At Active Health, our clinical team meets regularly to review the latest research, challenge assumptions, and strengthen the way we care for our patients. These roundtable discussions help us stay sharp, keep our care collaborative, and ensure that our recommendations reflect both evidence and real-world experience.
Recently, our physicians—Dr. Abra Mabasa, Dr. Nicole Altorelli, and Dr. Jon Lis—focused on a topic that affects millions of Americans: thyroid health. Their discussion highlighted several important insights about diagnosis, treatment, and what patients should understand about this often-misunderstood gland.
Why Thyroid Health Matters
Your thyroid plays a central role in energy regulation, metabolism, body temperature, digestion, and cognitive function. When it’s not working properly, symptoms can be subtle, confusing, and easily attributed to stress, aging, or lifestyle.
Understanding how thyroid disorders present, how they’re evaluated, and how lab results should be interpreted is essential for making informed decisions about care.
Key Insights from the Active Health Provider Roundtable
1. TSH Naturally Rises With Age—And That Changes How We Interpret Labs
Many patients worry when they see a TSH value that appears “high.”
TSH (thyroid-stimulating hormone) is produced by the pituitary gland and signals the thyroid to produce hormone. A higher TSH often means the body is asking the thyroid to work harder. However, TSH levels naturally increase with age.
A practical guideline our clinicians use:
A patient’s age ÷ 10 ≈ the upper limit of normal TSH
For example, an 85-year-old with a TSH of 8 may not require treatment if their free T4 (the main circulating thyroid hormone available to tissues) is normal and they are not experiencing concerning symptoms.
Key takeaway:
Thyroid lab interpretation must account for age, symptoms, and overall health—not just a reference range
2. The Most Useful Thyroid Tests Are Still TSH and Free T4
There are many thyroid-related tests available, but most patients do not need extensive testing.
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- TSH reflects how strongly the brain is signaling the thyroid
- Free T4 measures the amount of active thyroid hormone available in the bloodstream
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Together, these tests reliably diagnose the majority of thyroid disorders in primary care.
Tests such as reverse T3 (rT3) or broad “thyroid panels” are often discussed online. However, research shows wide variation in their use and limited evidence that they meaningfully change diagnosis or treatment decisions in routine clinical care. For most patients, they add complexity without improving outcomes.
One important nuance:
Even reliable thyroid tests can occasionally be affected by medications, supplements, illness, or laboratory assay interference. If results don’t align with how a patient feels—or change unexpectedly—clinicians may repeat testing or interpret results cautiously rather than chasing a single number.
3. Treatment Isn’t Always Straight Forward—And Symptoms Matter
Levothyroxine is the standard treatment for hypothyroidism. It is a synthetic form of T4, the same hormone your thyroid naturally produces.
Most patients do very well on levothyroxine. However, some continue to report symptoms such as fatigue, cold intolerance, or brain fog despite lab values appearing normal.
In select situations, providers may discuss alternative approaches, including:
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- Adjusting dose or timing
- Reviewing sleep, stress, nutrition, inflammation, or other contributing factors
- Combination therapy or desiccated thyroid extract (DTE) in carefully selected cases
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Desiccated thyroid extract (DTE) is a medication made from dried porcine thyroid glands and contains both T4 and T3 (the active thyroid hormone). While some patients report symptom improvement, clinical trials have not consistently shown better quality-of-life or symptom outcomes compared with levothyroxine. Long-term safety data are limited, and some studies note changes in heart rate or weight.
How we approach this at Active Health:
Treatment decisions are made through shared decision-making—balancing symptoms, lab results, goals, and potential risks—rather than defaulting to medication changes alone.
4.Thyroid Nodules Are Common—And Usually Not Dangerous
Thyroid nodules are small lumps within the thyroid gland and are frequently discovered incidentally during imaging done for unrelated reasons.
Important points for patients:
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- Most thyroid nodules are benign
- Ultrasound features help determine risk
- Many nodules require only observation
- Some may need fine-needle aspiration, a minimally invasive biopsy
- A thyroid nodule does not automatically mean cancer
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An important clarification:
Routine screening for thyroid cancer in people without symptoms is not recommended, as it can lead to over diagnosis and unnecessary procedures. Imaging is reserved for cases where there is a clear reason—such as a palpable lump, compressive symptoms, abnormal findings, or an incidental nodule seen on other imaging.
5. Autoimmune Thyroid Disease Often Occurs Alongside Other Conditions
Autoimmune thyroid disorders—such as Hashimoto’s thyroiditis—occur when the immune system targets thyroid tissue.
These conditions often cluster with other autoimmune diseases, including:
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- Celiac disease
- Type 1 diabetes
- Vitiligo
- Pernicious anemia
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When symptoms or family history suggest overlap, targeted screening may help identify related conditions early.
Thyroid Health FAQ
What does the thyroid do?
It produces hormones that regulate metabolism, energy, temperature, digestion, and many other body systems.
What is hypothyroidism?
An underactive thyroid that doesn’t produce enough hormone. Symptoms may include fatigue, weight gain, constipation, depression, and cold sensitivity.
How is thyroid function evaluated?
Most often with TSH and free T4, which together provide a clear picture of thyroid activity.
Do I always need treatment if my TSH is elevated?
No. TSH increases with age, and treatment decisions depend on symptoms, free T4 levels, and overall health.
What are thyroid nodules?
Lumps in the thyroid gland. Most are harmless and only require monitoring.
Can thyroid disease be linked to other conditions?
Yes. Autoimmune thyroid disease often occurs alongside other autoimmune disorders.
What This Means for Patients
Thyroid care is nuanced. Two people with identical lab results may require very different approaches based on age, symptoms, and health history. That’s why our providers collaborate—to ensure decisions are thoughtful, evidence-based, and individualized.
At Active Health, your care reflects the combined expertise of a clinical team—not a single perspective.
Interested in Learning More About Active Health?
If you’re curious about how our practice works, want to meet our providers, or would like to learn more about our approach to preventive and primary care, we offer:
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