Real Example of Thyroid Misunderstanding

Dr. Krupka (00:01):

So I just had a situation with a patient. I thought I'd discuss it since we recently did a couple of thyroid hormone related videos. Had a patient call in today. We were going over some of her thyroid results. She deals with another practitioner to get her thyroid hormone prescribed. She takes NP thyroid, which is kind of a mix of T4 and T3. So there was a misunderstanding on the part of her practitioner, and it's a good example of what can happen if you don't understand what the different numbers mean.  I'm just going to go over it with you real quick. Because she's taking thyroid hormone, her TSH is very low. Remember, TSH is how you ask for thyroid hormone. If you're taking pretty much everything you need for thyroid hormone, your pituitary doesn't have a reason to ask you to make more, right?

(00:56):

So your TSH is going to go very low. It's perfectly normal. We expect it. In fact, in cases where someone's had thyroid cancer, they'll give them enough T4 that their TSH goes almost all the way down to zero because they don't want anything stimulating any leftover cells from removing the thyroid cancer. Anyway, so she has a low TSH, no big deal. Her T4 levels were in the normal range. I think it was like 7.1, something like that. And then her free T3, she was missing a few of the other tests, but her free T3, I think it was like 2.7. So a little bit lower than I like (three to four is what I'm looking for). So to me, okay, maybe a little bit more thyroid hormone. See how she feels. Now, what the other practitioner told her was because your TSH is so low, you might be losing bone density. So we may have to switch you to a different form of thyroid hormone that doesn't drive your TSH that low.

(02:01):

Well, to me, that's a misunderstanding, right? Understand that if I'm not taking any medication, the only reason my TSH would be that low is if I'm overproducing my own thyroid hormone. If that's the case and I'm hyperthyroid, yes, I could be losing bone density because of that, because I'm kind of hyper metabolizing at that point because I've got so much thyroid hormone. But if my TSH is low because I'm taking thyroid hormone, just look at my levels of thyroid hormone. If they're not elevated, no problem, right? No harm, no foul low. TSH has nothing to do with dropping your bone density unless it's low because you have too much thyroid hormone. So really the risk there would be are you hyperthyroid? Do you have too much thyroid hormone? You just can't use TSH as a gauge for that once you're taking thyroid hormone because it's going to be low just because you're taking thyroid hormone. So the patient actually understood that pretty quickly.

(03:13):

Now she has to go try to educate her practitioner about TSH and what it means. It's responsive to T4, not T three, all that stuff that we've talked about. She has to go try to educate her practitioner because my patient could actually use a little bit more thyroid hormone than she's getting a little bit more of the free T3. But there's no way her practitioner is going to do that if she's already worried about her TSH being too low and her losing bone density or being hyperthyroid. So I just thought that was a good example of how understanding your numbers is really important. You can end up getting inappropriate changes to your medication because you don't understand your numbers or because your practitioner doesn't understand your numbers. So hopefully that made some sense to you and I didn't just confuse you more if what I just said seemed completely backwards and confusing to you, send me a message, leave me a comment and I'll see if I can reshoot this in a way that clears that up.

(04:26):

But I just wanted to put that out there since we just did a couple of thyroid related videos. This is a real life example of what a patient is being told and how we have to go try to reeducate this practitioner so that our patient can get the right amount of thyroid hormone and know that she doesn't really need to be worried about her bone density just because her TSH is low. It's got nothing to do with that. However, high thyroid hormone would have something to do with that, but low TSH, no, people have low TSH all the time. It's not a problem with bone density. Anyway, that's that hope that helped you out. Hope that made sense. Tell me if it doesn't. I know this is kind of technical stuff, but like I said, I just wanted to throw that out. There is kind of a real life example for that. Alright, guys, have a great one. Talk to you soon.