Dr. Amy Nett: OK, so regarding iron, again, I don’t know if you gave me her iron panel before, but if she does have iron deficiency, what we generally use—and we’ll be talking about this when we get to the blood chemistry section—is Proferrin ES, and that’s heme derived. It’s derived from bovine heme, so you want to let your vegetarian patients know. Make sure they’re OK with that. Proferrin ES. We have patients self-order that. It seems to be more bioavailable and better tolerated in terms of not causing as much nausea and constipation as some of the other forms of iron. Depending on the degree of iron depletion, we might recommend Proferrin ES one capsule taken twice daily. We don’t love the fillers in that, but again, we like the form of iron. Just so you know, there is a green coating on it, and I’ve actually found that if you wash off the coating, you’re probably getting rid of some of the artificial dyes and colors on it. It’s not ideal, but it’s the only form of that particular type of iron that we’re aware of at this time.
If iron deficiency is severe enough, you can also use ferritin. Again, if you go on Emerson, there’s an available ferritin. For pretty severe iron deficiency, you can do one capsule of ferritin and one capsule of Proferrin, both taken twice daily and with food probably, too, to improve tolerance. That’s what I would do for iron supplementation. Certainly adjust the dose as needed based on the degree of her iron deficiency.
Then you mentioned her hormone panel, and you’ve shown me a lot of the metabolites here. Basically DHEA was in range. Again, I’m not sure of the specific question you’re asking about the metabolites, so perhaps if you can submit more specifically what your question is so I have a better idea of what you’re asking. I do see that she had a very high 16-hydroxy E1, and some of her estrogens were high to high normal, so from that perspective, you could do something like DIM Detox. It’s not a true estrogen dominance picture from the numbers I’m seeing with the alpha- and beta-pregnanediol, but given the high 16-hydroxy E1, it looks like an overall pattern that shows slightly less favorable estrogen metabolism because there’s more going down that 16-hydroxy pathway, and we think that 16-hydroxy pathway is a little bit more associated with hormone-sensitive cancers. So think about doing something like DIM Detox and calcium-D-glucarate to help those.
What I’m also seeing sort of big picture here is that her androgens might be a little bit high, and I can’t tell too clearly from this if her alpha pathway is upregulated, meaning upregulation of the 5-alpha-reductase pathway, but if it is upregulated, you could maybe do DIM or even saw palmetto.
That’s what I’m gleaning based on the information I have here, but again, if you have some more specific questions, let me know.
Then you said her thyroid panel showed free T3 and T4 in the lower end of the range, TPO antibodies high end of the range, and TSH 2.4. OK, so that sounds fine. Depending on her symptoms, you can either consider a trial of something like Nature-Throid, a quarter grain, just because with a TSH of 2.4 with low-normal free T3 and free T4, you’re starting to think about subclinical hypothyroidism. I always test at least twice before I start thyroid medication because remember TSH can vary by about 50 percent even within a day. So I would always generally run a thyroid panel at least twice before starting a thyroid hormone. With those levels that you’re providing me, definitely think about what her symptoms are because I would take that into account as the primary deciding factor in terms of whether or not it’s worth giving it a trial. Also, does she tend towards anxiety? Does she already have heart palpitations? Those would be reasons that you might shy away from actually starting Nature-Throid.