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 full case review. It seems like I know, I appreciate all of the history; I’m still not totally clear on what her main complaint is. It sounds like maybe weight loss and what her symptoms are, the facetious, the low TSH is almost certainly due to the levothyroxine. It’s not even clear to me what her TSH would be without thyroid hormone and that’s something you’d want to know. Does she even need to be on thyroid hormone at all? And then what’s happening with her gut? What’s happening with her HPA axis? What’s going on with her other blood chemistry? Yeah, I mean this is why I do case reviews because all of this history is interesting and it’s an important part of her case, but it still doesn’t change how I would approach the patient.

Okay, I mean it may change the kind of tests that I order and what specific tests I add to the case review, but I’m still going to do the basic case review in almost every situation.