This doctor from Germany has come up with a different way of reflecting on advent.
Dr. med. Susanne Ruff-Dietrich
@medruff.bsky.social
It struck a chord of whimsy while being utterly focussed and serious.
Link to thread on sky:
bsky.app/profile/medruff.bs...
The originals are all in German and I have used automated translation as my German language skills don’t deserve to be called skills! 
If the name looks familiar, think Johannes W. Dietrich.
Obviously, about ten days to go!
#Advent calendar I was only on Bluesky for a short time when I posted a piece of wisdom about the thyroid every day during Advent last year. It was liked a lot and since I now have so many new followers, I will post it again this year. I'll attach the doors in this thread.
Door No. 1: The thyroid produces thyroxine. The free T3 and the free T4 (not bound to proteins) are measured, called fT3 and fT4. Of these two amino acids, T3 has only 3 iodine atoms, while T4 has 4 iodine atoms.
Door number 2:
TSH is not a thyroid hormone, but a hormone from the pituitary gland that signals to the thyroid how much hormone is needed.
If you are under a lot of stress, the value can rise slightly, even if the thyroid is healthy. If the thyroid is underactive, the value is significantly higher.
Door number 3:
In the case of hyperthyroidism, the TSH is reduced. Possible causes are a so-called "hot" nodule - an autonomous adenoma that is uncoupled from TSH control - or an autoimmune inflammation of the thyroid, short-term (e.g. Hashimoto) or long-term (Graves' disease).
Door number 4:
Thyroid diseases are very common. 3 to 5% of the population suffer from an underactive thyroid (hypothyroidism), nodules are found in more than 10% (in those over 45 years of age even in more than 40%) and L-thyroxine is one of the 4 most frequently prescribed medications in Germany.
Door number 5:
The fT3 is the active hormone that acts in many places in the body, fT4 is the storage hormone, but also has its own effect.
If there is an iodine deficiency, the ratio of fT4 and fT3 can shift slightly towards fT3. An iodine deficiency can lead to cardiac arrhythmias.
Sorry, the 6th door is late. Now there are two doors one after the other.
Door number 6 (sorry for the delay):
Iodine: The dose makes the poison. Both a deficiency and too much can be harmful. An intake of between 200 and 300 µg/day is optimal.
pubmed.ncbi.nlm.nih.gov/312...
Door number 7:
Iodine deficiency leads to enlargement of the thyroid gland, formerly known as goiter. This usually also causes nodules. They are usually benign with cystic parts and a less dense edge ("halo").
Using an ultrasound, the benign nature can be assessed using the Tirads criteria.
Door number 8:
During thyroid scintigraphy, radioactive iodine makes visible the areas of the thyroid that absorb a particularly large amount of iodine because a lot of hormone is produced there.
This can be used to find an autonomous adenoma, for example. Since the radiation exposure is very high, the benefits must outweigh the risks!
Door number 9:
TSH and fT4 form the control loop, even more precisely with fT3. The function of the thyroid cannot be fully analyzed with just the TSH value alone.
For example, the TSH can be low at the same time as the fT3 if there is a serious general illness. (Low T3 syndrome).
Door number 10:
Since TSH is produced in the pituitary gland, it can be reduced by a problem there.
Of course, this means that the thyroid is not working enough: a central hypofunction that can only be detected in the laboratory if fT3 or fT4 is determined. The symptoms are the most important clue!
Door No. 11:
Symptoms of an underactive thyroid can include: sensitivity to cold, weight gain despite loss of appetite, constipation, fatigue, apathy, dull hair, slow heartbeat, doughy swelling, low body temperature.
Not all of them have to be present.
oops, sorry,
I'll deliver door number 12 immediately…
Door number 12:
Symptoms of hyperthyroidism can be:
Heat intolerance, inner restlessness, palpitations, heart palpitations or racing. Weight loss despite increased appetite, diarrhea, increased body temperature, hair loss, bulging eyes. Not all of these have to be present.
Door No. 13:
Stress affects thyroid function: Patients with PTSD (after trauma) have an increased set point of the control circuit: the TSH level is increased despite a normal FT4 concentration. Diagnosis can therefore be difficult in cases of stress and certain mental illnesses.
pubmed.ncbi.nlm.nih.gov/331...
Link to thread on bsky:
Has anyone successfully treated an iodine deficiency please?
Testosterone Therapy & Thyroid Function Issues
