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Do you take thyroid medication? Judging from my integrative medicine practice, I believe we have an epidemic of underfunctioning thyroid on our hands. Most national organizations of endocrinologists have issued guidelines for thyroid levels that if you have symptoms of low thyroid function, a TSH (Thyroid Stimulating Hormone) < 2.5 makes the diagnosis, yet most conventional physicians use the older range of 0.5-5 as normal. Tighter range serves you better. In other words, you may need a boost to your thyroid function, which I usually approach in a step-wise function. I start with certain nutrients (Vitamin D, iodine, copper, zinc, selenium), and if that isn't enough, herbal therapies. If that is insufficient, I'll augment with natural thryoid hormone, and usually prefer to start with glandular therapies such as Armour or Naturethroid. If you are already on thyroid hormone, a new study from the journal Thyroid may affect your use of coffee in the morning (hopefully you've joined our Cleanse virtually and are either off or almost weaned off of the junk by now). According to the recent article, in folks who consume coffee at the time of taking their thyroid medication, we see a 25-57% drop in T4, one of the thyroid hormones, compared to non-coffee drinkers. This adverse effect persists for up to one hour. I tell my patients to take their thyroid hormone first thing in the morning with a small sip of filtered water, and nothing else to eat or drink for 20 to 60 minutes after. Most of my patients are able to do 20 minutes during the week, and 60 on the weekend. But many of them have a wicked caffeine habit, and that small sip just might be of coffee. Based on this study, I will ask my patients to wait an hour if they are having coffee. Time to go back to the filtered water, and to wait 60 minutes before you cup of Joe, or better yet, before your cup of hot water with 1/4 lemon and cayenne. Thanks to Mary Shomon for bringing the Thyroid article to my attention.