Ever met a set of thyroid results you didn’t like? Because you couldn’t work them out? Because they defied your expectations, & therefore your understanding, of how they should look in this patient given their weight, nutrition, meds, diagnoses? Yeah – me too.
In simple terms this is because we are taught ‘perfect patterns’ in thyroid interpretation:
* Iodine deficiency produces HN (high-normal) TSH and a shift towards T3
*Inflammation produces low TSH and T3 with a shift towards rT3
*Viral attack of the thyroid itself causes HN levels of both T4 & T3 due to spillage of preformed hormones, & secondary suppression of TSH
So can I ask: What about the patient who has a virus that is causing significant inflammation, attacking the gland directly but has a pre-existing Iodine deficiency?
Seriously. What would you expect to see as the HPT responds to all of these concurrent disruptors?
While it makes sense to start with the much simpler single-issue ‘perfect patterns’ in lab interpretation – we can’t stop there. I mean how often do we meet patients whose whole health story is defined and directed by one element/issue? Almost never. So too the behaviour of the HPT (hypothalamic pituitary thyroid axis) and the TFT patterns that result from those multiple directives that it’s receiving and responding to constantly. And sometimes, often, these can produce conflicting instructions for that HPT – just like the scenario I painted above. So suddenly, we’re all at sea, when there is no perfect pattern to be seen!
In fact, when there are 2, or more (!), opposing thyroid disruptors at play in a patient’s thyroid results, the patterns can look ‘less abnormal’ – the extremes of either single influence are muted and what results is something – slightly ‘off’ but mostly in the middle!
Cue…a set of thyroid results we met, and we don’t like!
So, we need to develop the ability to look beyond single perfect patterns and be able to recognise real-world ones – where there may well be determinants and disruptors and you need to identify each and every one & know which one is ‘speaking loudest to the HPT’ or you’re not going to know how to address this successfully. I call these ‘push pull patterns’ and they do take some work to spot & disentangle but I have been busy over the last year developing a whole range of new thyroid training to do just that and these come in 3 flavours:
The latest Update in Under 30: Opposing Thyroid Disruptors – Push Pull Patterns is really an extension of last month’s episode which looked at excess adiposity as a cause of thyroid dysfunction, not a consequence, and describes the 2 most common patterns seen in TFTs in overweight patients and how each tells a different story about what’s ‘winning’ and where treatment needs to start.
We have also just released a new 90min training called, ‘Thyroid Health in a time of Covid’ which is certainly going to get tongues talking. While there’s nothing new about the potential for viral driven thyroid disturbance, both acutely during infection and chronically following ‘recovery’, what is new and making news in the aftermath of the Covid 19 pandemic is the particular predilection this virus has shown for this gland. Thanks to its naturally high expression of ACE2 receptors (far more than seen in the lungs for example) the potential impacts, covering a wide spectrum of thyroid dysfunction & disease, have been observed and documented. This ranges from unprecedented rates of Euthyroid Sick Syndrome & Thyrotoxicosis during the acute phase to either activation (in an individual with a personal hx) or provocation (no previous hx or diagnosis) of autoimmune thyroid conditions as a result of either the infection or vaccination. Although there will be much more research to come that will help us clarify and confirm some of this detail, the data already in existence is undeniable and warrants our attention.
And last, but not least, we developed and released Advanced Thyroid Assessment in August last year. This is the very latest, comprehensive review of the key aspects of thyroid assessment that will revolutionise your understanding of thyroid markers. Gain clarity on how to provide the best, most individualised, thyroid management by learning to read the real story in each patient’s pathology patterns. Boost your knowledge and confidence looking at TFTs, rT3, thyroid antibodies & related nutrient patterns, as well as AITD, environmental EDCs, HPA driven HPT issues, thyroid nodules, the impact of dietary macro and micro-nutrient imbalances and much more!
No wonder I’m tired 😲🥱
Opposing Thyroid Disruptors – Push Pull Patterns (Fat is a Goitrogen Part 2)
Why doesn’t everyone affected by adiposity, or inflammation, or even iodine deficiency have an identical HPT response and corresponding TFT pattern? Well that would be because very few patients’ health can be defined and determined by one single element or issue. So too the HPT axis is commonly responding to not only more than one ‘situation’ but often to conflicting ‘top down directives’ as a result of these. And as a critical ‘first responder’, the HPT will do its best to respond to both – so any textbook pattern or extreme shift in results becomes ‘obscured’ by results ‘somewhere in the middle’. The key illustration we dive into in this episode is really an extension of ‘Fat is a Goitrogen’, which looked at excess adiposity as a cause of thyroid dysfunction, not a consequence. This instalment describes the second dominant contrasting pattern that is well documented in these patients. As practitioners it is critical to recognise the story each reveals and use this to direct treatment, redefine ‘success’ in terms of lab results & ultimately achieve better outcomes for thyroid and the total health of that individual.
You can purchase Opposing Thyroid Disruptors – Push Pull Patterns here.
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