a If you are taking thyroid medication, especially T4, and your body didnt actually need it, then stopping the medication may actually make you feel better. Celi, Francesco S., Marina Zemskova, Joyce D. Linderman, Nabeel I. Babar, Monica C. Skarulis, Gyorgy Csako, Robert Wesley, Rene Costello, Scott R. Penzak, and Frank Pucino. Liothyronine: answering patients' questions. I am a former Doctor of Osteopathic Medicine (no longer practicing) that now focuses on producing the information you see here while also formulating some of the best supplements on the market (in my HUMBLE opinion) :). Different symptoms and health impacts appear at different points on the way to thyroid hormone depletion. If you skip or stop your medicine entirely, you can experience a number of short-term and long-term consequences, including: Debilitating weight loss. None of the lines follow the spike-crash-tail shape seen in Jonklaas or Van Tassell, above. Withdrawal syndrome is found among people who take Cytomel, especially for people who are female, 60+ old, have been taking the drug for 2 - 5 years. Just realize that some people may feel better when they stop the medication, but the exact reason should be evaluated on the individual level. How long does it take for the final dose of synthetic LT3 (Liothyronine) hormone to clear from blood, and how much suffering might a withdrawal cause? The normal subjects were placed on T3 doses of 50 mcg daily the 1st wk, 75 mcg daily the 2nd wk; and 100 mcg daily for the last 10 d., The athyreotic patients were switched from oral thyroxine replacement to oral T3 (Cytomel), 75 mcg daily., There was only one dose per day. Contraindications feature history of a heart attack, adrenal glandular problem or thyrotoxicosis. sun dried tomato bread recipe jamie oliver; laura englander levin wedding; how a guarded man tests you; red thread spaces llc east hartford, ct TSH is part of an important axis known as the hypothalamic-pituitary-thyroid axis (5). This site uses Akismet to reduce spam. nervousness. In answer to Question 1, the following were only permitted a maximum score of 0.5 each, simply by answering yes/no: It is hard to imagine weight gain or dry skin occurring within only 2 weeks of withdrawal. Dosing adjustments are based on an assessment of the individual patient's clinical and laboratory parameters [see Dosage and Administration (2.3, 2.4)]. Levothyroxine helps regulate your metabolism and energy, as it is a replacement for a hormone your thyroid normally produces that does this. So, your 5 mcg of Cytomel is equivalent to 20 mcg of Levoxyl. A better approach, however, is to find a Doctor who is already knowledgeable and understands how to help. (whole-body scan (WBS) or stimulated thyroglobulin (Stim Tg) blood test). The duration of LT3 monotherapy prior to withdrawal. It has been a common practice for many decades to treat thyroid cancer patients after a total thyroidectomy with either LT4 or LT3 monotherapy, and then completely withdraw thyroid hormone prior to radioioidine (RAI) ablation of any thyroid remnants left behind after surgery. whether or not you have T4 in bloodstream, and how much T4, that is converting to T3 while the LT3 dose clears from blood. Stay hydrated. Are you struggling with getting proper thyroid care? In addition, Cytomel often needs to be taken multiple times a day since it has a short half-life, resulting in fluctuating levels in the body. 2008. I am a big fan of thyroid supplementation and recommend that many of my patients use very specific and powerful supplements. The autoimmune component of Hashimotos may lead to the eventual destruction of your entire thyroid gland which means it can no longer produce thyroid hormone by itself. It is created by eHealthMe based on reports of 6,191 people who have side effects when taking Cytomel from the FDA, and is updated regularly. Different individuals may respond to medication in different ways. This is a compensatory mechanism by which the body reduces the effect of hypothyroidism on the one hand, and can clear out short term excess on the other hand. The Pharmacodynamic Equivalence of Levothyroxine and Liothyronine. . This resource is dedicated to helping people with thyroid problems, hormone imbalances, and weight loss problems get the help that they need. Among them, 31 people (0.5%) have Withdrawal syndrome. Therefore, signalling effects linger on even after the T3 is no longer bound to the receptor and is depleted from blood. It is not known whether Thyrogen can appear in human milk. At peak levels, a properly dosed LT3 patient with healthy adrenals will not experience any thyrotoxic symptoms. If your current doctor is unwilling to order these tests then you may need to seek out a second opinion and look for someone who specializes in thyroid care. It is used with or without a radiology test using a form of iodine. In case you arent already aware, another very important factor that is within your control is the food that you put into your body and how much you exercise. The survey minimized several debilitating symptoms such as fatigue, insomnia, cold intolerance, and weight gain. Is your current physician unwilling to work with you to try something new? Levothyroxine Withdrawal. Patients experience significantly less depression, anxiety and psychomotor retardation while on their thyroid hormone medication. Obviously, symptoms such as a menstrual disturbance would have less chance of appearing within only 2 weeks post LT3-withdrawal, or if the patient was male or a woman in menopause. Once you get to the 100 mcg + range, you put yourself at a much higher risk of side effects like Tachycardia, muscle loss, anxiety, and feeling weak. The brand name for rhTSH is Thyrogen. Uses. Pharmacokinetics of L-Triiodothyronine in Patients Undergoing Thyroid Hormone Therapy Withdrawal. Thyroid: Official Journal of the American Thyroid Association 29 (10): 137179. If you know that you have gut issues that may be contributing to your Hashimotos, then taking a probiotic may be ideal. 2019. 1972. Patients over 65 years old with large amounts of leftover thyroid tissue after surgery, or with a history of heart disease, should discuss with their physicians the risks and benefits of Thyrogen. Official answer. A high MCR (metabolic clearance rate) means it is cleared faster. But make no mistake, the problem is not necessarily the medication (you probably need thyroid medication), instead, the problem has more to do with dosing, the type of thyroid medication you are taking, etc. Use the percentage index to get a quick start on clinical assessment. Too many studies of Low T3 syndrome (nonthyroidal illness, NTIS) have shown that low T3 is an independent predictor of mortality and morbidity (Rhee et al, 2016), and the outcome worsens when serum T4 levels also fall below normal range. Fortunately, there are VERY few deaths from these conditions due to the ability to catch and diagnose thyroid dysfunction. The first step is to get a complete thyroid lab panel. Ive discussed various options for patients post-thyroidectomy in this post here. How effective is Topiramate for Neuropathic Pain? We are not responsible for the content or availability of linked sites. Obtain ethical informed consent from the patient first, and offer alternatives. Patients, do not do this at home! Walter, Kimberly N, Elizabeth J Corwin, Jan Ulbrecht, Laurence M Demers, Jeanette M Bennett, Courtney A Whetzel, and Laura Cousino Klein. Cytomel and T3 thyroid hormones have a direct effect on the heart and cardiac tissue. Thyrogen can cause serious side effects, including: Dramatically increased appetite and thirst. This is because LT3 dosing will lower TSH stimulation and therefore lower the T4 level to make room for a higher average T3 level). If you arent doing these two things then you are potentially missing out on an improvement in your symptoms. Clearly, we do not all metabolize or clear T3 at the same rate. Titrate the dose of CYTOMEL carefully and monitor . Dosing T3 in light of circadian rhythm, Remissions and fluctuations in autoimmune thyroid disease: TRAb. If the patient has no symptoms before treatment (just a low temperature). Mathew, Vivek, Raiz Ahmad Misgar, Sujoy Ghosh, Pradip Mukhopadhyay, Pradip Roychowdhury, Kaushik Pandit, Satinath Mukhopadhyay, and Subhankar Chowdhury. Drug cravings. (in a child or teenager) pain, stiffness, and trouble moving the legs. Its very possible that these patients may have been incorrectly placed on thyroid hormones, to begin with. Compare the rates above to the pharmacokinetics of a 50 mcg single dose of LT3 in healthy euthyroid subjects over the same time period. The exception would be if you are starting a new medication, altering your dose or if you are doing it with physician supervision. In people with healthy thyroid glands, the rise and fall in Free T3 and Total T3 is parallel over time. Thyroid Patients Canada is a registered federal not-for-profit organization. Thyroid Symptoms, Solutions . Thyrogen (thyrotropin alfa) is used to help identify thyroid disease by testing the blood for a hormone called thyroglobulin in the follow up of patients with a certain type of thyroid cancer known as well differentiated thyroid cancer. Stress may not always be within your control, but what you can control is how well you cope with it by adding certain techniques. 39K subscribers in the Hypothyroidism community. On Sunday I'll take my last Cytomel, having taken it for 2 weeks. Cytomel. (This is not common. If you have Hashimotos, and youve had it for many years, there is a good chance that you have some element of permanent thyroid damage to your gland. Very few studies measure LT3 withdrawal in both types of patients at the same time on the same laboratory tests. China L-Triiodothyronine T3 CAS 200-223-5 Organic Herbal Weight Loss Raw Steroid, Find details about China Raw Steroid Powders from L-Triiodothyronine T3 CAS 200-223-5 Organic Herbal Weight Loss Raw Steroid - Shenzhen Diamond Pharmaceutical Technology Co., Ltd. Alpha Lipoic Acid (ALA) and Thyroid Health: Is it Safe to Use? crying. Check with your doctor immediately if any of the following side effects occur: Incidence not known. In thyroid therapy, one must ask, half life in what kind of patient?. During withdrawal from thyroid hormone, to reduce symptoms of hypothyroidism, your doctor may prescribe a short-acting thyroid hormone called Cytomel (T3) for a few weeks. A drug's half-life is the time it takes for 50% of that drug to be removed from the body. This website is for U.S. healthcare professionals only. If you cant produce it naturally then you have to take it in some other way. The doctor wants me to add back Cytomel, but I am worried about doing so. menstrual changes. Very bad head fog, depression, etc. Stick to a structured sleep schedule. Consider that such medical resource utilizations were less likely to occur 3 times within 2 weeks of LT3 withdrawal compared to 3 times within 4 weeks of LT4 withdrawal. If you have questions regarding your health you should seek qualified information from a medical professional or your doctor. That means you will NEED to take thyroid medication for the rest of your life. Those words very good are from the doctors point of view. Other people experience severe symptoms. The lower your TSH goes the more your body is reliant upon thyroid medication for thyroid hormone. You can take part in a withdrawal program in: a residential detox unit or in a hospital. If THYROGEN is administered with radioiodine, the combination regimen should not be used in pregnant women. Patients who suddenly stop taking levothyroxine may go into withdrawal and may experience symptoms like debilitating weight loss, panic attacks, fatigue, muscle weakness, and nausea. Lum, S M, J T Nicoloff, C A Spencer, and E M Kaptein. Doctors such as endocrinologists and PCPs may, surprisingly, not be best suited to help you. Increased weight gain. Douglas Van Nostrand, M.D., Gary Bloom, and Leonard Wartofsky, M.D. Supplements also have the advantage of being available over the counter, which means that they are easy to get (much easier than thyroid medication). Heat intolerance, sweating. In this post you will learn more about why you shouldnt stop taking your thyroid medication (without physician supervision), the side effects of stopping thyroid medication abruptly, reasons why it isnt safe and what to do instead. These supplements can be used in conjunction with your existing thyroid medication and with other therapies, which makes them great for layering therapies on top of each other. The above mentioned symptoms improved as I brought the dose and levels down (which made the tsh levels higher). If you spend any time researching on the internet you will always find someone who has a positive experience when they stop taking their medication. In order for your body to activate this medication, it must convert it into T3 (through thyroid conversion) and not everyone does this at the same rate. I then conclude with data from a survey showing the harm to quality of life of even a short-term LT3 withdrawal, and a discussion of the serious health risks of withdrawal. LT3 monotherapy withdrawal: Clearance and effects, https://doi.org/10.1111/j.1365-2265.2009.03700.x, https://doi.org/10.1016/S2213-8587(15)00225-9, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC425050/, https://doi.org/10.1097/MED.0000000000000275, https://laws-lois.justice.gc.ca/eng/acts/C-42/page-9.html#h-26, Q&A. Normal levels of TSH are between 0.4 to 4 mlU/L. Acquisition & Support, a Dosing T3 in light of circadian rhythm Thyroid Patients Canada, Ingbar and Bravermans historic study of LT4 monotherapy Thyroid Patients Canada, Free T3 peaks and valleys in T3 and NDT therapy Thyroid Patients Canada, Focusing on T3: The T3 hormone or the LT3 pharmaceutical? I don't say that like I don't believe him . 2016 Jun; 25(2): 7984. The use of the eHealthMe site and its content is at your own risk. Jul 24, 2013 1:11 PM. In the treatment and follow up of thyroid cancer, for certain procedures, you need a high level of thyroid stimulating hormone (TSH). Lum et al 1984 (over)dosed euthyroid people on LT3 for 4 weeks to compare their clearance with hypothyroid people. Its important to realize that this axis is altered when you take thyroid function because it impacts your bodys ability to produce thyroid hormone if you stop or alter your medication. As a result, Cytomel T3 can help to improve a wide range of symptoms, including fatigue, weight gain, hair loss, and . Foods to Avoid if you Have Thyroid Problems: Ive found that these 10 foods cause the most problems for thyroid patients. Loss of appetite. The peak clears from blood within a few hours, followed by a very long tail. Im not depressed and my daughter is 11 years old. I'm on withdrawal protocol for RAI. #1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1980928/, #2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585732/, #3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737508/, #4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784889/, #5. https://www.ncbi.nlm.nih.gov/books/NBK278958/, #6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682381/. Thyroid hormones are regulated by the FDA which means that they require a prescription medication. Im not sure about Korea (where the study was done), but in our culture, it would require serious symptoms as neurological, cardiovascular or pulmonary distress go to a hospital, and such symptoms were not listed, though even ONE visit to a hospital would likely be for a very severe reason. Nervousness, anxiety, panic attacks. In pediatric patients in whom a diagnosis of permanent hypothyroidism has not been established, discontinue . chest pain or discomfort. Is it safe to stop taking thyroid medication? how much thyroid hormone supply you have before the final dose. It was especially difficult for the LT3 withdrawal patients to answer with maximums for their 2 weeks of withdrawal alone, since the maximum scores often required an answer of always, or a duration lasting more than 2 weeks, or an event occurring more than 2 times. The QoL survey items focused on physical symptoms, signs, problem duration, impact on social life, mood changes, and medical resource utilization. 3. 3) Rosario et al; Area under the curve of TSH after levothyroxine withdrawal versus administration of recombinant human TSH (rhTSH): possible implications for tumor growth. Experts calculate this period using the half-life of a drug. nausea. Abrupt discontinuation of SSRIs that have shorter half-lives, such as paroxetine, may induce withdrawal symptoms, some of which may mimic a recurrence of a depressive episode (eg, tiredness, irritability, severe somatic symptoms). Stages of Thyroid Cancer . (This is not common. In Jonklaas study, the average half life was 22.04 hours. Follow me on Facebook, TikTok, and Instagram for up-to-date thyroid tips, tricks, videos, and more. This typically stems from conditions such as hyperthyroidism or thyroid cancer. As a result, it may cause symptoms of acute hypothyroidism. Accessed June, 2020, 7) E. L. Constant et al. USE IN SPECIFIC PATIENT POPULATIONS Elevated Thyroid Stimulating Hormone Is Associated with Elevated Cortisol in Healthy Young Men and Women. Thyroid Research 5 (October): 13. https://doi.org/10.1186/1756-6614-5-13. Cytomel is the commonly associated brand name for the synthetic thyroid hormone Liothyronine Sodium. In this axis, your body produces TRH which stimulates TSH which stimulates thyroid hormone production. Ive discussed, at length, what is included in this panel, and you can find more information in this post. In a great many cases, feeling better can be as easy as switching up the type of medication you are taking. But symptoms may differ in another person with different concurrent health conditions. . Problems sleeping, including insomnia and/or fatigue. The worst symptom seems to be the head fog - he can't focus or get anything done - so he says. Here are the most recent graphs of LT3 clearance rate over 75 hours in 14 patients post-thyroidectomy after being treated with LT4 alone for 30 days, and terminal elimination was assessed over 11 days. (VanTassell et al, 2019.). This content is strictly the opinion of Dr. Westin Childs and is for educational and information purposes only. Remember, we said that thyroid hormone is required for you to function and for you to live. . Thyrogen-Induced Hyperthyroidism: Risks Associated with Radioiodine Treatment: ADVERSE REACTIONS Other symptoms may include delayed reflexes (such as the knee jerk when the knee is hit with a reflex hammer), brittle nails, increased blood pressure, and a slow heart rate. Many times, cravings may be mistaken for thirst or hunger. https://doi.org/10.1016/S2213-8587(15)00225-9. Children:Safety and effectiveness in young patients (under the age of 18) have not been established. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. But you have to ask yourself a very important question: Are their experiences, medical conditions, circumstances, etc. Myxedema Coma in a Patient with Subclinical Hypothyroidism. Thyroid: Official Journal of the American Thyroid Association 21 (1): 8789. chest tightness or heaviness. Patients who have been on very high doses of levothyroxine for long periods of time may need to stop their medication more than 4-6 weeks prior to their treatment in order for the TSH to increase sufficiently.5. The withdrawal symptoms can appear after as few as 6-8 . Such half-life estimates are easily misapplied to the severely thyroid-disabled people most likely to be taking LT3 in smaller doses several times a day over weeks, months, or years. We do not provide medical advice. Clearly, the persons with the least amount of T3 in circulation had the slowest clearance rate, and those with a higher T3 cleared it faster. The following is the timeline for the common symptoms of alcohol withdrawal: Stage 1 (8 hours after the last drink): The common symptoms during this stage are anxiety and restlessness, sleeplessness, abdominal pain, and nausea and vomiting. So, if you decide to stop taking your medication your body can only produce the amount that it is capable of producing. Depression. Headaches. Either of these conditions can set the stage for improper management in a patient with normal thyroid function. In most cases, you will find the answer to that question is no. . 1984. The answer is no, in many cases it is not safe to stop taking your thyroid medication (at least not without physician supervision). If THYROGEN is administered with radioiodine (RAI), the serious side effects for RAI apply to this combination regimen. Please consult with your doctor for a list of contraindications for radioiodine. You are now leaving Thyrogen.com and going to a website that is not operated by Sanofi Genzyme. Low intracellular T3 secondary to hypothyroidism is the basic underlying pathology in myxedema crisis which leads to hypothermia and suppression of cardiac activity. 1) Clinical Thyroidology for the Public; Vol 4 Issue 1 Vol 4 Issue 1 p.3-4;https://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-4-issue-1/vol-4-issue-1-p-3-4; Accessed June, 2020. Endocrine and Metabolic Considerations in Critically Ill Patients. The Lancet. 2022 Genzyme Corporation. Their goal is not clearance of T3, but a target TSH that will strongly stimulate the thyroid remnant to take up the radioactive iodine. Cytomel causes an increase in the force of contraction and an increase in the heart rate (9). I'm Dr. Westin Childs. In rare cases, temporary hair loss may occur during the first few months of starting Cytomel (especially in children). Cytomel typically takes about one day to reduce by half. Thyrogen, Sanofi and Genzyme are registered in U.S. Patent and Trademark Office 1 white pill Synthroid - 50 mcg T4. In a study of people being prepared for treatment with a form of iodine after thyroid surgery, results were similar between those who received Thyrogen and those who stopped taking their thyroid hormone for up to 5 years after treatment. decreased bone mineral density. arm, back, or jaw pain. This group of people should never make changes to their thyroid medication without physician supervision as it can be very dangerous. Thyroid medication is always more potent and more powerful than any supplement (available over the counter). All rights reserved. It may surprise you that your thyroid is responsible for some very important functions inside your body. To put that in context, thereference rangeof total triiodothyronine (T3) is approximately 80-220 ng/dL in adults. Symptoms that impair complex and demanding tasks may appear long before the half life of the dose if one starts from a position of LT3-dependent euthyroidism (Busnardo et al, 1983) and then progresses all the way to depletion of T3 without any T4 support. 52 (72% of range) and my Free T3 283 (only 28% of range.) After withdrawal, some symptoms do not appear until after the medication has disappeared from circulation, due to the long-term and cumulative nature of thyroid hormone signalling. In many cases, adding some T3 to your current medication regimen is enough to improve your symptoms dramatically. The reason that this is so important is that, without it, you are really flying blind. Arq Bras Endocrinol Metab. In most cases, discontinuing your thyroid medication (abruptly or otherwise) is not a wise decision. A high level of TSH facilitates thyroid cancer treatment and detection of remaining, recurring, or metastatic thyroid cancer. Please consult with your doctor for a list of contraindications for radioiodine. #4. 1. Lastly, and perhaps the most important thing you can do is to try and find a physician or Doctor who is willing and able to help you with your condition. The answer to people in this category may be as easy as increasing your medication. Elderly: Studies do not show a difference in the safety and effectiveness of Thyrogen between adult patients less than 65 years and those over 65 years of age. severe headaches, ringing in your ears, dizziness, vision problems, pain behind your eyes; a seizure; or. WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. We will discuss more about that below (you can skip there if you want to now), but first I want to discuss some basics about how thyroid medication is impacting your body. 1 years. Check out my thyroid supplements. It is possible to purchase T3 and T4 via online pharmacies, but these pharmacies may not supply you with the correct dose or medication and they are not worth the risk (in my opinion). Get medical help right away, if you have any of the symptoms listed above. They want to know what would happen if they unexpectedly ran out of supply due to a pharmaceutical shortage, a health care system breakdown, or if they were unable to access their medicine cabinet for a few weeks. It is obvious why the alternative to withdrawal supplementation with recombinant human TSH (rhTSH) often sold under the brand name Thyrogen was given an average Quality of Life reduction score of 4.2 (pretty good!). This is an important question for many people who dose LT3. Liothyronine is used to treat hypothyroidism, a condition wherein the thyroid gland does not produce enough thyroid hormone. They considered this to be Loss of libido, impaired sexual performance, menstrual disturbances, and more than 1 week was given a maximum score of 3. This axis is very sensitive and it can take weeks to months for it to come back to normal. However, without thyroid replacement medication, a person with overt hypothyroidism cannot function optimally and will suffer from the physical and mental symptoms of hypothyroidism. https://doi.org/10.1186/cc6211. All information is observation-only. Seehttp://www.thyca.org/about/TCGuide/, 5) Jason Baker MD; The Effects of Hypothyroidism in the Body;https://www.healthline.com/health/hypothyroidism/effects-of-hypothyroidism#1; Accessed June, 2020, 6) RADIOACTIVE IODINE FOR THE TREATMENT OF THYROID CANCER. An accident or severe infection can upregulate DIO3 enzyme, thereby deactivating T3 at a higher rate, which may precipitate the dangerous crisis of myxedema coma. Hydrocortisone is a man-made version of a natural substance ( cortisol) made by the adrenal gland. Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain, slow . Feeling jumpy and restless. The first half of the half life describes a steep crash; the decline past the half-life takes a much longer time. Published online 2016 Jun 6. doi: 10.4274/mirt.88598;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096624; Accessed June, 2020. Effects of the drug can wear off fairly quickly. Sign up to receive 20% off your first order. Erlotinib Hydrochloride and Fungal Sepsis, Amlodipine Besylate and Vitamins drug interaction, Headache (pain in head): 8 people, 25.81%, Drug Administration Error: 5 people, 16.13%, Mobility Decreased (ability to move is reduced): 5 people, 16.13%, Drug Exposure During Pregnancy: 4 people, 12.90%, Malaise (a feeling of general discomfort or uneasiness): 4 people, 12.90%, Headache (pain in head): 5 people, 16.13%, Arthritis (form of joint disorder that involves inflammation of one or more joints): 5 people, 16.13%, Fibromyalgia (a long-term condition which causes pain all over the body): 5 people, 16.13%, Neuropathy Peripheral (surface nerve damage): 5 people, 16.13%. If you know that you have low T3 or have a problem converting thyroid hormone, then taking a supplement designed for improving T3 conversion is probably ideal. abdominal cramps. Click "continue" only if you are a U.S. healthcare professional. Anhedonia (loss of ability to feel pleasure). a, (MADRS) = Montgomery and Asberg Rating Scale, https://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-4-issue-1/vol-4-issue-1-p-3-4, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096624, https://www.healthline.com/health/hypothyroidism/effects-of-hypothyroidism#1, http://www.mythyroid.com/radioactiveiodinecancer.html.