Your Thyroid Labs Are “Normal”—But You Still Feel Awful

Your PCP tested your thyroid and told you your labs were normal. Let’s break it down.

Standard thyroid testing usually starts with TSH. If your TSH is “normal”—even at the higher end of the range—most PCPs won’t order more detailed testing.

The result? Many women in perimenopause are stuck with classic hypothyroid symptoms but are told everything looks fine, leaving them without treatment options.

Why High-Normal TSH Matters in Perimenopause

Perimenopause causes estrogen levels to fluctuate, and estrogen plays a key role in thyroid hormone metabolism. These fluctuations can destabilize thyroid function and amplify symptoms, including:

• Fatigue

• Mood swings

• Weight gain

• Hair loss

• Constipation

• Brain fog

Even a “high-normal” TSH can be clinically significant in this context.

Risks of Leaving High-Normal TSH Untreated

Ignoring thyroid dysfunction in perimenopause carries meaningful risks:

1. Progression to overt hypothyroidism
Without monitoring or intervention, mild dysfunction can worsen over time.

2. Cardiovascular risk
High TSH is linked to dyslipidemia, atherosclerosis, and increased cardiovascular events—especially in younger and middle-aged women.

3. Neurocognitive effects
Fatigue, depression, and cognitive impairment are more common and can exacerbate menopausal symptoms.

4. Bone health
Thyroid dysfunction accelerates bone loss, compounding menopausal osteoporosis risk.

Takeaway

A “normal” TSH doesn’t always mean optimal thyroid function, especially for women navigating perimenopause. If you’re experiencing these symptoms despite normal labs, a deeper evaluation of thyroid, hormone, and metabolic patterns may provide answers.

I specialize in hormone and metabolic care for women navigating this phase of life through a private-pay model, allowing for detailed evaluation and personalized follow-up.