Dr. Amy Nett: It sounds like she had … I think this is subclinical hypothyroidism, without having the reference ranges for the total T3 and the free T4. It looks like total T3 might have been a little bit low at that point, so you’re kind of hypothyroid and/or subclinical hypothyroidism. You did a repeat TSH, which went up slightly, but I would also want to see a repeat free T3 and free T4. You only tested the TSH six weeks after, but depending on how long it took her to get into the swing of the Paleo diet and the stress management and that sort of thing, the TSH just may not have responded yet, so I would definitely be reluctant to start medication here. You’re saying she has more energy. I don’t know what her other symptoms are. Does she have other symptoms of hypothyroidism? Does she have constipation, hair falling out, weak nails, dry skin, that sort of thing? If she has other symptoms of hypothyroidism, you could make an argument for starting her with, like, Synthroid, Nature-Throid, something like that. Based on this—you’re saying she has symptom improvement, but the TSH is still high—I would wonder, number one, has the TSH just not responded? Anytime I test, for example, after I’ve started a medication, I normally wait five weeks after starting on that medication dose. So again, if it took her a little while to get into these changes, it might be that we need to delay the TSH, but also check on the free T3 and free T4 levels to see what those look like.
I would be more inclined, if a patient has a slightly high TSH but not symptoms, maybe do something like thyroid support. For example, I think Pure Encapsulations has a Thyroid Support Complex. You could do something like kelp tablets for iodine. Have her take maybe 1 milligram of iodine daily, something like that. Depending on what she’s up for, you could also consider introducing something like thyroid glandulars. It’s not something I use a lot. I think Chris has used those more than I have. But just sort of giving her thyroid the building blocks. I think it’s tricky starting thyroid medication because then what are you going to use to bring her off of it? She’s already improving, and then you’re going to start the Synthroid, and then … I don’t know. What’s your decision point whether you can bring her off of it? You’re saying there’s symptom improvement, and we know that there’s a really strong relationship between the HPA-T axis, the hypothalamic-pituitary-adrenal-thyroid axis. So I would say if she’s feeling better, give her a little bit more time as long as she’s not complaining. See if that TSH actually normalizes with a little bit more time. If it doesn’t, if it persists, and/or if she has other symptoms, consider nutrient support, like the Pure Encapsulations Thyroid Support Complex, and/or thyroid glandulars if she wants more support. If her TSH continues to increase, then I would probably say it’s pretty reasonable to start with a prescription medication.