Episode #332: Thyroid Symptoms But Normal Labs? Here’s What to Look At Next with Dr. Elena Genik

Thyroid Health, Labs & Root Causes: What Women Need to Know About Hashimoto’s, Graves’ & Feeling Better

If you’ve ever been told your thyroid labs are “normal” — while you’re still exhausted, cold, losing hair, constipated, anxious, gaining weight, or simply not feeling like yourself — this conversation is for you.

In this episode of The Core Connections Podcast, I sat down with Dr. Elena Genik to talk about one of the most common health concerns I hear from women: thyroid health.

We covered the difference between hypothyroidism and hyperthyroidism, the connection between Hashimoto’s and Graves’ disease, why standard lab testing often misses the bigger picture, and how things like gut health, nutrient deficiencies, blood sugar dysregulation, chronic stress, and inflammation can all play a role.

Most importantly, this conversation is a reminder that a diagnosis is not the end of the story. There is often so much more you can do to support your body. 

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Episode Timeline:
02:44 – Hypothyroidism vs. hyperthyroidism: what’s the difference?
04:55 – Graves’ disease, Hashimoto’s, and understanding autoimmune thyroid conditions
08:25 – Common root causes of thyroid autoimmunity
09:28 – Genetics, environmental triggers, and leaky gut
11:05 – Blood sugar dysregulation, insulin resistance, and chronic stress
12:38 – Mental health, self-talk, and nervous system support
13:03 – Why TSH alone is not enough
15:01 – The thyroid labs Dr. Elena wants women to know about
18:44 – Thyroid antibodies and why testing them matters
20:26 – How often to recheck thyroid labs
24:10 – Ferritin, vitamin D, zinc, copper, and selenium
26:13 – Vitamin D levels and why many women are still low
31:04 – Iodine: helpful or harmful?
35:25 – Selenium, Brazil nuts, and supplement considerations
37:50 – Detoxification, liver support, and thyroid conversion
39:34 – Castor oil packs: are they worth trying?
40:59 – Infrared sauna and who it may or may not benefit
44:03 – Gentle movement, Pilates, walking, and thyroid support
46:53 – Why overtraining can backfire
47:39 – Gluten, dairy, soy, sugar, carbs, and nightshades
50:12 – Mediterranean-style eating and thyroid-friendly nutrition
55:00 – The most important first step after diagnosis
58:40 – Why community support matters in the healing journey

Why thyroid issues are so often missed

One of the most frustrating things about thyroid dysfunction is how often women know something is off long before they get answers.

You may feel:

• tired no matter how much you sleep

• cold all the time

• constipated

• mentally foggy

• anxious or wired

• prone to hair loss

• stuck with weight changes that don’t make sense

• like your body is working against you

And yet many women are told their labs are “fine” based on a TSH-only test.

As Dr. Elena shared, TSH alone does not tell the full thyroid story. It can be influenced by other hormones and doesn’t always reflect how well your active thyroid hormones are functioning in the body.

That’s why a more complete look at thyroid health matters.

Hypothyroidism vs. hyperthyroidism

Dr. Elena explained it simply:

Hypothyroidism

This is when the thyroid is functioning too slowly. Everything in the body tends to slow down.

Common symptoms may include:

• fatigue

• feeling cold

• constipation

• weakness

• sluggishness

• low mood

• hair loss

• poor workout recovery

Hyperthyroidism

This is when there is too much thyroid hormone in the body, so the system is running too fast.

Common symptoms may include:

• increased heart rate

• palpitations

• tremors

• anxiety

• insomnia

• increased bowel movements

• feeling overstimulated

• appetite and weight changes

Dr. Elena also shared her own experience of flipping from symptoms that looked more hypothyroid into a hyperthyroid state and eventually being diagnosed with Graves’ disease and thyroid eye disease.

Hashimoto’s vs. Graves’ disease

These are both autoimmune thyroid conditions — but they affect the body differently.

Hashimoto’s

Hashimoto’s is typically associated with hypothyroidism. Over time, the immune system’s activity can damage the thyroid and reduce its ability to produce hormones well.

Graves’ disease

Graves’ is typically associated with hyperthyroidism. It stimulates the thyroid to produce too much thyroid hormone.

Thyroid eye disease

Dr. Elena also discussed thyroid eye disease, which is commonly associated with Graves’ disease and can cause inflammation behind the eyes, pain, bulging, blurry vision, double vision, and facial asymmetry.

One important takeaway from this episode: just because you’ve been given an autoimmune diagnosis does not mean there is nothing you can do. Supporting the body, reducing triggers, and addressing root causes can make a meaningful difference.

What can trigger thyroid autoimmunity?

This is where the conversation got especially important.

Dr. Elena explained that autoimmunity often involves three big factors:

1. Genetic predisposition

2. An environmental trigger

3. Intestinal permeability (“leaky gut”)

Some of the most common triggers she sees include:

• gut infections or imbalances

• candida or yeast overgrowth

• parasites

• dysbiosis

• chronic stress

• mold exposure

• Lyme

• Epstein-Barr virus (EBV)

• nutrient deficiencies

• insulin resistance and blood sugar dysregulation

One of the biggest patterns she sees in practice? Gut issues.

According to Dr. Elena, she has yet to see a thyroid client who didn’t have something going on in the gut.

That matters because you can take supplements, change your food, and try all the “right” things — but if deeper gut dysfunction is still driving inflammation and immune stress, progress can stall.

Why stress matters more than most women realize

We also talked about how chronic stress affects everything.

Even women who are eating well can still struggle with blood sugar issues, hormonal disruption, poor recovery, and immune imbalance when stress is high.

That includes not just physical stress, but also:

• mental overload

• emotional stress

• overtraining

• under-eating

• poor sleep

• constant rushing

• negative self-talk

This is one reason I talk so much about nervous system support, breathing, and gentle movement. Your body needs safety and support, not more punishment.

Thyroid labs: what to check beyond TSH

This is such an important part of the conversation.

Dr. Elena made it very clear that a full thyroid panel matters far more than TSH alone.

Labs discussed in this episode included:

• TSH

• Free T4

• Free T3

• Reverse T3

• TPO antibodies

• TG antibodies

• TSI

• TRAB

Her point was not to obsess over numbers, but to get a more complete picture of what’s happening.

We also talked about how antibody testing is often skipped — even though antibodies can be elevated for years before more obvious thyroid dysfunction shows up on standard labs.

That means many women may have signs of autoimmune thyroid issues long before they are formally diagnosed.

Other important labs and nutrients to look at

Beyond thyroid markers, Dr. Elena highlighted a few key nutrients that are often overlooked:

Ferritin

A basic iron panel may look “fine,” while ferritin is still too low. Low ferritin can contribute to:

• hair loss

• fatigue

• feeling cold

• poor resilience

Vitamin D

This was a big one.

Dr. Elena shared that she likes to see vitamin D at a minimum of 50, with 70 being more ideal for many women.

Low vitamin D can affect immune strength and may be especially relevant in women dealing with autoimmunity.

Zinc, copper, and selenium

These nutrients are all important for thyroid health and immune support.

Dr. Elena especially highlighted selenium, and mentioned that selenium with myo-inositol may be particularly helpful in lowering thyroid antibodies.

What about iodine?

Iodine can be a confusing topic in the thyroid world.

Yes, the body needs iodine to make thyroid hormone. But in women with thyroid autoimmunity, too much iodine can be aggravating.

Dr. Elena’s take was clear:

• get iodine from whole foods

• avoid overdoing supplemental iodine

• be cautious with high-iodine products like kelp supplements

• do not assume more is better

This is such a good reminder that even helpful nutrients can become unhelpful when taken in the wrong context.

Food triggers that may worsen thyroid symptoms

We also touched on foods that may be inflammatory or triggering for some women with thyroid issues.

Dr. Elena commonly sees problems with:

• gluten - learn more about gluten and going gluten-free with Dr. Pedre here

• dairy

• soy

• sugar

• excess refined carbs

• nightshades for some women

She explained that gluten can be a major trigger because of a concept called molecular mimicry, where the immune system may confuse gluten with thyroid tissue.

She also emphasized that many women are more sensitive to blood sugar swings than they realize — which is why meal composition matters.

Her general nutrition approach leaned toward a Mediterranean-style way of eating:

• quality protein

• healthy fats

• lots of vegetables

• lower-sugar fruits

• fiber-rich foods

• colorful, nutrient-dense meals

Not in a restrictive, fear-based way — but in a nourishing, supportive way.

That’s a distinction I always want women to hear: the goal is not punishment. The goal is to help your body feel safe, supported, and better nourished.

Movement with thyroid issues: less punishment, more support

This part of the conversation felt especially important to me.

When women are dealing with thyroid dysfunction, exercise can become a source of frustration.

Many women with sluggish thyroid symptoms are already exhausted — and then assume they need to push harder, do more cardio, cut more food, and “burn off” the weight.

But as we talked about in this episode, that can become a vicious cycle.

Dr. Elena emphasized that movement should be gentle and supportive, especially when symptoms are active.

She mentioned:

• walking

• yoga

• Pilates

• gentle strength work

• bodyweight-based movement

And this is exactly why I’m such a fan of helping women reconnect with breath, deep core support, posture, and functional movement before just pushing intensity.

That’s also why my Core Rehab Program can be such a powerful place to start. It helps women rebuild connection, improve movement patterns, and support the body in a way that feels gentle and effective.

You can learn more here: www.corerehabprogram.com

And for my prenatal and postpartum moms, this is also why I’m so passionate about teaching women how to move well during pregnancy and beyond through Knocked-Up Fitness. Pregnancy and postpartum are major windows where core, breath, pelvic floor, and whole-body support matter deeply.

You can explore that here: https://knocked-upfitness.com

Detox support: what actually helps?

We also talked about detoxification.

Dr. Elena is not a fan of jumping into aggressive detox protocols just because they’re trendy. Instead, she emphasized supporting the liver gently, especially when there are known triggers or toxic burdens involved.

That may include:

• supporting liver function

• eating more greens

• using targeted nutrients like NAC or milk thistle when appropriate

• focusing on gut health

• reducing inflammatory burden

She also pointed out that the liver plays an important role in converting T4 into active T3, which means liver support can matter for thyroid health too.

Infrared sauna, castor oil packs, and supportive tools

We also touched on a few popular supportive therapies.

Castor oil packs

These may be a helpful self-care tool for some women, though results vary person to person.

Infrared sauna

Dr. Elena noted that infrared sauna may be more supportive for women with Hashimoto’s or hypothyroid tendencies, but not always for those dealing with Graves’ or hyperthyroid symptoms, since heat can be too stimulating.

That kind of nuance matters. What helps one thyroid condition may not always help another.

The biggest takeaway: test sooner, don’t just guess

When I asked Dr. Elena what she wishes she had done sooner in her own journey, her answer was simple:

functional testing

She shared that if she could go back, she would have investigated her root causes much earlier rather than spending years guessing, trying supplements, and dealing with repeated flare-ups.

That’s such an important message.

You do not need to keep blindly throwing things at your body and hoping something works.

The right testing, the right support, and the right root-cause lens can help you move forward with so much more clarity.

Learn more about functional health coaching with Erica here.

You are not alone

If you are dealing with thyroid issues, please hear this:

You are not crazy.
You are not lazy.
You are not failing your body.

And you are definitely not alone.

There are answers worth looking for, patterns worth understanding, and supportive steps you can take.

This episode is a powerful reminder that healing is rarely about one magic fix. It’s about stepping back, looking at the whole picture, and supporting your body with more strategy, gentleness, and consistency.

If this episode resonates with you, share it with a friend, save it for later, and make sure you’re taking the time to look deeper — not just at symptoms, but at what may be driving them.