
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.
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Dr. Josh Axe
Shop now@palmolive.com if you've tried thyroid medications, birth control, antidepressants, metformin, TRT or HRT, and you're still dealing with fatigue, weight gain, or brain fog. You don't have one hormone problem. You 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 Axe Show. So I can't tell you how many patients I've seen over the years, and they've told me, Dr. Axe, I've tried thyroid medications. I've tried hormone creams, birth control, even insulin, but nothing is working for me. But when I zoomed out, I was able to realize something crucial. They were treating the symptoms, not the root problem, which is a hormone cascade. Issued. And once we fixed 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. But an example of this would be with the endocrine cascade. You know, one of the things that happens so often when people eat foods that 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 horm. And then your thyroid is impacted. And then your sex hormones, like estrogen and testosterone, then those are impacted. And 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 100%. There'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 diet 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. And 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, okay? 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 a thyroid, okay? In fact, hypothyroidism is almost always starts in the brain or the gut or the adrenals or the liver, okay? So everywhere, pretty much anywhere. But the thyroid is where thyroid problems start, okay? 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. And so your pituitary is impacted, and this is really where TSH 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. And the pattern works something like this. The hypothalamus senses chronic stress, inflammation, or blood sugar swings, okay?
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Dr. Josh Axe
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 to not the original problem. And medications fall short again because of this. Thyroid 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 wanna reduce chronic stress and cortisol overload. I really believe that's the number one thing. If you wanna 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. And 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 need to do to stop the stress on the thyroid. Now, let me say this. The thyroid is of course involved and you do wanna support thyroid health and you do wanna 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. The carbs that tend to be the best for the thyroid, according to Chinese medicine specifically, are berries and pomegranate. So really dark fruit, black whole grain rice is good. And sweet potato, those carbohydrates. 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. You 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, you 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, and then what happens is that down regulates 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 herbal 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. So 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, we 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. But we 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? So if cortisol's 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 need to say, well, I need to fix this issue and this one. And then your hormones will come back into balance. But 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, for you walking in nature, spending more time you know 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. Targeted 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 Axe Show. Remember, each and every week we're diving deep into the science and principles of how you can heal physically, physically, mentally, spiritually and take your health and your life to the next level. Hey, 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. Subscribe sometimes, because we talk about controversial topics on the show such as cancer and certain natural remedies like ivermectin and hydroxychloroquine. And 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.
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Episode: The Real Cause of Hypothyroidism (It’s Not Just Your Thyroid)
Host: Dr. Josh Axe
Date: March 16, 2026
In this episode, Dr. Josh Axe challenges the conventional approach to hypothyroidism, arguing that the disorder—and many hormonal imbalances—aren’t simply problems with individual glands or specific hormones. Instead, he frames them as "hormone cascade" issues that begin upstream, often in the brain, and impact the whole endocrine system. Throughout the episode, Dr. Axe shares his clinical insights, nutritional guidance, and practical steps for identifying and resolving the real root causes behind hypothyroidism and related health concerns.
Timestamp: [01:23]–[03:40]
“Hormones don’t work independently. They work in sequences.” — Dr. Josh Axe [02:20]
Timestamp: [03:40]–[10:00]
“One in four people on thyroid medication still report symptoms despite completely normal lab values.” [05:53]
“In hypothyroidism, it never starts with the thyroid. In fact, hypothyroidism almost always starts in the brain, or the gut, or the adrenals, or the liver.” [06:05]
Timestamp: [07:56]–[12:00]
“Studies show stress and inflammation reduce that T4 to T3 conversion by up to 50% even when TSH is normal.” [09:36]
Timestamp: [10:00]–[15:00]
Diet should emphasize:
“For hypothyroidism, your body’s cold. So you’re eating cold ice water, cold salads, and raw foods. And that’s terrible.” [13:18]
Avoid the “one-size-fits-all” concept of healthy eating; instead, tailor your nutrition to your unique hormonal needs.
Infrared sauna, heating pads, and red light therapy to “warm the body up” and support relaxation and mitochondrial health
Ashwagandha is the top adaptogenic herb for hypothyroidism, not for direct thyroid hormone support, but for lowering cortisol and improving stress resilience:
“Ashwagandha is known as an adaptogenic herb and it helps your body better adapt and deal with stressors. So what it does is it lowers cortisol and then it improves thyroid hormone because of how it's impacting cortisol.” [12:53]
Emphasize overall lifestyle changes—more time for yourself, sleep, nature walks, spiritual practices, saying “no” more often.
“Instead of asking which hormone is low, ask which signal is broke first.” [14:03]
Timestamp: [15:00]–[16:30]
Dr. Axe’s approach reframes hypothyroidism as a “messenger” problem, not just a glandular malfunction. He urges listeners to “zoom out,” identify upstream triggers (especially cortisol and stress), and treat the whole system through smart nutrition, lifestyle reset, and holistic support. Personalized and comprehensive care, including proper diagnostics, are critical for tackling stubborn hypothyroidism and restoring true well-being.
Further Resources: