Thyroid—Treat the Patient, Not the Lab

• How conventional medicine gets it wrong on thyroid testing and treatment.
• Why conventional medicine gets it wrong

From time to time, individuals who come to Tahoma Clinicwith signs and symptoms of weak thyroid tell me that their physician doesn’t want them to even try thyroid medication “because my thyroid blood test didn’t show a need.” Frequently, these individuals have copies of their thyroid tests with them; the most common reason given is “your TSH is too low.”
Conventional medicine also routinely uses T₄(also called thyroxine) alone as treatment for individuals with weak thyroid function (hypothyroidism), occasionally adding T₃(also called tri-iodothyronine), even though there are more than one or two active substances secreted by a healthy thyroid gland. (More about this topic later.)
In 2010, Denis St. John O’Reilly (Department of Clinical Biochemistry, Royal Infirmary, Glasgow, Scotland) published his review[1] of published articles concerning thyroid hormone replacement.
In this article, he wrote:
“no studies have been published which demonstrate that hypothyroid patients treated with thyroxine are euthyroid [healthy thyroid function] when their serum TSH is within the reference range or, as it is more commonly referred to ‘the normal range’.”
In English: there no studies correlating the TSH measurement—which is the measurement conventional practitioners rely on the most—with normal thyroid function in individuals treated for weak thyroid!
He continues:
The use of serum TSH measurements to assess thyroid status in patients on thyroxine replacement could be considered as a classic example of the misapplication of a laboratory test.
Yes, that’s “a classic example of the misapplication of a laboratory test”!
Dr. O’Reilly continues with an explanation of this statement:
“The first report on measurement of the serum TSH in patients on thyroxine replacement was in 1971 in a study by Cotton et al. from the Mayo Clinic, published in the New England Journal of Medicine
In English: the lab test became normal, but there was no report at all about the patient! Were symptoms and physical signs (“clinical assessment”) improved or not?No report at all!
More from Dr. O’Reilly:
“…This was rapidly followed by a series of high impact publications from virtually all the major figures in the thyroid field confirming this observation. However, none of these publications gave any data as to the clinical status of patients on the lower dose of thyroxine replacement.”
Despite these confirmations of the “normalization” of the TSH test, there were—several times repeated—zero reports on the patients physical signs and symptoms! “Normalize the test, not the person tested!”
He then reports:
“…numerous studies published on euthyroid patients on thyroxine replacement by highly reputable authors…clearly demonstrate that in up to 50% of [euthyroid] subjects, the TSH is suppressed below the normal, or reference range….”
In English: up to 50% of individuals with healthy thyroid function and response (“euthyroid patients”) when tested have a low TSH test—which is interpreted by conventional practitioners to mean they need thyroid treatment, even though they have healthy thyroid function and response (euthyroid)!
He points out why this happens: body tissues are stimulated by free T₃, not free T₄, which delivers its message to the pituitary gland, signaling it whether it should secrete more or less TSH. So how can the TSH indicate whether the rest of the body—which depends on free T₃—is getting adequate stimulation, when TSH is not responsive to free T₃, just to free T₄ ?
So what should physicians do for the best treatment of individuals who need thyroid replacement?Dr. O’Reily writes:
“…TSH is not a good indicator of the adequacy of thyroxine replacement…Prescribe sufficient thyroxine to restore the patient to a clinically euthyroid state, while maintaining the serum T₃ within the reference range.”
Since almost all body tissues depend on free T₃, one should be guided by the free T₃ measurement plus actually paying close attention to whether the body signs of weak thyroid are gone!
Elsewhere in his report, Dr. O’Reilly points to three textbooks of thyroid disease, which all stated that the usual dose of thyroxine needed to help normalize overall thyroid status was 200 to 300 micrograms daily. These textbooks were all published before the TSH alone—with no attention to symptoms or body signs—was anointed the “gold standard” for determining the correct dosage of thyroid for each individual. It’s a classic example of “treat the lab test, not the patient.”
If you think you may have a weak or underperforming thyroid, see a physician skilled and knowledgeable in natural medicine. Such a physician is much more likely to discuss symptoms of weak thyroid with you, as well as checking for body signs of this problem. He or she is also very likely to do laboratory testing too, but as part of overall evaluation, making sure to “treat the patient, not the lab test.”
A physician skilled and knowledgeable in natural medicine is very also likely to add a measurement of “reverse T₃” to other thyroid hormone measured. (See the article “’Reverse T3’ Should Be a Routine Part of Thyroid Testing!”on page X). If thyroid treatment is indicated, he or she is also likely to consider prescribing “whole thyroid,” preferable for most but not all individuals. Whole thyroid (Armour Thyroid was for years the only whole thyroid preparation) contains not just T₄, but also T₃,T₂,and all the other entirely natural hormonal substances made by the both human and animal thyroid glands.
Why does conventional medicine rely so heavily on just the TSH test, no free T₃, no free T₄, rT₃, no  other thyroid test, and allows very little if any time to review physical signs and symptoms. Because—unless your physician refuses payment directly from insurance companies or government agencies—he or she must do only what they will “cover”, (not what his or her judgement says is best for you as an individual) and with all the rules and regulations (see Green Medicine Newsletter for March), there’s almost no time in an appointment to talk to you!
 
 
 
[1] St. John O’Reilly D. Thyroid Hormone replacement: an iatrogenic problem. Int J ClinPract, June 2010;64(7):991-994.