Wellness Trends
Patients increasingly arrive taking thyroid-related supplements. Low-dose T3, around 5 mcg, is unlikely to cause harm if TSH remains unsuppressed, Messer said, though she noted meta-analyses have not supported T3 augmentation for refractory depression. Bovine thyroid products are harder to assess because their content is often unknown.
Iodine-rich supplements such as kelp pose a less obvious risk. In patients with Hashimoto thyroiditis, high iodine exposure can produce a permanent shutdown of hormone production, while patients with TSH receptor antibodies may develop hyperthyroidism. Brandon emphasized taking a thorough supplement history in any patient with new anxiety or mood changes.
Monitoring and Follow-Up
For patients starting lithium, Messer recommended a baseline TSH, a repeat at 1 month, and testing every 6 months thereafter, cautioning against more frequent checks. Both speakers agreed that serial testing driven by health anxiety offers only brief reassurance and may reinforce the cycle.
When hypothyroidism is treated, symptom relief can trail TSH normalization by several months, so dose escalation is not automatically warranted.
“We’re all colleagues and we can all just curbside each other,” said Messer.
Dr Brandon is the founder and medical director of Whole Body Psychiatry. She is dual board-certified in adult psychiatry and consultation-liaison psychiatry, and specializes in gut-brain health.
Dr Messer is a double-board certified endocrinologist and the founder of both Well by Messer and Fifth Avenue Endocrinology.