Health

Jacob Teitelbaum, MD Says: "All Study Shows is That Poor Treatment Appoach Gets Poor Result"

By Mary Shomon, About.com GuideOctober 23, 2003

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Chronic Fatigue, fibromyalgia and metabolism expert Jacob Teitelbaum, MD has these insights about the T4/T3 studies: All the study shows is that if you treat people poorly with any treatment, you'll get a poor result...

It was interesting that in their study over half the patients were dissatisfied with their thyroid therapy. This likely occurred because instead of adjusting the thyroid therapy dose to what feels best, the doctors often used a "one size fits all" approach.

Much of this tendency to ineffectively treat patients comes from the misconception and confusion in modern medicine about the difference between OPTIMAL INDIVIDUALIZED dosing and the "normal range." The normal range that we use in medicine is simply a statistical device that reflects that one is not in the highest or lowest 2.5 percent of the population. This is like saying that the normal range for shoe Sizes -- i.e., the range that 95 percent of the population falls into -- fall between a size 3 and 13. In medicine, we are trained to believe that as long as a person is given a "shoe size" that falls into that normal range, all is well. In other words, using the approach that they take goes like this...

When a person's thyroid fails, they get just enough thyroid to put their blood tests in the "normal range." To use an analogy that most people understand in day-to-day life, it would be as if I lost my shoes. I would go to the doctor and he would give me a size 4 shoe as this would be in the normal range. Unfortunately I wear a size 11 1/2. This makes no difference medically as the doctor does nothing to see what that individual's optimal size would be.^* What our research and clinical experience has been finding over the last 20+ years is that the thyroid dose needs to be adjusted to what FEELS best to the patient (but now, like trying on shoes, we just pick any shoe in the store and say live with it) while keeping the thyroid level in the normal range for safety. This study simply picked two pairs of shoes instead of one from the store--and they're still surprised that neither fits. In fact, this was not a surprise. What is interesting is that they left the T3 group on a dose that left them overtly hypothyroid (TSH3) by current definitions-and they still felt as good on the mixed T3/T4 treatment as the T4 treatment group felt being kept in the "normal range." What is needed is a study that tests the approach that clinicians experienced in using the mixed T3/T4 therapy finds works best (Armour Thyroid).

Sadly, it seems the researchers did not consult with physicians experienced in the use of this approach. They would have noted: 1-Use an ~ 4:1 ratio of T4 to T3( not 10:1) 2-adjust the dose to that which feels best to the patient, while keeping the Free T4 level in the normal range 3-If one type of thyroid does not work adequately, try another (their study posits that only one "brand" of shoe is best for everyone instead of asking the key question - "Did one form work best for some patients and the other type for others?") 4-Do some patients benefit from split Dosing (eg, twice a day) while some do fine with once a day? 5- Are there other components of the natural thyroid that also result in a better outcome 6-For those who still respond poorly, what other problems are being missed?

*Mistakenly, doctors are taught that the TSH test does this. Over the last fifteen years, experience has shown that our interpretation of this test has resulted in the vast majority of hypothyroid patients being undertreated or not treated at all. As an example, the normal range was once again changed last autumn, reflecting that our interpretation of this test had resulted in another 13 million Americans not getting the thyroid treatment they needed. And this is just the ''tip of the iceberg."

For more information about Dr. Jacob Teitelbaum, see his website.