digest
Short Summary
Main recommendation: Get a full thyroid evaluation (TSH, T4, and T3, plus thyroid antibodies when indicated) rather than relying on TSH alone, and treat a low thyroid as a possible driver of weight-loss and diabetes problems. Dr. Eric Westman says keto is considered safe for people without a thyroid, and that carb reduction may help autoimmune thyroid conditions such as Hashimoto's.
Key Points
- Dr. Westman describes the thyroid as the main regulator of metabolic rate, comparing it to a car's idle speed: low thyroid means low energy burn, and high thyroid means excessive burn.
- Low thyroid is described as the most common thyroid problem seen in obesity, weight-loss, and diabetes patients.
- Many non-specialist doctors check only TSH or TSH plus T4, which he says can miss cases; he states that T3 is the most active thyroid hormone.
- A normal blood level does not guarantee normal thyroid function inside cells, which he compares to insulin resistance.
- Thyroid medication takes weeks to show its effect, like turning an ocean liner rather than pressing an accelerator.
- He states that keto simply changes the body's fuel from mostly carbohydrates to mostly fat and ketones, and is considered fine even without a thyroid if the thyroid is optimized with medication.
Details Worth Noting
- Concrete instructions: Ask for a full thyroid panel (TSH, T4, and T3), not just TSH, and ask for thyroid antibody testing if symptoms persist despite normal levels or if on medication.
- Concrete instructions: Check for underlying causes before treating, including a proper evaluation for primary, secondary, or tertiary problems such as brain abnormalities, since a low thyroid can have a root cause elsewhere.
- Concrete instructions: If only T3 is low and symptoms are present, treatment may be merited; options include synthetic T4 (Synthroid), synthetic T3, or a combined T4/T3 product such as desiccated or dried thyroid, depending on whether the body converts T4 to T3 adequately.
- Concrete instructions: Watch for doses written in different units (milligrams, micrograms, and the old grain unit), and use conversion formulas when comparing them.
- Concrete instructions: Monitor for symptoms such as cold intolerance (feeling colder than others) and low energy as signs of low thyroid.
- Concrete instructions: Reduce carbohydrates if you have an autoimmune thyroid problem like Hashimoto's, since he says carb-driven inflammation can worsen autoimmune conditions.
- Dr. Westman says endocrine problems often occur together, so in his experience people with diabetes are more likely to also have low thyroid.
- Dr. Westman says some people may get better symptom relief from combined T4/T3 medication than from T4 alone, based on his clinical experience.
Bottom Line
Thyroid testing is often incomplete in standard care, so a fuller evaluation can uncover problems that a single normal test would miss, and keto is presented as a reasonable approach even for people without a thyroid when the thyroid is properly managed.
