PERSPECTIVE— 

How does the thyroid work? What do the hormones affect, how, and in what way? On this week’s A Different Perspective, Nicole Saleske, FNP, AP, NP, walks us through the ins and outs of all of it. 

• How prevalent is thyroid disease?  

Thyroid problems aren’t thyroid problems. 

• What does thyroid hormone do? 
• Red blood cells are the only cells the thyroid doesn’t affect. 
  • When the body needs help, it tells the brain so. 
  • The pituitary produces TSH and tells the thyroid to start and keep moving 
  • ~97% of thyroid hormone is T4–tyrosine with 4 iodine. 
    • To meet the body’s needs, it needs to convert to T3 so it can connect to a receptor 
      • To convert to T3, what is needed? 
        • Iron 
        • Selenium 
        • Zinc 
    • This is what levothyroxine gives you. If your body isn’t converting T4 into T3, why take more T4? 
• One of the biggest things that can bind to receptor sites and take it away from thyroid hormone is estrogens. So if you have estrogen dominance, that may be why you’re not feeling well. 
• Autoimmune diseases—Antibodies tend toward three tissues 
  • Thyroid 
  • Ovaries 
  • Hippocampus in the brain 
• It’s not a thyroid problem—it’s a body problem. So why are we ripping thyroids out? 
• It takes firemen a while. It takes carpenters even longer. 

What do you need to get an idea of how your thyroid is functioning? 

• TSH 
• Total T4 
• Free T4 
• Total T3 
• Free T3 
• T-uptake 
• Reverse T3 
• Thyroid antibodies 
• DHEA 
• Cortisol 
• Ferritin 
• CBC with differential 
• CMP 
• Esterone 
• Estradiol 
• Testosterone  
• Progesterone  

Taught in Nurse Practitioner school 

• If you can’t fix something with a medication, don’t test it. Why should insurance pay for something you can’t fix? 
• Three pillars of nurse practitioner school 
  • Human assessment 
  • Pathophysiology (how does this affect the body so we can give it a name?) 
  • Pharmacology (How do we fix it with a drug?) 
• Most prescribed medications of 2020