"Your TSH is perfect. Your T4, maybe even T3 looks great," Dr. Sarah said gently, sliding my labs across the desk.
"Then why is my hair still falling out?" I whispered.
She pulled out a piece of paper and started drawing.
"First - your hair follicles need active T3 to stay in the growth phase."
"Second - that T4 to active T3 conversion happens in your liver. Not your thyroid."
"Third — with Hashimoto's, your liver gets chronically inflamed from the autoimmune attack. So he conversion gets blocked."
"And fourth - even if T3 shows up in your bloodwork, or you're taking T3 medication, it doesn't mean T3 is reaching your follicles. Because that only happens through proper liver conversion."
"Wait," I said. "So my labs look fine… but my follicles are starving?"