Abstract. Famine causes adaptive changes in thyroid function which helped individuals survive during times of low food availability. These changes in thyroid function and metabolism have become maladaptive as the induced hypothyroidism associated with intentional weight loss restricts the success of diet attempts and encourages weight regain. In our previous paper[1] we described the mechanisms and consequences behind maladaptive hypothyroidism associated with intentional weight loss. Here we give two specific patient examples of this syndrome and how the biochemical and clinical changes were managed for the clinical benefit of our patients. More broadly, we address the need to understand that there are limitations to our ability to detect every appropriate variable in any one patient, so that we do not overestimate the value of any particular lab reading in any one patient.

Keywords  • Famine • Weight loss • Maladaptive hypothyroidism