Thyroid and Its Treatment – The Cliff Notes Version

Over the past year, the emphasis of our series of articles has been on brain function and the fact that brain dysfunction is a core factor in most if not all chronic pain syndromes. So why an article on thyroid function? Two reasons – when thyroid function is poor it creates a lack of oxygen and increased inflammation in multiple parts of the brain. Thyroid malfunction is closely linked with multiple brain related problems. Reason two – there’s been much confusing information out there on thyroid and we’ve had many requests to clear it up inasmuch as to treat the brain you must be highly conversant in thyroid function and how to correct it. While thyroid dysfunction, its diagnosis, and correction is complex, in fact very complex, we offer you here the cliff notes version on this topic which may answer many of your questions as to why your thyroid is not responding to current treatment.

There are 7 major patterns and 22 major biological pathways that must be understood to be able to evaluate and successfully treat thyroid. In this article we will outline six of the seven major patterns as I feel it will accomplish helping the reader to get a valuable general grasp of this amazingly delicate organ and why symptoms may not be responding to your present therapy.

Pattern Number One – Decreased T4 Production on Lab Test

This is a true hypothyroid and is highly uncommon despite the fact that it is the number one most rendered thyroid diagnosis. Only 10% of thyroids diagnosed as hypothyroid are actually hypothyroids. When this diagnosis is correct, this is the only diagnosis that responds to medication. Stop and think about that.

Pattern Number Two – Pituitary Hypofunction

The pituitary puts out the thyroid stimulating hormone (TSH) that is the one marker always measured in thyroid lab tests. TSH is negatively affected by chronic stress, postpartum depression, inappropriate thyroid medication (see pattern number one. This is very very common) and too much estrogen. Thus, the pituitary gland stops putting out TSH which then comes up in the labs as low TSH which is then misdiagnosed as hyperthyroid. But the patient has hypothyroid symptoms.  This finding drives doctors crazy. The solution for this pattern is usually to address the chronic emotional and adrenal stresses that generally accompany life and pregnancy and to be diligent about discussing your thyroid meds with your doctor when the medications aren’t working.

Pattern Number Three – Thyroid Over Conversion

In other words, the inactive T4 hormone that must be changed to active T3 hormone in order to create energy is over converted and too much T3 is made. This is caused by increased testosterone in a woman caused by PCOS, insulin resistance, poor gut function, and chronic stress.  Metabolic syndromes, and testosterone creams are the cause in men, and in diabetics of both sexes taking insulin is the culprit. What happens is that the active T3 hormones overwhelm the cells in which T3 helps to make energy.  The overwhelmed receptor sites where the cells let T3 enter the cells then become resistant to the T3 hormones. Thus, the T3 doesn’t get into the cell and no energy is created and you develop hypothyroid symptoms. Problem is T4 and TSH are normal on your blood tests and the doctor doesn’t know what to do with you. The solution in this case is finding the cause of the inflammation (testosterone creams, metabolic syndromes, insulin resistance, PCOS, poor gut function) and improving antioxidant status.

Pattern Number Four – Too High of Estrogen in Women

Premarin, estrogen creams, HRT, etc.  There are proteins that carry the inactive T4 hormone from the thyroid to the liver, small intestines, and cells where it is converted into usable T3. When the brain becomes aware that there is too much estrogen in the system it tells the body to create too many carrier proteins. These carrier proteins then over enthusiastically suck up all T4 and T3 hormones so that not enough gets to the cells. Thus, no energy, hypothyroid symptoms, and the diagnostic challenge that your thyroid lab values of TSH, T4 and T3 again read as normal. The treatment – get rid of exogenous estrogen and detox the liver.

Pattern Number Five – Thyroid Under Conversion

The receptor sites mentioned above simply stop working and no thyroid hormone can get into them to create energy.  Result – low thyroid symptoms. Cause – adrenal stress (everything – emotional, infections, inflammation, NSAIDS and other medications).  The diagnosis of this condition is poor because low T3 doesn’t affect TSH and T4 thyroid markers – which are frequently the only markers run. Translation – labs are normal again! Treatment – remove stress, inflammation, infection.

Pattern Number Six – Thyroid Resistance

This is another stress-related pattern in which the pituitary and thyroid glands function normally and make the right amount of thyroid hormones, but the hormones are not getting into the cells to take effect. Symptoms of hypothyroidism appear. Again, elevated levels of the stress hormone cortisol cause the cells to become resistant to thyroid hormones. Managing fight flight response, adrenals and other causes of stress related inflammation indicated by increased homocysteine levels is the treatment.

As stated in the first paragraph of this article we have briefly outlined six of the seven major patterns of the biochemistry, immunology, and neurology that cause thyroid symptoms. For the record the astute diagnostic physician must do a relevant history, full physical exam, and then testing to determine the presence of these causes and this goes even more so for number seven. Number seven is not really a pattern. It’s a condition called autoimmunity and is the cause of both Graves’ disease and the controversial, complex, and omnipresent condition of Hashimoto’s thyroiditis. Next month we will discuss these conditions in as much detail as the space allows.  You can find that article here.

Dr. Martin Rutherford

Dr. Rutherford has worked with thousands of patients from all over the world to help them get to the root cause of their health issues and start to feel better again naturally.

If you are interested in having a consultation with Dr. Rutherford to discuss your specific case and if he feels you would be a good candidate for his protocols please visit


Tsigos C, Chrousos GP. Hypothalmic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002 Oct; 53 (4):865-71

LoPresti, JS and Nicoloff JT Thyroid response to critical illness, endocrinology of Critical Disease Human Press, Totawa N.Y. 1997 Pp 157-173

Datis Kharrazian, DHSC, DC, MS, Chapt 4 Six patterns of Low Thyroid Function and How to Find Them on a Blood Test; Pps 67-95 Why Do I Still Have Thyroid Symptoms When My Blood Tests are Normal, Morgan Jamed RBL, Garden City, NY 2010


  1. Greetings,
    The info is wonderful, however, it is so hard to find a doc to help with fixing it correctly. Such a shame. I’m 70 & I have given up.

  2. Thank you for the Information. It helps to hear what is going on.

  3. Thank you for all this great information! Looking forward to more details–thyroid just emerging on my radar.

  4. I need information on the Hashimoto’s thyroidism. The cause and treatment. Thanks

  5. Thank you so much for this information. It sheds light on this journey and quest I’ve been on for the last 40 years. Right now I’m back into struggle mode and can only pray that the DR who I will be seeing 2 days understands at least some of this. This helps me to be able to give her some history information that I may not have if I hadn’t read your information. I’m so thankful to have found you and am looking forward to your next presentation.

  6. Thank you for this information. I am looking forward to the next article in this series. I developed graves disease and thyroid eye disease several years ago and after three stable years developed hashimotos. I have also suffered from fibromyalgia and joint hypermobility for years and PTSD. Learning the truthabout these conditions is invaluable to me. Thanks again christine

  7. Waiting for #7. I was dx with Hashimoto’s in Oct. and with CLL in 2004. Wondering if they’re related.

  8. Diana Hilsendeger

    Like PB, I have given up. I am sick of bring treated like I am not truthful regarding my symptoms. My thyroid quit working properly after my 1st pregnancy at age 27. I gained weight, my hair & skin dried out, I had every symptom of hypothyroidism, was put on levothyroxine & every time I complained about my symptoms, I was told my tests were normal. Just because I now have grey hair & am 72, does not make me an idiot & I am tired of the attitude of the various doctors I have seen. I have even gone so far as to keep a complete journal of everything I eat & my exercise routine to present to the doctor , only to be told my tests were “normal”. My frustration is overwhelming.

  9. I too have been told w/thyroid med my numbers are in normal range. Yet my skin is cracking my hair falling out my emotions extremely unpredictable fibromyalgia worsening. At times suicidal, have tried in the past. Other autoimmune symptoms suspected. I literally feel like I’m going crazy. I don’t know what thoughts are real

  10. Hello. I have Hashimotos and am very concerned if I can ever feel like myself again. Looking forward for the information about this specific autoimmune.

  11. Hi Dr. Rutherford ,

    Thank you for sharing your knowledge , I enjoyed your article . I have been diagnosed with how Hashimoto disease . Could you recommend a good book on the subject There is so much information on the Thyroid , The research I see is I am in need of iodine and others say that it aggravates the condition .

    Thank you kind regards ,

    Laurie RN PHN

  12. My husband is 50 and really low thyroid. He suffers from severe joint pain and we can not find a doctor to help him with his pain.

  13. Thank you so much for the info but being someone who is not well educated (I am a high school graduate), I found it hard to understand I started out at age 11 with hyperthyroidism & a goiter, sometime along the way it changed to hypothyroidism & a diagnosis of thyroid cancer.

  14. This is great information- thank you! I may be in the 10% that is legit hypothyroid. I fought the diagnosis for a couple years before finally going on Levoxyl – I didn’t know how bad I felt until I started feeling better and then I wanted to give everyone some Levoxyl! I was so confused by several friends who were diagnosed as hypo but did NOT feel better on medication – makes more sense now.

  15. I get blood work every 3 months & my thyroid changes often, the doctor put me on Thyro-gold….300mg at times….when 3mos later it’s over active, so I switch to the 150mg as per Doctor….I can usually tell if it’s over active when my Essential Tremors get worst….

  16. It is the tendency to depend on blood work and assume that one is suffering from something else. I too was on thyroid meds and high anxiety near the change time. I was place on birth control pills monthly regular at that point hair nails all better. Time to time I’d get flight fight .cold all the time. I’m looking for new PCP and not certain where to start at my age over 60. I have many symtoms and the dam seems to break seasonally.

  17. How can I follow you? Interested in the upcoming article you mentioned.

  18. Thank you so much for all the information that you are putting out. I am a second year Nutritional Therapy student and listening to your podcasts and reading your articles has made things so much clearer and understandable. so, once again, I thank you xxx

  19. I wish there were doctors that cared about thyroid patient’s. They only care about the tsh numbers not the person. I’m done fighting to feel better. No reason to fight anymore. Sick and tired of being tired weak and no doc listing to me. 42 years of dealing with this um tired of never feeling good.

  20. Dr. Rutherford
    Thank you for explaining all of this. Could you recommend a doctor here in San Diego, CA that views thyroid as you do. My doctor is an endocrinologist, but only adjusts my RX via my labs, not my ongoing symptoms.
    Thank you

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