The Real Cause of Hypothyroidism (It’s Not Just Your Thyroid)

16 Mar 2026 · 19 min · 10 chapters

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In short

The episode argues that hypothyroidism is usually caused by an “upstream hormone cascade,” not a primary thyroid problem. It claims chronic stress/cortisol disrupts the HPA axis (hypothalamus-pituitary-adrenal), dysregulates TSH, reduces T4 production, and—critically—impairs liver/gut conversion of T4 to T3 (said to drop up to 50% even when TSH is normal). It extends the cascade idea to insulin resistance, PCOS, infertility, low testosterone, and menopause.

Guest backgrounds

No guests are named; the host is Dr. Josh Axe.

Key claims

Treating symptoms with T4 (levothyroxine) often leaves fatigue, weight gain, hair thinning, low body temperature, and low energy because the root signal isn’t restored.

Notable examples

A patient example of trying thyroid meds, birth control, antidepressants, metformin, TRT/HRT without relief; a hypothyroidism scenario where labs normalize but symptoms persist; dietary example warning against cold salads/raw foods and recommending warm soups/teas, protein/fiber, and dark fruits (berries, pomegranate). Mentions ashwagandha as the top functional-medicine herb for lowering cortisol.

Written by AI. May contain mistakes. Listen to the episode to check what was said.

Chapters

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Introduction to Hormone Cascade Problems

1:02 to 1:57

Understanding hormone cascade issues and their effects on health.

“within the first six months of card membership.”

Understanding Hormone Treatment Failures

3:13 to 4:12

Why traditional hormone treatments often miss the root cause.

“Axe, I've tried thyroid medications, I've tried hormone creams, birth control, even insulin, but nothing is working for me.”

The Domino Effect of Hormones

4:12 to 5:35

Explore how hormones interact and the impact of imbalances.

“And I'm going to walk you through exactly how you can heal the root causes of, as I mentioned, PCOS, low testosterone, insulin resistance, hypothyroidism, and menopause with this strategy.”

Identifying Thyroid Cascade Issues

5:35 to 6:45

Learn how thyroid issues may originate from other body systems.

“I can tell you from taking care of thousands and thousands of patients with hypothyroidism, even when they get on a T4 medication like levothyroxine, they still don't feel a hundred percent.”

The Role of the HPA Axis in Thyroid Health

6:45 to 7:48

Understanding the HPA axis and its connection to thyroid function.

“And these are examples of hormone cascade issues because it's not just one hormone, it's many hormones that are impacting each other.”

Cortisol's Impact on Thyroid Function

7:48 to 9:10

How cortisol affects thyroid hormone levels and health.

“And for a lot of people, it starts with this hormone cortisol and you have something called your HPA axis, your hypothalamus pituitary adrenal axis.”

Strategies to Support Thyroid Health

9:10 to 10:30

Diet and lifestyle changes to improve thyroid function.

“And medications fall short again because of this.”

Key Nutrients for Thyroid Support

10:30 to 12:20

Essential nutrients for maintaining healthy thyroid function.

“The carbs that tend to be the best for the thyroid, according to Chinese medicine specifically, are berries and pomegranates, so really dark fruit.”

Dietary Changes for Hypothyroidism

12:20 to 14:00

Learn dietary adjustments that can help manage hypothyroidism.

“The number one herb prescribed today by functional medicine practitioners for hypothyroidism is ashwagandha.”

Healing Hypothyroidism Through Diet and Lifestyle

14:00 to 15:47

Learn how dietary choices and lifestyle changes can positively impact hypothyroidism.

“and you're doing cold salads and you're doing raw foods.”
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Transcript

Automatic transcript. May contain errors.

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1:24you actually have what I call a hormone cascade problem. Today, I'll show you how hormones work like dominoes. When the upstream signal breaks, everything downstream fails. And I'll cover the biggest cascades behind issues like hypothyroidism, stress and insulin resistance, PCOS, infertility, low testosterone, and menopause. And I'll walk you through exactly how to restore the signal at the source and heal your hormones at the root cause. Welcome to the Dr. Josh Jack Show.

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3:37And once we fix the upstream signal, the downstream hormones corrected themselves automatically. Now, most doctors today treat hormones like isolated light switches. One hormone is on or one is off, and they try to fix it in isolation. But hormones don't work independently. They work in sequences. They work synergistically together. Think of hormones like a domino chain or a waterfall. one signal triggers the next and the next and the next. And this happens over time. Now, I want to give you an example of how this happens. And I'm going to walk you through exactly how you can heal the root causes of, as I mentioned, PCOS, low testosterone, insulin resistance, hypothyroidism, and menopause with this strategy.

4:25But an example of this would be with the endocrine cascade. One of the things that happens so often when people eat foods that It can imbalance blood sugar, and it could be not just sugar, processed carbohydrates. It could be even certain types of dairy. And what this will do is all of a sudden your blood sugar is off, okay? So we see blood sugar is off. And then what happens is insulin's impacted, right? So we see insulin. Well, when insulin increases, that increases stress on the adrenal glands. So then the adrenal glands start impacting your pituitary gland, and this is where you're releasing cortisol and stress hormones, and then your thyroid is impacted, and then your sex hormones like estrogen and testosterone, then those are impacted.

5:11And we see that there are different initial dominoes that will kick off hormone imbalance. And if the first domino falls the wrong way or the water source is disrupted upstream, everything downstream is then impacted. Even those glands themselves that are perfectly healthy, those are impacted. And that's why fixing one hormone number often doesn't fix how you feel because the original signal never got restored. I can tell you from taking care of thousands and thousands of patients with hypothyroidism, even when they get on a T4 medication like levothyroxine, they still don't feel a hundred percent.

5:48There's still metabolism issues. There's still thinning hair problems. There's still low body temperature. There's still weight gain. There's low energy. All of those things are still there. Now, some of them change a little bit to where you get a little bit of relief, but those problems are still underlying there because you never got to the root of that first domino causing the hormone imbalance in the first place. Listen, I believe 80 % of hormone issues actually start in the brain. So it's not a gland like your thyroid gland. It is in the brain and treating a final hormone like T4 or estrogen or insulin often misses the root problem and doesn't put an end to the symptoms for good.

6:30And this is why you continue to have, you feel a level of chronic stress, there's a level of inflammation, right? And with that inflammation, you don't look as young or feel as young as you want to. And that's the key is if we can start to fix things at the root, you will feel younger, you will look younger, your hormones will balance out, right? And these are examples of hormone cascade issues because it's not just one hormone, it's many hormones that are impacting each other. So let's dive into the thyroid cascade. Now, here's a common scenario. Someone is exhausted, gaining weight, and just generally struggling, feeling overwhelmed, and they finally go to their doctor and get told, your thyroid is low.

7:09Okay? So they're prescribed a thyroid medication, their labs improve, but they still don't feel like themselves, one in four people on thyroid medication still report symptoms despite absolutely and completely normal lab values. And that's because what looks like a thyroid problem is actually a bigger issue. So here's what's typically causing this cascade in hypothyroidism. It never starts with the thyroid, okay? In fact, hypothyroidism is almost always starts in the brain or the gut or the adrenals or the liver, okay? So pretty much anywhere but the thyroid is where thyroid problems start, okay?

7:48And for a lot of people, it starts with this hormone cortisol and you have something called your HPA axis, your hypothalamus pituitary adrenal axis. And so your pituitary is impacted and this is really where TSH, right, is released. That then impacts the thyroid. Your thyroid then releases T4, But then in order for your body to function properly, okay, for your cells and your organs to be fueled like they should, they need a hormone called T3. So your T4 that your thyroid produces needs to be converted to T3. And 80 % of that conversion happens in the liver and another 20 % happens in your gut microbiome.

8:30And the pattern works something like this. the hypothalamus senses chronic stress, inflammation, or blood sugar swings, okay? And it sends a danger signal to the pituitary, and the pituitary lowers or dysregulates TSH, that's thyroid-stimulating hormone, and then the thyroid produces less T4, okay? And then the liver and the gut struggle to convert T4 to T3, and so your cells slow their metabolic activity to conserve energy. This is what hypothyroidism is. And by the time symptoms show up, the thyroid is just the messenger, not the original problem. And medications fall short again because of this.

9:13Thyroid meds can replace hormones, but they don't automatically restore proper brain to thyroid signaling, which is converting T4 to T3. Again, that conversion happens in the liver and in the gut. So here's the solution. We want to reduce chronic stress and cortisol overload. I really believe that's the number one thing. If you want to know what is the main upstream problem causing hypothyroidism today, it's not TSH, it's not T4, it's cortisol, and it's really your brain. It's chronic stress causing cortisol overload. And studies show stress and inflammation reduce that T4 to T3 conversion by up to 50%, even when TSH is normal.

9:56And I've done episodes on how to reduce stress in the past. We'll link them in the show notes. And here's some things you get to do to stop the stress on the thyroid. Now, let me say this. The thyroid is, of course, involved, and you do want to support thyroid health, and you do want to support the body in some very specific ways that then impact the thyroid. And let me walk you through how this works. So one of the first things you want to do to kind of lower cortisol, but also balance out insulin and support liver and gut health is you want to consume a diet that's higher in protein and fiber and healthy fats, but you do want to get some carbs.

10:30The carbs that tend to be the best for the thyroid, according to Chinese medicine specifically, are berries and pomegranates, so really dark fruit. Black whole grain rice is good and sweet potato. Those carbohydrates tend to be the best for keeping stabilized blood sugar, but still having some carbohydrates in your diet because you do want some when you have hypothyroidism. There are also some really key nutrients, both the thyroid needs and the adrenals need, iodine being one. Now, if you have Hashimoto's thyroiditis, you need to be careful of, or autoimmune disease, you need to be careful of how much iodine you take.

11:06You typically want to start with a lower dose and start taking some other things to lower the autoimmune reaction first, like selenium. Selenium is one of the most critical nutrients for thyroid function and overall organ function when it comes to stabilizing and supporting thyroid hormones. Typically, around 200 micrograms a day is the ideal dosage. And you also need to make sure you have proper levels of zinc and iron and B vitamins. You want to be methylating properly as well. So iodine, selenium, zinc, and iron are key nutrients if you have hypothyroidism. And you do want to make sure you're eating enough calories.

11:43You also want to warm your body up. This really helps. It helps with relaxation. It helps with mitochondrial health, which is also deeply connected to hypothyroidism. And I would say getting in an infrared sauna, getting red light therapy, doing an infrared heating pad, warming up your feet and your midsection, and even doing some of that light right on your thyroid is good as well. But again, when we're looking at these hormone cascades, the single biggest hormone that is negatively impacting hypothyroidism or thyroid issues today is when cortisol gets too high. And when cortisol gets too high, insulin gets high, estrogen can get too high.

12:19And then what happens is that downregulates the thyroid hormones. So listen, if you have a hypothyroidism issue and you're just trying to treat it with a medication or even outside thyroid supplements, it typically is not a total fix because we really need to impact cortisol in a positive manner. Now, let me say this. The number one herb prescribed today by functional medicine practitioners for hypothyroidism is ashwagandha. Now, ashwagandha doesn't magically impact thyroid hormone. You know what it does impact, though, is stress and cortisol. So ashwagandha is known as an adaptogenic herb, and it helps your body better adapt and deal with stressors.

12:59So what it does is it lowers cortisol, and then it improves thyroid hormone because of how it's impacting cortisol. So that's why ashwagandha is such a well-known herb for hypothyroidism, and typically the number one herb I recommend for hypothyroidism. But again, if you want to cure and fix the thyroid cascade, you first and foremost need to fix cortisol. And typically to fix these issues, again, it's not one medication or one supplement. And that's what's happening so often today. It's, no, we need a protocol. We need a lifestyle change. We need to say no more often, right? We need to get better sleep.

13:34We need to take a few supplements, but we need to change and improve our diet and eat the foods that are exactly right for you. Listen, the diet doesn't taste better or worse. One, it's what your body is craving and needs. But I'll give you an example. I've had so many women come in with hypothyroidism and they've said, well, I'm eating really healthy. I'm eating a lot of salads and smoothies. That's not healthy in most cases for hypothyroidism. Your body's cold. So you're eating, drinking cold ice water and you're doing cold salads and you're doing raw foods. And that's terrible for hypothyroidism.

14:04We got to warm the body up. We need to also lower cortisol. So we need to lower insulin. What do we do? It's a lot of soups. It's a lot of herbal teas. It's a lot of warm home-cooked meals. It's a lot of things like sweet potato and grass-fed beef and wild-caught salmon, that fixes it. That'll fix it, okay? So there's different types of eating healthy. You need to eat the type of healthy that's right for you and your body and your hormones, okay? And here's my challenge. Instead of asking which hormone is low, ask which signal is broke first, okay? And what is the most likely reason that it broke, okay?

14:42So if cortisol is high, ask, what's causing me to live in a fight or flight state, okay? Is it stress at work? Is it I've said yes to everything? Is it I have no free time in my day? And then figure out how to solve that problem. That's how you'll start to see real results, okay? In that way. And listen, sometimes it's coming from multiple angles. Sometimes if your diet's poor, that's an insulin issue. And then you have high cortisol, that's another issue. So you have both those issues. So sometimes there's a couple pathways that are impacting you and you need to say, well, I need to fix this issue and this one, and then your hormones will come back into balance.

15:18But if you want to heal your hormones, you have to start with that first domino, okay? So it's lowering cortisol, it's improving insulin, and it's getting to bed earlier. It's having some more time to yourself. It's more protein and fiber at every meal. It's taking one or two supplements that are the ones that are the needle movers for you, walking in nature, spending more time reading and personal growth and spiritual growth, prayer, those things will start to get to the root of your hormonal issues. And you can finally address your hormones at the root cause. By the way, I want to mention I'm offering a simple at-home blood test that actually tests for the right things.

16:01Targeted biomarkers, including hormones, thyroid, and metabolism, plus a full hour with one of my senior health advisors to help you understand your results. So if you are interested in learning more about the blood work and getting testing done, that's very cost effective to understand the root of your issues. You can go to mybloodwork.com. That's mybloodwork.com and get testing. I want to say thanks so much for tuning in here to the Dr. Josh Ack Show. Remember, each and every week we're diving deep into the science and principles of how you can heal physically, mentally, spiritually, and take your health and your life to the next level.

16:41Hey, I've done a lot of podcasts on a lot of these topics as well. So if you want to continue to learn more about a certain element, maybe it's getting better sleep. Maybe it's about hypothyroidism or low testosterone. Just search on YouTube, Dr. Josh Axe testosterone or hypothyroidism or look in the show notes. And I'm going to have more of those episodes in there that you can look back at and listen to to further your wisdom and knowledge on these areas to help you take your health to the next level. Also remember, the number one thing you can do to support the show is subscribe. sometimes because we talk about controversial topics on the show, such as cancer and certain natural remedies like ivermectin and hydroxychloroquine.

17:19And I have some controversial experts on the show. It gets shadow banned. And so if you're not subscribed, you may not see it. So thanks so much for your support on that. Thank you for sharing. And I can't wait to see you on the next episode.

From the publisher

What if your thyroid isn’t actually the root of your hypothyroidism? In this mini episode, Dr. Josh Axe breaks down the thyroid hormone cascade—the step-by-step process your body uses to produce, convert, and activate thyroid hormones. Discover why focusing on your thyroid alone may be missing the real problem—and what actually needs to heal for your metabolism, energy, and hormones to come back into balance.

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DISCLAIMER

This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.

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