Thyroid Optimization: Achieving Wellness Through Hormones

Unlock the secrets of thyroid optimization for hormones to improve your health. Learn how to support your thyroid function effectively.

Abstract

In this educational post, I share my first-person clinical perspective on optimizing thyroid health in the real world. I explain why many patients remain symptomatic despite a “normal” thyroid-stimulating hormone (TSH), and how focusing on cellular triiodothyronine (T3), deiodinase physiology, and tissue-level thyroid signaling improves outcomes. I integrate modern evidence on T4 monotherapy, T4/T3 combination therapy, and desiccated thyroid, clarify the role of reverse T3 (rT3) and micronutrients (iron, selenium, zinc, iodine), and show why sleep, insulin resistance, inflammation, and circadian biology matter as much as prescription choices. I also detail how integrative chiropractic care—through autonomic balancing, rib and thoracic mobility, neuromuscular re-education, and pain reduction—supports endocrine resilience and day-to-day function. Throughout, I reference leading researchers and guidelines, present stepwise protocols, standardize lab timing to support reproducible decision-making, and offer clinical observations from my practice. My goal is a clear, physiology-first roadmap you can use immediately.

Why Patients With “Normal” Labs Still Feel Unwell

I gained a profound understanding of thyroid medicine through direct experience while talking with patients. Years ago, a patient underwent thyroid ablation and intentionally experienced hypothyroidism with TSH levels exceeding 150 mIU/L. This taught me firsthand the debilitating effects: profound fatigue, cold intolerance, constipation, slowed thinking, and a body that felt like it was moving through molasses. Later, their thyroid health further illustrated the intricacy of this endocrine system and how our unique environments, genetics, and personal histories shape individual outcomes.

In my chiropractic practice, thousands of patients have expressed the same sentiment: “My labs look fine, but I don’t feel right.” Most were taking levothyroxine (T4) with a TSH in the normal range. Yet, they continued struggling with classic hypothyroid symptoms such as weight gain, low energy, brain fog, mood disturbances, hair thinning, exercise intolerance, dry skin, depression, and muscle weakness. Others presented with signs of hyperthyroidism, including unintended weight loss despite increased appetite, heat intolerance, anxiety or irritability, rapid heartbeat or palpitations, diarrhea, tremors, restlessness, insomnia, and excessive sweating. Understanding the full spectrum of thyroid dysfunction is essential.

This common patient experience led to a pivotal question that transformed my approach: If we’ve normalized circulating thyroid hormone levels enough to stabilize the pituitary feedback loop, why are tissues throughout the body still exhibiting hypothyroid (or hyperthyroid) symptoms?

The answer lies in tissue-level thyroid physiology. The pituitary is highly sensitive to T4-to-T3 conversion and can register as “normal,” while other key tissues—such as skeletal muscle, brain, liver, and adipose—may remain relatively T3-deprived (Bianco & Kim, 2018; Jonklaas et al., 2014). This physiological mismatch is exactly why we must treat the whole patient’s physiology, not just lab values. In my chiropractic practice, I integrate this insight by optimizing nervous system function through precise spinal alignment and holistic care. This whole-body approach supports better endocrine regulation, helps resolve persistent symptoms, and empowers patients to restore energy, metabolism, mood, and overall vitality.

Thyroid Physiology Made Practical: Why T3 Is The Cellular Key

The thyroid gland produces mostly thyroxine (T4) and a smaller amount of triiodothyronine (T3). Interestingly, about 80% of the active T3 your body uses every day is actually made outside the thyroid gland by special enzymes called deiodinases.

T3 is the active thyroid hormone. It binds to receptors inside your cells 3–5 times more strongly than T4 does. Think of T4 as a storage or “reserve” form (a prohormone) and T3 as the “workhorse” that actually gets the job done in your body.

These deiodinase enzymes control how much active T3 is available in different tissues:

• D1 and D2 convert T4 into active T3, which boosts cellular activity.
• D3 converts T4 into reverse T3 (rT3), an inactive form that acts like a brake on your metabolism.

Here’s the tricky part that confuses many treatment plans: The pituitary gland (the one that releases TSH, the hormone doctors measure in blood tests) has very strong D2 activity. So it can still have plenty of T3 even when the rest of your body is low on it. That means you can have “normal” TSH levels while also having low-normal free T3, high rT3, and actual hypothyroidism in your tissues.

Inflammation, insulin resistance, poor sleep, and restrictive dieting often slow the activity of the helpful D1 and D2 enzymes while ramping up D3. This shifts your body toward producing more inactive rT3 and less active T3 where it’s needed most (Bianco & Kim, 2018; Mullur, Liu, & Brent, 2014). That’s exactly why some people feel hypothyroid even when “the labs look fine.”

Why Weight Gain Persists On Replacement: The Metabolic Web

Weight loss doesn’t usually happen automatically just by taking thyroid hormone “replacement.” Metabolism isn’t a simple on/off switch—it’s a whole interconnected network.

In people who keep gaining weight despite treatment, several common issues get in the way:

• Insulin resistance makes it harder for your body to break down stored fat for energy. Instead, it encourages greater fat storage, reduces overall calorie burning, and even weakens the enzymes that convert T4 into active T3.
• Chronic inflammation (via signals such as IL-6 and TNF-α) reduces the amount of active T3 your cells can use. It slows the helpful D1 and D2 enzymes, ramps up the D3 enzyme that makes inactive reverse T3 (rT3), and makes thyroid hormone receptors less responsive (Bianco & Kim, 2018).
• Poor sleep and messed-up body clocks raise the hunger hormone ghrelin, make your brain less sensitive to the “full” signal from leptin, and worsen insulin problems—leading to more cravings and less energy use.
• An autonomic nervous system imbalance tips the scales toward “fight-or-flight” mode, elevating stress hormones like cortisol and making your cells less responsive to thyroid hormones.
• Loss of muscle (sarcopenia) slows your resting metabolic rate and makes blood sugar control even harder.
• Ongoing pain reduces how much you move throughout the day, which lowers your total calorie burn.

From what I see in the clinic, the most reliable way to stabilize weight isn’t just adjusting thyroid hormones alone. It’s combining good thyroid optimization with practical steps that also target insulin resistance, sleep quality, inflammation, and pain. When you address the whole network, the results are much more consistent.

Beyond TSH: A Physiology-First Evaluation Strategy

When symptoms stick around even though your TSH looks “normal” on paper, it’s time to look at the bigger picture.

Here’s what a more complete workup usually includes:

• Full thyroid panel: TSH, free T4, free T3, and reverse T3 (rT3) — especially if there are signs that your body isn’t converting T4 to T3 well, or if you’re dealing with chronic stress or illness.
• Autoimmunity check: TPO and Tg antibodies, to see if Hashimoto’s is playing a role and how active it is.
• Metabolic health: Fasting glucose, fasting insulin, HOMA-IR (a measure of insulin resistance), a full lipid panel, and hs-CRP (an inflammation marker).
• Key micronutrients: Ferritin (iron stores), B12, folate, vitamin D, magnesium, zinc, and selenium.
• Sleep and stress assessment: A sleep tracker (actigraphy), if possible, or morning cortisol levels / full-day cortisol patterns in certain cases.
• Medication review: Looking for drugs or supplements that can block thyroid hormone absorption (like iron, calcium, or acid-reducing PPIs) or interfere with conversion (such as amiodarone or steroids).

The reason these extra checks matter is straightforward: Iron, selenium, and zinc are essential” helpers” your body needs to make and activate thyroid hormones. Inflammatory signals and stress hormone patterns can directly shut down the enzymes that convert T4 to T3. And hidden issues like untreated sleep apnea or poor gut absorption can quietly undermine even the best thyroid plan (Virili et al., 2019; Jonklaas et al., 2014).

T4 Monotherapy, T4/T3 Combination, And Desiccated Thyroid: What The Evidence Shows

Levothyroxine (T4) is still the standard first-choice treatment for hypothyroidism, and it works very well for a large number of patients (Jonklaas et al., 2014).

That said, several studies and real-world patient reports show that a meaningful subset of people feel noticeably better with combination therapy (T4 plus T3) or desiccated thyroid extract (DTE). They often report clearer improvements in mood, energy, and sometimes modest weight control—even when the overall average results from clinical trials appear neutral (Hoang et al., 2013; Peterson, McAninch, & Bianco, 2018).

Why adding T3 helps some people:

• It completely bypasses the body’s conversion step. If the enzymes that convert T4 into active T3 are slowed or blocked, giving T3 directly delivers the active hormone where it’s needed.
• Brain and muscle tissues are especially sensitive to T3 levels, so direct T3 support can make a bigger difference in how people feel day to day.

Safety always comes first. Too much T3 can cause heart palpitations, anxiety, or gradual bone loss over time. That’s why I start with a low dose (usually 2.5–5 mcg once or twice a day), increase it very slowly, and split the doses throughout the day to keep blood levels steady. I also keep a close eye on heart rate, blood pressure, and—when appropriate—bone density. This approach gives symptom relief while protecting long-term health.

The Reverse T3 Problem: When The Metabolic Brake Is On

Elevated reverse T3 (rT3) is your body’s way of hitting the brakes on metabolism. It’s a signal that the system has shifted into “energy-saving mode.” Levels often climb during chronic stress, ongoing inflammation, very low-calorie diets, overtraining, or any illness.

Patients who have high rT3 along with low-normal free T3 typically feel classic hypothyroid symptoms—fatigue, feeling cold all the time, constipation, brain fog, and poor exercise tolerance—even though their TSH still looks “normal.”

Why it’s worth fixing:

• rT3 competes with active T3 at cell receptors, effectively blocking the “go” signal and slowing cellular energy production.
• Simply giving more T4 in this situation can backfire: the body converts even more of it into rT3, turning the brake pedal harder instead of releasing it.

How I approach it:

• Lower the overall stress load on the body (better sleep, stress management, and making sure you’re eating enough calories).
• Improve insulin sensitivity and quiet down inflammation.
• Replenish key nutrients, such as iron and selenium, that the conversion enzymes need to function properly.
• Consider adding T3 to the treatment plan (often split throughout the day) to restore proper thyroid signaling while we address the underlying issues.

This is a “fix the terrain first” strategy. Instead of just pushing more T4, we work with the body’s actual physiology to get people out of these low-T3 states safely and effectively.

---

Thyroid Dysfunction-Video

---

Why “Normal” Is Not Always Optimal: Interpreting The Bell Curve

Population reference ranges tell us what’s “average” or common in a large group of people—they don’t always show what’s truly optimal for you as an individual.

Research in heart health, metabolism, and brain function shows a clear pattern: people whose free T3 levels fall in the lowest third of the normal range tend to have worse outcomes. In contrast, TSH and free T4 levels are much less useful at predicting problems such as heart failure or heart attacks (Jabbar et al., 2017).

What this means in practice:

• Many patients who are stuck in the low-normal free T3 range feel and function noticeably worse than they should.
• For the right individuals, gently guiding free T3 toward the upper part of the normal range—always within safe limits—can bring meaningful improvements in energy, ability to stay warm, mood, and exercise tolerance.
• I never treat a lab number in isolation. I adjust treatment based on how you actually feel, along with vital signs, heart-rate variability (HRV), sleep quality, and other objective measures—while keeping safety front and center at every step.

Testing Right The First Time: Standardizing Lab Timing For T3 Therapies

When you’re taking liothyronine (T3) or desiccated thyroid extract (DTE), the timing of your blood tests really matters. Free T3 levels rise quickly, peak about 2–4 hours after a dose, and then gradually drop. Random lab draws at different times can therefore give misleading or inconsistent results.

My clinic standard:

• I have patients draw their thyroid labs 5–6 hours after their morning T3-containing dose. This avoids the early peak and gives much more consistent, comparable numbers from one test to the next.
• If you split your doses (for example, 6 a.m. and 1–3 p.m.), I keep the blood draw at the same time relative to your morning dose and always record the exact times.
• For patients who notice symptoms right after a dose, I sometimes order labs closer to the low point (right before the next dose) so we can better match the numbers with how you actually feel at your lowest.

Why this matters:
Consistent timing turns unreliable “snapshots” into clear, trustworthy trends. It lets us make smart, logical treatment adjustments instead of reacting to noisy or misleading data.

A Stepwise, Physiology-Driven Treatment Roadmap

I follow a clear, step-by-step protocol that connects what the lab numbers show to how you actually feel and function every day.

1. Baseline characterization
   We start by building a full picture of where you are right now:
   • Symptoms: energy levels, mood, thinking and memory, bowel habits, hair and skin changes, how well you stay warm, menstrual cycles (if relevant), pain, and how well you tolerate exercise.
   • Vitals and physical function: resting heart rate, blood pressure, orthostatic blood pressure (checking for dizziness when standing), body temperature patterns, heart-rate variability (HRV), grip strength, and—if it makes sense—a simple 6-minute walk test.
   • Labs: TSH, free T4, free T3, reverse T3 (when needed), TPO and Tg antibodies, ferritin, CBC, CMP, fasting insulin and glucose, lipid panel, hs-CRP (inflammation marker), vitamin D, B12/folate, magnesium, zinc, and selenium.
2. Optimize the T4 foundation.
   • Make sure the thyroid medication is absorbed properly: take it on an empty stomach with water and separate it from iron, calcium, or other interfering supplements by at least 4 hours.
   • Set an individualized TSH target based on your symptoms and safety, then recheck labs in 6–8 weeks.
   • Always compare lab changes with your symptom diary and vital signs so we know what’s actually helping.
3. Consider adding T3 or switching to desiccated thyroid (DTE)
   • If symptoms persist and free T3 is low-normal or reverse T3 is high, we add a small dose of liothyronine (T3) — starting at 2.5–5 mcg once daily, then increasing to 5 mcg twice daily if needed — or consider switching to desiccated thyroid at the appropriate equivalent dose.
   • We use split dosing to keep T3 levels steady and avoid big peaks.
   • I monitor your pulse and blood pressure closely and repeat labs in the same consistent time window.
4. Correct metabolic and inflammatory “rakes.”
   • Nutrition: enough protein (usually 1.2–1.6 g per kg of body weight per day, as you can tolerate), plenty of fiber and colorful plant foods, and steady blood-sugar control.
   • Training: gradual strength training to rebuild muscle and improve energy production in cells, plus low-intensity cardio and mobility work.
   • Sleep: morning sunlight exposure, consistent bedtime, and screening for sleep apnea if needed.
   • Stress and nervous system balance: HRV training, breathing exercises, or talk therapy, when it fits.
5. Integrative chiropractic care
   • Gentle spinal adjustments and neuromuscular retraining to reduce pain, improve movement, and make exercise easier to stick with.
   • Work on rib and upper back mobility, plus diaphragmatic breathing, to boost vagal tone (calming the nervous system), improve breathing efficiency, and support better sleep.
   • Myofascial release and carefully progressed loading to ease the muscle aches and tendon problems that often come with hypothyroidism.
6. Iterate with shared decision-making.
   • We reassess every 6–8 weeks at the beginning, always adjusting to the lowest effective dose.
   • For patients on long-term T3, we monitor bone health.
   • Every step is discussed together—we track your personal goals, progress, and safety checkpoints.

Why this works
It matches the real-life timing and behavior of thyroid hormones with what your tissues actually need, while removing the common “brakes” (insulin resistance, inflammation, poor sleep, and pain) that can blunt T3 signaling. The result is a more reliable, whole-person improvement rather than just chasing lab numbers.

Micronutrients And Iodine: The Small Hinges That Move Big Doors

Here are the key micronutrients for thyroid health:

• Iron (measured as ferritin): Iron is essential for the enzymes that produce thyroid hormones and for the ones that convert T4 into active T3. Many patients with ongoing symptoms have low ferritin levels. I usually aim for a ferritin level of at least 50–70 ng/mL (adjusted to your personal situation) because it helps boost energy, support hair growth, and improve hormone conversion.
• Selenium: This mineral acts as a key helper for the D1 and D2 conversion enzymes and serves as a powerful antioxidant that protects the thyroid gland. When it’s needed, I often recommend 100–200 mcg per day. In people with Hashimoto’s, it can help lower antibody levels and support better T4-to-T3 conversion.
• Zinc: Zinc helps regulate the brain signals (TRH and TSH) that control the thyroid and supports how well thyroid hormone receptors work on your cells. Low zinc levels are commonly linked to hair loss and an immune system imbalance.
• Iodine: Iodine is the basic building block your body uses to make T4 and T3. It must be used carefully—especially if you have autoimmune thyroid disease. In Hashimoto’s, I always pair iodine with selenium, increase it slowly, and closely monitor antibody levels and symptoms. A temporary rise in TSH after starting iodine is often a good sign that the thyroid is ramping up its ability to take in iodine, not a sign that things are getting worse.

Why do these nutrients matter?
Trying to fix thyroid problems with hormones alone—without the right cofactors and raw materials—is like pressing the gas pedal with an empty fuel tank. Restoring proper levels of iron, selenium, zinc, and (when appropriate) iodine gives your body the biochemical tools it needs to make, activate, and effectively use thyroid hormones.

How Integrative Chiropractic Care Fits: Autonomics, Mechanics, And Metabolic Flow

As a chiropractor and nurse practitioner, I see daily how pain, autonomic imbalance, rib and thoracic restrictions, and movement inefficiency keep patients stuck. Integrative chiropractic care helps the endocrine system work better by improving the terrain in which hormones act.

• Autonomic balance and vagal tone: Gentle cervical/thoracic mobilization, rib mechanics, and diaphragmatic training enhance vagal signaling, improving GI motility and lowering inflammatory tone—both critical for absorption and conversion.
• Pain reduction and sleep quality: Resolving nociceptive drive lowers cortisol and sympathetic arousal, supporting D1/D2 activity and receptor sensitivity.
• Circulatory and lymphatic flow: Restoring rib cage dynamics improves ventilation and venous/lymphatic return, which many patients experience as reduced “puffiness,” better recovery, and steadier energy.
• Gait and strength integration: Improving movement efficiency lowers the cost of daily activity, allowing patients to engage in resistance training and aerobic work without “crashing”—a common trigger for rT3 surges.

From my clinic (dralexjimenez.com; linkedin.com/in/dralexjimenez), I consistently see faster improvements in energy, bowel regularity, and thermoregulation when manual therapies, breath-led mobility, and progressive strength training are layered into hormone optimization. It is a systems-level synergy: when the body is less inflamed, better perfused, and more parasympathetic, thyroid hormone signaling lands.

Clinical Pearls From Daily Practice

Many patients who take only T4 (levothyroxine) still deal with ongoing fatigue, feeling cold all the time, constipation, and a low body temperature. These symptoms are often tied to low free T3 and elevated reverse T3 (rT3). In these cases, adding a small amount of T3 in split doses—while also fixing sleep issues and insulin resistance—frequently improves constipation and morning energy within 6–8 weeks.

In my practice, women are more likely to show low free T3 patterns, while men more commonly have low testosterone (androgen deficiency). When we address both issues together when needed, patients usually see better results in body composition and overall energy.

A suppressed (very low) TSH in a patient who feels well, has stable vital signs, and normal free thyroid hormone levels is not automatically a problem. I monitor these patients based on their clinical status rather than reflexively cutting the dose, which could undo their hard-won progress.

People who have been chronic dieters often have slowed D1 enzymes and higher rT3 levels. Gradually increasing food intake with enough protein, eating meals on a consistent circadian schedule, and adding resistance training can naturally improve thyroid hormone conversion and sometimes lower the need for higher medication doses.

Safety, Cardiac, and Bone Monitoring, And Documentation

Here are the safety considerations that are established:

• Heart Health: I screen for heart rhythm problems when appropriate and regularly check resting heart rate and blood pressure. For patients at higher risk, I may order a baseline ECG. If someone has a history of heart disease, I increase doses very slowly and cautiously.
• Bone Health: When T3 is used long-term—especially in postmenopausal women—I monitor bone density with scans. I also make sure vitamin D and calcium levels are optimized and that the patient is doing resistance training to help protect bone strength.
• Pregnancy: Levothyroxine (T4) remains the standard and preferred treatment. I avoid using T3 or desiccated thyroid extract (DTE) while pregnant and closely follow the stricter, trimester-specific TSH targets recommended for pregnancy.
• Documentation and Transparency: When using T3-inclusive therapies (which are sometimes considered off-label), I thoroughly document the medical reasoning, labs drawn at consistent times, how symptoms are changing, and all safety measures. Clear communication and shared decision-making with the patient are always essential.

Public Health Context: Thyroid Is One Pillar In A Metabolic Landscape

The U.S. obesity trajectory has accelerated over the last few decades, with most states reporting adult obesity prevalence above 30% by 2023. Thyroid disease alone does not explain this. Ultra-processed foods, lowered physical activity, poor sleep, psychosocial stress, and environmental exposures all compound metabolic strain. Expecting thyroid replacement alone to normalize weight ignores this reality. Success comes from integrating nutrition, movement, sleep, stress modulation, and pain reduction with precise hormone therapy—the exact domains where integrative chiropractic care enhances real-world adherence.

Putting It All Together: A Practical, Evidence-Based Roadmap

Here’s the practical framework I use with patients:

• Start with physiology first: Take your symptoms seriously, get a complete picture from labs and your daily lifestyle, and build a strong foundation with T4 medication—while making sure you’re taking it correctly so it absorbs well.
• Personalize the plan: For carefully selected patients, add a small dose of T3 (or switch to desiccated thyroid) if free T3 remains low, and symptoms persist.
• Clear the metabolic traffic jams: Address insulin resistance, inflammation, poor sleep, and pain so thyroid hormone signals can actually reach and work in your tissues.
• Activate real function: Bring in integrative chiropractic care to reduce pain, balance the nervous system, and restore efficient movement. This amplifies everything the hormone therapy is trying to do.
• Standardize lab timing: When T3 is part of the regimen, always draw blood 5–6 hours after the morning dose. This gives us consistent, trustworthy numbers instead of misleading snapshots.
• Iterate together: Reassess every 6–8 weeks at the start. Adjust based on both lab results and how you actually feel day to day. We document safety measures and make every decision as a team.

As a physician who lives without my own thyroid and has guided thousands of patients on the same journey, I can say this with confidence: when we respect how T3 really powers your cells, how the conversion enzymes shape what happens in different tissues, and how your nervous system and body mechanics influence that signaling, real change happens. Patients warm up, move more easily, think more clearly, and get their days back. That is the promise of a modern, evidence-based, integrative approach.

References

• Bianco, A. C., & Kim, B. W. (2018). Homeostasis of thyroid hormone deiodination. Annual Review of Physiology, 80, 83–105. https://doi.org/10.1146/annurev-physiol-022516-034125
• Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. M. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-masked, crossover study. Journal of Clinical Endocrinology & Metabolism, 98(5), 1982–1990. https://doi.org/10.1210/jc.2012-4107
• Jabbar, A., Pingitore, A., Pearce, S. H. S., et al. (2017). Thyroid hormones and cardiovascular disease. Nature Reviews Cardiology, 14(1), 39–55. https://doi.org/10.1038/nrcardio.2016.174
• Jonklaas, J., Bianco, A. C., Bauer, A. J., et al. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028
• Jonklaas, J., Bianco, A. C., Cappola, A. R., et al. (2021). Evidence-based use of levothyroxine/liothyronine combination therapy in hypothyroidism: An update. Journal of Clinical Endocrinology & Metabolism, 106(10), e3821–e3839. https://doi.org/10.1210/clinem/dgab515
• Mullur, R., Liu, Y.-Y., & Brent, G. A. (2014). Thyroid hormone and metabolism. New England Journal of Medicine, 371(6), 593–603. https://doi.org/10.1056/NEJMra0801368
• Peterson, S. J., McAninch, E. A., & Bianco, A. C. (2018). Patient-reported outcomes and LT4 vs. combined therapy: A comparative effectiveness review. Endocrine Practice, 24(3), 299–309. https://doi.org/10.4158/EP-2017-0109
• Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
• Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5, 258. https://doi.org/10.3389/fpubh.2017.00258
• Virili, C., Centanni, M., Santaguida, M. G., et al. (2019). Levothyroxine therapy and malabsorption. Endocrine Reviews, 40(1), 118–136. https://doi.org/10.1210/er.2018-00168
• Centers for Disease Control and Prevention. (2023). Adult obesity prevalence maps. CDC.
• Alexander, E. K., Pearce, E. N., Brent, G. A., et al. (2017). 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid, 27(3), 315–389. https://doi.org/10.1089/thy.2016.0457
• Duarte, G. M., Appenzeller, S., & Bertolo, M. B. (2020). Musculoskeletal manifestations of thyroid disease. Current Rheumatology Reports, 22, 67. https://doi.org/10.1007/s11914-020-00591-3
• Hoermann, R., Midgley, J. E. M., Larisch, R., & Dietrich, J. W. (2019). Functional and symptomatic individuality in the response to levothyroxine therapy. Frontiers in Endocrinology, 10, 664. https://doi.org/10.3389/fendo.2019.00664
• Stamatakis, E., Gale, J., Bauman, A., et al. (2019). Sitting time, physical activity, and risk of mortality in adults with noncommunicable diseases. BMJ, 366, l4570. https://doi.org/10.1136/bmj.l4570
• Escobar-Morreale, H. F., Botella-Carretero, J. I., Gómez-Bueno, M., Galán, J. M., Barrios, V., & Sancho, J. (2005). Double-masked crossover trial of liothyronine and levothyroxine combination therapy. Journal of Clinical Endocrinology & Metabolism, 90(5), 2666–2674. https://doi.org/10.1210/jc.2004-1974
• Santini, F., Chopra, I. J., & Pinchera, A. (2014). Thyroid hormone transport and metabolism: Implications for the pathophysiology of hypothyroidism and its treatment. Pharmacology & Therapeutics, 141(2), 150–163. https://doi.org/10.1016/j.pharmthera.2013.09.002
• Midgley, J. E. M., Hoermann, R., Larisch, R., & Dietrich, J. W. (2015). Physiological modeling of thyroid hormone homeostasis. Frontiers in Endocrinology, 6, 66. https://doi.org/10.3389/fendo.2015.00066
• Jimenez, A. (n.d.-a). Clinical insights and multidisciplinary care pathways. Retrieved from https://dralexjimenez.com/
• Jimenez, A. (n.d.-b). Professional profile and integrative practice highlights. Retrieved from https://www.linkedin.com/in/dralexjimenez/

SEO tags: thyroid replacement, T4 T3 combination therapy, desiccated thyroid extract, reverse T3, deiodinase D1 D2 D3, integrative chiropractic care, autonomic balance, vagal tone, insulin resistance and thyroid, sleep apnea hypothyroid, thyroid labs timing, liothyronine split dosing, ferritin, selenium, zinc iodine, Hashimoto’s thyroiditis, evidence-based thyroid care, functional medicine thyroid