When ‘Eat Less, Train More’ Doesn’t Work: What Most Miss About Thyroid Health

When ‘Eat Less, Train More’ Doesn’t Work: What Most Miss About Thyroid Health

When the scale keeps creeping up, your energy dips despite sleeping eight to nine hours, and your body feels out of sync—yet lab results appear “normal”—it’s easy to blame yourself. Dr. Amie Hornaman understands this struggle firsthand. As a former fitness competitor who meticulously tracked macros, trained twice daily, and followed industry protocols, she unexpectedly gained weight during a competition prep in her 20s despite perfect adherence. “I kept gaining—5, then 10, then 15 pounds,” she recalls. “My coach assumed I was cheating, but I wasn’t.”

The Diagnostic Odyssey: Six Failed Attempts

After dropping out of competition due to worsening fatigue, brain fog, and hair loss, Hornaman sought medical help. Six different doctors dismissed her symptoms as stress or lifestyle issues, advising her to simply “eat less and exercise more.” It wasn’t until a seventh physician manually examined her thyroid and ordered a full thyroid panel that she received a diagnosis: Hashimoto’s thyroiditis, an autoimmune condition attacking the thyroid gland.

Standard Treatment Falls Short

Prescribed levothyroxine (synthetic T4), Hornaman saw no improvement after five months. Her own research uncovered a critical gap: Her body wasn’t effectively converting T4 into active T3 hormone. Switching to a functional medicine practitioner who prescribed T3 alongside T4 finally restored her energy and metabolism. “It took six months to a year to fully feel like myself,” she says. This experience drove her career shift into functional medicine, where she now specializes in thyroid and hormone optimization for women.

- Advertisement -

Why Thyroid Issues Evade Diagnosis in Active Women

Hornaman’s case reflects a common pattern. Thyroid dysfunction is frequently missed in fitness-focused women, with symptoms often misattributed to training intensity, stress, or aging. The American Thyroid Association estimates 20 million Americans have thyroid disease—60% undiagnosed—with women 5-8 times more susceptible than men. Hornaman notes, “High physical stress and low caloric intake can trigger or worsen conditions like Hashimoto’s,” especially during hormonal transitions like perimenopause or postpartum.

The Overlooked “Thyropause” Phenomenon

Hornaman coined the term “thyropause” to describe midlife thyroid changes overshadowed by perimenopause. Hormonal fluctuations during this period can activate underlying thyroid dysfunction, particularly with genetic predisposition. Symptoms like unexplained weight gain, fatigue, and brain fog overlap with perimenopause, complicating diagnosis and delaying treatment.

Navigating Medical Appointments: Be Your Own Advocate

Standard TSH-only testing often misses subclinical dysfunction. Hornaman urges patients to request comprehensive panels including:

• Free T3 and Free T4
• Reverse T3
• Thyroid antibodies (TPO, TgAb)

“TSH is a brain hormone—not a thyroid hormone. It doesn’t show the full picture,” she emphasizes. Bring a symptom list and lab requests to appointments, and seek second opinions if denied.

The Critical Role of T3 in Thyroid Therapy

While levothyroxine (T4) is standard first-line treatment, many patients struggle with T4-to-T3 conversion. Though research on combination therapy (T4 + T3) remains mixed, Hornaman reports 100% of her patients require T3 inclusion: “Zero do well on T4 alone because it’s biologically inactive.” Clinical guidelines acknowledge some patients benefit from combination therapy when T4 monotherapy fails.

Lifestyle Supports Beyond Medication

Thyroid health extends beyond prescriptions. Key factors include:

• Nutrient Optimization: Iodine, selenium, magnesium, and vitamin D support thyroid function.
• Inflammation Management: Black cumin seed oil may reduce thyroid antibodies in autoimmune cases.
• Stress & Training Balance: Avoid chronic overtraining and extreme calorie restriction.

Hornaman compares thyroid hormone replacement respectfully to insulin for diabetics: “It’s foundational. Stopping it reverts your body to a low-hormone state.” Proper treatment often eliminates the need for antidepressants, statins, or sleep aids by resolving root causes.

Conclusion: Beyond “Normal” Lab Ranges

Thyroid health requires looking beyond standard lab ranges and simplistic lifestyle advice. For women battling unexplained symptoms despite “normal” results, comprehensive testing, T3-inclusive treatment, and lifestyle adjustments can be transformative. As Hornaman asserts, “Normal doesn’t mean optimal. You need to know what good feels like and have tools to advocate for it.” Her upcoming book The Thyroid Fix (May 2026) provides actionable guidance for reclaiming metabolic health.

FAQs: Thyroid Health Essentials

Why might thyroid issues be missed in fit women?

Symptoms like fatigue or weight gain are often attributed to intense training, dieting, or stress. Many physicians also rely solely on TSH testing, missing conversion issues or autoimmune activity.

What’s the difference between T4 and T3?

T4 (thyroxine) is an inactive hormone produced by the thyroid. T3 (triiodothyronine) is the biologically active form that regulates metabolism. Some bodies inefficiently convert T4 to T3.

What labs should I request beyond TSH?

Demand Free T3, Free T4, Reverse T3, and thyroid antibodies (TPOAb and TgAb) for a complete picture of thyroid function and autoimmune activity.

Can lifestyle changes improve thyroid function?

Yes. Stress reduction, balanced nutrition (prioritizing selenium/iodine), and avoiding extreme dieting support thyroid health—especially alongside proper medication.

Is thyroid medication permanent?

For autoimmune or irreversible thyroid damage, hormone replacement is typically lifelong. Stopping treatment reverses improvements, as the body cannot produce adequate hormones independently.