In this episode of Thyroid Pharmacist Healing Conversations, Dr. Izabella Wentz interviews Dr. Eric Balcavage, co-author of The Thyroid Debacle and host of the Thyroid Answers Podcast, about seeing thyroid disorders through the lens of adaptive physiology.

Dr. Balcavage explains how the cell danger response, mitochondrial stress, and chronic inflammation, can drive a deliberate downshift in thyroid function – even when TSH and T4 levels appear “normal.”

Together, they explore the limitations of both conventional endocrinology and “greenwashed” functional medicine, dig into hot topics like T3 therapy, ferritin, vitamin D, and TSH ranges, and discuss why mindset, relationships, and emotional stress can be just as important as lab work in restoring true thyroid homeostasis. Listeners will walk away with a richer understanding of why they still feel unwell despite treatment, and a more hopeful roadmap for moving out of survival mode and into healing.

What you’ll learn in this episode:

Why your thyroid may not be “broken” – it may be adapting. Dr. Balcavage explains how the cell danger response and mitochondrial stress can trigger a protective downshift in thyroid hormone conversion, where the body is trying to protect itself from danger, such as an infection, toxins, or emotional trauma. This shift reframes thyroid disease from “self-attack” to an intelligent (but uncomfortable) survival strategy.
Why you may be stuck in “thyroid purgatory.” Dr. Balcavage and Dr. Wentz discuss the pitfalls of conventional endocrinology (TSH-only, medication-for-life) and “green allopathy” (using different hormones or supplements solely to normalize labs). When we’re searching for the “perfect” T3, reverse T3, or TSH level, we often miss the real driver: cell stress and inflammation.
Why more T3 isn’t always better, and when it may backfire. Dr. Balcavage breaks down the main reasons T4-to-T3 conversion goes down (inflammation, stress, excess T4, and genetics), and why simply adding more T3 can increase oxidative stress, suppress natural hormone production, and even blunt immune surveillance in some people. Instead, he encourages us to ask why T3 is low and address the underlying triggers first.
The hidden role of mindset, relationships, and finances in thyroid recovery. Dr. Balcavage and Dr. Wentz explore how emotional turmoil like chronic fear, resentment, relationship stress, and money worries wind up the limbic system, keep the body in fight-or-flight, and shut down gut, reproductive, and thyroid physiology. Dr. Balcavage shares real-life stories of clients whose symptoms improved dramatically when they shifted how they viewed their circumstances – even before changing labs or supplements.
How Dr. Balcavage’s “fitness factors” create a roadmap back to homeostasis. Dr. Balcavage evaluates 18 “fitness factors” – including sleep, breathing, emotional fitness, relationship health, habitual routines, and metabolic fitness – to identify the biggest stressors keeping the body in a stressed state. Addressing these systematically allows thyroid physiology to normalize, sometimes even allowing for dose reductions or gland recovery.
Why TSH “optimal ranges,” ferritin goals, and vitamin D obsession can be misleading. Dr. Balcavage and Dr. Wentz discuss whether a TSH above 2 is always bad, if low ferritin always means iron deficiency, why 25-OH vitamin D isn’t the whole story, and whether Hashimoto’s can exist without antibodies.

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For the full list of resources and products mentioned in this episode, and to get the full episode transcript, see complete show notes here: https://thyroidpharmacist.com/articles/podcast/

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