What would be your criteria for a patient who wants to begin decreasing or getting off thyroid hormone replacement?

I mean, you have to monitor the thyroid panel, basically, because you need to do that very slowly because you don’t want to drop their thyroid hormone support. If I have somebody who wants to get off thyroid hormone, it depends where they are. I mean, to be very, very honest, most of my patients are not getting completely off of thyroid hormone support. But you start nutrient replenishment, so getting your vitamin A, selenium, iodine, and zinc, [and] make sure they’re getting their exercise—all those factors that influence thyroid hormone production, the conversion of T4 to T3, the receptor sensitivity, you need to think about all those elements. Once you feel like you’ve optimized those, you just start very slowly tapering the dose. If they’re on a natural desiccated thyroid hormone replacement, you might be cutting that by something like a half of a quarter. Quarter green tablet is the smallest, even though those aren’t even available right now. But generally, you would think about cutting it by, like, a quarter grain or maybe even an eighth of a grain, [and] do that for five weeks, check the thyroid panel, do you have room to go down. Any time I am tapering off a medication, it’s very, very, very slowly, monitoring symptoms and monitoring labs. With thyroid medication, that’s no exception. I keep a very close eye on the numbers, a close eye on how the patient is feeling, and just do things very slowly.