 Hi, this is Dr. Ruscio and let's discuss a simple nutritional intervention that can help maybe two-thirds of women better respond to their thyroid hormone. I'd like to share with you the results of this study. I'll put the abstract up here on the screen in which they make a comment in two-thirds of women with persistent symptoms of hypothyroidism despite appropriate levothyroxine therapy, restoration of serum ferritin, excuse me, above 100 ameliorated symptoms. So when women who have hypothyroidism, who are on levothyroxine and not feeling well, when supplementing them with iron and getting their ferritin, a marker of iron, above 100, it relieved the symptoms in two-thirds of women. So this is exciting. And I fact-checked this because I wanted to see where the conclusion is coming from. And so we have to look at another paper here and put the abstract of that up on the screen. And this study did in fact find in one study, restoring ferritin to 100 alleviated symptoms in roughly 75% of women who are non-responsive to levothyroxine. This was a smaller study, 25 women, and it took about six to 12 months for the ferritin to become normal. Now, what is ferritin? Ferritin is a marker in the iron family that tells you essentially the functional iron status in your body. So it's tied in with anemia. And for women who are suffering with hypothyroidism, there is a lot you have to contend with when you go on the internet. There are many theories and philosophies. Much of this is well-intentioned. A lot of it also, unfortunately, is speculation. So having evidence to help you parse through the litany of claims can help you get to the interventions that will have the highest probability of helping you. So in this case, while the results here are preliminary, only really one good study, maybe two others that hint at this, because this is a nutritional intervention, it's something I would certainly consider if you're a woman or a man on levothyroxine for your hypothyroidism and you're not feeling well, have your doctor run your ferritin. But here's the twist. 100 is not considered the cutoff from normal to abnormal. It's usually, some labs will have it around, I believe it's up around 25 or even 10. So the cutoff for ferritin is actually quite low on most labs. So this is a case where a more nuanced examination at your blood work can be helpful. I want to be careful to say there are some circles in integrative medicine that look at pretty much every value on lab work in a more narrowed range. And I don't know if that's a fully tenable approach. In my experience, what ends up happening there is you end up treating the labs instead of the patient and it's getting way too into the minutiae. But there may be a few choice markers like ferritin that having a closer look at that may be helpful. And there's actually a very strong kind of theoretical basis for this. Women who have hypothyroidism are also at higher risk for gastritis or irritation to the lining of their stomach, which inhibits their ability to secrete hydrochloric acid, which ostensibly would lead to a decreased absorption of iron. And that's been well documented. I believe it's about 30% of patients may have something known as autoimmune gastritis. Now what you do about that in terms of treatments is another story and I wouldn't so much to be worried about that because I don't believe there are really great treatments for that. But if you're a woman with hypothyroidism, you have a higher probability that the lining of your stomach and your ability to secrete acid may be slightly impaired. And this is why you may see deficiencies in iron. And so this is why a population of those with hypothyroidism may be at higher risk for malabsorption of iron. As we see in this study, there may be this non-optimal absorption of iron and by getting iron or ferritin specifically to 100 and above that may resolve your symptoms. So this is something I would highly consider. There's something else here. I just want to juxtapose into this conversation, which is many women or men who are on levothyroxin, which is a T4 only form of thyroid hormone, are told that the reason that they're having symptoms is because they're not on a T4 plus T3 medication combination. Now this could be levothyroxin or synthroid combined with cytomyl, or this could be just taking something like armyothyroid or natrothroid. And there is support for that argument, however, before going there I would recommend looking at your ferritin levels and optimizing your ferritin levels to above 100 because there are some people who actually end up feeling worse while they are on T4 plus T3 and theoretically if you are not addressing iron but you're taking a different form of medication, you're not really treating the source of the problem. So yes, a combination T4, T3 medication has merit, but in a hierarchy of interventions I would place double checking your ferritin and optimizing your ferritin above the order of operations of then considering a T4 plus T3 combination medication. So in recap, if you're on levothyroxin and if your dose is where it should be meaning your TSH and your T4 are normal and you're not feeling well, consider testing your ferritin and if your ferritin is not at 100 you can supplement with iron until your ferritin gets to 100 and then reassess your symptoms. There's about a 70, 75% chance that after doing that your symptoms will be gone. If they are not gone then you can consider other therapies, most namely you can consider a T4, T3 medication or please don't forget about the massive impact the gut, your gut health has on your overall symptomatic picture and consider doing a gut tuneup to optimize the health of your gut. So ferritin and hypothyroid, a interesting connection, something to definitely consider if you're struggling on your levothyroxin and hopefully this can help you get healthy and get back to your life.