Do I still need to see my regular GP?

Yes. We work alongside your GP. Functional and integrative medicine is complementary — we don't replace your primary care relationship.

My results keep coming back normal. Can you actually help?

Yes. Standard blood tests typically look for overt disease. We run broader panels — reverse T3, fasting insulin, inflammatory markers, microbiome analysis, provoked urine testing for heavy metals — that pick up patterns standard testing misses.

Will I need a lot of testing?

It depends on your case. Your first appointment includes a thorough history. Testing is ordered based on what we find — never a panel-for-the-sake-of-a-panel approach.

Where is Mojo Klinik located?

Suite 11, 40 Yeo Street, Neutral Bay NSW 2089, Sydney, Australia.

What are the clinic hours?

Monday to Friday, 9:00am to 5:00pm. Bookings are by appointment only.

Is parking available?

Yes. There is 2-hour free parking on Yeo Street and surrounding streets, plus public transport options including the Neutral Bay ferry wharf a 5-minute walk away.

Do you offer telehealth?

Yes. Telehealth follow-ups are available Australia-wide. The first appointment is strongly recommended in-person at our Neutral Bay clinic.

What kinds of conditions do you treat?

Chronic, complex, multi-system, often unexplained conditions — including hormonal, digestive, metabolic, fatigue, immune and toxicity-related presentations. We do not provide acute or emergency care.

Do you treat cancer, Alzheimer's or dementia?

No. We do not advertise treatment for cancer, Alzheimer's, dementia or serious neurodegenerative conditions per TGA prohibited representations.

How do I know which condition page to start with?

Most patients begin with the Mojo New Patient Appointment (one hour) which covers the full clinical picture. From there we identify which condition-specific testing is needed.

Can I see both doctors?

Yes. Many patients see both Dr Mackey and Dr Varipatis — typically Dr Mackey for hormonal, digestive and metabolic presentations and Dr Varipatis for environmental, heavy metal and chronic infection work.

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria that normally live in the large intestine overgrow in the small intestine, causing bloating, gas, abdominal pain and altered bowel habits.

How is SIBO diagnosed?

We use a lactulose or glucose breath test that measures hydrogen and methane gas over 2-3 hours. This identifies bacterial overgrowth and the dominant gas pattern (hydrogen-dominant, methane-dominant, or hydrogen sulfide).

Is IBS the same as SIBO?

No, but they overlap. IBS is a functional diagnosis of digestive symptoms without identifiable disease. SIBO is one identifiable cause of IBS-like symptoms. Many IBS patients have underlying SIBO, but not all.

How long does treatment take?

Treatment duration depends on the case. A typical SIBO protocol involves 2-4 weeks of antimicrobial therapy followed by gut repair and prevention of recurrence. Underlying motility and digestive function must also be addressed.

Yes, SIBO has a moderate recurrence rate. We focus on identifying and treating the underlying causes (motility, structural issues, MMC function, diet) to reduce recurrence risk.

Do I need to stop my medications before testing?

Some medications (particularly antibiotics and probiotics) need to be stopped before breath testing. Your practitioner will advise specific preparation instructions at booking.

Will Medicare or private health insurance cover this?

The Mojo New Patient Appointment carries a Medicare rebate. Breath testing is privately billed. Private health fund rebates depend on your policy — check with your insurer.

What is perimenopause?

Perimenopause is the transition period leading up to menopause, typically lasting 4-10 years. Hormone levels fluctuate, causing symptoms that often begin years before periods stop.

At what age does perimenopause start?

Most women begin perimenopause in their mid-40s, but it can start earlier. Symptoms before age 40 may indicate primary ovarian insufficiency and warrant investigation.

Menopausal Hormone Therapy (formerly HRT) replaces the hormones that decline during perimenopause and menopause. Modern body-identical MHT is far safer than older synthetic versions.

Current evidence shows body-identical MHT is safe for most women when started within 10 years of menopause onset. Individual risk assessment is essential — your family history, personal history and current symptoms all inform the decision.

What is DUTCH testing?

DUTCH (Dried Urine Test for Comprehensive Hormones) measures hormones and their metabolites over 24 hours, giving a fuller picture than a single blood draw. It's particularly useful for perimenopause where hormone levels fluctuate.

Do I need blood tests or urine tests?

Both. We typically run a full blood panel (thyroid, sex hormones, metabolic markers, vitamins) plus DUTCH for detailed hormone metabolite analysis. The combination gives the clearest clinical picture.

Can I take MHT if I've had breast cancer?

This requires careful specialist input. Non-hormonal options are usually preferred. Decisions are made in consultation with your oncology team.

What is heavy metal toxicity?

Accumulation of toxic metals (mercury, lead, arsenic, cadmium, aluminium) in body tissues beyond levels the body can safely excrete. Sources include dental amalgams, contaminated fish, occupational exposure, old plumbing and some traditional medicines.

How do you test for heavy metal burden?

We use provoked urine testing — a chelating agent is administered to mobilise stored metals, then urine is collected over 6 hours. This reveals what's actually stored in tissues, not just recent exposure. Blood tests only show recent exposure.

Is chelation therapy safe?

When medically supervised, chelation is safe and well-tolerated. The Heavy Metal Initial Appointment assesses kidney function, mineral status and overall suitability before any chelation is undertaken. Treatment is individualised.

Do I need to see a specific doctor?

Both Dr Mackey and Dr Varipatis offer Heavy Metal Initial Appointments. For chelation therapy specifically, both doctors prescribe — Dr Varipatis has the longer clinical history with chelation, Dr Mackey integrates it with broader hormonal and metabolic work.

Will my insurance cover this?

The Heavy Metal Initial Appointment does not carry a Medicare rebate. Private health fund coverage depends on your policy. Itemised receipts are provided for you to submit.

How long does treatment take?

A typical chelation programme runs 6-12 months depending on the metal burden identified. Repeat provoked urine testing guides treatment duration.

What's the difference between you and a naturopath?

Dr Mackey and Dr Varipatis are AHPRA-registered medical doctors. Provoked urine testing, chelation therapy and pharmaceutical prescribing are medical acts not available to naturopaths. Your treatment is medically supervised throughout.

Clinically termed 'increased intestinal permeability' — the gut lining becomes more porous than it should, allowing partially digested food particles, bacterial fragments and toxins to enter the bloodstream, driving systemic inflammation.

What causes bloating?

Common drivers: SIBO, food intolerances (FODMAP sensitivity, histamine, lactose), microbiome imbalance, low stomach acid, sluggish motility, and increased intestinal permeability.

How do you diagnose it?

We use a combination of detailed symptom analysis, breath testing (SIBO), stool microbiome analysis, intestinal permeability markers (zonulin, lactulose/mannitol test), and food intolerance panels where indicated.

Is bloating always related to food?

Not always. Bloating can also be driven by HPA axis dysfunction, hormonal fluctuations, stress, structural issues, and microbiome imbalance independent of specific foods.

How long does treatment take?

Most patients see significant improvement within 8-12 weeks. Full gut repair typically takes 6-12 months depending on the underlying cause and how long the issue has been present.

Should I do an elimination diet?

Elimination diets can help identify triggers short-term, but they're not a long-term solution. We use targeted testing where possible to identify specific drivers, then individualise dietary advice.

Sometimes, but not always. The wrong probiotic for your specific microbiome imbalance can worsen symptoms. We test first, then prescribe specific strains based on your results.

Can stress cause bloating?

Yes. Chronic stress alters gut motility, microbiome composition, digestive enzyme secretion, and intestinal permeability. We address the stress component alongside the physical drivers.

Hashimoto's thyroiditis is an autoimmune condition where the immune system attacks the thyroid gland, gradually reducing its function. It's the most common cause of hypothyroidism in Australia.

Why is my TSH 'normal' but I still have symptoms?

Standard TSH testing misses many thyroid issues. We test the full panel — TSH, free T3, free T4, reverse T3, and thyroid antibodies (TPO and TG). Patterns of suboptimal T3 conversion, elevated reverse T3, or positive antibodies explain persistent symptoms.

Do you prescribe thyroid medication?

Yes. As AHPRA-registered medical doctors, we prescribe all forms of thyroid medication including T4 (Oroxine), T3 (Cytomel/Tertroxin), and combination T4/T3 therapy. Decisions are based on the full panel and your symptoms.

What's reverse T3 and why does it matter?

Reverse T3 is an inactive form of T3 that blocks thyroid receptors. Elevated reverse T3 (from chronic stress, calorie restriction, illness, or low iron) causes hypothyroid symptoms even when TSH and free T4 look 'normal'.

How long until I feel better on thyroid treatment?

Most patients notice meaningful improvement within 4-8 weeks of starting treatment, with full stabilisation over 3-6 months. Repeat testing at 6-8 weeks guides dose adjustment.

Will my GP continue to manage my thyroid?

We work alongside your GP. Once stable, we can transition thyroid monitoring back to your GP with a clear management plan. Many GPs prefer this collaborative approach for complex thyroid cases.

How do you test hormones?

We use a combination of blood tests (for thyroid, sex hormones, metabolic markers) and DUTCH (Dried Urine Test for Comprehensive Hormones) for detailed hormone metabolite analysis. The combination reveals patterns a single blood draw misses.

Do I need to test on a specific day of my cycle?

Yes for blood tests — typically day 21 for progesterone, day 2-3 for baseline hormones. DUTCH can be done any day and is more forgiving.

Can hormones cause weight gain?

Hormonal drivers of weight gain include thyroid dysfunction, cortisol dysregulation, insulin resistance, oestrogen dominance, and perimenopausal changes. We test for these before any weight management advice.

What about testosterone in women?

Testosterone in women is essential for energy, libido, muscle mass and motivation. We test and address both deficiency and excess (PCOS-related).

Thyroid & Hashimoto's | Dr Mackey

Mojo Klinik / Conditions / Hormones / Thyroid Dysfunction and Hashimoto’s

DR MARIA MACKEY

Mojo Klinik · Neutral Bay Sydney

Thyroid dysfunction and Hashimoto’s.

TSH alone does not tell the full clinical story.

Your TSH is in range.

Your symptoms are not.

There is more to thyroid investigation than the standard panel.

SOUND FAMILIAR?

You will recognise yourself in some of these.

Most patients arrive carrying one or more of these.

You have classic thyroid symptoms (fatigue, weight gain, cold intolerance, hair thinning) but your TSH is in range
Your TSH has crept up over the years and you have been told it is still fine
You have a Hashimoto’s diagnosis and feel that managing it is more complicated than your standard care suggests
You are on thyroid medication and still do not feel well
You have unexplained brain fog, low mood, or persistent fatigue
You suspect your conversion of T4 to T3 is part of the problem
You want a doctor who will run a full thyroid panel, not just a TSH
You suspect your gut, your stress, or your nutrient status is affecting your thyroid

There is almost always a clinical explanation. Pulling on the thread is what we do.

WHAT THYROID DYSFUNCTION ACTUALLY IS

Thyroid dysfunction is rarely just a TSH problem. It is a system problem.

TSH (thyroid stimulating hormone) is a feedback signal from the pituitary, not a measure of thyroid hormone activity. Free T4 is the inactive storage form. Free T3 is the active hormone that actually drives metabolism. Reverse T3 is a brake. Antibodies tell you whether autoimmunity is part of the picture.

A thyroid doctor Sydney approach assesses all of these together. Plus the cofactors that drive T3 conversion: iron, selenium, zinc, vitamin D. Plus the systems that disrupt thyroid function: gut, stress, inflammation.

"TSH is one signal. The thyroid is a thermostat. The thermostat reading is not the temperature of the room. The full panel, plus the cofactors, plus the antibodies, is the picture of what is actually happening."

Dr Maria Mackey, MBChB. FRACGP. FAARM. Mojo Klinik Founder

A PANEL MAP

The full thyroid panel.

What standard testing misses. What Mojo Klinik tests for.

MARKER

WHAT IT IS

STANDARD VS MOJO

OUR READ

TSH

Pituitary feedback signal

Useful but limited

Becomes abnormal late

Free T4

Inactive storage form

Often within normal

Read against Free T3

Free T3

Active thyroid hormone

Drives metabolism

Conversion often impaired

Reverse T3

Brake on thyroid activity

Almost never tested

Elevated in stress states

Anti-TPO

Autoimmune marker

Hashimoto

Adds to autoimmune picture

Anti-Tg

Autoimmune antibody

Hashimoto

Adds to autoimmune picture

Cofactors

Iron, selenium, zinc, B12

Required for T3 conversion

Frequently insufficient

A complete panel changes the diagnosis in a substantial number of cases.

OUR THREE – PHASE APPROACH

Map the thyroid. Address the drivers. Stabilise the picture.

Phase 1

Investigate

Weeks 1 to 3

Full thyroid panel. Antibody status. Cofactor assessment. Gut, stress, and inflammatory drivers reviewed. We note any existing thyroid medication prescription and review it in the context of your full picture.

Phase 2

Treat

Weeks 3 to 12

A plan built from what your testing shows. Cofactor repletion. Gut and inflammation work. Adjustments to existing thyroid medication where the picture supports it. Any prescribing change is communicated to your GP. Lifestyle frameworks.

Phase 3

Stabilise

Months 3 to 12

Most patients notice improvement within 6 to 12 weeks. Re-test, review, and adjust. The aim is sustained stability, not endless tinkering.

THE FULL THYROID PANEL

What we look at, and what each marker tells us.

the standard GP test TSH alone is the starting point, not the picture.

TSH

Free T4

Free T3

Reverse T3

TPO and Tg antibodies

Cofactors

Hashimoto’s thyroiditis is the most common cause of hypothyroidism in Australia. It is an autoimmune condition where the immune system attacks the thyroid gland. The standard approach is to wait until thyroid function declines enough to need replacement and then start medication. The integrative approach is to investigate the autoimmune driver alongside the thyroid replacement: gut health, inflammation, nutrient cofactors, stress, and infection where relevant.

IS MOJO KLINIK RIGHT FOR YOU?

Is this approach right for you?

IT'S A FIT IF

You have classic thyroid symptoms with a TSH in the upper normal range
You have a Hashimoto’s diagnosis and want it treated as more than a prescription alone
You are on thyroid medication and still do not feel well
You suspect your T3 conversion is impaired
You want a full thyroid panel including antibodies and cofactors, not just a TSH

NOT A FIT IF

HOW TO START

Two ways to start with us.

You have two booking options with Dr Maria Mackey. The right one depends on whether you want a focused thyroid consultation or a deeper big-picture investigation.

OPTION 1

Hormone Assessment with Dr Maria Mackey

The fast-track. If your concerns are primarily thyroid and hormonal. Targeted testing and a personalised plan. Suitable for thyroid presentations with or without an existing diagnosis.

OPTION 2

Mojo New Patient Appointment with Dr Maria Mackey

Medicare rebate available for in-person initial consultations

The deep dive. If your thyroid concerns sit alongside gut, fatigue, adrenal, or other multi-system contributors that need investigating together.

For full pricing, see Consultation Fees. Telehealth available Australia-wide for followups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.

FAQ

Frequently Asked Questions.

How much does a thyroid consultation cost at Mojo Klinik?

The Hormone Assessment with Dr Maria Mackey is the focused entry point:
45 minutes, $390 in-person or $410 by Zoom, with a Medicare rebate
available for in-person initial consultations. The deeper option is the Mojo
New Patient Appointment: 1 hour, $490 in-person or $510 by Zoom.
Functional pathology (full thyroid panel, antibodies, cofactors) is billed
separately by the lab.

"The 45-minute Hormone Assessment is enough for most thyroid presentations. The full hour is the right call when thyroid sits alongside fatigue,gut, hormonal, or adrenal concerns that need to be looked at together."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Approximately 1 in 33 Australians have hypothyroidism, with an estimated 1 million people
undiagnosed. Australian Thyroid Foundation, 2024.

Can I have thyroid symptoms with a normal TSH?

Yes, very commonly. TSH is a single feedback signal from the pituitary. It
does not tell you about your Free T3, your Reverse T3, your conversion of T4
to T3, or your antibody status. Many patients with classic thyroid symptoms
have a TSH in the upper normal range with abnormal patterns elsewhere on
the panel that standard testing never looks at.

"ATSH of 3.5 is often called fine. The reference range goes up to about 4.0. The reality is that many of those patients have measurable thyroid dysfunction on the broader panel that explains their symptoms. We test the broader panel."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2023 review in the Journal of Clinical Endocrinology and Metabolism documented significant
clinical improvement in patients with subclinical hypothyroidism (TSH 2.5 to 4.0) treated based
on broader panel assessment.

How is Hashimoto’s different from regular hypothyroidism?

Hashimoto’s is an autoimmune condition where the immune system attacks
the thyroid gland. It is the most common cause of hypothyroidism in Australia. The clinical implication is that there are two things to address: replacing the thyroid hormone the gland is no longer making, and addressing the autoimmune drivers (gut health, inflammation, nutrient cofactors, stress) so the autoimmune process slows or stabilises. A 2024 review in Autoimmunity Reviews documented that addressing the underlying autoimmune drivers (gut, inflammation, nutrient cofactors, stress) alongside thyroid replacement is associated with reduced antibody titres in many patients with Hashimoto’s thyroiditis.

"You can have positive Hashimoto’s antibodies for ten years before your TSH starts to rise. The window for addressing the autoimmune drivers is in those years. By the time thyroid replacement is on the table, a lot of damage has already been done."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Will I come off my thyroid medication?

Sometimes, sometimes not. It depends on the underlying picture. Patients
with significant gland destruction will need ongoing replacement. Patients
whose hypothyroidism is driven primarily by reversible factors (severe
nutrient deficiency, gut-driven autoimmunity, stress-driven conversion
problems) sometimes find their dose reduces over time. Any change to
thyroid medication dosing is gradual. We write to your GP about the change.

"I do not promise patients they will come off their thyroid medication. For some, that is realistic. For others, lifelong replacement is the right call. The aim is the right dose, the rest of the picture optimised, and the patient feeling well."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

How long until I feel better?

Most patients notice improvement within 6 to 12 weeks of starting a
structured plan. Energy, mood, and cognitive symptoms often respond first. Hair, skin, and weight changes typically take 3 to 6 months. The aim is
sustained improvement, not a quick fix.

"I tell patients to budget three to six months. The first month is foundation. The second and third are when the cofactor repletion and the gut work start to land. By month four to six, most have a clear sense of how much further the picture can move."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

What about the gut and the thyroid?

The gut is a major driver of thyroid dysfunction, particularly in Hashimoto’s. Gut dysbiosis affects T4 to T3 conversion. Intestinal permeability is increasingly implicated in autoimmune thyroiditis. Many patients with Hashimoto’s also have measurable gut issues. Addressing the gut is part of the thyroid plan, not a separate workstream.

"Patients are sometimes surprised that I am asking about their gut when they came to see me about their thyroid. The gut-thyroid connection is one of the most reproducible findings in the literature on autoimmune thyroiditis. We address them together."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

What testing will I need?

A typical thyroid investigation includes: TSH, Free T4, Free T3, Reverse T3,
TPO antibodies, Tg antibodies, iron studies, selenium, zinc, vitamin D. Where
Hashimoto’s drivers are part of the picture, gut microbiome and
inflammatory markers may be added. The specific panel is decided at
consultation based on your history and prior results.

AN INVITATION

Ready to be properly investigated?

One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.

WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089

HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement