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Thyroid Disorders

Thyroid Disorders

Running thyroid panels plus or minus reverse T3 and often finding tests within normal limits. Can you comment on how common it is of subclinical hypothyroidism, how the symptoms may differ from overt hypothyroidism, and common differentials for subclinical presentations?

Dr. Amy Nett: I was a little bit unclear on this one because subclinical hypothyroidism is defined by having an...

Can you figure out these thyroid test results in a patient who’s taking three-quarters of a grain of WP Thyroid and 45 micrograms of T3. TSH is zero, not surprising given how much thyroid medication she’s on, free T4 is low, also not surprising given that she’s taking free T3 and WP Thyroid, which contains T3 in it. So T3 suppresses negative feedback system and the body’s only way of- What can we do to reduce the levels of thyroid hormone?

Chris Kresser: The only thing the body can do in that situation is to reduce the output of T4 because...

I have a case study for you. Patient had a comprehensive lab panel done, and with regard to her thyroid, all functional markers were normal. However, her thyroid antibodies were very high: antithyroglobulin was 234, thyroid peroxidase, 126. What do you make of these high antibody values with normal markers, and what suggestions would you have for treatment of exposome measures? She eats a gluten-free, dairy-free diet, exercises regularly, does yoga twice a week, several walks outside, not a daily meditator but working on it. Sleeps approximately seven to eight hours a night.

Chris Kresser: Yeah, so I think in the thyroid unit we covered this, but a large percentage, well, let’s see...

Patient that cannot tolerate associated thyroid meds because of lactose intolerance may also be insulin resistant. Currently taking T3 80 micrograms twice a day. She’s monitoring basal body temperature is between 97.1 and 97.5. It feels like she’s still hypothyroid. What would you suggest? Bump up the T3, give it multiple times a day? Is there a desiccated thyroid medication you’re aware of that does not contain lactose?

Chris Kresser: Yeah, so good questions. I think so, just kind of stepping back before we get into the specifics...

I noticed that Quest has recently significantly narrowed the thyroid antibody reference range to less than nine, while the LabCorp reference range is still less than 34. Any thoughts on still following the lab range or is a functional range needed?

Dr. Amy Nett: Yeah, I noticed that too, recently, and I don’t know if, I haven’t had a chance to...

On page 11, part 2 of week 38 it says in a box to watch out for falsely low TSH levels of thyroid medication replacement. But why is it falsely low? As in the explanation given on that page below the box, the pituitary actually does decrease the TSH production when the body has TSI production. To me this would be actual low TSH levels versus false, is what I’m saying. Is this the example talking about Graves’ disease or facetious hyperthyroidism? Would you treat until T4 and T3 are both normal even if TSH is low? But if T4 is high and TSH is low and T3 is within the normal limits, does it just depend on if they have symptoms?

Chris Kresser: No. So the most recent research I’ve seen suggests that facetious hyperthyroidism is only risky when T3 is...

Just started working with patient that’s been on levothyroxine for two years. Wants to get off it due to weight gain and other possible issues that can occur with its use. Free T3 and free T4 are within normal optimal range, but TSH is zero so I’m assuming this would be facetious hyperthyroid at this point. She also has a history of hep C but recently finished Zepatier and has no evidence of any antibodies and therefore considered cured. She did take interferon 20 years ago, and five years after developed hypothyroid symptoms. I see in the literature there’s an association with hep C and interferon and development of thyroid disease. One study even recommends patient be warned of this prior to use. She used Armour in the absence of blood tests for 10 years and developed acute tachycardia and arrhythmias that came and went. So she was encouraged to stop it and was put on the levothyroxine. Where would you focus with so many directions here?

Chris Kresser: Yeah, so I guess I would do, I know I always say this, but I would do the...

In hypothyroidism, do you always do an iodine test? Is it okay to supplement with iodine without testing if eating a few of the foods rich in iodine?

Chris Kresser: I think it is. But you want to be careful especially if they have Hashimoto’s. Start at a...

I’m confused about facetious hyperthyroidism presentations because it seems like it can present in a variety of different fashions. For example, there’s been discussion that these patients can have low or low-normal TSH with normal T3 and T4. One elevated and one normal or low or both T3 and T4 high.

Dr. Amy Nett: So normally, facetious type of hyperthyroidism you see a suppression of T4. So facetious hyperthyroidism most often,...

How do you determine if the patient has transient Hashimoto’s thyrotoxicosis or Graves’ disease if they present with a low TSH and elevated TPO or thyroglobulin antibodies? Is it based on if they have TSI production?

Dr. Amy Nett: Yeah, I would probably test the … you want to look at TSI as well. But then...

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