The Hidden Epidemic: Why Hypothyroidism in Women Is Still Underdiagnosed and Undermanaged

Hypothyroidism is incredibly common, especially in women, yet it often goes undiagnosed or undertreated. In my naturopathic practice here in Oregon, I regularly work with women who are experiencing symptoms like fatigue, weight changes, low mood, or brain fog—only to find their thyroid hasn’t been fully evaluated. It's a reminder that we need to take a closer, more thorough look at thyroid health and how it impacts women throughout their lives.

Hypothyroidism Is Common—But Often Missed

An estimated 1 in 8 women will develop thyroid problems during her lifetime, with hypothyroidism being the most common diagnosis. This condition becomes increasingly prevalent with age and is especially common during major hormonal transitions such as postpartum, perimenopause, and menopause. Autoimmune thyroid disease, specifically Hashimoto’s thyroiditis, is the most common cause in developed countries—yet it is still routinely overlooked.

The Limits of Conventional Testing

Most conventional screenings for hypothyroidism rely solely on measuring TSH (thyroid stimulating hormone). While TSH is useful, it’s only one piece of the puzzle. A more thorough assessment includes checking:

• Free T4 (thyroxine) – the storage form of thyroid hormone

• Free T3 (triiodothyronine) – the active form that powers metabolism and mood

• Thyroid antibodies (TPO and TgAb) – to detect autoimmune causes like Hashimoto’s

  
  

Without looking beyond TSH, many women are told their thyroid is “normal” even though their symptoms—fatigue, weight gain, brain fog, cold intolerance, hair thinning—tell a different story.

"Normal" Isn’t Always Optimal

Another critical issue is the use of wide, outdated TSH reference ranges. A TSH of 4.0 or 5.0 might be technically normal, but in my clinical experience, many women feel best when their TSH is between 1.0 and 2.0. Optimizing thyroid levels isn’t just about hitting lab numbers—it’s about how you actually feel.

Treatment: One Size Doesn’t Fit All

Most conventional care relies solely on levothyroxine (T4-only medication), but this approach doesn’t work for everyone. Many patients feel better on combination therapies that include T3—either as compounded prescriptions or naturally derived options like Armour Thyroid or NP Thyroid. Unfortunately, these aren’t typically offered unless a patient seeks care outside the standard system. The pros and cons aren't even discussed.

A Holistic, Root-Cause Approach

In my Oregon-based naturopathic practice, I take an integrative approach to thyroid care that includes:

• Targeted nutrition – Supporting thyroid hormone production and conversion with nutrients like iodine, selenium, zinc, tyrosine, and iron

• Herbal medicine – Using plant-based therapies to support T4-to-T3 conversion or calm autoimmune inflammation

• Dietary changes – Reducing inflammatory triggers and supporting gut health

• Stress and adrenal support – Since chronic stress impairs thyroid function and conversion

• Pharmaceuticals when needed - Along with education on risks/benefits of the options available.

Every woman’s thyroid story is unique. Managing hypothyroidism is not just a protocol—it’s an art that requires personalized care, comprehensive lab assessment, and a willingness to go beyond the basics.

You Don’t Have to Settle for “Normal”

If you’ve been told your labs are fine but still don’t feel like yourself, you're not alone—and you're not crazy. Hypothyroidism is an epidemic hiding in plain sight, and there are effective ways to uncover and treat the root causes.

If you're in Oregon or the Portland area and are seeking a more thorough, holistic approach to thyroid health, I invite you to reach out. You deserve to feel vibrant, clear, and energized—and it starts with getting the full picture.

"This blog post is for informational purposes only and is not intended to diagnose, treat, or replace medical advice from your healthcare provider. Always consult with your physician or a qualified healthcare professional before

making any changes to your medication, treatment plan, or health regimen."