Consultants in Metabolism

Consultants in Metabolism I am a board certified physician with a practice focused on optimizing thyroid, hormone management and wellness.

Your labs may say “normal,” but if you feel like your body is aging faster than it should, your thyroid deserves a close...
09/22/2026

Your labs may say “normal,” but if you feel like your body is aging faster than it should, your thyroid deserves a closer look.

T3 controls metabolism, tissue repair, and recovery. When it’s low or blocked, the body slows down even when TSH looks fine.

That slowdown can show up as weight gain, fatigue, poor recovery, and visible signs of aging.

The issue isn’t too few tests, it’s testing the wrong things.

The CORE 5 Thyroid Labs look at thyroid function at the cellular level, not just screening numbers.

Comment CORE5 and I’ll send you the lab guide and a short video you can share with your doctor.

You cannot interpret thyroid function by comparing Free T3 to Reverse T3.Reverse T3 only exists in total form, which mak...
09/21/2026

You cannot interpret thyroid function by comparing Free T3 to Reverse T3.

Reverse T3 only exists in total form, which makes Free T3 : Reverse T3 ratios invalid even though they’re still commonly discussed online.

The correct clinical ratio is:
Total T3 / Reverse T3

This ratio helps determine whether thyroid hormone is reaching and activating receptors or being functionally blocked.

It’s one of the most useful tools I rely on when patients have symptoms of hypothyroidism despite “normal” labs.

That ratio is part of the CORE 5 Thyroid Labs, and for many patients, it’s a turning point.

Comment CORE5 and I’ll send you the lab guide and a short explainer you can share with your doctor.

Hashimoto’s disease is often treated as a lab abnormality but it’s a progressive autoimmune condition.Thyroid antibodies...
09/19/2026

Hashimoto’s disease is often treated as a lab abnormality but it’s a progressive autoimmune condition.

Thyroid antibodies show immune activation. But hormone levels — especially T3 — determine how your body actually feels and functions.

Many patients are told they’re “doing better” because antibodies are lower, yet they still feel exhausted, foggy, and unwell.

If T3 isn’t reaching the tissues, symptoms persist, regardless of antibody trends.

The CORE 5 Thyroid Labs help patients and their doctors understand both sides of the equation: autoimmunity and thyroid hormone activity.

Comment CORE5 and I’ll send you the lab guide and a short video you can share with your doctor.

09/19/2026

If your TSH is in the normal range and you still don't feel well, this is one of the most important things to understand about how levothyroxine actually works.

The pituitary gland, the part of the brain that controls TSH, contains a specialized enzyme that converts T4 to T3 almost exclusively within its own microenvironment. When you take a once-daily levothyroxine dose, the pituitary is flooded with T4, converts enough T3 for its own needs, detects that level, and drops TSH right into the normal range.

Your doctor sees a perfect TSH and concludes everything is fine.

But your muscles, liver, brain, and other body tissues rely on a completely different set of conversion dynamics. Those are vulnerable to stress, inflammation, illness, and genetic variation in ways the pituitary is not. T3 production in the tissues can drop significantly while the TSH remains perfectly normal.

This is not a mystery. It is a documented mechanism, and it is one of the main reasons a significant number of people on levothyroxine never fully get back to normal.

Dr. Dana Gibbs breaks this down in Episode 56 of Beyond the Thyroid. Watch on YouTube and share this with someone whose labs look fine but who still doesn't feel like themselves.

Track your full symptom picture at danagibbsmd.com/tracker. Link in comments below 👇

09/18/2026

Episode 56 of Beyond the Thyroid is one I've been wanting to write about for a long time, because I hear this pattern constantly.

Someone is diagnosed with hypothyroidism. They start levothyroxine. Their TSH normalizes. And they still don't feel well -- or in some cases feel worse than before they started.

Dr. Dana Gibbs spends this episode going through five myths that explain why this happens and what to actually do about it. Some are things you can change tomorrow. Some require having a harder conversation with your doctor.

The one that surprises most people: taking your full dose of levothyroxine all at once in the morning causes a T4 spike of 30 to 50 percent that your body interprets as "too much thyroid hormone" -- and responds by slowing down T3 conversion for days. Your TSH looks perfect. You're making less active thyroid hormone than before you started the medication.

The fix is splitting your dose. Half in the morning, half at night. It's that simple, and it makes a meaningful difference for a lot of people.

She also covers why the pituitary is getting a completely different hormonal picture than the rest of your body, why the Free T3 test got dismissed in the 1990s and why that hasn't changed, how the T3/Reverse T3 ratio actually tells you what's happening with conversion, and the other conditions -- ferritin deficiency, insulin resistance, gut issues, cortisol -- that get missed when everything gets blamed on the thyroid.

Link in the comments to listen or watch the full episode.

09/13/2026

There's a lot of conversation about the cardiac risks of too much thyroid hormone. Almost none about what happens when thyroid is chronically undertreated.

Low T3 affects the heart through a slower and less obvious set of mechanisms. It limits the capacity to exercise. It worsens insulin resistance. It reduces basal metabolic rate and shifts the lipid panel toward higher cardiovascular risk. Over years, that combination contributes to the kind of gradual vascular disease that eventually shows up as a heart attack.

Undertreated hypothyroidism is not a safer failure mode than overtreatment. It is the mirror image of the same problem, just slower and far less likely to get flagged in a routine appointment.

Dr. Dana Gibbs makes this case in Episode 55 of Beyond the Thyroid, where she walks through the full cardiac picture in both directions of thyroid dysfunction. Watch on YouTube and share this with someone whose thyroid treatment has never been fully optimized.

Drop your questions in the comments below 👇

09/12/2026

If you've been told your heart palpitations are caused by low thyroid, this research is worth knowing about.

Population studies consistently show that people with subclinical hypothyroidism do not report more palpitations than people with completely normal thyroid function. When researchers went a step further and put hypothyroid patients on continuous heart monitors, then treated them with thyroid hormone, the measurable extra heartbeats did not resolve. In some patients they increased slightly.

The data suggests that being hypothyroid does not reliably cause more of these episodes, and treating hypothyroidism does not reliably eliminate the ones that are already present. Low T3 alone is not a straightforward explanation for palpitations, even though it's frequently presented that way online.

Dr. Dana Gibbs covers this and the full cardiac picture of thyroid disease in Episode 55 of Beyond the Thyroid. Watch on YouTube and share this with someone who has been searching for answers about palpitations and thyroid function.

Drop your questions in the comments below 👇

09/10/2026

If you've ever been advised to skip your T3 dose the night before a lab test, this is worth understanding.

T3 has a very short half-life, less than a day. Testing first thing in the morning before your dose only captures the lowest point in the cycle, not the peak your body experienced in the hours after taking it. Some thyroid influencers actively recommend skipping the dose before labs so the T3 number comes back lower and appears safer than it actually is.

The problem is that TSH doesn't work the same way. TSH reflects thyroid hormone exposure over a longer window, not just that morning's snapshot. A suppressed TSH sitting underneath a manipulated T3 reading is usually the more accurate picture of what's actually happening.

Dr. Dana Gibbs breaks this down in Episode 55 of Beyond the Thyroid. Watch the full episode on YouTube and share this with someone who has been given this advice without understanding what it actually does to their results.

Drop your questions in the comments below 👇

09/08/2026

Episode 55 of Beyond the Thyroid came out of a social media poll that Dr. Dana saw making the rounds -- the claim being that low T3 causes atrial fibrillation, and that high-dose T3 therapy with a suppressed TSH is the appropriate fix.

She decided to go through the actual evidence, because if you're on T3 or considering it, this conversation matters.

The episode covers what thyroid hormones genuinely do to the heart in both hyperthyroidism and hypothyroidism -- and it turns out both directions carry real cardiac risk. Hyperthyroid states increase the risk of tachycardia, atrial fibrillation, cardiac remodeling, and heart failure. Hypothyroid states bring diastolic dysfunction, bradycardia, and increased vascular resistance. Neither extreme is safe.

She also covers something that doesn't get enough attention: the way T3 is typically dosed and timed means that supraphysiologic peaks can happen and never show up in routine lab work. And levothyroxine, for many patients, doesn't fully restore T3 to normal physiologic levels -- which is a real clinical problem, but not one that "more T3" automatically solves.

The bottom line is that a suppressed TSH is a clinical signal worth taking seriously, not a number to optimize around.

Link in the comments to listen or watch the full episode.

09/05/2026

If you have Hashimoto's and you're on thyroid medication, this conversation is worth your time.

Lindsey Patrice Perez was diagnosed with Hashimoto's at age 9 and spent years navigating a healthcare system that kept telling her everything was fine. When she started GLP-1 therapy for insulin resistance, her Synthroid levels needed close monitoring, and she learned firsthand that more medication is not always better. Heart palpitations, shakiness, and hormonal imbalance were the signals her body was sending that she was being overmedicated.

Her response was to build SOLAIA, an AI-powered health advocacy platform designed to help patients track their symptoms, prepare for appointments, and advocate for themselves effectively. Because as she puts it, accessibility, advocacy, and education should be standard in healthcare, and especially for women, who are consistently underdiagnosed and underresearched.

Dr. Dana Gibbs sits down with Lindsey in Episode 54 of Beyond the Thyroid for a conversation that goes well beyond labs and medication. Watch the full episode on YouTube and share this with someone who has felt dismissed by the healthcare system.

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