Physician Hormone Replacement Training for Treating Hypothyroidism

If you are a physician or medical provider who offers hormone replacement therapy in your practice, reestablishing thyroid hormones levels is likely an issue you encounter on a weekly, if not daily, basis.  And, as you already know, addressing the deterioration in thyroid hormones that occur due to age or disease is one of the most important aspects of helping a patient regain health and vitality.

In this article the physician hormone therapy training experts at SottoPelle discuss some of the recent research and methodology behind our proprietary hormone dosing method as it applies to thyroid optimization in your patients who may be suffering from hypothyroidism.


Hypothyroidism is exceptionally common throughout the population in the United States. Data compiled by the National Health and Nutrition Examination Survey suggests that about one in 300 persons in the U.S. suffers from hypothyroidism. The prevalence of this condition increases with age – and is significantly higher in females than it is in males.

However, not all hypothyroidism is the same. Many medical providers, including endocrinologists, assume that normalization of TSH can be done with T4 alone. But, most often, ‘primary hypothyroidism’ (high TSH and low T4) is NOT the problem.

Much more commonly, patients present with Type 2 hypothyroidism – which shows up with normal TSH, sometimes normal T4, and low T3 levels. As a result, Type 2 hypothyroidism may appear to return completely ‘normal’ lab values, in spite of the fact the patient is plagued with a variety of symptoms.

In fact, recent research has concluded that T4 could maintain decent levels of T3 in the pituitary resulting in normal TSH test results – while but virtually all other tissues throughout the body had low T3 concentrations (Escobar-Morreale, et al. 1996). Further, a suppressed TSH does not necessarily indicate a hyperthyroid state. Actually, the likelihood that a suppressed TSH indicated over replacement was approximately only 16% of the time (Fraser, W. et al., 1986).

Influences & Symptoms of Hypothyroidism

Ethnicity, gender, age, the patient’s body mass index and even iodine intake, may all influence the reference range of serum TSH which is not reflected on lab reference ranges (Biondi, 2013).

Concurrently, there are over 200 symptoms related to thyroid deficiency with which patients may present. Symptoms of hypothyroidism for the physician to be “on the lookout” for include, but are not limited to, cold extremities, thinning hair, weight gain, increase body fat, fatigue and loss of energy, ‘brain fog’ or cognition issues, depression, irregular menstrual cycle, and even compromised gut motility.

Treating Hypothyroidism with Hormone Replacement

The benefits of thyroid optimization through physician guided hormone replacement therapies have been reported to include an improvement in most, if not all, of these symptoms. Physician thyroid optimization can help reduce cardiovascular disease, improve brain function, enable weight loss, improve lipid profile, and much more (Barnes, 1976).

And more specifically, hormone optimization by physicians of T3 in obese patients who have normal thyroid labs, has been shown to result in a statistically significant reduction in CV risk factors – including improved lipid levels and enhanced insulin sensitization (Krotkiewski, 2000).

Physician Training is Key to Hypothyroid Hormone Replacement

Unfortunately, thyroid deficiency is often attributed by under-trained physicians to a decrease in hormone production by the thyroid gland. While this can be one cause, two other significant – and more insidious – causes of hypothyroidism should be considered:

#1. Thyroid deficiency can also be caused by decreased conversion of T4 to T3.

#2. Hypothyroidism can result from resistance at the receptor site causing low thyroid symptoms despite “normal” blood test levels.

These phenomena are very similar to what is seen with testosterone deficiency and insulin resistance. (Larsen, 1982; Maia, 1995; Ortiga-Cavalho, 2014; Persani, 2012).

So, for trained physicians, it is crucial to understand that when symptoms do not correlate with laboratory levels of TSH thyroid treatment may still be indicated – even with a normal TSH level.

Sadly, because many physicians still follow traditional “guidelines” that rely only on TSH levels, the patient’s problems will continue to persist.  This widespread undertreatment of hypothyroidism not only keeps patients from getting well but leads to the unnecessary use of other pharmaceuticals that only treat the “symptoms” rather than the underlying cause. Drugs to treat weight gain, cognitive decline, and other low thyroid symptoms come with side effects, contraindications, and negative reactions – all of which could be avoided with treatment of the underlying hypothyroidism through hormone therapy!

Thyroid Hormone Replacement Training for Physicians

Low thyroid symptoms are diverse and extremely widespread – but they are not always accurately reflected in lab results. And the incidence of secondary hypothyroidism (which presents with normal THS) is significant.

Accurate physician identification and treatment of secondary hypothyroidism is extremely important for effectively developing an individualized treatment plans for patients. The treatment of choice for most hypothyroid patients is DTE (T4 and T3) rather than T4 alone as several patients have issues converting T4 in the peripheral tissue.

SottoPelle® Method offers in-person and online hormone replacement therapy training and certification. Didactic training, subcutaneous hormone pellet insertion training, methodology, best practices, and case study reviews are taught according to the methodology of the original HRT pellet pioneer Gino Tutera, MD FACG.

Hormone optimization, including thyroid management is imperative to health, disease prevention, and quality of life in women and men alike. SottoPelle® Method physician hormone replacement therapy training enables medical providers to increase their knowledge in this area, to better serve their patients and grow their practice as they help more and more individuals.

If you are a physician or medical provider who is interested in expanding your understanding of hormone replacement therapy using subcutaneous pellets, CLICK HERE to learn more about Sotto SottoPelle® BHRT training and certification.

Hormone Replacement Training for Physicians: (323) 986-5100


Barnes, B. & Galton, L. (1976). Hypothyroidism: The unsuspected illness. Canada: Fitzhenry & Whiteside Limited.

Biondi, B. (2013). The normal TSH reference range: What has changed in the last decade? The Journal of Clinical Endocrinology & Metabolism, 98(9), 3584–3587.

Cerillo, A., Bevilacqua, S., Storti, S., Mariani, M., Kallushi, E., Ripoli, A., et al. (2003). Free triiodothyronine: a novel predictor of postoperative atrial fibrillation. Eur J Cardiothoracic Surgery, 24(4), 487-92.

Escobar-Morreale, H.F., et al. (1995). Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest, 96(6), 2828-2838.

Escobar-Morreale, H.F, del Rey, F.E., Obregon, M.J., de Escobar, G.M. (1996). Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology, 137(6), 2490-2502.

Fraser, W.D., Biggart, D., O’Reilly, St. J., Gray, H.W., McKillop, J.H., & Thompson, J.A. (1986). Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine therapy?

Larsen, P.R. (1982). Thyroid-pituitary interaction: feedback regulation of thyrotropin secretion by thyroid hormones. NEJM, 306(1), 23-32.

Krotkiewski, M. (2000). Thyroid hormones and treatment of obesity. International Journal of Obesity, 24, S116-S119.

Maia, A.L., et al. (1995). Pituitary cells respond to thyroid hormone by discrete, gene-specific pathways. Endocrinology, 136, 1488-1494.

Ortiga-Carvalho, T.M., et al. (2014). Thyroid hormone receptors and resistance to thyroid hormone disorders. Nat Rev Endocrinology, 10(10), 582-591.

Persani. L. (2012). Central Hypothyroidism: Pathogenic, diagnostic, and therapeutic challenges. Journal of Clinical Endocrinology & Metabolism, 9(7): 3068-3078.

IMPORTANT DISCLAIMER: This article is provided as general information only and is not intended to be used as medical advice. While the benefits of hormone replacement are well documented through clinical research, we are not representing that hormone therapy is a “cure” for any disease. Only your treating physician can determine if hormone replacement may be a beneficial part of your healthcare regimen, based on your age, overall health, risk factors, and lifestyle.

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