Let’s Get Rid of Monkey Medicine: What Hypothyroid Disease Revealed to Me
In the first half of my career, adjusting and refilling thyroid medications was another routine part of my day. I’d write a prescription, send a refill, adjust the dose often higher, and move on to two to three times a day. When I asked my colleagues if they were doing the same, they always answered yes. No surprise—levothyroxine is the fourth most prescribed medication in the country (and if you add in all thyroid medications, it's the second most prescribed).
In 2009, I attended a national Family Medicine conference and reconnected with old residency colleagues. One session, led by an endocrinologist, promised an “update” on hypothyroidism. Expecting to learn something new, I walked in eager—only to sit through an hour-long lecture that could have been titled Hypothyroidism 101 for Monkeys. I honestly felt insulted. The key takeaway?
• Only test TSH.
• Treat based on TSH.
• End of discussion.
I walked out of that session with a gnawing feeling—it was one of the first moments in my career when I realized I needed to look beyond the teachers I was learning from.
The Turning Point: Functional Medicine & a New Perspective
Fast-forward to 2012, when I began studying Functional Medicine. For the first time, I heard hypothyroidism explained via treatment as it was meant to be - an autoimmune condition—not just a thyroid problem. Instead of blindly replacing thyroid hormones in a protocol designed for a monkey, the real question became: Why is the immune system attacking the thyroid in the first place? More importantly, can we stop and reverse it?
That shift in thinking changed everything. Since then, I’ve started fewer than five new prescriptions of thyroid medication since 2012. Yes, you read that right—five. And for the numerous new patients who have come to see me already on thyroid meds, I’ve often been able to cut their dose or even help them come off entirely by addressing the root cause.
The Big Picture: Why Your Thyroid Matters
Your thyroid is your body’s gas pedal—it controls metabolism, energy, and brain function. When it slows down (hypothyroidism), you feel sluggish, cold, and foggy. When it speeds up (hyperthyroidism), you feel anxious, sweaty, and like you’ve had one too many espressos.
The #1 Cause: Hashimoto’s (An Immune Problem, Not Just a Thyroid Problem)
Roughly 95% of hypothyroidism cases are due to Hashimoto’s thyroiditis, an autoimmune condition where your immune system mistakenly attacks your thyroid. This isn’t just a thyroid issue—it’s an immune system issue, often tied to gut health, inflammation, and nutrient deficiencies.
The Problem with “Just Checking TSH”
Many doctors rely solely on TSH (thyroid-stimulating hormone) testing and, if you are lucky, Free T3. But that’s like judging a restaurant by its sign outside instead of tasting the food inside. TSH fluctuates and doesn’t tell the whole story. To truly understand thyroid health, you need:
Free T4 & Free T3 – The actual thyroid hormones
Reverse T3 – Can block active thyroid hormone
TPO & TG Antibodies – To check for Hashimoto’s
Can You Have “Normal” Labs and Still Have Thyroid Symptoms?
Absolutely. If your body isn’t converting T4 into T3 properly, or if high stress and inflammation are causing excess reverse T3 (>17ng/dL or rising trend), you can feel terrible—even with “normal” lab values.
Should You Treat Subclinical Hypothyroidism?
If your TSH is slightly high (4.5–10 μlU/mL), but you feel fine, there’s no rush. But if you have symptoms, positive antibodies, or are pregnant, it’s worth addressing. If your TSH is over 10, treatment is usually recommended to prevent long-term issues.
Beyond Medication: What Else Affects Your Thyroid?
Taking thyroid medication won’t fix the root cause. Here’s what really matters:
🔥 Gut Health – Gluten/Dairy sensitivity and gut inflammation can trigger Hashimoto’s.
🧘 Stress & Adrenals – Chronic stress and high cortisol reduce the conversion of T4 to Free T3 (the active form of thyroid).
🥩 Nutrients Matter – Selenium, iodine (cautiously), zinc, iron, B12, vitamin D, and magnesium all play a role.
🏋️ Exercise & Sleep – Movement helps boost T3, and quality sleep keeps everything in balance.
Medication: One Size Doesn’t Fit All
Most doctors prescribe levothyroxine (T4-only), but if your body doesn’t convert T4 to T3 well, you may need a T3 combination (like Cytomel) or natural desiccated thyroid (NDT). The goal? It is to get you feeling your best—not just hitting a “normal” lab value.
Also, the work of Dr. Bihari in the mid-1990s found that in his practice, working with low-dose naltrexone for his cancer patients started showing that his patients with autoimmune diseases such as Lupus often showed prompt control of disease activity. Over the subsequent decades, research has repeatedly pointed to one's endorphin secrections (out internal opioids) playing a central role in the beneficial orchestration of the immune system.
Yet, endocrinologists—the supposed experts in thyroid disease—often fixate on prescribing T4 alone, arguing that combination T4/T3 medications are “less precise.” But there’s a difference between book knowledge and clinical reality.
Here’s the reality: most people today are stressed—physically and emotionally. That means they produce excess reverse T3, which blocks active thyroid hormones. Plus, 80% of T4 is converted into T3 in the liver and gut. And let’s be honest—we live in an obese, alcohol-drinking, processed-food-eating country with fatty liver and gut dysbiosis. If we don’t address these more significant issues, handing out more T4 is like pouring water into a leaky bucket.
The Bottom Line
If your doctor isn’t checking your thyroid antibodies, Free T3, or reverse T3, or considering how your liver and gut affect thyroid function, you might want to find another provider.
I always remind my patients that my practice design's beauty is that you can fire me anytime. If I’m not helping you feel, function, and look your best—if I’m managing your disease instead of working toward healing—then fire me.
Doctors are meant to educate, guide, and heal—not just manage disease. A monkey could do that.
Be BioFIT- Be Educated, Not Influenced.
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Kevin Hoffarth MD, IFMCP
BioFIT Medicine
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