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Thyroid Disorders

Thyroid Disorders

In prescribing thyroid hormone replacement, what is your go-to? Levothyroxine, porcine-derived form, liothyronine, or compounded?

Dr. Amy Nett: Yeah, it varies a lot. That’s a great question. I would say if a patient comes to...

Have you ever seen any other practitioners run boron as a marker for thyroid health?

Dr. Amy Nett: No, I haven’t. I’ll dig into that a little bit more this weekend and see if I...

With women who are deficient in ferritin chronically, even when increasing iron intake, could it be an indication of SIBO or bacterial overgrowth if the bacteria is using the iron, so absorption does not take place? I have women who are hypothyroid with significantly low ferritin and can’t get ferritin up.

Dr. Amy Nett: If a patient with a ferritin as low as 20. If there’s no iron deficiency, I don’t...

An 18-year-old with low TSH of 0.27, normal free T3 and free T4, heavy menstrual bleeding, and irregular cycles. Other history of eczema and depression. Suggestions on how to follow up?

Dr. Amy Nett: Well, because of the menstrual issues, I would think about getting hormone testing. I’d probably start with...

Female patient, 60-year-old. Grain-free Paleo for 30 days. Has asthma, abnormal glucose, hypothyroidism, granuloma annulare, which hasn’t gotten any better through diet. Stool test shows low short-chain fatty acid, low good bacteria. Any recommendation for the granuloma annulare?

Dr. Amy Nett: Again, I would approach this the same way I would any other case. You need to think...

I saw a study recently about how lowering TPO antibodies is not clinically significant and that patients can have improvement in terms of thyroid symptoms with levels below 350. Have you seen anything similar in terms of thyroglobulin levels, and is there a number that you view as a concern in a lab test result? I recently had two patients come back with their thyroglobulin levels around 10.

Dr. Amy Nett: This is a little bit tricky. I wonder if you can post that study on the Facebook...

A 39-year-old female diagnosed with Hashimoto’s after first baby—that’s the most common time of diagnosis in women —also tested positive with Blastocystis. Functional doctor prescribed LDN, but she didn’t take it, did a reset with antimicrobials. She has had two miscarriages since second baby. Obstetrician thinks it’s thyroid causing it and advised going on thyroxine low dose. The patient is unsure if they’ll try for another baby but does want to know if it’s the best option or if should she do LDN or the Armour. Open to getting her stool screened again to see if Blastocystis is still there. Currently follows Paleo but include eggs, nightshades, and full-fat raw dairy. Scared to give them up because she loves them. Also wants to know even if she doesn’t have any more kids should she be on something for thyroid considering she can’t get the antibodies completely down through diet supplements and lifestyle.

Chris Kresser: Okay, lots of questions in there. First is if she’s not willing to try —if a patient has...

I have a patient with Hashimoto’s. Recently had lab work that came back with positive markers for rheumatoid arthritis. I haven’t actually seen the result. The patient has been on and off the autoimmune Paleo diet, has a difficult time adhering to it. Questions: Number one, do you know anything about ashwagandha and autoimmune disease? I see different ideas. It’s a nightshade so some practitioners say to stay off it.”

Dr. Amy Nett: Yes. I’m wondering what came back positive a little bit more specifically. That can be helpful because...

What to do if parathyroid markers are off? Why would iron be functionally high if ferritin is low at 15?

Chris Kresser: Okay, let me take the first one first. Since you’re on the call, Adam, maybe you could let...

I have a patient with burning mouth for the past year, has Hashimoto’s.

Dr. Amy Nett: Burning mouth … Have you sent her to see a dentist? I honestly haven’t heard of a...

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