Looking for advice on an odd pattern we’ve been seeing for a while. We frequently find patients with a functionally normal thyroid panel on the initial case review testing. Then they do a 30- to 60-day reset, then repeat the blood about two to three months after the first test. Even with most markers on the case review panel improving, we invariably find total T3 has dropped to 80 or less with little to no change in other thyroid markers. Is there some other kind of physiologic reason for this other than standard factors that impair T4 to T3 conversion? Most of them are on a standard American diet, so they usually add lots of veggies.

Dr. Amy Nett: Total T3 is dropping and all of the other thyroid markers are staying normal. I’m just thinking, so are you doing any treatment during that time? Like, are you doing gut treatment? Because I’m not really able to think of any other reasons that would affect T3 but not T4 other than the decreased conversion. I mean the other thing is like, are patients significantly increasing goitrogenic foods? Like when people are doing the kind of, if you put them on a Paleo reset-type diet, are they adding in a lot more in the way of broccoli and cauliflower and doing really goitrogenic foods that could potentially be decreasing T3. Not typically any treatment other than the reset diet, but yes they may add goitrogens. Yeah, I’m not sure. That’s really interesting, and honestly we don’t normally do a follow-up blood panel after the retest. So that isn’t something I’ve seen. But interesting, but their TSH is staying the same.

Interesting. I don’t know, and I mean again sometimes with functional medicine we see that things get a little bit worse before they get better. So Anthony is saying, TSH stays the same. It’s just the total T3 that decreases. I don’t know. I don’t know why. Now I’m curious to start running that on my patients. I don’t know why but it’s interesting. I would obviously, yeah, continue to monitor thyroid and see what the trend is. But no, I don’t know why that’s happening.