needed. You can book directly
Is this you?
Do these thyroid symptoms sound familiar?
- Tiredness that sleep doesn't fix
- Feeling cold when others aren't
- Weight gain or difficulty losing weight
- Hair thinning, dry skin or brittle nails
- Low mood, anxiety or brain fog
- Constipation
- Heavy or irregular periods, or fertility problems
- A family history of thyroid or autoimmune disease
If any symptoms are sudden or severe, contact your GP, call NHS 24 on 111, or call 999 in an emergency.
Why can a normal TSH miss a thyroid problem?
TSH is a signal from the brain asking the thyroid to work harder. It is a useful screening test, but it doesn't show how much active thyroid hormone (T3) is reaching your cells, or whether your immune system is attacking the thyroid.
Hashimoto's thyroiditis, the most common cause of an underactive thyroid in the UK, can be developing for years while TSH is still in range. Problems converting T4 into active T3, often linked to stress, nutrient levels, inflammation or gut health, can also cause symptoms while results look "normal".
Reference ranges are wide, too. Being inside the range is not the same as being where you feel well. I look at the full picture, alongside your symptoms, rather than at one number.
Looking for the cause
What affects thyroid function?
Most people have more than one contributing factor. The aim is to find yours, so treatment targets the cause rather than just the symptoms.
Poor T4 to T3 conversion
Stress, low selenium, zinc or iron, and inflammation can all reduce active hormone.
Gut health
A good share of thyroid hormone activation depends on a healthy gut. Coeliac disease is also linked to thyroid autoimmunity.
Nutrient gaps
Iodine, selenium, iron, vitamin D and B12 all affect thyroid function and how you feel.
Stress & cortisol
Ongoing stress raises reverse T3, which blocks thyroid hormone from working.
Life stages
Pregnancy, the postnatal period and perimenopause are common times for thyroid problems to appear.
How I investigate
What does a full thyroid test include?
A full thyroid assessment usually includes:
- TSH, free T4 and free T3how much hormone is made and how much is active
- Reverse T3the 'brake' on thyroid hormone, often raised by stress or illness
- Thyroid antibodies (TPO and TG)to check for Hashimoto's or other autoimmune thyroid disease
- Iodine, selenium, iron and ferritin, B12, vitamin Dnutrients the thyroid depends on
- Gut and adrenal testing where relevantbecause both affect thyroid function
Tests are priced separately and always agreed with you first. Bring any recent NHS or private results to your consultation. See all laboratory tests
How it works
How does working with Charmaine work?
Free discovery call
Tell me what’s going on and find out whether my approach is right for you.
Initial consultation
A detailed look at your history, symptoms and lifestyle, with tests recommended only where they will help.
Your plan & follow-up
A written plan covering nutrition, lifestyle and targeted supplements, reviewed as your results and symptoms change.
In person at 4 Albyn Place, Edinburgh, or online by video. See all fees
Hormonal Imbalance and Fatigue Resolved Through Gut Health
1 min readRead →
A patient story
Three years of "normal" results
A 42-year-old woman with severe fatigue had been told her results were normal for three years, based on TSH alone. Fuller testing found raised thyroid antibodies, gut dysbiosis and a hormone-clearance problem. Within three months her energy returned and her cycles became regular.
Everyone is different, and results vary from person to person.
Questions
Questions about thyroid problems
Can’t see your question? Book a free call or ring the clinic on 0131 235 1232.
See also: All laboratory tests · Perimenopause & menopause
Can you diagnose Hashimoto's?
Testing can show raised thyroid antibodies, which is how Hashimoto's is identified. I'll share results with you and, with your agreement, your GP, who can confirm a diagnosis and prescribe thyroid medication if you need it.
I'm already on levothyroxine but still feel unwell. Can you help?
Yes, this is very common. We look at conversion to T3, antibodies, nutrients, gut health and stress, which can all affect how well your medication works. Any change to your prescription stays with your GP.
Can I bring my NHS results?
Please do. I'll review them and only suggest extra tests that would add something new.
Can thyroid testing be done online?
Yes. Blood tests can be done at the clinic, at a local phlebotomy service or with a home finger-prick kit, depending on the test.
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Talk to me about thyroid problems
Book a free discovery call and we’ll work out the best next step together.
Book a free discovery callFree, no obligation. First consultation £354, including a health coaching session. See fees
