Thyroid Optimization
Comprehensive thyroid hormone optimization beyond conventional "normal" ranges to support metabolism, cognition, and overall vitality.
Evidence Summary
T4 replacement well-established. T3 addition beneficial in subset of patients. Optimization beyond TSH normalization supported by clinical outcomes.
Evidence Scale
Mechanism of Action
T4 (levothyroxine) converts to active T3, which binds nuclear receptors regulating metabolism, mitochondrial function, and gene expression across all tissues.
Who Is This For?
Hypothyroidism, subclinical hypothyroidism, symptoms despite "normal" labs, reverse T3 dominance.
Protocol & Dosing
Dose
Levothyroxine 25-200mcg, Liothyronine 5-25mcg or NDT 30-120mg.
Frequency
Daily, typically AM fasting
Duration
Ongoing
Protocol Summary
Combination T4/T3 or desiccated thyroid for some patients. Monitor free T4, free T3, reverse T3, antibodies.
Interactions & Precautions
Contraindications
- Untreated adrenal insufficiency
- Acute MI
- Thyrotoxicosis
Potential Risks
- •Overreplacement risks
- •Bone density concerns
- •Cardiac effects
Potential Side Effects
Practitioner Notes
Clinical annotations from Dr. Goel
Free T3 optimization often overlooked. Consider reverse T3 in non-responders. Address iron, selenium, zinc for conversion.
Dr. Sanjeev Goel
Chief Medical Officer, Peak Human
Cost & Access
Cost Range
$
Accessibility
Availability varies by location
Sample member
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