 And this is Dr. Ruscio, and let's discuss if you're truly hypothyroid. This is something that I've discussed in the past, but I just got out of a visit with someone who was told that they were hypothyroid, and they were put on armor thyroid, and they felt terribly the entire time, actually gaining weight, losing hair, becoming more fatigued, having lower moods, and having trouble with sleeping. Now why might this happen? Well perhaps you've heard me comment before that while I appreciate much of what the feel of integrative and alternative medicine does as someone who practices in that field, unfortunately I think the liberal use of using thyroid medication and doling out a diagnosis of being hypothyroid has gotten so bad to the point now where we really need to call attention to it and amend this problem. Now what happens here? Well in functional medicine we will sometimes use ranges that are a bit narrower than conventional medicine will use, and this in some cases has merit. However we have to be careful with being too liberal in how tight of a range we use because the downside of that is we can start diagnosing people with a condition who actually don't have it, and therefore patients can be treated with treatments that they don't actually need. And this is exactly what is happening more often than not. I would say now I probably see a case of this a month and I just got done with one. And so it is something that needs to be called attention to. And I don't think it's the fault of the provider, I think the providers are trying to do the best they can, I think the problem emanates from the fact that the educational model and functional and alternative medicine might be a bit too progressive. So what happens is someone is told that they have hypothyroid when they actually don't. And so the short story is if you're seeing a natural provider or even a conventional provider who's operating in more of an integrative and functional and progressive model, again that's a good thing, but to safeguard against the fact that the person you might be working with might be operating under a model that's way too progressive with the use of thyroid hormone, I would get a second opinion. Now there's a fairly easy way to check this even if you can't get a second opinion. If your TSH is not flagged high by the lab and correspondingly your free T4 is not flagged low by the lab, by the lab, not by the clinician, but the lab would have a high next to it or bold or out of range, if you don't see both of those then you most likely do not need thyroid hormone. Now for someone who is suffering and not feeling well, I understand someone telling you, oh these thyroid levels aren't where they should be and this could explain your fatigue, your depression, your constipation, your loose and falling hair. I understand how attractive that is, but it's important that we don't fall prey to a promise that does not have the appropriate substantiation attached to it. And unfortunately I think this is happening more often than it should be in the realm of integrative and functional medicine care for thyroid. Now on the other side of the coin, I'm not fully in opposition to someone who may have non-optimal levels of thyroid hormone performing a trial on a thyroid hormone medication to see if they feel better. But I would say after four to 12 weeks, one to three months, if someone's not clearly feeling better, clearly feeling better, then that is likely not something to be used and that I think is the most progressive statement that we can make. So if you are told by a progressive minded provider, it doesn't matter if they're an MD or a DC or an ND or what have you, if you're told by a provider that you have hypothyroidism, I would inquire if it's true hypothyroidism or if it's non-optimal thyroid function but not hypothyroid and try to discern that in the conversation with the clinician. And I would also either get a second opinion or look at the labs yourself. And if you're not seeing flagged high TSH paired with flag low free T4, then you may want to be a bit more cautious before you jump on a thyroid hormone. I understand the appeal is there, but if you're given hormone and you don't need it, you can actually have an exacerbation of your symptoms and feel worse. Now, there's a time and a place for considering a trial of thyroid hormone. Yes, but I would first recommend going through a protocol to improve your lifestyle and your diet and your gut health because this can be the source. And in fact, in this case, I'm referring to this gal clearly has digestive symptoms that are likely driving her fatigue. And as we get her digestion better, as she's less bloated, less constipated and has less abdominal pain, I'm very confident her fatigue will improve. So I would make one of the first couple maneuvers be look to your diet and lifestyle, look to your gut health. My book Healthy Gut Health U does lay out a plan for both of these in case you're in need for that. But before you jump to the thyroid hormone, whatever plan you do, I would take steps to improve your diet and your lifestyle and your gut health, then reevaluate your symptoms because the need for this thyroid hormone may not be there and make sure you are crystal clear in knowing that you actually need to thyroid hormone before you go on it because while, yes, oftentimes thyroid hormone level optimization is typified as being this holy grail of wellness. Unfortunately, when you are not hypothyroid and you are given hormone, the hormone can actually make you feel worse. And that's, of course, kind of productive and something that we want to avoid. So this is Dr. Rishal. Hopefully this information helps you get healthy and get back to your life. Thanks.