February always feels like a turning point.
The light shifts. The air smells different and then there are daffodils.
I love daffodils. They are not delicate flowers. They are resilient pushing up through cold soil long before conditions are ideal. That blast of colour and joy for us, is the result of months spent quietly underground, preparing.
In many traditions they symbolise renewal and hope. In Wales they are worn as a national emblem, a marker of resilience and identity.
There is something reassuring about that rhythm. Growth does not begin when everything feels perfect. It begins when there is just enough light.
In clinic, this is often one of the busiest months, where people reassess energy, mood, medication and direction.
So here is what has been happening with us.
New Substack Structure
I have recently reorganised the publication into clearer sections to make it easier to navigate:
Foundations
Treatment and Monitoring
Risk and Safety
Hormones Beyond Thyroid
Commentary and Updates
If you are new here, Foundations is a good place to begin. It covers the core principles that underpin everything else.
Recent pieces include:
Risk in Thyroid Medicine Works Both Ways
Atrial fibrillation and thyroid treatment: what our clinic data shows
Why TSH is not everything
I have also published a longer historical piece on why medicine moved away from Armour Thyroid. It is important context for understanding how we arrived at current guidelines.
New Video Coming: T4 to T3 Conversion
I am recording a video this week exploring T4 to T3 conversion.
This is one of the most misunderstood areas in thyroid medicine. For many patients, it is the missing piece in understanding persistent symptoms despite “normal” blood results.
The video will cover:
How conversion works physiologically
Why TSH normalisation does not always equal optimal tissue thyroid function
When combination therapy may be considered
Where risk needs careful management
It will be published shortly.
TRT Is Now Live
Our medically supervised testosterone service is now fully up and running.
This is something we have built carefully and responsibly. Testosterone therapy requires structured assessment, clear indication, and careful monitoring. It is not something to be approached casually.
We are offering:
Comprehensive hormonal assessment
Structured follow up
Clear safety parameters
Ongoing monitoring
If you or someone you know may benefit from assessment, please do direct them to the clinic website.
This is an important area of men’s health that deserves thoughtful care rather than online shortcuts.
A Note on Risk
Much of my recent writing has focused on risk.
Overtreatment carries risk. Undertreatment carries risk. Dogma carries risk.
The aim of this clinic has always been to sit in the middle ground. Evidence informed. Physiology aware. Individualised.
That remains unchanged.
As We Head Towards Spring
If you are adjusting medication, reviewing blood results, or considering next steps, this is a good time to pause and assess calmly rather than reactively.
Hormone systems are dynamic. They respond to stress, sleep, illness, and life.
Stability often comes from small changes rather than dramatic ones.
As always, thank you for reading and for engaging with my work.
If you find this publication useful, you are very welcome to subscribe to the paid section, where I share more detailed clinical analysis and extended pieces. Paid subscribers also have access to our private subscriber chat area, which is there for thoughtful discussion and peer support.
If it no longer feels relevant, please do feel free to unsubscribe at any time. I would always rather people read because they want to.
Best wishes
Dr Georgina Conway
The Thyroid Clinic
Today has been lovely. Warm enough to be outside in a t-shirt in the sun. Bright. My goodness I have missed bright light from the sky. The garden is literally bursting up and out. The darn grass is growing.
The medication increases are kicking my ass, but I remain hopeful and I'm pushing myself to really start to clear out my working space. I filled it with clutter I didn't know what to do with from mum's house. I don't know why I kept it, filling up may spare space and depressing me every time I go to work. It has to go. So far I've done two tip trips and filled my commercial bin. I could have done all that in a morning before hypothyroidism hit me. But I'm still proud I've done it. Just wish my legs and feet would give me relief from pain. Tomorrow I hope to sort out another trip to the tip and start doing a stock take. I hadn't realised it, but I do suddenly feel as if I might be waking up a bit.