Neglecting Hypothyroidism

Is mainstream medicine ready to change?

- Raphael Kellman, MD

A recent article in the Wall Street Journal highlighted the huge chasm between standard protocols for hypothyroidism and the failure of these methods to work for a large percentage of patients.

Nearly two decades ago, it became clear to me that these methods are ineffective for people more often than not. Patient after patient described symptom after symptom, all of which appeared to be hypothyroidism, yet the routine thyroid-stimulating hormone (TSH) test came back “normal.” Additionally, the standard treatments left many patients suffering. It didn’t take long to figure out something wasn’t working, so why is much of the medical community still so far behind?

The failures of current testing

Testing is the first area of concern when it comes to properly managing a thyroid patient. A simple blood test checks the level of TSH, a hormone released by the pituitary gland to “talk” to the thyroid and stimulate production of its regulatory hormones, T4 and T3, when they are low. A high level of TSH is meant to correlate with low thyroid function, however, there are several common conditions that suppress TSH levels, such as Hashimoto’s hypothyroidism, euthyroid sick syndrome, or a pituitary tumor (pituitary micro-adenoma), making otherwise high levels appear normal. Testing also fails to consider that hormone levels can be normal in the blood but low in the tissues that desperately need them—a condition called thyroid hormone resistance. In these scenarios, routine testing is ineffective.

The next problem is interpretation. The reference ranges used for diagnosis differ between laboratories and governing medical bodies that decide guideline recommendations. A patient could actually test positive for low thyroid at one lab, yet normal at another. Worse, the same test result could be interpreted differently by two doctors.