In this video Dr. Ashley Frazee, a direct primary care physician, explains Hashimoto's thyroiditis, its relationship to hypothyroidism, and when thyroid medication is truly warranted. She describes how Hashimoto's is an autoimmune attack on the thyroid that may exist for years with normal hormone levels, and clarifies that elevated TPO antibodies alone do not justify treatment. Dr. Frazee walks through the key thyroid labs—TSH, free T4, free T3, and reverse T3—explaining what each measures, typical thresholds, and why TSH is the primary screening tool. She outlines a cautious decision‑making framework: if TSH is high and free T4 or T3 are low, medication is likely needed; if all hormone levels are normal despite high antibodies, watchful waiting with repeat testing (usually after four weeks) is preferred. The video warns of overtreatment side effects (anxiety, insomnia, palpitations, bone loss) and the practical challenges of taking levothyroxine correctly. Dr. Frazee shares a patient case where natural interventions (dietary changes, supplements, stress‑reduction practices) helped normalize labs without medication, emphasizing that Hashimoto's is an autoimmune condition that benefits from reducing systemic inflammation. She concludes with practical advice: get the right labs, work with a knowledgeable provider, consider lifestyle support, and only use medication when labs are persistently abnormal. The video also promotes her direct primary care model and invites viewers to subscribe.
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In this video, I'm going to break down what exactly Hashimoto's disease is, when thyroid meds truly do help, and when they might be doing more harm than good. And if you stick around to the end, I'll walk you through how I personally evaluate and look for hypothyroidism and why I like to be really sure before putting anybody on a medication that they're going to take long-term. So what is Hashimoto's and how does it relate to hypothyroidism? Hashimoto's thyroiditis is an autoimmune condition and it's the most common cause of hypothyroidism in the developed world. Anywhere where we have sufficient iodine in our food or salt. In order to get Hashimoto's, your immune system has to attack your thyroid gland, which lives here. And over time, if your thyroid gland is under enough attack, it starts to not function as well, leading to low output of thyroid hormone, which is hypothyroidism. Now, if you don't know already, thyroid hormone is responsible for basically all of your metabolic processes— how fast you make and burn energy, your temperature regulation, your digestion, your heart rate, and more. Now, this next point is important. You can have Hashimoto's Hashimoto's disease with completely normal thyroid function for years. Some people get told they have Hashimoto's based on something called TPO antibodies in their blood, and then suddenly every symptom you have, such as fatigue or weight gain, gets blamed on hypothyroidism, but the rest of your blood work's completely normal. And so putting you on treatment might sound like a good idea, but it doesn't actually help in the long run. The tricky part about Hashimoto's is that the progression from having it to overt hypothyroidism is very unpredictable. Some people progress really quickly, but some people never develop hypothyroidism. So the big question becomes, do you actually need medication? Well, here's the real story according to doctors who think like me. Take it for what it's worth. If your thyroid stimulating hormone is high, and you can let the doctor be the judge of what is high, and either your free T4 or T3 levels are low, then yes, you probably need thyroid replacement or medication. But if your TSH, T4, and T3 levels are normal despite having high TPO antibodies, you really don't have any reason to take medication yet. And some providers, me included, will just say, let's just watch things. Others start treatment really early on, and it's too early in my opinion, even before checking your numbers again or giving your body time to realign itself. You see, when you check thyroid numbers on any given day, they could be up or down. It's just a snapshot of you on that particular day. But just one set of labs isn't necessarily enough to commit you to lifelong medication, especially in this case. Here's what I've seen. A lot of patients just accept the medication. They start taking thyroid meds thinking they're going to get better energy, better metabolism, they're going to lose weight, they're going to think clearer. And maybe when you start it, it does that for a while. But many of those same people circle back later thinking, is this really doing anything for me? Did I actually need the medication in the first place? You see, people question if they need the medication, number one, because most people don't like taking medication, period. But thyroid medication is extra tricky. You have to take it first thing in the morning on an empty stomach with absolutely nothing else, maybe a little bit of water. But you have to wait 30 minutes before you take anything else— food, drink, medication, other supplements. It has to be by itself. And in my opinion, that sounds like a pain. It's actually possible that I've taken more people off thyroid meds than I've started. You see, true hypothyroidism is only present in about 0.3% of the general population. So if you're on thyroid medication and you think you might not need it, it's okay to question that. And plus, overtreating your thyroid can come with some serious risks. Anxiety, insomnia, palpitations, diarrhea, accelerated bone loss. And hey, there's a lot of people out there who actually need the medication, and I'm not saying that everybody needs to trial off of medication, but I'm seeing a lot of people being diagnosed and treated for hypothyroidism that maybe don't need to be treated that way in the first place. Let's talk about the blood work a little bit more just so you understand things. When you get your blood work done, you'll be equipped to understand it. Okay, TPO antibodies, thyroid peroxidase antibodies. These can help diagnose Hashimoto's like we discussed in the beginning of this video, no question, but they don't tell you whether or not you need treatment. In fact, around 13% of the population have elevated TPO antibodies without thyroid dysfunction or symptoms. Just having elevated antibodies doesn't cause your weight gain or fatigue. I'm sorry to tell you that. Some people want medication anyway just to see if it'll help. Just monitor it really closely and do it with your doctor. Free T3— this is your body's active form of thyroid hormone. Your thyroid gland that lives right here makes T4, the inactive form of thyroid hormone, then converts it into T3, the active form of thyroid hormone. Now, levels of T4 reflect direct output from the thyroid gland, but levels of T3 are highly up and down because your body is using it. T3 levels can fluctuate with illness, inflammation, stress, if you're fasting, if your gut health is off. So they're just less stable and less reliable as a marker of thyroid gland function. So we prefer to use levels of T4. We also order something called a TSH, and we actually order this more than your T4 or T3 levels. TSH is thyroid stimulating hormone. You see, what happens is when your body is low on thyroid hormone, it sends a signal up to the pituitary to make more of something called thyroid stimulating hormone. Thyroid stimulating hormone stimulates the thyroid gland to make more T4. So if you have high TSH— 4, 5, 6, 7, 8, 9, 10— anything higher than a 4 to 6 range, you're going to want to pay close attention to that, and your doctor is going to order direct T4 levels. A lot of people will ask me for something called a reverse T3, and this is where I kind of draw the line. Reverse T3 is actually something that shows that your body's hitting brakes on thyroid function. Like if you're really sick or inflamed or undereating or fasting, your body will make more reverse T3 to just kind of deaden your thyroid function. But high reverse T3 does not mean that your thyroid is broken. It just means that your body is pushing the brakes. So those are the thyroid tests in a nutshell. And here's what I promised at the beginning of this video: how I personally approach diagnosing and looking for hypothyroidism. First off, I always check a TSH with your routine labs. Some doctors don't do this, but it's not a very expensive test. It's like $4 to $10 for the lab to do it. So in my opinion, it's not really wasting Healthcare dollars. If you come to me with fatigue, cold intolerance, hair falling out, I'm gonna check your TSH plus free T4. And if either of those are abnormal, we just wait. Unless your numbers are wildly off the charts and I have reason to believe that all your problems are due to your thyroid, I'm not gonna rush to start you on medication based off of one set of labs. I'll usually wait and retest in 4 weeks. And honestly, I see things normalize about 50 to 75% of the time on the recheck. So if that's you, don't panic. Just keep a close eye on things. Get your thyroid checked every 3 to 6 months. But if your TSH and T4 are persistently abnormal and you clearly have true hypothyroidism, then I'll start you on a medication. That's how I do it. It's not really that complicated. Now I want to take this opportunity to tell you about a patient that I've had who absolutely refused to take thyroid medication despite her TSH being elevated and her free T4 being low persistently over multiple lab tests. She just didn't want to take the medication. She ended up going all in on natural remedies to reset her body, and it worked. She made me a believer in being able to turn hypothyroidism around. You see, Hashimoto's thyroiditis, it's an autoimmune condition. It's likely sometimes caused by inflammation and stress on the body, which can come from things like poor diet, anxiety, depression, alcohol, inactivity, trauma, all the kinds of things that affect us that we're always told to be working on constantly. My patient, she started drinking Like celery juice and using acupuncture mats or grounding mats, and I think infrared sauna. She had some supplements too. I can't really remember everything, but I never put her on medication. I didn't have to. So if you're watching this and you have Hashimoto's, there might be some things that you can do to get it to calm down. It's not a guarantee, and I want you to talk to your doctor about it before doing anything. You know, I was really skeptical of my patient being able to reverse her own hypothyroidism because I've seen untreated hypothyroidism progress into serious consequences like going into a coma. But I'm just saying anything's possible. Just work with a doctor when you've got the problem. So if you've been told you've got Hashimoto's, or if you've got elevated TPO antibodies, just try some things. There are some natural things that have been known to support thyroid health. You can try things like getting your vitamin D level up, taking selenium supplements, taking zinc supplements. Myo-inositol might actually help. It can lower insulin resistance. I've got a whole video on that. Taking magnesium at night to get better sleep might actually help. You know, focus on sustainable changes for you to get the level of stress and inflammation on your body down. Remember, Hashimoto's is an autoimmune condition, not just a thyroid problem. That means the real goal isn't just boosting your thyroid levels up, it's calming down the stress on your body. If you're motivated, consistent, and working with a provider who gets it, maybe you can turn around Hashimoto's. Let me know in the comments if you have. So in summary, if you're taking thyroid medication and you're not exactly sure that you need it, just go talk to your doctor about it. It seems to be a trend. You don't need every thyroid test under the sun to diagnose hypothyroidism, and you don't need to panic if somebody tells you that you have high TPO antibodies. But it can be a motivator for you to reevaluate the amount of stress on your body and your mind. You need the right labs, the right diagnosis, and the right provider to walk you through things and help you understand what's going on with you. Hey, if you like this video, hit subscribe for me. I'm just getting started. My name is Dr. Ashley Frazee. I run a direct primary care clinic in Mesa, Arizona. Direct primary care is a model that allows me to take extra time with my patients, and it's allowing me to make these videos for you. If you want to learn more about direct primary care, there are some links in my description. You guys have a good day.
