Frequently asked questions

A comprehensive thyroid panel includes TSH (thyroid-stimulating hormone), Free T4 (active storage hormone), Free T3 (active metabolic hormone), Reverse T3 (the inactive blocker), TPO antibodies (thyroid peroxidase — Hashimoto's marker), and TgAb (thyroglobulin antibodies).

The AxisThyroid panel also covers the HPA axis (cortisol, DHEA-S, pregnenolone) and HPG axis (sex hormones) because thyroid dysfunction rarely exists in isolation.

TSH measures the pituitary's signal to the thyroid — not what the thyroid is producing, and not whether T4 is converting to the active T3. A normal TSH can coexist with low Free T3, high Reverse T3, or positive antibodies — all of which cause symptoms.

TSH alone misses: Hashimoto's in early stages, poor T4-to-T3 conversion, rT3 dominance from chronic stress, and cellular thyroid resistance. A single number cannot capture a multi-step hormonal cascade.

The HPT axis — hypothalamic-pituitary-thyroid — is the feedback loop that regulates thyroid hormone production. The hypothalamus releases TRH, which signals the pituitary to release TSH, which tells the thyroid to produce T4 and T3.

When any link in this chain is disrupted, symptoms arise even when TSH looks "normal." Understanding the full axis is why AxisThyroid tests the complete panel rather than a single marker.

Early signs often include: persistent fatigue that sleep doesn't resolve, unexplained weight changes, feeling cold when others are not, brain fog and poor concentration, hair thinning or loss, dry skin, constipation or digestive changes, low mood or anxiety, irregular menstrual cycles, and poor recovery from exercise.

Many patients experience multiple symptoms for years before a diagnosis — often because TSH-only testing misses subclinical dysfunction.

Yes. When Free T3 is low or Reverse T3 is elevated, the cells cannot maintain normal metabolic rate — lower thermogenesis, slower fat oxidation, reduced resting energy expenditure — regardless of caloric intake.

Cutting calories aggressively can make this worse by triggering an rT3 cascade (the body's starvation response), which further blocks T3 at the cellular level. The fix is correcting the hormonal signal, not eating less. Persistent weight gain despite diet adherence is one of the most common reasons patients come to AxisThyroid.

Evidence-based options: selenium (RCT-supported for reducing TPO antibodies in Hashimoto's), zinc (required for T4-to-T3 conversion), vitamin D (deficiency correlates with autoimmune thyroid disease), and iron/ferritin (low ferritin impairs T4 conversion).

Important cautions: biotin supplements interfere with thyroid lab results and should be stopped 5–7 days before testing. High-dose iodine can accelerate Hashimoto's autoimmune activity. Supplement protocol should always follow lab testing — not guesswork.

Yes — through the HPA (hypothalamic-pituitary-adrenal) axis. Chronic stress elevates cortisol, which suppresses TSH secretion, reduces T4-to-T3 conversion, and drives up Reverse T3 production. The result is thyroid-like symptoms even when the thyroid gland itself is functioning correctly.

The cortisol-thyroid connection is one reason AxisThyroid tests the full three-axis panel — HPA-axis dysfunction often mimics or compounds primary thyroid disease.

Hypothyroidism is a condition — insufficient thyroid hormone output. Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US — an autoimmune disease where the immune system attacks thyroid tissue.

You can have hypothyroidism from other causes (iodine deficiency, thyroid surgery, medications), and you can have Hashimoto's with normal thyroid function in early stages. Distinguishing them matters because Hashimoto's treatment involves immune modulation, not just hormone replacement. TPO and TgAb antibody testing is how you tell the difference — tests most standard panels skip.

No. Treatment depends on root cause. For Hashimoto's, addressing immune triggers — dietary, environmental, nutrient deficiencies — is foundational. For conversion problems, selenium, zinc, and iron optimization matter. For rT3 dominance driven by HPA-axis stress, addressing cortisol is part of the protocol.

Medication is appropriate when indicated, but many patients see meaningful improvement through targeted supplementation and lifestyle protocol before or alongside medication.

We do not accept insurance. HSA (Health Savings Account) and FSA (Flexible Spending Account) funds are accepted. New York permits HSA payments for services like these — which can reduce your effective out-of-pocket cost to approximately $3,100–$3,300 depending on your plan.

The 13-month program is $4,997, paid in full. This includes 17 clinical visits, 4 comprehensive three-axis lab panels, 3 protocol refinements, unlimited secure messaging during months 2–3, PCP coordination, and a complete portable clinical record at program close.

Payment arrangements can be discussed during your intake consultation.

Due to the personalized nature of clinical services — including lab interpretation, protocol development, and provider time — the program is non-refundable once the initial lab panel has been ordered. All services and clinical records remain yours.

Yes. AxisThyroid is a fully telehealth practice serving New York State residents. Labs are ordered electronically to a local Quest or LabCorp draw site near you — no in-person visits to our practice required. All consultations happen via secure video.

All of New York State. Because AxisThyroid is fully telehealth, we serve patients across every county — New York City, Long Island, the Hudson Valley, Western New York, the North Country, and everywhere in between. Lab draws are done at local Quest or LabCorp sites near your home.

No referral is needed. AxisThyroid is a direct-access telehealth practice. You apply through the intake form, and if you're a good fit for the program, you'll consult directly with Bernadette Spencer, FNP-BC, FMACP. No PCP referral, no endocrinologist gatekeeper.

The initial comprehensive visit is 90 minutes — enough time to review lab panels, complete intake history, and build the first protocol together. Follow-up visits are 30–60 minutes depending on where you are in the program.

Over 13 months: 5 comprehensive visits, 4 biweekly check-ins, and 8 monthly deepening visits — 17 total.

As a board-certified Family Nurse Practitioner (FNP-C), I can order medications if clinically indicated. I will not change any existing medications without consulting your PCP.

No. This program adds a layer of care your current providers are not offering — three-axis interpretation, serial protocol refinement, and intensive oversight. PCP coordination is included. Many patients run AxisThyroid alongside their existing care team.

• 17 clinical visits over 13 months — 5 comprehensive 90-min visits, 4 biweekly check-ins, 8 monthly deepening visits
• 4 comprehensive three-axis lab panels (HPT, HPA, HPG — not just TSH)
• 3 full protocol refinements
• Unlimited secure messaging during months 2–3
• PCP coordination
• Full portable clinical record at program close

Three-axis panels — HPT (hypothalamic-pituitary-thyroid), HPA (hypothalamic-pituitary-adrenal), and HPG (hypothalamic-pituitary-gonadal). The HPT panel includes TSH, Free T4, Free T3, Reverse T3, TPO antibodies, and TgAb. Four full panels are included across your 13-month program.

Many patients are. Your current medications are reviewed at intake. No changes are made without PCP consultation. The program frequently helps patients whose current medication is no longer working — or was never optimized to begin with.

At program close, you receive a complete portable clinical record — intake notes, lab interpretations, protocol history, and a closing summary — for your future clinicians. Alumni visits are available as needed.

Yes, under a separate contract. Note that telehealth primary care has limitations in scope.