Dr. Amie Hornaman knows that feeling all too well. She has spent years participating in fitness and figure competitions, tracking her macros, training twice a day and doing everything the industry says should produce results. But during a prep cycle in her 20s, something wasn’t right. Despite adhering to the rules, her weight began to rise.
“I followed everything perfectly, but I kept gaining weight, at first just five, then 10, 15 pounds,” she said Muscle & Fitness. “My coach assumed I was cheating on donuts and pizza, but I wasn’t.”
Hornaman eventually quit her competition. By this time, she was also experiencing fatigue, brain fog and hair loss. But when she sought help, they said several doctors attributed her symptoms to lifestyle factors or stress. So she kept searching for more answers.
How six misdiagnoses led to a lifelong mission
Over the course of several months, as she became increasingly tired and felt like “a shell of a human being,” multiple doctors discharged her, according to Hornaman. “Eat less and exercise more. Stop worrying about it,” she recalled of their guidance, noting that “six doctors misdiagnosed me, rejected me, didn’t run the right tests, told me I was normal and I was fine.”
It wasn’t until the seventh doctor touched her throat and told her to swallow. “I feel something on your thyroid,” Hornaman remembers the doctor telling her and ordering a full thyroid panel.
She was diagnosed Hashimoto’s thyroiditisan autoimmune disease in which the immune system attacks the thyroid gland. She was prescribed levothyroxine (Synthroid), a standard synthetic T4 drug. “I hoped it would help. But after five months I didn’t feel any different.”
Hornaman began researching thyroid physiology and discovered T3, the active form of thyroid hormone, which her body could not effectively convert from T4. She left conventional care and started working with a functional medicine practitioner, who changed her medications and added T3. Hornaman slowly started to feel her energy and metabolism returning.
“It took six months to a year to feel like myself again,” she said. “But the first improvements were noticeable.”
That experience led her to make a career change, study functional medicine, and now, as the “Thyroid Fixer,” she specializes in thyroid and hormone optimization for women, especially those experiencing symptoms despite “normal” lab values.
Why thyroid dysfunction is missed in fit women
Hornaman’s case is not unusual. Thyroid dysfunction can be underdiagnosed, especially in active women whose symptoms are attributed to training load, stress, or age.
According to the American Thyroid AssociationAn estimated 20 million Americans have some form of thyroid disease, and up to 60% of them are undiagnosed. In addition, women are five to eight times more likely than men to develop thyroid problems.
“High physical stress and low calorie intake are known stressors for the thyroid,” Hornaman explains. “It can cause or worsen conditions like Hashimoto’s.”
In women, thyroid problems are more likely to surface during periods of hormonal changes, including postpartum, perimenopause, and menopause.
Understanding ‘thyropause’ and hormonal shifts in midlife
Hornaman coined the term “thyropause” to describe thyroid changes that occur during middle age but are often overshadowed by perimenopause.
“Hormonal fluctuations are stressors. In women over 40, these stressors can activate underlying thyroid dysfunction, especially if there is a family history or previous immune problems,” she noted.
Symptoms such as fatigue, weight gain, delayed recovery, and cognitive changes can occur in both perimenopause and hypothyroidism, making the diagnosis more complex.
Take a list with you to your doctor’s visit
Hornaman explained that standard thyroid testing often only includes TSH (thyroid stimulating hormone), which may not detect early or subclinical dysfunction. That’s why she encourages her patients to request a comprehensive panel that includes free T3, free T4, reverse T3, and thyroid antibodies.
“TSH is a brain hormone, not a thyroid hormone,” she said. “It shows part of the picture, but not the whole story.”
She recommends that patients bring a written list of symptoms and specific lab requests to appointments. “If your supplier won’t order them or tells you they aren’t needed, get a second opinion.”
According to a 2021 study in Frontiers in endocrinology, Patient dissatisfaction with thyroid care is common and often related to gaps in testing, treatment options, and communication.
Why T3 matters
Levothyroxine (T4) is the standard first-line treatment for hypothyroidism. But Hornaman explains that many patients, like her, are unable to efficiently convert T4 to T3, the active hormone. Research remains mixed on whether combination therapy is superior, but clinical guidelines recognize that some patients may benefit from a T4/T3 combination.
“In my clinic, 100% of my patients only need T4 and T3 or T3,” Hornaman noted. “Zero only does well on T4 because it is the inactive thyroid hormone.”
Lifestyle considerations for thyroid health
Hornaman emphasizes that medication is only one part of managing thyroid function. Nutrition, sleep, stress and training load all influence the balance of those hormones.
She highlights some important nutrients involved in thyroid function, such as iodine, selenium, magnesium and vitamin D. For women with autoimmune thyroid diseases, reducing inflammation can also improve symptoms. She says, for example, black cumin seed oil has been studied for its role in lowering thyroid antibody levels.
For Hornaman, thyroid hormone replacement is a lifelong solution. “You’d have to pry my thyroid hormone medication out of my dead hands before I would ever stop taking it,” she said. “It gives me life.”
She often compares it to insulin for type 1 diabetes. “When we replace a hormone that is no longer being produced properly by your body, you can’t just stop. If you do that, you go right back to that low hormonal state.”
She also points out that thyroid hormone is not a band-aid, but a fundamental therapy that can make other medications unnecessary. “Instead of needing an antidepressant, a statin or a sleeping pill, we treat the thyroid. And then suddenly the depression goes away, cholesterol improves, sleep returns and the metabolism starts functioning again.”
Her upcoming book, The thyroid fix, releases in May and aims to educate women about navigating thyroid health using data, context, and choice. It’s a guide to understanding how thyroid hormones affect the entire body, and what to do when standard care doesn’t go far enough.
“You can’t assume that ‘normal’ means optimal,” Hornaman said. “You have to know what good feels like and have the tools to ask the right questions.”
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