Thyroid Optimization + Hashimoto's Treatment

The Lee Clinic has been a leader in integrative and functional medicine in Northern Virginia for over 40 years. Founded by Dr. William Lee, MD and now led by Dr. Megan Lee, DO, we take a root-cause approach to thyroid and adrenal health — one that goes beyond standard lab ranges to understand how you actually feel, and why.

Thyroid Dysfunction: When "Normal" Isn't Good Enough

The thyroid gland plays a central role in nearly every system in the body — energy production, metabolism, mood, cognition, weight regulation, cardiovascular function, and reproductive health. When it is not working optimally, the effects are wide-reaching and often significantly impact quality of life.

One of the most common frustrations we hear from patients is this: they have classic symptoms of low thyroid function, but they have been told their labs are normal. This is a real and well-recognized clinical problem, and it is not simply in your head.

Standard thyroid screening typically measures TSH — thyroid stimulating hormone — which reflects the pituitary's signal to the thyroid, not the actual amount of active thyroid hormone available to your cells. A TSH that falls within the reference range does not necessarily mean your thyroid is functioning optimally for you as an individual. Free T3, free T4, and thyroid antibodies tell a much more complete story, and we routinely measure all of them.

The T3 Problem

The most commonly prescribed thyroid medication — levothyroxine (Synthroid) — replaces T4, the storage form of thyroid hormone. For many patients, this works well. But T4 must be converted to T3 — the active form of thyroid hormone that your cells actually use — and this conversion can be impaired by a number of factors including chronic stress, gut dysfunction, nutrient deficiencies, certain medications, and genetic variation in the enzymes responsible for conversion.

For patients who do not feel well on levothyroxine alone despite normal TSH levels, the addition of T3 — either as liothyronine or as natural desiccated thyroid (NDT), which contains both T4 and T3 — can make a significant difference. This is not a fringe approach; it is supported by clinical evidence and is appropriate for a subset of patients who are genuinely not converting T4 to T3 adequately.

At every initial visit, we run a full thyroid panel including free T3, free T4, TSH, and thyroid antibodies. We interpret these results alongside your symptoms — not in isolation.

Hashimoto's Thyroiditis

Hashimoto's is an autoimmune condition and the most common cause of hypothyroidism in the United States. In Hashimoto's, the immune system produces antibodies that attack the thyroid gland, gradually impairing its function over time.

Many patients with Hashimoto's are simply placed on levothyroxine and told nothing more can be done. We take a more comprehensive approach, addressing the underlying autoimmune process directly. This includes:

Low Dose Naltrexone (LDN) — increasingly supported by evidence as an immune modulator that can help reduce autoimmune activity and lower antibody levels in Hashimoto's patients.

Vitamin D optimization — vitamin D plays a central role in immune regulation, and deficiency is common in autoimmune thyroid disease. Correcting this is a routine part of our approach.

Gut health support — there is a well-established connection between intestinal permeability and autoimmune disease. Addressing gut dysfunction is often an important part of managing Hashimoto's effectively.

These approaches do not replace thyroid hormone therapy when it is needed, but they address the root of why the immune system is attacking the thyroid in the first place.

Common Symptoms of Thyroid Dysfunction

You may benefit from a more thorough thyroid evaluation if you are experiencing any of the following, particularly if previous testing has come back "normal":

Fatigue and low energy despite adequate sleep · Unexplained weight gain or difficulty losing weight · Depression or low mood · Brain fog and difficulty concentrating · Cold hands and feet · Hair loss or thinning · Dry skin and brittle nails · Constipation · Elevated cholesterol despite a reasonable diet · Irregular or heavy periods · Loss of the outer third of the eyebrows

HPA Axis Dysfunction

The adrenal glands — small glands that sit above the kidneys — produce cortisol, the body's primary stress hormone. Cortisol follows a natural daily rhythm, peaking in the morning and declining through the day. When this rhythm is chronically disrupted by ongoing stress, poor sleep, or other physiological strain, it can contribute to a pattern of fatigue, poor stress tolerance, sleep disruption, and immune dysregulation sometimes referred to as HPA axis dysfunction.

We want to be honest about this area of medicine: the concept of "adrenal fatigue" as it was described in functional medicine circles before is not well-supported by the current evidence, and we no longer use that framing. The adrenal glands themselves rarely fail outside of true Addison's disease. What can occur, however, is a disruption in the signaling between the brain, pituitary, and adrenal glands — and for some patients who are genuinely struggling, mapping this pattern can be clinically useful.

For patients with significant, persistent fatigue who have not found answers elsewhere, we offer four-point salivary cortisol testing, which measures cortisol at four time points throughout the day and provides a more complete picture of the daily cortisol rhythm than a single blood draw can. When results reveal a meaningful pattern — for example, a flat cortisol curve, or cortisol that is significantly dysregulated at a particular time of day — this can help guide targeted interventions around sleep, stress management, nutrition, and in some cases, supplementation.

We use this test selectively, for the right patient, not as a routine screening tool.

Our Approach

Thyroid and adrenal health exist in the context of your whole hormonal picture. At The Lee Clinic, we evaluate thyroid function alongside other hormones — including sex hormones, DHEA, and vitamin D — because these systems interact closely. A comprehensive evaluation gives us the most accurate and actionable picture of what is going on.

Treatment is individualized. For some patients that means optimizing levothyroxine. For others it means adding T3 or transitioning to NDT. For Hashimoto's patients it may mean incorporating LDN, vitamin D, and gut support alongside thyroid hormone therapy. We work with you over time, adjusting based on how you feel as much as what your labs show.

Have questions about your thyroid or want a more thorough evaluation than you have received elsewhere? Fill out the form below or call us at 540-542-1700.