Updated June 10, 2015.

But, clinically, a TSH over 2.0, symptoms of low thyroid (particularly fatigue, sluggish bowels, dry skin and cold intolerance) with a normal TSH, and a low underarm basal body temperature all raise the possibility of sluggish thyroid function, and these groups of patients will still be "normal thyroid" according to the Academy guidelines. So, guidelines are just that, suggestions that help to inform a physician's decision, but should not be adhered to at the expense of evaluating the patient.

3. Do you feel that soy products are safe for thyroid patients? Do you differentiate between fermented soy products, and soy pills/powders?

I am not aware of any proof that a diet rich in soy products is detrimental to thyroid patients. For instance, this is not the common finding in Japanese research. The problems with soy seem to be when the isoflavone components are given in a concentrated form. Certainly this is the case in soy-based infant formulas and some of the menopause-related products on the market. Even with soy pills and powders, I think it takes a significant amount to have a suppressing effect on the thyroid, but I try to limit These products in patients with sluggish thyroid function. In fact, I generally emphasize an increase in soy foods rather than soy supplements, and I prefer other phytoestrogenic supplements like flax, alfalfa and black cohosh. The same is true for cruciferous vegetables. I consider their positive health benefits to far outweigh possible effects on the thyroid, but I do have thyroid patients avoid supplements made of these foods.

On occasion, when I've had problems managing a patient's thyroid function, I have them eliminate soy and cruciferous vegetables, but this situation is rare. And, I don't restrict fermented soy products in any circumstance.

4. You mention in the book that using T3 in a cycled treatment for addressing high Reverse T3 levels (sometimes called Wilson's Syndrome) is gaining interest. Do you follow the protocol Wilson has outlined?

In my book Thyroid Balance, I did mention that Wilson's protocol is gaining interest. Unfortunately, this does not necessarily imply efficacy or success. I find Dr. Wilson's explanation of the formation of reverse T3 and its subsequent blocking effect on the proper utilization of T3 in the cells, to be quite interesting and supported by research, although I've measured rT3 in people to be normal when I know they are not converting T3 adequately. The place that Wilson's Syndrome really breaks down for me is the idea that cycling the patient in the way that the Wilson's Syndrome protocol does will "capture" the temperature and thus re-set the proper thyroid hormone balance. In honesty, I don't buy it as a therapeutic strategy, I don't see why it would work and I don't think Dr. Wilson gives a convincing explanation.

Do you prescribe this sort of therapy yourself in your own practice?

Perhaps because of this (there is research that suggests that a treatment is more effective if the prescribing doctor believes it's effective!) I haven't gotten good results with the dozen or so patients that I have tried on this therapy.