The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
I think this goes back to tissue sensitivity and this is actually a pretty well-documented phenomenon that on ketogenic diets tissue sensitivity the t3 probably increases and we don't need t3 to be as high so if people are not having symptoms of hypothyroidism I do not worry about a slightly low t3 or free t3 on a ketogenic diet it seems to be a feature
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what we see in these situations what I've seen clinically is that although we will sometimes see a reduction in the free t3 levels of people on a low carb or ketogenic diet we don't see a rise in the TSH or that they were in stimulating hormone so what's been proposed is that just like we see an increase in insulin sensitivity just like we see an increase in the leptin sensitivity is we are seeing an increase in thyroid sensitivity
the reason I think this is true is because the patients are not symptomatic even my patients who have a free t3 that is on the lowest end of normal their TSH is normal and they have no symptoms no symptoms being cold fatigue weight gain
do ketogenic and low carb diets cause thyroid problems I would say know
you should get free T3 and free T4 know what's going on with your TSH and your thyroid that's a key thing that you'll see change with ketogenic or low carb diets often in the wrong direction