After having thyroid nodules for about 20 years, my nodules eventually became large enough to begin impairing swallowing and breathing. Thyroid cancer had previously been ruled out, and for years the goiter was considered non-toxic, but the goiter eventually did become toxic, so that in combination with the swallowing and breathing issues, resulted in the decision being made to do a complete thyroidectomy about a year ago. While I had an excellent surgeon, there have not been a lot of answers to questions or support from my endocrinologist, and I am now under the care of my PCP, to manage my thyroid medication, since he was open to helping me solve the issues below. Post surgery my thyroid levels appeared to be in a good range, and were monitored frequently, but after a few months, even though levels still looked good, I was having some major hypothyroid symptoms (I was not able to get warm to my core, had hair loss, severe fatigue, and eventually my body temperature dropped to 1.5 degrees below normal). I was checked again, and the Endo doctor said since my bloodwork still looked fine she did not know what my problem was and chose not to do anything. I finally spoke with my PCPC about taking over my care in this area. He did a slight increase in my levothyroxine prescription from 112 to 125 and the symptoms resolved fairly quickly, thankfully, although I think it still might be slightly low. My questions... I was the one that asked in class about whether methylation could possibly be an issue with using the levothyroxine, since my levels really did look fine. I clearly had sufficient levels in my blood but at the same time did not seem to be using it. The other thing I was wondering about is how a person without a thyroid can have a sufficient amount of calcitonin? It is my understanding that other areas of the body do make this, but wondering if there are long term concerns with this. This whole system is so complex I am wondering what I may be missing even beyond that. Then last but not least I am wondering in general if there are supportive things that I can continue to do herbally throughout the rest of my life to support my body while missing this major part of my endocrine system. Thanks so much for your consideration of this long message. Joni McKeown

Dear Joni, This is a complex issue and I would honestly suggest contacting my former student Adi Benito-Herraro MD who is a superb endocrinologist. As to your questions, levothyroxine is T-4, you may not be able to convert T-4 in to the active T-3 very well. Do you take Selenium and zinc ? They are needed to do this. Chronic Kidney or liver disease, chronic inflammation, elevated cortisol levels and gut dysbiosis, as well as drinking coffee when taking your meds can cause or contribute to this issue. A medication known as Cytomel is T3, so it may be helpful, or take Armour desiccated thyroid which has calcitonin in it. Herbally, Gum Guggul (or Myrrh) enhances peripheral conversion of T4 into T3. A lack of calcitonin can increase risk of osteoporosis, osteopenia and spinal stenosis. I hope this is helpful and offers you some direction . blessings, david

Thank you David!