Q&A Doctor Series
The Q&A Doctor Series brought some of the world's leading experts in thyroid healthcare together to answer some of your important questions! The series aimed to highlight the best practices in thyroid healthcare to an international audience.
I invite you to submit your thyroid-related questions for blog consideration to firstname.lastname@example.org.
You may also book a 1-1 consult with Denise here.
Thyroid Resistance, Introducing T4 Medication, and Free T3/Reverse T3 Ratios
Submitted by: Justine W. (Rochester, MI, USA).
Response by David Borenstein, MD
Patient Question: 1. What indicators tell you that a patient is ready to introduce T4-only medication or natural desiccated thyroid medication to their T3-only medication that he/she might have been on for thyroid resistance? 2. What are optimal values for Reverse T3? How do you evaluate Reverse T3 and Free T3? Is there an optimal ratio between the two labs?
Follow-Up Testing and 'Healing' from Hypothyroid Episodes
Submitted by: Monica M. (Charlotte, NC, USA).
Response by Theodore C. Friedman, MD, PhD
Patient Question: What do you suggest for follow-up testing (which tests and how often) once a patient is on thyroid medication? Do you ever find that that people have hypothyroid "episodes" and can gradually go off of meds?
Cause of Reverse T3 and Treatment After Clearing It
Submitted by: Sharon (Philadelphia, PA, USA).
Response by: Jacob Teitelbaum, MD
Patient Question: What is the major cause of high reverse T3 (RT3)? When high RT3 is cleared with T3-only therapy, is it usually necessary to continue on some type of thyroid medication containing T4 as well (such as natural desiccated thyroid)?
Interpretation of Labs After Being Hyperthyroid, Now Hypothyroid
Submitted by: Jeannie (Naperville, IL, USA).
Response by: Gary Pepper, MD
Patient Question: I have some test results that I wanted a clearer understanding of. I had a total thyroidectomy for Graves' disease and a multi-nodule goiter at the end of July. I had just come down from being hyperthyroid to the higher end of "normal" when I had the surgery. My levels as of last week were T4 (1.3), TSH (2.36) and T3 (2.6). What is an acceptable range for T3 levels? I am currently on levothyroxine with a dosing of 0.125. I will also say that since surgery I was initially told I was still hyperthyroid on my dose of .125 levothyroxine. I objected because I was experiencing what I knew as hypothyroid issues (extreme fatigue) and subsequently cut out all gluten and soy products.
Does Hashimoto's Go Away with Treatment?
Submitted by: Erica H. (Canada).
Response by: Ridha Arem, MD
Patient Question: Does Hashimoto's go away with treatment? I have Hashimoto's and it seems to go away and then it comes back. It also seems to come in cycles: skin breakouts (hormonal acne, predominately on my chin and neck) followed by extreme dry skin/hair and water retention/weight gain/constipation. I'm currently taking 100mcg of Synthroid and iron supplements. Are these types of flare-ups with Hashi's normal? Or, should I be looking for a secondary diagnosis? I have tried cutting out gluten and it has had no impact.
Adrenal Dysfunction Testing and Optimal Ranges
Submitted by: Susan N. (Memphis, TN, USA).
Response by: David Borenstein, MD
Patient Question: Why are optimal cortisol levels important when taking thyroid medication? How do I test for adrenal fatigue and what are optimal cortisol levels?