The Thyroid Is Rarely the Root Problem

A root-and-branch approach to thyroid imbalance

In my practice, I see thyroid hormone imbalance every single week. Fatigue, weight gain, hair thinning, brain fog, cold sensitivity, low mood, cycle changes, and stubborn inflammation are often quickly traced back to the thyroid.

Thyroid imbalance has quietly become epidemic, especially among women. What concerns me most is not how common thyroid diagnoses are - but how often the investigation stops once a prescription is written.

In conventional care, the focus is frequently on the branch - the lab value - without asking what is happening at the root.

Why Replacing One Hormone Isn’t the Whole Story

Levothyroxine (T4) is one of the most commonly prescribed medications in the United States. Millions of people are started on it every year, often after a first set of low or borderline labs.

In some cases, thyroid hormone replacement is absolutely appropriate and necessary. I respect that. But I also see how often medication becomes the end of the conversation, rather than the beginning of a deeper one.

A healthy thyroid does not produce just one hormone. It produces:

• T4 (thyroxine) – a storage and transport hormone

• T3 (triiodothyronine) – the active hormone used by cells

• T2, T1, calcitonin, and other regulatory compounds

Levothyroxine replaces T4 only. It assumes the body will reliably convert that T4 into active T3. But physiology does not always cooperate that neatly.

What T4 and T3 Actually Do

I often explain thyroid hormones this way:

T4 is supply. T3 is action.

T4 (The Branch Supply)

• Circulates in the bloodstream as a reserve

• Reflects thyroid output, not cellular use

• Must be converted to T3 to have effect

• Can appear “normal” on labs even when symptoms persist

T3 (The Root-Level Regulator)T3 is the hormone that enters cells and tells them how fast to function. It directly influences:

• Energy production and metabolic rate

• Brain function, focus, and mood

• Heart rhythm and cardiac strength

• Muscle tone and recovery

• Digestive motility

• Temperature regulation

• Cholesterol metabolism

• Bone remodeling and bone strength

• Hair, skin, and nail growth

• Fertility and hormone signaling

When T3 is low at the tissue level, the body shifts into a low-energy, low-repair state, even if T4 and TSH appear acceptable on paper.

This is one of the most common reasons I hear, “My labs are normal, but I don’t feel normal.”

When T4 Doesn’t Convert to T3

Conversion of T4 into T3 is not automatic. It is a root-level metabolic process that depends on multiple systems working together.

Common reasons T4 is poorly converted to T3 include:

• Chronic stress and elevated cortisol

• Ongoing inflammation

• Nutrient deficiencies (iodine, selenium, zinc, iron, B vitamins)

• Gut dysfunction

• Liver congestion or overload

• Blood sugar instability

Does any of this sound familiar? Could one - or several - apply to you?

If so, I don’t assume your thyroid is failing. I ask what your thyroid might be responding to.

Is the Thyroid the Root Problem - or a Branch Response?

One of the most important questions I ask is this:

Is the thyroid truly underproducing - or is it adapting to a deeper imbalance?

In many cases, reduced thyroid output is a protective, downstream response. The body may be slowing metabolism in response to:

• Chronic stress or unresolved trauma

• Autoimmune activity

• Inflammatory burden

• Hormonal imbalances, such as estrogen dominance or adrenal dysfunction

• Nutrient depletion

• Environmental toxin exposure

When we treat only the branch with hormones, we may temporarily improve numbers - while the underlying cause continues unchecked.

Levothyroxine Is Common - And Overtreatment Happens

Another piece of the conversation that deserves attention is what happens after thyroid medication is started.

Research shows that a meaningful percentage of people on levothyroxine become overtreated over time, particularly as weight, stress levels, age, and overall physiology change. Low TSH from overtreatment isn’t just a lab issue - it can increase strain on the heart and accelerate bone loss.

This isn’t an argument against medication. It’s an argument for ongoing reassessment and individualized care.

Iodine: A Root Nutrient Can’t Be Ignored

Iodine is essential for the production of both T4 and T3. Without adequate iodine, the thyroid simply cannot do its job.

Iodine also supports:

• Breast and ovarian tissue health

• Immune function

• Cellular metabolism

Both iodine-rich foods and appropriate supplementation are imperative for thyroid health. However, iodine must always be used thoughtfully, with proper cofactors - especially selenium - and within the context of the full clinical picture.

Supporting the Root to Heal the Branch

In my work, thyroid care is never about a single lab or a single prescription.

A root-based approach often includes:

• Assessing key nutrient status

• Supporting gut and liver function

• Regulating stress and adrenal output

• Addressing inflammation and autoimmunity

• Balancing blood sugar and hormones

• Determining whether thyroid suppression is primary or secondary

Medication may still be part of the plan - but it should never replace understanding why the thyroid is struggling.

Your thyroid may not broken but communicating.

When we listen at the root instead of silencing the branch, the body often responds with resilience and clarity - not because it was failing, but because it needed support in the right places.

About Dr. Elena Nott, DAcHM, LAc

Dr. Elena Nott is a Doctor of Acupuncture and Herbal Medicine, and the founder and practitioner of Roots and Branches Healing Center, where she provides individualized holistic therapies. She is passionate about preventative care as the foundation of health and well-being.

Disclaimer: This content is for informational purposes only and should not be considered medical advice, diagnosis, or treatment.