In Thyroid Treatment, Does Size Fit All? Drs. Richard and Karilee Shames Respond
When it comes to thyroid treatment, patients often come up against the idea that "one size fits all." Most commonly, we see this in the attitude some doctors have regarding the TSH test and their faith in the idea that it is the only way to diagnose a thyroid problem. Many of those doctors also believe that if you are hyperthyroid, you must immediately schedule radioactive iodine treatment (RAI), or if you are hypothyroid, you should be taking Synthroid, and only Synthroid, period, end of discussion.But it's not just conventional doctors who tend to get dogmatic and narrow minded like this, however. Now, we're seeing it among patients. A patient finds that a particular option works for him or her, and then extrapolates that experience into some sort of truism for everyone. The next thing you know, you have patients declaring unequivocally that they know the answer: "All thyroid patients need T3," or "everyone who is hypothyroid needs to be on Armour Thyroid" or "all thyroid patients have a candida problem," or "everyone who is hypothyroid should eat kelp or coconut oil" or "all thyroid patients should take iodine, or selenium, or progesterone, etc. etc." It never ends.
I recently asked Drs. Rich and Karilee Shames, noted thyroid practitioners, and authors of the books Thyroid Power, and Fat, Fuzzy and Frazzled, about this tendency for doctors, and now patients, to buy into a particular dogma, and then turn around and insist that it's the answer for everyone else.
MS: What in particular is concerning you about some of the dialogue you're hearing about thyroid disease?
RS/KS: In our 30 years of shared medical practice (that's 60 yrs total!) the biggest mistake we've seen from both practitioners, and now patients, is to assume that if a diagnostic or therapeutic approach is good for some people, then it good for everyone. Despite the popularity of this logic, "one size fits all" medicine is far from optimal care.
MS: Isn't it reasonable for a patient to claim that a particular approach works if there is medical research to back it up?
RS/KS: You have to be careful, because if a treatment approach or procedure has a favorable outcome in one or even several research studies, that doesn't mean that it is the best choice for everyone. In our view, trying to apply the same, cookie-cutter treatment approaches to everyone with a thyroid problem is like suggesting that each person has the same genetic material, the same exposures, the same experiences, or the same potential. And of course, that is clearly not true.
MS: I've always felt that the best thyroid medicine is the one that safely works best for each patient. So I've always argued against the whole "Synthroid is the best medicine for everyone who is low thyroid" idea. And I know many patients who, like me, find that sort of thinking very narrow. Yet, it's not clear to me why some of those same patients feel that an alternative approach that works for them is somehow the answer for everyone. For example, I hear a lot of "Armour is the one best medicine for everyone who is hypothyroid." And that's ridiculous. It works better for some people, absolutely. But to suggest it works for everyone, or is best for everyone, is just wrong.
RS/KS: Exactly. This is the problem. Armour might be better than Synthroid for many people with hypothyroidism, and could be especially helpful for those post thyroidectomy or radiation, but that doesn't mean it is the one and only "best medicine" for anyone who is hypothyroid. The thyroid system is just too complex, physiology is too complex, and people's responses to medications are so individual -- there's no way anyone can say "one size fits all."
In fact, suppose one of our patients asks us, "What is the best medicine for this condition?" We always say that this is NOT the right question, because it leads some people in the wrong direction. A better question is, "Which of all the available, useful therapies might be a good one for me to start with in my situation?"
MS: There's clearly a desire to come up with one "standardized" magic bullet treatment, though, whether for conventional endocrinologists, or on the holistic end, right?
RS/KS: Over the years, we've seen some of our medical colleagues take strong stands for one particular therapy or another. Some say Synthroid is best for everyone, others that everyone should be on the active hormone T3, like in Cytomel. When Dr. Broda Barnes' work became popular, some colleagues felt that everyone should be on Armour thyroid. There are adherents to the T4/T3 combination, and even to particular ratios of T4/T3. Then it was compounded thyroid. Of course, along the way we heard that everyone could improve their thyroid problems with coconut oil. More recently, we have been told that everyone with a thyroid problem should should be on high doses of iodine, to fix not only the thyroid, but also fibrocystic breasts and even thyroid cancer.
But after working with thousands of thyroid patients, it's clear. Some people do best on standard thyroid drugs, others seem to do better with compounded mixtures. Some people are fine on Synthroid, others do best with Armour, or Thyrolar, or Naturethroid, or combinations of various drugs. Some people will thrive on 98% T4, 2% T3, others need a different ratio to feel well. Some people need iodine, others don't. The truth is -- no one treatment approach is a panacea for everyone.
MS: So, what you're saying is presenting a one-size-fits-all solution -- whether it's conventional or holistic, and whether it's coming from practitioners or other patients -- is not really in the best interest of patients?
RS/KS: That's right. The one thing we know is that "absolutes" are not trustworthy. It is unlikely that any one of our present therapies will be viewed in the future as "the one best thing for everyone." We've seen all of the above therapies do well for some people, but not for others. No one therapy is ever likely to be right for everyone.
MS: So, how can patients be sure that they are making smart decisions? They hear one thing from doctors, and another from friends or support groups. Everyone is equally adamant that they know best what the patient should do.
RS/KS: We all have been trying to educate patients that they will frequently encounter doctors who have the very narrow view that TSH tests and Synthroid are the only solution for hypothyroidism diagnosis and treatment. I think the word is getting out, and patients are increasingly knowledgeable, and looking for practitioners who take a less dogmatic view of thyroid disease.
But at the same time, patients need to realize that their friends, relatives, fellow thyroid patients, and thyroid support group leaders and members can be equally dogmatic. While well-meaning, these folks often have strong opinions about what is good for you, and what works and doesn't work and are unafraid to tell you exactly what treatment you must pursue, how to do it, and even going so far as to tell you where to buy prescription drugs abroad so you can bypass doctors completely, and how much of those drugs to take. This sort of approach can lead to serious consequences.
MS: So what do you recommend patients do when they are evaluating recommendations from anyone -- whether it be from a doctor or a fellow patient?
RS/KS: We urge thyroid patients and their practitioners to be interested and open-minded regarding each other's therapies. Any one of them might be the exact best medicine for a particular sufferer, or might not be. And we urge all who suffer from thyroid problems to become more acquainted with the wide variety of available options, and embrace those practitioners/advisors who will further explain those options to you, help you make your own informed choice, and work with you to safely carry out your chosen options.
And in support groups or with fellow thyroid patients, share your stories, but not your dogma. Recognize that what worked for you might be valuable for the next person, or it could lead to harm. Don't tell others what to do, tell them what you did and how it worked for you. Trust them to be the best healer for themselves, knowing all they know about their own lives and story. Let them make their own best decisions, and when they have questions, concerns, fears or challenges, keep an open mind. Don't try to shame others for not thinking as you do, respect each other. The ability to think for ourselves is what makes our world so special, so magnificent, so diverse. Don't try to box others in; instead, help them to expand.
MS: So what you are saying is that whether you're coming from the practitioner or patient perspective, it's still useful to take a "holistic" approach to thyroid disease?
RS/KS: Definitely. When trying to re-balance the delicate, complex thyroid system, it is not the job of the practitioner/advisor to have one favorite therapy, or a pat answer that applies to everyone. Instead, the practitioner/advisor does best by helping patients find out what actually works well in their own unique bodies. Our job is to listen, to love, to care, and to inspire. Working holistically has expanded our medical practice, with the understanding that each person is a unique combination of body, mind and spirit. Each person deserves to be honored and cherished for who she or he is. Finding balance for the challenges of the body is an integral part of each soul's journey. For those reading this today, may your journey be blessed with the support you need to find your own best path to health.
Drs. Richard and Karilee Shames are co-authors of two books on thyroid disease, Thyroid Power and Fat, Fuzzy, Frazzled? Richard Shames, MD graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for more than twenty five years. Karilee Shames, RN, PhD is a Certified Clinical Specialist in Psychiatric Nursing and in Holistic Nursing. Both doctors offer holistic medicine practice and coaching -- with a focus on thyroid, autoimmune and hormonal balance issues.
Photos: Richard and Karilee Shames
Comments
I certainly agree with this article, but I do have a question. What is the likelihood that similar therapies would work for family members? My mom’s doctor has recently agreed to start her on synthroid, but I personally did not feel better until I was on a combination of synthroid and cytomel. Her doctor is unwilling to prescribe it, despite the fact that she is still quite symptomatic. Given the link of thyroid problems within family members, does it follow that treatments would also be similar?
Great article! Now if we can only get the “one size fits all” folks to read it…and practice it!
Excellent and valuable advice. Shows that the cookie cutter approach is not limited to just the medical profession and that we patients need to be realize that one man’s meat can indeed be another man’s poison.
Why wouldn’t the best thyroid replacement therapy be one that most closely approximates what the thyroid gland makes? Which is T4, T3, T2, T1 and calcitonin. Armour and other brands of dessicated thyroid contain all of those hormones, although the T3 percentage is a bit higher than humans make and T4% lower. I could understand a combo of Synthroid/Armour to better balance the T4/T3 ratio for some people, but why would solely Synthroid or levothyroxine ever be superior?
This is an opinion piece. I would like to see some evidence of why Synthroid would be a superior treatment to dessicated thyroid. Most problems tolerating Armour are usually due to poor adrenal function. So help the adrenals, don’t just give an inferior thyroid treatment.
While I couldn’t agree more that it is important to be open to all options and find the one that works the best for you, it also seems quite probable that natural thyroid such as Armour, being as close in composition as possible to what your own thyroid would make if it could: including T4, T3,T2,T1 and Calcitonin, would be more effective for most people than a synthetic which contains only T4.
Natural and synthetic thyroid hormones are not equal to begin with!
Regarding the comments above that Armour should be better, because it contains more of the right ingredients, let me explain. In my 30 years of clinical practice, some of my patients have found it to work well for them, and some have not, even when adrenal function has been normalized first.
Various groups of doctors or patients each have their own favorite therapy. Nobody so far, however, has found any one medicine or mix of medicines that is best for everyone. I have recommended them all, even the compounded pills and the prescription transdermal creams. Every one of them has worked well for some people and not for others. None of the scientists or researchers seem to know why. For now, the state of the art is still a ponderous ‘trial and error.’
hi
i take thyroxine from last 6 months,i feeling much better,about my symtoms,but the doctor told me your thyroid functions test are normal.i stop the medications but symtoms comback again.when i stop it make me worse,my concentrations,blonting in tomy,and no feel energy to go forward.
T4 is good. T4 is good. T4 is good. Just repeating it over and over again doesn’t make it true. Dr. Shames, the list of patient symptoms on T4 meds is absolutely shameful. Hair loss, high cholesterol, bone loss, high blood pressure, depression, fatigue, weight gain, and fibromyalgia just to name a few. I find it sad that so few doctors know what so many patients have found out for themselves.
Nothyroid, you’re not getting Dr. Shames’ point. One size does not fit all. Some patients do fine on T4, some don’t, and need T3. Others do best on natural thyroid. The truth is that we are not all the same, and that we need doctors who want to work with us to find out which approach will work best for us. We don’t need doctors or other patients telling us that only Synthroid or levothyroxine or Armour or (FILL IN BLANK WITH NAME OF YOUR FAVORITE THYROID MEDICATION) is the one that works for everyone!
I think a really important point you’ve made with this article is that it’s not only Drs who can have an opinionated or even dogmatic view of what works, but patients too. Isn’t a major idea of this article to remind us that what works for one may not be the best answer for another, and to not try to force one particular treatment onto others? I thought it was really sensible and clear. I do think it’s also very important in support groups to remember that there are diverse roads and choices to health and wellness.
‘Generally speaking I have no patience for people who generalize’. (lol)
This article was wonderful because it is EXACTLY what I am going through right now. I had a thyroidectomy due to papillary cancer and my doctor has me on synthroid. I still feel awful and she has me breaking 1/2 pills and see how I feel 6 weeks later. She said I am hyperthyroid with a tsh of 0.01. Each time I break the pill I am getting worse. Hair falling out, bone aches, fatigue, and more syptoms. My doctor has now dropped all insurance and given us the option of staying with her and paying cash upfront or going to another doctor. I feel so alone in this situation. This article helped me decide I should find another doctor. I just don’t know what questions to ask them so I know they are open to different treatments. HELP!!
I totally get it. I have no thyroid, so believe me, 20+ years of sub-par existence on T4 meds helped me to get it.
Who ever said one size fits all? Where is this idea coming from? My point is that patient experience, those of us who have been ill on T4 and switched to dessicated thyroid, is important and real.
Why are the real problems associated with T4 only meds being ignored, such as high blood pressure, high cholesterol, hair loss, depression, bone loss, fibromyalgia, fatigue (less stamina), and weight gain? Why do patients on dessicated thyroid show dramatic improvement in these areas once on an optimal dose?
When folks find something awesome that gives them their lives back, they will always want to share that with others. I’m glad someone shared with me, or I would still be laying on my couch today!
A note to Alyssar…. See another Dr IMMEDIATELY!
I am on synthroid with great results for 24 years. I tried levothyroxine when the insurance company suggested it. I jumped 2 doses higher in 6 months and felt like crap. Now that I am back on synthroid, my levels are much more stable. Incidentally, I am allergic to iodine. Some of the things (like Armour or taking iodine) that are suggested on the About Thyroid website concern me since there are a number of people who use the Internet as a self-help site without real data from tests and Dr.guidance. I’ve had friends use homeopathic remedies to treat hypothroidism (self diagnosed or even Dr. diagnosed) and literally make themselves sicker. Seek help from a Dr. you trust.
I am a bit concerned with Hazmar’s comment. Your tests would have become normalish and you feel better because of the meds. If you stop them your symptoms will come back. Did your Dr tell you to stop them? Taking Thyroxine is generally a lifetime thing, not something you stop when you feel better because taking them is what is making you feel better. I think you should see your Dr and start back on them.
What a breath of fresh air this article is!Finally doctors and Mary S’s thyroid site got it and realize what the Chinese have known for years – that each person is unique and needs to be treated on an individual basis! Kudos to Drs. Shames!! After years of being on T4 replacement and developing depression, anxiety, restless legs, periodontal disease, dry hair, mega-irritability, hypersplenism, weight gain and finally hypercholesterolemia despite vigilent exercise program and diet, I had enough! (My husband and I eat the same meals each day and his total cholesterol is less than 100!) My taking one pill exploded into being treated with 6 more for its side effects! And how do I know these are all related to my thyroid replacement? Because I no longer take it and I have none of the sypmtoms mentioned above! Even my periodontal disease improved dramatically within just 3 months! I am sleeping like a baby, have thick shiny hair again, no more dry skin, no more witchy woman attacks, nice clear eyes, energy, etc, etc… Despite seeing top endo docs recommended on About.com thyroid disease, I STILL was treated by my lab values and not by my symptoms… I was falling through the cracks because what worked for some did no work for me! I am really outraged at how medical treatment has evolved in the past 30 years. As outraged as the New Zealanders if not more! We cannot afford economically or physically to continue to go from doc to doc and not be listened to. We are treated like lab rats and when experiencing symptoms, given another pill. It is no wonder people are looking for alternatives! I cringe when I read about advocates for lowering TSH “normal ranges” to 0.3 to 3…normal for who??
Because the more replacement I was given the more symptoms I developed. I realize doctors need diagnostics to let them know what is going on with a patient. But truly the physicians of the past who actually “examined” their patients by looking at them, asking what hurt, what is bothering are gone – in my experience. When I see a physician now they are looking at the computer to read my medical record and lab values, and sending me to the lab. In some ways medicine has not come so far…
.01 isn’t hyperthyroid, necessarily. What are your free T3 and T4 levels? That is what excellent doctors use to see how your thyroid is functioning, since those are THYROID hormone tests. The TSH is a pituitary hormone, so it’s not a good test of thyroid function. Being ‘in range’ doesn’t mean much, either. How are your symptoms? Good doctors will ask that. I drive over an hour to see my good doctor who uses armour, doses by free T3/4 and always says my symptoms are more important than “ink on a piece of paper”.
I was on synthroid/levoxyl for 20+ years on varying doses, put on AD’s for depression, was hypothyriod my entire life, my childhood was miserable with classic hypothyroid symptoms and no one ever got it. It wasn’t until I did some research of my own, on the internet, and found Armour thyroid and finally found relief. Now, I don’t believe in cookie cutter therapy, but I do believe in Armour, and that is with treating my very strained adrenals from years of super stress. Synthetics never did me one bit of good. I know quite a few people like this; people that say they are fine on synthetics, but have high cholesterol, high blood pressure, depression, and other problems, and are put on medications to control these conditions, when all they need is proper thyroid control. One person said it well – doctors no longer use their powers of observation – they put all their eggs in one basket now – TSH. I have fired several doctors until finally finding one that will work with ME. I have lived in this body for 55 years and I think I know a little bit more about it than any doctors. Doctors need to be willing to listen to patients and not dismiss their concerns and be open to treating the whole patient.
T4 is better than natural thyroid for me. Why so many people against T4? They use their own standard to fit others. No, thanks.
Wonderful article!
I would love to read more about this subject and Iodine. I’ve had too many people try to tell me that taking Iodine would fix my thyroid problems but it turned out that my problems were made much, much worse by it.
Iodine is not the answer!
I have been on synthroid for the past 3 or 4 years and do have the high cholesterol, hair loss and fibromyalgia symptoms that the Armour people are talking about. The only problem is I was on the Armour for five years before that and had the same problems. Sorry guys, in me it is a case of having those problems in addition to the thyroid problems and not caused by the synthroid. Unfortunated thyroid problems can be much more compleX than you give them credit for.