Just as optimal integration of lab results into our patient work-ups makes ‘the invisible visible’ we thought we might make visible some of the everyday Q & A that we engage in with wonderful practitioners who are fast becoming Diagnostic Divas & Divos.

Practitioner :  I thoroughly enjoyed taking a deep dive into your Mastercourse II Thyroid & Adrenal Diagnostics and have also tuned into your Update in Under 30 episode on Thyroid Nodules – thank you so much for consolidating the research and helping us to become better practitioners.  I just have one question, if you wouldn’t mind. 

  • Corrected Urinary Iodine 40.7 ug/gCR
  • TSH was 1.46, now 0.79
  • FT4 is 18.9, FT3 5.1
  • Thyroid nodule – solitary large hypervascular, TR3 configuration
I want to treat the low iodine because of course I know a deficiency can be the underpinning cause of nodules, but am worried that this nodule might not be cold and that there might be some associated risk – would love to hear your thoughts
Rachel: Thanks for your lovely message 🙂 I have 2 thoughts for you:
1. Based on the full TFT there is a fair chance this nodule could be hot with both T4 & T3 high-normal and especially given the TSH suppression – therefore iodine is contraindicated and
2. If it isn’t hot – due to its morphology (hypervascular + TR3) it might be pre- or already cancerous – therefore iodine is contraindicated.
Practitioner: Yes I hear you loud and clear. Really grateful for your insights. 
An increasing number of our patients have thyroid concerns but unbeknown to many of us the most likely explanation of all is thyroid nodules, whose incidence is on the rise globally. The development of nodules has always been primarily viewed as a nutritional disease. Traditionally attributed to chronic iodine deficiency but recently novel nutritional causes have emerged. Benign nodules come in 2 flavours: hot and cold and while patients can present with a mixture, it is the presence or absence of a hot nodule that radically changes what complementary medicines you can and can’t use and what an effective treatment plan looks like. The pointers, as is often the case, are there for us in the patient’s presentation and pathology, so knowing the difference is no longer a guessing game. This UU30 comes with a great visual clinical resource and includes key papers on the nutritional management of nodules.