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Thyroid Disorders

Thyroid Disorders

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...

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...

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...

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,...

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,...