 Hey, everyone, this is Dr. Ruscio. Let's talk about if you need to be on thyroid hormone. Now, we've done a couple posts about this in the past, kind of alluding to the fact that hypothyroidism and the corresponding utilization of thyroid medication, like levothyroxine, seems to be overused, in my opinion. And this is especially by probably well-intentioned, but more progressive, integrative, and functional medicine providers. And I think it's a problem that needs to be called attention to. And we all need to work a bit more conservatively to stop the overuse of thyroid medication. Now, I'd like to share with you a study that really found this. And here's, I think, the bottom line for people. If you're not feeling well, you want to feel well. Thyroid hormone, or potentially being hypothyroid, is one promise that circulates that, well, if you could find this elusive hypothyroidism, get on medication, you could then feel well. That's all fine and good. But what we don't want to do, the other thing that we're trying to counterbalance against is having people on thyroid hormone who don't need to be on thyroid hormone. We don't want to be giving lifelong thyroid hormone replacement therapy to people that don't need it. Because these people, most often, will not respond to the hormone, yet they will lifelong be on thyroid hormone medication. And I do see this. I see cases of patients who've been on thyroid hormone for five years, and when I check the diagnosis, the diagnosis seemed to be made very ambiguously. And these patients are oftentimes able to come off thyroid hormone, or I should mention that when we check the lab work for justifying the initial diagnosis, they were not actually hypothyroid. Now, I've been kind of calling attention to this, but I want to share with you a study, and I'll put the abstract up here on the screen, that actually documented the same exact thing that we've been discussing in the past. The study entitled, Levothyroxine Replacement Therapy and Overuse, a timely diagnostic approach, meaning it seems that being hypothyroid is kind of in vogue right now that may be leading to over diagnosis and treatment. Now, let's look at what they did. They took 291 subjects, aged between average age of 48 years of age who are on Levothyroxine Replacement Therapy. Who they felt did not have a solid diagnosis of hypothyroidism being provided. And they then paused their treatment so they had them come off Levothyroxine. And what they did was they tested at the start of this assessment. So right when someone went off thyroid medication, they kind of did a baseline, and then six to eight weeks later, they tested again. So they could see, did someone's thyroid hormone levels in their blood tank, meaning that they were hypothyroid? Or did they actually maintain a normal level, meaning they actually weren't hypothyroid? So let's look at what happened. And I just also mentioned, they looked at a TSH value of over 4.5 as meaning someone was hypothyroid, which I think is absolutely justifiable. Now, among this 291 individuals, 39% became hypothyroid. Okay, great, we've identified that. Now they go on medication and they can do that in a confident manner. While 60%, six is zero, remained normal thyroid, normal off of thyroid hormone medication. That is a big number. That is the majority. And the groups were comparable in terms of their weight. So it wasn't to say people who were heavier had more hypothyroidism. There was a similarity between that. And also the duration of treatment, meaning people who had been on thyroid hormone for various lengths of time, that didn't seem to dictate whether they became hypothyroid. So this is a common concern. I've been on this medication for five years. Will I be able to come off? From what this study has found, it appears that your length of time on thyroid hormone prior does not dictate your future prognosis as to whether you will become hypothyroid or maintain a normal thyroid state. So that's encouraging news. The thyroid volume was also similar and the presence of autoantibodies, the presence of antibodies against thyroid, the presence of Hashimoto's was similar between groups. So this also did not seem to be a major piece dictating if someone was or was not hypothyroid, which also dovetails in with some of my criticisms of overutilization or over extrapolation from thyroid antibody assessments. And I'll see if I can find the links for some of these previous posts if you wanna go deeper into how to know if your thyroid antibody levels are abnormal or normal. But again, in this case, your thyroid antibody status did not seem to dictate whether you would become hypothyroid or normal thyroid. So that's good. Now there was one thing that was different between these groups. The group that had a poor ultrasound finding, or I should say this way, poor ultrasound findings were more common in the group who became hypothyroid. So if you wanted to add a assessment to running this experiment with your doctor, you could ask for a thyroid ultrasound and if you have abnormal what's known as echogenicity or the ultrasounds use echoes and if there's a decreased amount of echo that usually means that the gland has become somewhat scarred. So that's something that you may want to use with your doctor, although you probably don't need to, to be honest, you can just run the experiment and if you see at the end of six to eight weeks off of your thyroid hormone, your TSH levels go above 4.5, then you've affirmed that you are likely hypothyroid and should go back on medication. So their conclusion, and I think it's an important one, these findings suggest considerable overuse of thyroxin therapy, levothyroxin. Our results underline the need to initially firmly establish a diagnosis before treatment initiation and to undertake periodic evaluation of all patients on chronic levothyroxin as to the necessity for treatment continuation. So essentially we need to be more careful in making the diagnosis and before we put people on lifelong levothyroxin therapy. Continuing, and all patients on long-term levothyroxin therapy in whom the diagnosis had not been identified, had not been definitively established, it appears rational to introduce a six to eight week period of discontinuing the levothyroxin preceded by a TSH test, okay? So again, good somewhat simple news here is that you can, if you wanna test this, and I'm gonna do this with your doctor supervision, of course, perform a baseline test, perform another TSH test, and I would pair that with T4 also, but perform another test six to eight weeks later, and if you see your TSH go above 4.5, then this firms up the diagnosis of hypothyroid. If you don't see your TSH go above 4.5, then the likelihood of hypothyroid is very small. Now, what if you have symptoms, and what if you wanna feel better? Because I understand the ploy of, oh, you know, I'll do anything to feel better. Well, it doesn't mean that taking thyroid hormone when you don't need it is going to solve your problems. And I would suggest a number of things, and I know this may sound kind of moot, but make sure you're eating the right diet for you, especially a diet that's healthy for your gut, because gut inflammation, in my experience, is one of the most commonly overlooked causes of symptoms that look like a thyroid problem, and this is why we've documented a number of case studies in our weekly newsletter of people who are able to decrease or come off thyroid medication once they improve the health of their gut. So one thing, not the only thing, but one thing that may lead to this over-utilization of thyroid hormone could be missing the fact that there's a problem in the gut. That problem in the gut is what's causing the symptoms, and if you can address that, your symptoms go away, and then, thankfully, you don't need to be on thyroid hormone for the rest of your life. So remember, there is a time and a place for thyroid hormone utilization, of course, but as I've been saying, and as now as research literature is definitively helping to substantiate overuse of both thyroid hormone and over-rendering of a hypothyroid diagnosis is becoming a documentable and serious problem. In this case, 60% of patients who did not have a firm diagnosis of hypothyroidism were actually able to come off medication and be totally fine and maintain normal thyroid status. So this is definitely something for you to consider double-checking if you're on thyroid medication. This is Dr. Ruscio, and I hope this information helps you get healthy and get back to your life. Thanks.