digging deeper

Have you still got some thyroid patients that don’t fit any sort of traditional thyroid disease model and are difficult to get results with? Oh yes me too… and watch out…I’ve been spending the last few weeks with my nose firmly embedded in hundreds of articles digging around for more answers. As I am presenting on thyroid conditions for ACNEM in Adelaide March 18-19th, I couldn’t resist going back to the literature to see if by delving a little deeper again I could come up with some more answers to these weird, wacky and hard to treat thyroid presentations that we’re increasingly seeing and guess what…I think I’ve found a few gems.

In particular where I’ve been spending a lot of my  leisure time 😉 is in the evidence of pervasive environmental contribution to thyroid disease.

 I keep thinking we’re all exposed to unpronounceable things like phthalates, parabens, perchlorates and PCBs so why would some of us remain euthyroid with exposure and not others?  Surely that is an important thing to elucidate…and we’re getting there!  

The other big one for me, is by understanding the mechanism of thyroid disruption these environmental agents use, we can at times, be able to identify HPT results most suspicious for particular agents.  So for example, the other day, one of my cluey mentees asked, “We’re always talking about the risks of high rT3 but I have a patient with very low rT3 levels relative to her T3 – is there anything wrong with this and why would this happen?’ Well with a family history of Grave’s disease, this is a critical consideration. So I went back to the literature…turns out their just might be a link with high PCB levels!

Always keen to share whatever I learn, I’m excited about passing on all these new discoveries on environmentally driven thyroid disease as well as going back over the nutritional foundations of effective hypo- and hyperthyroid management.   I am looking forward to presenting with Dr. Nicole Avard as well, as she gives her perspective on clinical management of thyroid conditions.  From our discussions so far, I have to say, we appear to be very much on the same page especially in regard to the opportunities and threats that come with iodine supplementation and we’ve been feeding each other interesting articles, getting ourselves into a lovely nerdy head-spin!

Adding further to the thyroid library for 2017 is also a webinar I am delivering for ATMS on Thyroid Assessment in Preconception, Pregnancy and Post-partum on March 8th.  Given that pregnancy has been described as the ultimate stress test for thyroid health – it’s easy to see why so many of our clients fall at the first (conceiving), second (1st trimester), third (trimesters 2 and 3) or fourth (the post-partum period) hurdle!  This presentation is all about being able to quickly recognise and understand thyroid distress signals at each stage and how to monitor patients’ thyroid health appropriately.

For me, understanding the whys and the what to do around thyroid, never gets static because case after case after case teaches me something new that truly adds to the scientific perspective and that I can bring to the table and I love the opportunity to dig deeper 🙂

I’ve recorded a 30-minute review on Iodine Excess in Action which is a must for anyone working in thyroid. With both practitioners and patients alike getting increasingly excited about this mineral, the risk of excess is real and chances are it’s sitting in your clinic.  Do you know how to recognise it?  Who’s most at risk of the associated adverse effects and what to do when it’s happening?  This recording, complete with lab results, is about a subclinical hypothyroid patient of mine who I was treating with iodine and then she decided that more might equal more results! And another post-partum thyroiditis case as well.  It’s an amazing illustration of what happens when we tip the scales too far in this direction.  You can download this here.

 

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