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In secondary hypothyroidism the TSH is unreliable, and doses should be titrated to the T4 level Advise patients: Treatment is usually lifelong There is an association with other autoimmune diseases, particularly: Pernicious anaemia Addisons disease About the risk of side effects Typically few, and usually dose related due to too much thyroxine causing signs of hyperthyroidism: Palpitations and atrial fibrillation Diarrhoea Increase appetite Anxiety Insomnia Tremors Subclinical hypothyroidism Historically, a contentious issue Defined as elevated TSH, with normal T4

Malabsorption Changes Everything Beyond competition, SIBO disrupts digestion of fat by potentially interfering with bile acids

Hay un mecanismo de absorcin que en condiciones normales se satura aproximadamente sobre los 1.5-2 g por comida

La vitamine B12, en cas de carence, peut aussi entraner des symptmes plus gnraux tels que la chute de cheveux, la pleur, etc