Is your thyroid doctor treating 17 years behind current medical research?

Is your thyroid doctor treating 17 years behind current medical research?

I’ll never forget the day I stumbled upon a 2011 study published in the Journal of the Royal Society of Medicine.[1] Researchers reviewed the literature on the time it takes for published research to be implemented in medical practice. The answer left me speechless. 17 years!

I would have been dead in 17 years, more than likely from the heart disease and diabetes that began to rear their ugly heads when I was first diagnosed with severe hypothyroidism. Wait 17 years to finally get help? Hell NO.

Written by Kent Holtorf, MD

There is a good chance your doctor is treating thyroid disease 17 years behind the current medical research. Major medical journals including The New England Journal of Medicine, The Journal of the American Medical Association, and BMJ (originally called British Medical Journal) have been looking at what doctors know.[2-4]. What they have found is that most doctors are practicing 10 to 20 years behind what’s available in the medical literature.

How the heck can that be?

Doctors read medical research, don’t they?

No they don’t. What they do is they read the limited amount that the drug reps bring in or they go to a conference once a year or they look to their medical society for recommendations. This has created a system in which doctors are not practicing based on the most up-to-date research. In fact the studies have shown that it takes on average a proven new concept (I said proven) to be accepted by mainstream medicine on average 17 years.

What is the big reason that doctors are so behind the medical literature?

A number of reasons.

One, most doctors don’t read medical journals.

An even more important finding was that if you give a doctor 50 studies or 100 studies showing that what they are doing is not accurate or optimal, they don’t want to hear it. Basically, don’t mess with what they’ve been doing.

Also, they will look to societies, like The Endocrine Society, because they are shown to change so slowly. It can take 10 to 15 years for these major societies to catch up.

Here there are proven treatments, supported by the medical literature, that will allow you to have a better, healthier life, but your doctor isn’t using them.

One of the major areas where doctors are not practicing with the most up-to-date methods is with thyroid, especially hypothyroidism.

In medical school, I was very closed-minded like everyone else. If it wasn’t being done at the university then it was “quackery”. I didn’t want to hear it.

Then, I got sick myself.

I started feeling extreme fatigue. I got to the point where I was too tired to talk to a patient. I went to the university doctors and, of course, they told me I was “fine” and that I must be stressed or depressed.

I thought, “I’m not depressed. I just feel horrible.”

It got to the point where I didn’t think I could continue practicing medicine. I was so tired that I just couldn’t make it through each patient appointment with all the talking. I went into anesthesia because there I wouldn’t have to talk to the patients because they were asleep!

During my anesthesia residency, I attended some so-called “alternative” conferences. I found like, oh my gosh, these are more evidence-based than what I’ve been taught at medical school.

I started trying some of those “alternative” treatments including the thyroid. My levels looked “normal” if you based it on the standard way of looking at thyroid but I discovered that the standard tests (most often TSH is the only test run in the doctor’s office) are missing 80 to 90 percent of people with low thyroid!

I started treating my thyroid and, oh my gosh, I felt like a new person.

I got out of anesthesia, no offense to the anesthesiologists, and started to incorporate all of these treatments. There are so many proven effective treatments when you look at the medical literature and wonder why isn’t every doctor doing this?

I would have patients come in feeling terrible for ten years, get them feeling so much better, then they would go back to their regular doctors and I was expecting calls from doctors saying, “WOW thank you! What did you do to help my patient?”

NO. They were MAD. They said I was bad. They would sometimes dismiss these patients and refuse to continue treating them in their practice.

I’m used to it now but years ago I wound wonder, “What in the world is wrong with doctors?”

Egos are much more important than you can imagine.

I’ve found having been to medical school that the majority are very sheep like. Here’s the mindset. If there are all these published studies, why aren’t other doctors doing this? They want to be sure they aren’t going to be criticized by their colleagues. Especially if they work in hospitals. If another doctors says, “Hey you are treating this patient with a normal thyroid.” They are more scared of that than not treating the patient optimally. That’s bonkers!

Endocrinology in particular is so slow at changing.

Patients are told their thyroid is “normal”, but it isn’t.

If you can do one thing for yourself make sure your thyroid is fixed. I can pretty much guarantee that, if you have symptoms, then you have low thyroid. What types of symptoms? Now people will have different symptoms but here are some of the most common ones associated with hypothyroidism found in the literature and in my own experience with presenting symptoms in patients.[5]

  • Extreme fatigue
  • Weight gain
  • Headaches
  • Constipation
  • Depression
  • Hypoglycemia
  • Sensitivity to cold
  • Hair loss
  • Dry skin
  • Brittle nails
  • Low basal body temperature
  • Swallowing problem
  • Muscle/joint aches
  • Low libido
  • Mood swings
  • Puffiness of the eyes
  • Chronic yeast infections
  • Labored breathing
  • Difficulty concentrating/brain fog
  • Infertility
  • Irregular menstrual cycles
  • High cholesterol

11 diagnoses commonly caused by thyroid disease

Have you been diagnosed with one of these?[6-16]

Is your thyroid doctor treating 17 years behind current medical research?

The standard thyroid approach is a failure

There is something I see very often which complicates the standard thyroid approach. It’s called thyroid resistance. The majority of people with low thyroid have thyroid resistance at the cellular level. With stress or aging or any inflammation or chronic illness, what happens is your thyroid levels in the tissue go down but the standard blood tests look normal.

Let’s look at this more closely.

Your brain will secrete TSH (thyroid stimulating hormone).

TSH will tell your thyroid gland in your neck to produce more thyroid hormone. The thyroid produces 80 to 90% T4 thyroid hormone and the rest is T3.

T4 is inactive. It needs to convert to T3. T3 thyroid hormone goes into the cells and activates nuclear receptors and you get higher metabolism and more energy like pressing a gas pedal. When people are trying to lose weight, for example, they need more T3. If you have low T3, you are not going to be able to lose weight and you will experience fatigue, depression, hair loss, and the list goes on. I see this all the time. Patients come in with normal TSH and T4 lab tests told they are “normal” thyroid but they still feel terrible. The majority of low thyroid people will have normal TSH and T4.

Now T4 can also convert to Reverse T3. T3 and Reverse T3 are the same compound, but they are the mirror image of each another. Reverse T3 is the same compound but backwards so it sits on the receptors but nothing happens. People say that Reverse T3 is an inactive metabolite. NO. It actually blocks T3 from getting to the nuclear receptors.

Is your thyroid doctor treating 17 years behind current medical research?

The standard treatment once you’ve finally been diagnosed with hypothyroidism is to give you T4 thyroid hormone replacement medications like Synthroid. Nothing happens with T4 unless it is converted into the active T3. The more stress, the sicker, the older you are, the more Reverse T3 is created that blocks T3. If you take more T4 Synthroid, then the more Reverse T3 you make so you are actually blocking T3 more and more. For some people T4 works if you don’t have any stress, no inflammation, you’re young and otherwise healthy. However for the majority of people, it doesn’t work.[17] Doctors are giving T4 only medications hoping that it will convert properly and get in the cells, but it doesn’t for the majority. As physicians we have to come in and optimize what matters and that’s T3. The sicker the patient, the more T3 they normally need.

Normally when your T3 level drops, your pituitary in the brain should sense that and increase production of TSH to produce more. However what happens with any chronic illness is that TSH and T3 goes down. What most doctors do is test for TSH only and so it will look normal but really the T3 level is too low in cases of chronic illness you see.[18]

We are taught in medical school that hypothyroidism is easy to treat. If your TSH is high, you are low thyroid. If you have low TSH, you are high thyroid. If you are normal TSH, you are normal. The problem is this approach doesn’t work 80% of the time!

What really matters is what is going on inside the cells (intracellular) in terms of activation of the nuclear receptors by T3 as well as the level of Reverse T3 which can block it. So your Free T3/Reverse T3 ratio is your most important lab test. A study in The Journal of Clinical Endocrinology & Metabolism demonstrated that increased T4 and Reverse T3 levels and decreased T3 levels are associated with hypothyroidism at the tissue level with diminished physical functioning  and the presence of a catabolic state (breakdown of the body). This study adds to the mounting evidence that giving T4 preparations such as Synthroid or Thyroxine are inadequate for restoring tissue euthyroidism. The authors of this study concluded, “Subjects with low T3 and high reverse T3 had the lowest PPS [PPS is a scoring system that takes into account normal activities of daily living and is a measure of physical and mental function- ing].”[19]

An international journal of medicine showed that looking at someone’s ankle reflex was an even better test for thyroid than blood tests.[20] The ankle reflex test was found to be a better measure of tissue levels of thyroid hormones. The lower the thyroid, the slower the relaxation phase of the reflex. There are computers that can measure that. Remember that blood tests measure the thyroid hormone in the blood not the tissues.

The overwhelming majority of people with low thyroid will actually have “normal” blood levels of TSH, which is the only one normally checked and sometimes T4, but their tissue levels of T3 are low. Ask your doctor to have a Free T3/Reverse T3 ratio. They should also be checking your reflexes. They are better markers for tissue levels of thyroid hormone.

Is your thyroid doctor treating 17 years behind current medical research?

Hashimoto’s thyroiditis is when the body creates antibodies that attack the thyroid. It causes the thyroid to become inflamed and kills off the thyroid over time. As soon as it gets bad enough, most doctors will pick it up with a high TSH. But often times you will have 20 years when you are told your thyroid is “normal”, you are not bad enough yet. What also happens with Hashimoto’s is as the body is killing off the thyroid, thyroid hormone gets dumped into the blood so you get these highs and lows. People will say, “Oh my gosh I’m anxious and I can’t sleep but I’m also fatigued. Most mainstream doctors don’t even check thyroid antibodies because they don’t have any idea how to fix it. Oh YES you can. The key is to balance the immune system. There are many things that can trigger it like chronic infections, food sensitivities, stress, and allergies. A prescription called Low-Dose Naltrexone is highly effective for Hashimoto’s and actually all autoimmune diseases.[21,22]

I also check metabolism on every person with diagnosed hypothyroidism or that I suspect of hypothyroidism that comes in my office. People will say they can’t lose weight and family, friends, and even their doctors will accuse them of eating bonbons at night and not exercising. I find that the majority of hypothyroid people have about 25% lower than normal metabolism. They are burning 25% less calories than they should at rest. That is about 500 calories a day. If you eat normally, you are going to gain about a pound a week. As you diet more, you lose weight, and your body goes, “Hey we’re losing weight so we have to lower metabolism even more.” It’s a vicious cycle. Especially a woman that exercises will have a lower metabolism than someone that doesn’t because the body will sense at a certain point that that’s too much stress for the body. Extreme exercise can kill a woman’s metabolism. This study found calorie restriction caused alterations in thyroid function including a decrease in T3.[23] No wonder diet and exercise don’t work, a 95% failure rate. We keep saying diet and exercise more. NO. Fix your THYROID.

Another marker you should ask your doctor to test is Sex Hormone Binding Globulin SHBG. This goes up and responds to two things in the liver. The liver secretes SHBG according to the level of estrogen and thyroid in the liver.[24] For a woman, it should be above 70 to 80. If it’s not, she’s either low estrogen, low thyroid or both. If you look at a pre-menopausal woman especially if she has regular periods and you know their estrogen is okay, then they are low thyroid.

The most important thing for thyroid above all else is symptoms, even when the standard blood tests look normal. I can accurately tell by looking at a patient’s list of symptoms from moderate to severe, whether they are low thyroid or not. List your symptoms and look for these big ones – fatigue, depression, chronic fatigue syndrome, fibromyalgia, chronic illness, autoimmune disease, insulin resistance, diabetes, and high cholesterol. So much money is being put into cholesterol lowering medications, statins, with all their potential side effects including poor memory which I see in my office all the time. The high cholesterol might be a symptom of low thyroid and fixing the thyroid could be the solution.[25,26]

A controversial study in the prestigious Journal of the American Medical Association concluded that antidepressants are no more effective than placebos for depressed people with mild or moderate symptoms![27]You look at the STAR*D study, which is the largest study ever done on antidepressants, and it showed that T3 was a better antidepressant than antidepressants.[28] It’s right there in the scientific literature. Why aren’t psychiatrists using T3? Unbelievable.

About Kent Holtorf, MD

Dr. Kent Holtorf is the medical director of the Holtorf Medical Group with locations in Los Angeles, Foster City, Atlanta, and Philadelphia. He is also founder and director of the non-profit National Academy of Hypothyroidism (NAH), which is dedicated to dissemination of new information to doctors and patients on the diagnosis and treatment of hypothyroidism.

He has been a featured guest on numerous TV shows including CNBC, ABC News, CNN, EXTRA TV, Discovery Health, The Learning Channel, The Today Show, The Doctors, Dr. Dean Edell, Glenn Beck, Nancy Grace, Fox Business, ESPN, Rush Limbaugh, CBS Sunday Morning, Sean Hannity, So Cal News, and quoted in numerous print media including the Wall Street Journal, Los Angeles Times, US New and World Report, San Francisco Chronicle, WebMD, Health, Elle, Better Homes and Garden, US Weekly, Forbes, Cosmopolitan, New York Daily News, and Self magazine.

READ NEXT: 10 Tips to Lose Weight with Hypothyroidism

References:

1. Zoe Slote Morris, Steven Wooding, Jonathan Grant. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-520.

2. Lenfant, C. Clinical Research to Clinical Practice – Lost in Translation? N Engl J Med 2003;349:868-874.

3. Westfall, J., et al. “Blue Highways” on the NIH roadmap. JAMA 2007;297:403-6.

4. Davis, D., et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003 Jul 5;327(405):33-35.

5. Ghane, G., Ahmadi, R. Common Signs and Symptoms in Patients with Hypothyroidism in North-Western Iran. International Conference of Social Science, Medicine and Nursing (SSMN-2015) June 5-6, 2015 Istanbul (Turkey).

6. Verma, I., et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med REs. 2012 Jan-Jun;2(1):17-19.

7. Oppo, A., et al. Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function. J Endocrinol Invest. 2011 Jun;34(6):449-53.

8. Hage, M.P., Azar, S.T. The Link between Thyroid Function and Depression. J Thyroid REs. 2012;2012:590648.

9.  Laurberg, P., et al. Thyroid Function and Obesity. Eur Thyroid J. 2012 Oct;1(3):159-167.

10. Bathla, M., et al. Prevalence of anxiety and depressive symptoms among patients with hypothyroidism. Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):468-474.

11. Kasem, A.A., et al. Carpal tunnel syndrome in hypothyroid patients: The effect of hormone replacement therapy. American Journal of Internal Medicine. 2014;2(3):54-58.

12. Udovcic, M. et al. Hypothyroidism and the Heart. Methodist Debakey Cardiovascular J. 2017 Apr-Jun;13(2):55-59.

13. Alvarez-Pedrerol, M., et al. TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in health preschoolers. Clinical Endocrinology. 2007;66:890-898.

14. Daher, R., et al. Consequences of dysthyroidism on the digestive tract and viscera. Work J Gastroenterol. 2009 Jun 21;15(23):2834-2838.

15. Heydy Luz Chica-Urzola. Case report: sleep alterations associated with hypothyroidism. Rev Fac Med. 2016. 64(3):565-9.

16. Marise de Farias LIma Carvalho, Josian Silva de Medeiros, Marcela Moraes Valenca. Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine. Cephalalgia. 2017. 37(10):938-946.

17. Hoang, T.D., et al. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013 May;98(5):1982-90.

18. Bhat, K., et al. Assessment of thyroid function in critically ill patients. Biomedical Research. 2016;27(2):449-452.

19. Annewieke W. van den Beld, Theo J. Visser, Richard A. Feeders, Diederick E. Grobbee, Steven W.J. Lamberts. Thyroid Hormone Concentrations, Disease, Physical Function, and Mortality in Elderly Men. The Journal of Clinical Endocrinology & Metabolism. 1 Dec 2005;90(12):6403-6409.

20. Krishnamurthy, A., Vishnu, V.Y., Hamide, A. Clinical signs in hypothyroidism – myxoedema and Woltman sign. QJM: An International Journal of Medicine. 1 March 2018;111(3):193.

21. Bernard Bihari, MD: Low-dose Naltrexone for Normalizing Immune System Function. Alternative Therapies. 2013 March/April. 19(2):56-65.

22. Khong, K.P., et al. Alteration of prescription-only drug utilization by low dose naltrexone users with hypothyroidism. A cohort study based on the Norwegian prescription database from 2011-2015. Research in Social & Administrative Pharmacy. 2017 May-June. 13(3):e9.

23. Ravussin, E., et al. A 2-Year Randomized Controlled Trial of Human Caloric Restriction: Feasibility and Effects on Predictors of Health Span and Longevity. The Journals of Gerontology: Series A. 2015 Sept;70(9):1097-1104.

24. Selva, D.M., Hammond, G.L. Thyroid hormones act indirectly to increase sex hormone-binding globulin production by liver via hepatocyte nuclear factor-4α. Journal of Molecular Endocrinology. 1 July 2009;43:19-27.

25. Rizos, C.V., et al. Effects of Thyroid Dysfunction on Lipid Profile. Open Cardiovascular Medicine Journal. 2011;5:76-84.

26. Desai, J.P., et al. A study of correlation of serum lipid profile in patients with hypothyroidism. International Journal of Medical Science and Public Health. 2015;4(8):1108-1112.

27. Fournier, J.C., et al. Antidepressant Drug Effects and Depression Severity. 6 Jan 2010;303(1):47-53.

28. Gaynes, B.N., et al. The STAR*D study: Treating depression in the real world. Cleveland Clinic Journal of Medicine. 2008 January;75(1):57-66.

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About Dana Trentini

I founded Hypothyroid Mom October 2012 in memory of the unborn baby I lost to hypothyroidism. Hypothyroid Mom is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links to favorite resources including the Amazon Services LLC Associates Program. Connect with me on Google+

Comments

  1. I have Hashimotos, my 13 year old daughter has been gaining weight and experiencing fatigue for the past couple years. It’s only gotten worse. She suffers from anxiety and depression. I feel like my sweet girl is slowly drowning and I have never felt so helpless!! I’ve been told she’s “normal” by an endo yet I know something is going on with her thyroid!
    I just got her recent labs back and I feel it proves something is wrong although her Dr says she’s normal.
    Her cholesterol is high
    Triglycerides extremely high
    Mine were both very high before I began treatment…
    While I realize you cannot diagnose over the internet, I’m hoping you can please give me your opinion of her labs. I’m desperate to help my little girl.

    TSH- 1.1
    T-4 .83 (.69-1.5)
    T-3 4.43 (2.30-4.10)
    He didn’t test reverse T-3 even though I asked him to.
    TSHR ab .50 ( .00-1.75)
    TPO ab 1 (.00-9)
    C-reactive protein – inflammatory marker

    I am so appreciative of you and what you do. Thank you.

  2. can you tell me a good understanding doctor in the Norwich CT area or surrounding towns I am sick of being sick please and thank you

  3. How about a list of doctors by state that will actually help those of us suffering? I have difficulty finding someone to listen.

  4. I’m so thankful I stumbled upon your website. I was just diagnosed 3 days ago with Hypothyroidism. My gynecologist prescribed the thyroid panel. She would like to start me on NP Thyroid medicine to treat it. Do you take a prescribed med? While gaining weight, feeling exhausted, and having 11 day periods, I have decided to wait until I see an Internal Medicine Doctor in August for a second opinion. At this point, I’m overwhelmed with everything that I’ve read and not sure where to even begin.
    Any and all advice would be much appreciated.
    Thanks again for allowing me to see a light when I thought there was no hope.

  5. Brandi Reece says:

    Hi! I was diagnosed with thyroid cancer in 2014 and had my thyroid removed. I have hypothyroidism, autoimmune thyroid disease, and very low adrenal function. I’ve seen multiple doctors, the very worst being an endocrinologist, and spent over $30,000 on medicine, supplements, labs, and doctor appointments. I had to have heart ablation surgery and a hysterectomy, both caused by thyroid disease.
    My question is about the T3 medicine, Cytomel. I take 225mcg of Levothyroxine (natural didn’t work for me at all), and 10mcg Cytomel and haven’t been able to lose one pound in a year. My doctor told me the maximum dose of Cytomel when paired with Levothyroxine is 12.5mcg/day. I’ve read that the average dose is 25-65mcg/day. What is correct? Thanks so much!

  6. Nancy J Roberts says:

    I don’t see any mention of taking the minerals iodine, selenium, and zinc in addition to T4 and T3 supplementation. Huge game changer for me. Had a left lobe thyroidectomy 38 years ago, and was put on levothyroxin. Nothing changed until my holistic practitioner had me add these specific minerals. Food is medicine, first and foremost.

    • Hi Nancy, Thanks for mentioning iodine, selenium, and zinc. This article could have been the length of a full-length book if every piece of the thyroid puzzle was included. Good to have you at Hypothyroid Mom.

  7. Connie Reading says:

    I was diagnosed 20 yrs ago with hypothyroidism. Where can i go to get help. I am so so sick of being fat and tired. My hair is getting thinner and the aches and constipation… The list goes on! I live in Tucson. Can you suggest somewhere that could help me? Please

  8. I have read so many of these articles. I still don’t have an answer. My thyroid has been removed, I take levothyroxin as my Dr. Orders. I have every symptom listed here. I still don’t have an answer just more info on T3 and T4 that I and apparently no one else can fix.

  9. You somehow failed to mention the thyroid also produces T3 , although a small amount , it is very important.
    This Thyroid SECRETED T3 , is different than the T3 that is Converted from all the T4.
    The Hypothalamus detects T4 AND T3 levels in the blood.
    It is known that different areas of the brain , the Receptors prefer thyroid secreted T3 , not the product of conversion.
    This straight T3 has specific functions in different areas.
    T3 IS the Actual Active Hormone, it is the Free T3 level that determines how hypo vs hyper you are AND FEEL.

    • So what do we do about this? I’ve had Hashimoto’s for 26 years. I’m on complete t3 and t4 replacement. I still have PCOS and take Metformin to regulate my hormones. I still struggle with weight issues even though I diet and exercise every day. I can’t even the volume of food suggested or I gain weight. My doc and I tend to keep my levels running a little “hot” because that is where I feel better but I still get cold easily, am starting to have fibromyalgia symptons and I eat CLEAN for that very reason. To keep joint and body inflammation as low as possible. But I still don’t feel great. I have depression and this last year developed anxiety. There has to be a better way to treat this.

      • Hi Tammi, Hashimoto’s is an autoimmune disease where the body’s immune system has mistakenly targeted the thyroid gland for attack. What complicates treatment of Hashimoto’s is that it is more than a thyroid condition. Optimal thyroid hormone replacement medication is important but not the only thing to address. Balancing of the immune system can be done and I highly recommend you read this book by Dr. Izabella Wentz available at Amazon: https://amzn.to/2HqaNgF

    • Thanks Donna. I think what the article should have included is that both T4 and T3 are synthesized in response to thyroid stimulating hormone (TSH) from the pituitary by follicular cells in the thyroid gland, but that the majority is T4 thyroid hormone, and I will edit the article although I think he was trying to keep the description as simple as possible because this article was already at 3,000 words and I asked him to shorten it to not make it the length of a book.

      Various sources indicate that the thyroid gland produces from 80 to 90% T4 thyroid hormone. Thyroglobulin is a precursor protein synthesized by thyroid epithelial cells and secreted in the lumen of the thyroid follicles which provides the backbone of tyrosine. The production of T4 and T3 thyroid hormone requires the iodination of the tyrosine molecules. Yes the thyroid gland produces T3 thyroid hormone but it predominately produces T4, which is released into the circulation and transported by several binding proteins to target tissues. Thyroid co-factors T2, T1 calcitonin, and iodine are often not mentioned but they make you wonder if that’s the explanation for why many of us including me feel better on natural desiccated thyroid from pig thyroid which includes these other components. I wish that amount that our thyroid gland produces of T3 was enough to make hypothyroid people feel well.

    • Phillys says:

      The article does state “The thyroid produces 80 to 90% T4 thyroid hormone and the rest is T3.”

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