The Lanby's Approach to Hashimoto's

You've been tired for a year. Your hair is thinning, your hands are always cold, your cycles have changed, and your weight won't move no matter what you do.

You had labs drawn. They came back normal.

Normal only means you fall within the same reference range as 95% of the population. It doesn't mean you're optimized. And when it comes to thyroid autoimmunity, it often doesn't even mean you were tested properly.

What Hashimoto's Actually Is

Hashimoto's thyroiditis is an autoimmune condition.

In Hashimoto’s thyroiditis, the immune system produces antibodies that attack the thyroid, gradually damaging tissue and potentially reducing thyroid hormone production. It’s more common in women, who are affected four to ten times more often than men.

Two things follow from that, and they shape everything about how we approach it.

It starts long before your TSH moves. Thyroid antibodies can be detectable years ahead of any change in thyroid function. You can be in an active autoimmune process, with labs that read as normal, and feel every bit of it.

The thyroid is the target, not the cause. Replacing hormones addresses what you've lost. It doesn't answer why your immune system is attacking in the first place. Most people have only ever had the first conversation.

How It Shows Up

Early on, damaged tissue releases stored hormone, and some pass through a brief hyperthyroid phase — palpitations, anxiety, heat intolerance, disrupted sleep.

As it progresses, the picture turns:

• Fatigue that sleep doesn't fix
• Cold intolerance
• Weight gain, or a plateau that won't budge
• Brain fog, low mood, trouble concentrating
• Thinning hair, dry skin, brittle nails
• Constipation
• Heavier or irregular cycles, difficulty conceiving
• Neck fullness or pressure

Any one of these is easy to write off as a busy life in New York. Together, they're a pattern. Patterns are what we test.

Where We Look Deeper

Autoimmunity is rarely driven by one factor. We look at how several may overlap across the same four systems we examine in every member.

Gut health. The gut-thyroid connection matters. Intestinal permeability and dysbiosis may play a role in autoimmune conditions, and celiac disease occurs more frequently in people with Hashimoto’s.

Hormone health. Postpartum and perimenopause are common windows for onset. Acute stress and trauma may trigger flares, while chronic stress and altered cortisol rhythms can influence immune regulation.

Metabolic health. Thyroid dysfunction can affect cholesterol and body composition, particularly when hypothyroidism is undertreated. Metabolic markers help us understand the broader picture and monitor treatment.

Nutrient and environmental health. Selenium, iodine, iron, zinc, and vitamin D all contribute to thyroid function and immune regulation. We also consider potential environmental exposures, including mercury, which can affect thyroid function at sufficient levels, and assess liver health as part of the body’s broader metabolic and detoxification systems.

No two members arrive with the same combination. That's the case for testing instead of assuming.

Through Primary Care

Your physician starts with a complete thyroid panel, not a screening TSH.

That means TSH, free T4, free T3, total T4 and T3, reverse T3, and both antibodies. Antibodies are what separate Hashimoto's from every other cause of hypothyroidism — and they're frequently not ordered. We read all of it against optimal ranges, not just the lab's reference range, which is built from a population that includes a great number of people with undiagnosed thyroid disease.

If hormone replacement is indicated, levothyroxine remains the standard of care and is the right answer for many members. Some do better with the addition of T3, or with a different formulation. That's a clinical decision your physician makes with you, from your symptoms and your labs together.

And if you arrive already on medication and still don't feel like yourself, that's a conversation worth reopening. "Your dose is fine" is not the same as "you're well."

Through Functional Medicine

Once we know what the thyroid is doing, we look at the terrain around it. Depending on what the first panel shows, your Care Team may add:

• Celiac serology and food sensitivity testing
• A micronutrient panel — selenium, ferritin and iron, zinc, B12, vitamin D
• Comprehensive stool analysis, when gut symptoms are part of the picture
• A full hormone assessment, including cortisol rhythm and sex hormones
• Metabolic and lipid panels
• Environmental exposure or heavy metals screening, where your history warrants it

The point is never to order everything available. It's to order what will change your Care Plan.

Where the evidence supports and your labs justify it, your Care Plan may include targeted supplementation. Selenium has been shown across multiple trials to lower anti-TPO antibodies, with the clearest effect in people who are found to have insufficient stores. Myo-inositol paired with selenium has been studied in subclinical hypothyroidism with autoimmunity, with improvements in both TSH and antibody levels. Vitamin D is dosed to your measured level and retested. Omega-3s are considered case by case.

These are doses your physician sets. Selenium in particular has a narrow therapeutic window, and thyroid "support" blends sold direct to consumers have been found to contain undisclosed iodine and actual thyroid hormone. Bring us what you're taking. We'll look at it together.

Through Wellness

This is where a Care Plan becomes something you can actually live.

Your dietitian builds your nutrition plan from your labs and your real life — not from a Hashimoto's handout. An anti-inflammatory, nutrient-dense foundation. Adequate protein. Selenium-rich foods like Brazil nuts, sardines, and eggs. Iron and zinc sources, if your panel shows gaps.

Gluten gets a considered look rather than a blanket verdict. With celiac disease, removal isn't optional. Without it, a structured trial with your dietitian is genuinely clarifying — and far more useful than an indefinite elimination you undertake alone. The same goes for protocols like AIP: a useful diagnostic tool, not a lifestyle, and the reintroduction phase is where the real information lives. We supervise both halves.

Iodine we handle carefully. Too much and too little can each aggravate autoimmune thyroid disease, which makes iodized salt, seaweed, and supplements worth being deliberate about.

Your health coach takes the rest: sleep, stress load, movement that supports you instead of depleting you, and the ordinary work of making any of this stick through a demanding season. Hashimoto's fatigue is real, and a plan that ignores it doesn't get followed.

The Difference Is Continuity

Hashimoto's is managed, not cured. The follow-up is the treatment.

• Six to eight weeks after any change in medication or supplementation
• Three to six months for antibody trends — they move slower than TSH, and a falling titer means something
• Annually once you're stable, alongside nutrient status and the metabolic picture

Between those draws, how you feel is data too. Your Care Team wants it, and they're on the other end of a message thread, not a phone tree.

Functional medicine is most powerful when it's practiced over time. One panel is a snapshot. Years of them, read by a Care Team that knows your history, is how we connect the dots.

Your Health Is Our Incentive

Thyroid autoimmunity is exactly what falls through the cracks of fifteen-minute primary care. It needs a complete workup, the time to interpret it, nutrition that's built rather than recommended, and someone watching the trend across years.

Physician, dietitian, and health coach. One Care Plan. All under one roof.

Book a complimentary Discovery Call.

Educational content, not individualized medical advice. Thyroid testing, medication, and supplementation decisions belong with your physician.