1. Health
You can opt-out at any time. Please refer to our privacy policy for contact information.

Discuss in my forum

Mary Shomon

NBC's Today Show Tackles Thyroid Awareness and Controversies Over TSH Testing: Kent Holtorf, MD Comments

By January 28, 2010

Follow me on:

NBC's Today Show had an interesting segment this morning focusing on thyroid awareness. (You can view the segment online now.) The segment aired on Thursday Jan. 28, 2010, around 9:20 a.m. EST. The story featured California nurse practitioner (NP) Eola Force, who while caring for her own patients, was herself struggling with depression, fatigue, brain fog, and weight gain -- at one point she reached 400 pounds according to the story. Eola said that as a health practitioner, she recognized what were the classic symptoms of an underactive thyroid -- hypothyroidism.

Eola had what the NBC reporter called "the most common blood test to detect thyroid disease, called a TSH," and her TSH apparently came back as normal. Eola said that doctors told her: "It's just because you're fat. You're fat, you're fat, you're fat and you're menopausal, and you're female...and you're fat!"

California thyroid expert Dr. Kent Holtorf -- who we've interviewed here at the About.com Thyroid site a number of times -- was interviewed for the story, and said that the problem is that the TSH test "only catches about 20% of thyroid disorders." Dr. Holtorf said that he worries that "doctors aren't spending the time to do other tests that could catch what the TSH misses."

According to the reporter, "endocrinologists agree that thyroid disorders can be missed, but badmouthing the gold standard for thyroid screening is a controversial idea."

The segment then featured University of Southern California endocrinologist Peter Singer, MD, who said: "We in the endocrinology field feel that we have very sensitive tests in order to be able to diagnose thyroid problems."

Even though Eola's TSH test showed "nothing wrong," according to the reporter, Dr. Holtorf said other tests showed there was a problem, and decided to treat her, which she says worked. Eola told Today: "Within two weeks I was going, 'I'm on the right path!'"

The reporter said: "Some doctors accuse Holtorf of practicing fringe medicine, and say any success is largely due to more of a placebo effect than anything else, but if it makes people feel healthier, so be it."

Dr. Singer then added: "For what he's doing I don't think there's a real scientific basis for it. What he's doing is laying on hands, and people are getting better. Nothing wrong with that."

Today Show co-host Ann Curry closed with the caveat that "Endocrinologists we spoke with for this story say Dr. Holtorf's thyroid treatments are controversial..."

What Did Today Miss?

There were two critical points that the Today Show missed. Let's take a look.

1. First, TSH may be considered the "gold standard" test for thyroid problems, but even endocrinologists DO NOT AGREE as to what is considered a normal result for that test, and haven't for 7 years! The old range of .5 to 5.0 is considered obsolete by some endocrinologists, who use the new range of .3 to 3.0 as the reference range for "normal" TSH. But many patients fall into the limbo between 3.0 and 5.0, where some doctors will treat, and others dismiss the possibility of thyroid disease. A TSH result of 4.5, for example, would be evaluated by some endocrinologists as normal, and by others as hypothyroidism warranting treatment.

The "war" among experts over the TSH range has actually been going on since late 2002 -- you can read about it in this article. In an interview "The TSH Normal Range: Why is There Still Controversy?," one of the nation's leading endocrinologists, Dr. Jeffrey Garber, said: "The TSH normal range should not be a polarizing issue. But as often seen in medicine, it's easier to agree on the extremes...Values between 2.5 and 4 are more likely to reflect early disease. Though intervention is not necessarily called for, it may be called for on an individual basis."

The fact is, you can't have a "gold standard" test if the supposed experts in the field can't even agree on how to interpret the results of that so-called "gold standard" test!

2. Second, even some ultra-conventional endocrinologists will test thyroid antibodies, and treat patients who have "normal" TSH levels but elevated antibodies, which is evidence of Hashimoto's disease. There is peer-reviewed, journal-published evidence -- also known as "a scientific basis" -- that shows that treating Hashimoto's disease in people with "normal" TSH levels may prevent progression to overt hypothyroidism, and help relieve symptoms. (See Treating Antibodies to Prevent Thyroid Disease, and Treatment Can Help Those Who Test Positive for Thyroid Antibodies.) Treating Hashimoto's patients with normal TSH levels is is not "fringe medicine" or "placebo." It's good medicine.

A thorough thyroid evaluation should include not only TSH tests, but antibodies tests, other thyroid blood tests, imaging tests when called for, plus a clinical exam, an evaluation of symptoms, and consideration of the patient's personal and family medical history. One TSH test does NOT constitute good thyroid care, as Eola Force -- and millions of other undiagnosed thyroid patients -- quickly discover. (Learn about all the specific components of a comprehensive thyroid examination and evaluation here.)

The fact is, quality thyroid care means more than a TSH test, and there IS a scientific basis for what Dr. Holtorf is doing. It's LESS scientific -- and frankly, just plain bad medicine -- to rely solely on the TSH test.

>> Find out what Dr. Holtorf has to say about the Today piece and the "hilarious" Dr. Singer...

The Hilarious Dr. Singer

It's hard to know if Dr. Peter Singer was being serious, or whether he thought he was making a joke when he referred to what Dr. Holtorf is doing as "laying on hands." Singer is known to make humorless jokes at the expense of thyroid patients. For example, in a national interview, Singer described the symptoms of hyperthyroidism as like being in love." But to me, his comments to Today certainly seemed patronizing and a lame attempt to discredit Kent Holtorf's approach to thyroid treatment, and present it as unscientific.

What does Kent Holtorf, MD Think?

I touched base with Dr. Holtorf this afternoon, and he had this comment:

"There is always controversy when a large body of endocrinologists have not bothered to review the literature and understand thyroid physiology. It is concerning when they fail to understand expected benefits based on hundreds of peer-reviewed studies, and attribute them instead to the 'laying on of hands.'"
My Thoughts

Despite their including the absurd and pointless comments by Dr. Singer, I considered the Today Show piece an example of great progress for thyroid patients. A few years ago, Today would never have even interviewed an integrative, cutting-edge practitioner like Dr. Holtorf. Instead, they'd have featured a conventional thyroid "insider" like Singer, telling us yet again how incredibly easy it is to diagnose thyroid problems, and how amazingly easy it is to treat thyroid disease, and how anyone who is still gaining weight, depressed and exhausted on standard protocol of annual TSH tests and synthetic thyroid medication MUST be suffering from mental health problems, because it's certainly NOT their thyroid! Today's willingness to feature Dr. Holtorf, and point out the controversy over the TSH test, was a major advancement for thyroid patients!

What Do Patients Say?

Some of the thyroid patients who visit Facebook viewed the segment and shared their comments with me.

Gail Berreitter says: "I am so tired of hearing about the 'gold standard' in testing for thyroid conditions. That endocrinologist thinks Dr. Holtrof's treatment is controversial? That's because they can't believe that something else can work and help. Give me a break. Every 'body' is so different and reacts so differently to problems with thyroid and hormones. And to hear the he feels it's just a placebo effect makes my blood boil. And don't even get me started on what 'normal' is in the TSH test. Gold standard my eye!"

Rudika Hall says: "Dr. Singer is the type of doctor that has me STILL searching for an UNconventional endocrinologist, that will LISTEN to me, take my SYMPTOMS into consideration, and find the best treatment that will get me results. Whether it be a standard or non-textbook solution. I do not understand why so many of these doctors are unwilling to think outside of the box. Here we are begging them to fix us, and they turn the other cheek. Hooray for doctors like Dr. Holtorf for trying to seek another path for us."

Liz O'Hara says "TSH testing alone caused me to go undiagnosed for twp years. I was told that I had either postpartum depression or alternatively that I was a stressed out mom. They then blamed my menstrual problems on the fact that I was overweight. Ultimately it was one doctor who took note of how big my thyroid was getting and started more testing and I feel 100% better. The only reason why I even saw that doctor was because I moved. If I hadn't moved, I probably would still be suffering 5 years later."

Christine Shull says: "I don't think the 'placebo' effect will last for months or even years - if you feel better and can finally live your life again, that is no placebo!"

What do you think? Share your thoughts in the comments section!

About Mary Shomon | Thyroid Forum | Twitter | Facebook

Image: NBC Today Show / screen capture

January 28, 2010 at 5:09 pm
(1) Lauren says:

My question is related to the medicine. If consistency is key to getting well. Why can’t a patch be developed? It would give most of us major relief and help those of us who suffer from chronic forgetfulness.

January 28, 2010 at 5:10 pm
(2) Johann Mitchell says:

Most doctors don’t seem to know that the trials that were done on their “gold standard” TSH test showed that about a third of the people taking it got results that had no correlation to thyroid function!

In one of the trials, half the people taking it got results that had no relationship to their thyroid function!

I may be an accurate way to measure TSH, but it is not an accurate way to measure thyroid function!

Personally, my TSH goes along at one level for a few years, then changes to another level. Wash, rinse and repeat. And while all this is going on, my thyroid function doesn’t change!

It’s really novel to have my doctor insisting that I need more medicine when it goes up, though! Usually, they tell me I don’t need medicine when I do.

January 28, 2010 at 5:29 pm
(3) JS Baker says:

At the end of the segment it was suggested that if those symptoms presented to tell your GP. I fought with my GP for 10 years over what I knew was an endocrine issue although not exactly what was wrong. At the age of 40 after a nasty bout with the flu, then a lung infection, I gained 40 lbs in one year, then again the next. I had significant hair loss, my eyebrows got very thin and I no longer had to shave “gorilla” legs and I had to wash my hair every day as it got “greasy” within 12 hours. Because my TSH levels were “normal” my GP started out by telling me I was peri-menopausal and then after I gained nearly 100 lbs that I was too fat. Then she told me I had Fibromyalgia – the first thing my Fibro doctor did was run a series of tests and LISTEN to my symptoms and put me on thyroid medication. Straight natural T3 that allowed me to eat normal rations without gaining weight and to actually lose weight with intelligent dieting. It also gave me more energy and most significantly my hair (eyebrows included) got thicker and I had to start shaving again. I can actually skip a day washing my hair if I need to.

The fact is that in the US too few of our medical professionals recognize results-based medicine and write it off as a “placebo affect”, “junk science” or “laying on of hands” – get with it guys. My symptoms were not just “feeling” poorly and fatigue – there were physical symptoms that could not be treated with a placebo. But my TSH results have never been “abnormal”. Further when I stopped the T3 due to financial difficulties all my symptoms came back – including the obvious physical ones. The clincher is – I dropped health insurance because it would not pay for my Fibro doctor or most of the tests he wanted to run – in other words for me to get healthy.

January 28, 2010 at 6:08 pm
(4) Denise says:

Frankly, I don’t think TSH should be used it all. It tells NOTHING of what is going on at a cellular level, which is what matters. It only tells what is in the blood. I had that same problem as the nurse. With a big goiter, I was told I didn’t have it because my TSH was fine…even though my T3 and T4 were so low they were far below range. JS Baker, I can relate!

January 28, 2010 at 6:12 pm
(5) Denise says:

Mary, your link isn’t working. It takes you back to this main page instead of to Dr. Holtorf’s views:

>> Find out what Dr. Holtorf has to say about the Today piece and the “hilarious” Dr. Singer…

Takes you back here and not to new or different info.

January 28, 2010 at 6:53 pm
(6) Melissa says:

Thank you so much for this article and your follow up.

From my own experience I have had my former GP tell me that my TSH was 4.5, she said that I was “low but normal”. She prescribed SSRIs despite my tangible, physical symptoms which she glossed over including a swollen thyroid. Mistakenly, I took the Zoloft for over 6 months, because being inexperienced, I thought the doctor must know best, and I wanted to do anything and everything I could to feel like myself again.
This experience, which only helped to throw my body more out of balance. It resolved none of my physical symptoms, or fatigue, in fact it made it all worse. More naps, more weight gain, and worst of all, isolation because I was no longer behaving like me. On this medication I was a numb, cold person, devoid of feeling or complex thought.
This experience and dismissal of how I, the patient felt, has colored my view of traditional, allopathic medicine and many of its practitioners. It makes me more interested in educating myself about this disease and ways to healthfully self-treat my condition with nutrition, supplements and exercise with help of open minded, nurturing health professionals (they are hard to find, but they are out there).

I wonder how many thousands, if not millions of women out there currently are struggling with fatigue, weight gain, joint pain, limb swelling, low body temperature, low blood pressure and the myriad of other “hallmark symptoms” who have succumbed to SSRI treatment out of a trust of their doctor to know best, would have better results if a doctor just took the time to run a few extra tests to see exactly where their hormone levels lie and helped them achieve their own personal balance.

The more of us there are, the harder we are to ignore!

January 28, 2010 at 7:17 pm
(7) Sue says:

Gee it must be nice to be Dr. Singer…and not have thyroid problems or have anyone around him with such problems. Wouldn’t we all like to have that life? Since he does not have such problems and therefore does not understand “true” thyroid conditions, I am sure anyone with normal TSH results that has to take thyroid medicine would be more than willing to spend two months with him. The first month with medication, then the second month without medication. Then maybe, just maybe he might come to realize that having a thyroid condition is in fact not at all “like being in love”. Unless his idea of being in love is being a freaked out miserable mess. Nope, I suspect that after spending a month with someone that is without their medicine, even though he says based on their TSH, they don’t need it, that he would not be singing.

January 28, 2010 at 9:04 pm
(8) gina says:

Too bad the piece ends with a recommendation to see a “thyroid specialist”!

January 28, 2010 at 11:05 pm
(9) lane says:

What little I’ve had a chance to read about tells me that this can be a complicated journey in the medical world. what options are out there? Just had blood work on 1/15/2010 that showed a TSH ref. range of .3 – 5.0 and my result showed it at 173.0 and I don’t quite understand whats going on. Doc said I needed to start meds right away ( 100 mcg generic Levothyroxine) and follow up w/ GP in 6 – 8 weeks and sent on my way. Been on meds for 9 days now and still no change – just a lot of unanswered questions.

January 29, 2010 at 12:37 am
(10) Flo says:

The TSH is certainly not timely and therefore is a bad “gold” standard. It wasn’t until my TSH was higher than the old reference range, that my antibody levels were tested and then an ultrasound of my thyroid done. The antibody test and the ultrasound were done within 30 days of my high TSH results. My antibody levels were many times greater than the high end of normal and there were 4 cm nodules on my thyroid. This didn’t happen in one month. My antibody levels had to have been elevated for a couple of years in order to develop 4 cm nodules on my thyroid.
I also agree with Denise’s comment above about TSH not reflecting the cellular level. While on levothyroxine my TSH was very good but I felt worse than when taking nothing. While the T4 was in my blood, my cells were starved of T3.

January 29, 2010 at 3:47 am
(11) redplanet says:

Singer is why I do not support health care reform if it means giving more people access to the medicine he practices. He’s trained and brainwashed by the drug companies as are most doctors. Real health care reform starts with getting rid of the Singers – no matter what it takes. If it means reporting him to the state med board, do it. Eventually it will make a difference. Putting up with ignorance is just more ignorance.

I have no health insurance, no M.D. and because I treated myself, no more thyroid problems. No one cares about my body like I do. People like Mary and her site and many others make us all able to take care of ourselves.

January 29, 2010 at 6:09 am
(12) Julie says:

I have been on thyoroid medicine Synthyroid, Levoxyl and Armour)for 16 years due to thyroid cancer. I finally got a GP to prescribe Armour last year becuase of reading how good some patients do on it, I felt wonderful while on both Levoxyl and Armour, then Armour disappears! I am now trying to convince a different GP (insurance changed) to give me at least Cytomel (their worry was that Armour wasn’t “regulated”) they actually took a blood test to check on both t3 and t4, I think patients need to keep talking and talking until someone listens. Trying to get into an endocrinologist in this town can take 6-8 months, I’ve gone 6 weeks on no thyroid meds to have the body scans done (years ago) and it is gross. Waiting that long to see a “doctor” is rediculous. I print all the articles I can (many from this site) and present them to my new GP, she is younger and I think wants to be on “the cutting edge”. It’s sad that after all those years in medical school that I am “teaching” them about thyroid issues. I was once told by a NP that “everyone’s body converts t4 to t3″ and then read that week that as much as 65% of people don’t convert properly……………do you think, as a person with NO thyroid that I may not be converting well?????? I wonder if, in my lifetime, will these doctors ever agree and actually LOOK at and listen to their patients instead of some “gold standard” test numbers? I also had a gynecologist tell me (after 3 months of periods that would last 3 weeks) that I should have a D&C, he was appallled that as a 31 year old that I had never had one. I begged the endo to change my thyroid meds and I’ve had normal, regular periods since (I am 46 now) You have to KNOW your body and pseak up for it.

January 29, 2010 at 6:21 am
(13) Julie says:

LOL Sue!!! Don’t they wonder when we come in and you can see our scalp through our thinning hair “hmmmm, I wonder why this 35 year old has such thin hair??” or “why does it look as though this woman needs sleep? it is only 9am, why does she look like she’s been on the red-eye from Singapore???”

January 29, 2010 at 7:21 am
(14) dlm says:

In Canada, the standard care is ONLY THE TSH.

January 29, 2010 at 7:47 am
(15) Denis White says:

I feel so sorry for Lane who says her TSH levels were 173! This is practically unheard of and warrants urgent further investigation from a proper specialist. For a start no Doc should ever start a patient on 100mcg thyroxine immediately ( a starting level this high can put a strain on the heart). Usually 25mcg is the norm and then building up by 25mcg increments until the optimum level is acheived. Apart from that a level as high as Lane’s means numerous other blood tests are needed such as T4, T3, thyroid anti-bodies, and a simple 24 hour saliva test for her adrenals. She may benefit as many people do from a natural form of thyroxine (like armour or equivalent) which would give her much quicker relief as it contains T3 in the correct proportion. T3 is the active form of thyroxine and reaches the blood stream within hours, whereas synthetic thyroxine takes several weeks! This is maybe one of the reasons why she hasn’t felt any better yet. As a final comment to lane I would say “knowledge is power” and it pays big dividends to learn as much about your condition as possible. There is plenty of info on the web and Mary Shomon is a good starting place.

January 29, 2010 at 8:20 am
(16) Jan Masleid R.N. says:

Great article, Mary. As a nurse and as a patient it was quite interesting to observe the attitudes and knowledge displayed on the well done news segment with Dr. Holtorf. How wonderful for our country to have a brilliant and successful physician share his hard won methodology for excellent patient care! I know many fine internal medicine docs as well as primary care physicians who will embrace good peer reviewed science as basis for thyroid treatment. How exciting to think that our medical schools will once again be leading the way in world influence- as we simply cannot afford to be held back by formerly acceptable, now frequently ineffective methods of care.
All physicians need to realize that they must remain strong leaders who must demonstrate that they understand that the time for change has come and it will be the most rewarding experience of their careers! Great work must be done…there are Far too many hypothyroid sufferers waiting.
Thankyou, Janet M. Masleid R.N.

January 29, 2010 at 8:42 am
(17) Stephen says:

I consider the “gold standard” test as a bogus test… If my memory serves me correctly, Dr. Broda Barnes stated that the “gold standard” test only measures the amount of TSH, and that test we need is a test to measure the amount of thyroid hormone in individual cells of our body. This type of test would get to the heart of the issue —-> How much thyroid hormone is being used at the cellular level by each individual’s body, which is unique. The doctor I was blessed to meet, who understood and accepted Dr. Broda Barnes’ 50 years of thyroid research, and put me on armour, used this approach to the “gold standard” thyroid test….. The TSH test was NOT used to diagnose hypothyroidism – instead symptoms were. AFTER the patient told him, the doctor, that their hypothyroid symptoms were gone with a specific dose of armour / naturethroid, THEN he would take a TSH test. He then considered this as the normal level of unused TSH floating in the bloodstream as normal for the patient. I suspect the reason medical schools have latched onto the “NON-gold standard” thyroid blood test is that it allows a doctor to spend very little time diagnosing a medical condition = less time = more money earned.

January 29, 2010 at 8:47 am
(18) Stephen says:

Correction shown at ->>>…

I consider the “gold standard” test as a bogus test… If my memory serves me correctly, Dr. Broda Barnes stated that the “gold standard” test only measures the amount of TSH –>>> in the blood stream, not what the cells in the body are using <<<–, and that test we need is a test to measure the amount of thyroid hormone in individual cells of our body.

January 29, 2010 at 8:56 am
(19) ibivi says:

I started developing signs of menopause at about age 47. When I told my doctor that I thought I was menopausal she said I couldn’t be as I was too young. She wouldn’t treat my symptoms until my periods stopped despite the discomfort I was in. By that time I had almost all the sypmtoms and I was gaining weight. I had also stopped smoking and was eating more as my apetite suddenly kicked in. I was never interested in food and ate little. I had never weighed more than 130 lbs in my life. I put on 20-30 lbs within a year. I was also on anti-depressants because I became depressed about 1 1/2 yr after I had a heart attack. Heart medications also slowed me down to reduce the strain on my heart. She finally put me on HRT (but very little estrogen because of the heart attack). My menopausal symptoms abated somewhat but I continued to have other symptoms which she attributed to depressiion. About a year later she told me that my thyroid was failing as shown by increased levels of TSH and decreased thyroid levels. She said that I probably had hypothyroidism for the past year or 2 at sub-clinical levels. She then put me on Levoxin at a small dose again because of my cardiac history. I continued to gain weight and could not get rid of my belly fat. My hypothyroid symptoms did not really get better and my depression worsened. About 6 months later she changed my medication to Synthroid at about double the previous dosage. My clinical levels of TSH, T3 and T4 stabilized but I continued to have symptoms. When I asked to see an endocrinologist she said that the specialist wouldn’t see me because my thyroid levels were normal. My hypothyroidism is still quite bothersome and has a daily impact on my ability to function. I am always tired. I have sleep difficulties and sleep apnea. I am always hot or cold. My feet are always freezing. I have developed osteoarthritis in my joints. I have muscle aches and pains. I have always had hyperhydrosis (excessive sweating) but my anti-depressant makes it much worse. My blood pressure is high. My cholesterol levels are high. I have developed blood sugar issues. I have tested as type 2 diabetic but am back to being glucose intolerant through changes in diet. As soon as we switch from daylight savings time I develop SAD and regain the weight I lose in the summer. I have multiple chemical and environmental sensitivities. I am very sensitive to noise. My allergies are getting worse. I am also becoming allergic to latex. I can’t wear wool anymore. My exczyma has come back after years of not having it. I constantly have colds. I have at least two bladder infections every year. I have muscle and joint pain every day. Some days it so bad I can’t do anything. Because of my weight my knees and feet hurt whenever I walk. Almost every year I develop some new medical condition. My depression is chronic. And so it goes.

January 29, 2010 at 9:29 am
(20) Denis says:

Just to clarify to some patients what TSH means and what it does because there is much confusion about this point. – TSH means ‘Thyroid Stimulating Hormone.’ It is not actually produced by the thyroid gland at all. It is produced by the pituitary gland. It monitors the thyroid and only reaches elevated proportions if inadequate thyroxine is produced by the thyroid. Hence in itself it is a pretty useless indicator of thyroid disfunction and must only be used in tandem with other tests. TSH is not a gold standard test at all, rather it could be classed as a ” wooden standard .” A true gold standard test could only be awarded after a careful clinical assessment, a basal temperature measurement over 4 days and comprehensive TSH, FT4, FT3 and preferably adrenal stress index test as well. A lot of bother one may think but we are talking about your health here and you must not compromise on that even though most doctors will.

January 29, 2010 at 10:03 am
(21) Bonnie Rincon says:

I started having problems in the 1990′s. I have a family history of thyroid disease. My TSH always came back normal. They told me I did not exercise enough (even though I walked 5 miles every day and watched what I ate). Kept gaining weight. We moved to Spain and the military drs there said the same thing. We moved back to the states in 2003. I was diagnosed with diabetes (did not have it). Finally I ended up in the emergency room in 2007 my TSH was over 10.5. I had a uptake scan. Found out I had a cold nodule. Had a biopsy done. Could not determine if I had cancer or not. Had half my thyroid taken out. It was sent to Walter Reed in DC. That is when I was diagnosed with Hashimoto’s disease. I am not being treated for my disease. My Mom, after finding out about my disease, asked he dr if she had Hashimoto’s. She has been on synthroid for 20 plus years. Guess what, she has it. If I had known she had it maybe I would have been diagnosed sooner.

January 29, 2010 at 10:11 am
(22) Ann Hansen says:

I had one of the so called “best in town” endocrinologists. He went strictly by blood tests and ignored my symptoms. After years of being in a mental fog, gaining weight, feeling depressed, forgetful, etc. I found a G.P. that was fairly progressive, let me go on Armour. For a few months I felt great. Unfortunately, he has now moved across the country. Now I have another doctor monitor my thyroid meds. We are still trying to get it adjusted right. I can tell when it is right because I can remember things, I can sleep, I have energy….but the blood test will show my thyroid levels are too high. But that is my “normal”. I wish doctors understood that.

January 29, 2010 at 10:50 am
(23) dlm says:

My history is very similar to yours and my medical care has been as poor.
Tonsils removed age 15 after tonsilitis once.

Constant migraines since 20 (aspirin/codeine causing ulcer/rebound addiction)

Quitting smoking age 40 (may exacerbate thyroid)

Hypoglycemia (both Candida and Hypoglycemia were seen as ‘fad diseases’ patients make up)

Menopause leading up to age 50, many symptoms including hot flashes, weight gain of 35 lbs after always being slim under 120 lbs, etc

Systemic Candida (constant gutaches, etc) from much penicillin and being a junkfood junkie: alternative doctor prescribed antifungal and Caveman Diet which lost the weight amazingly well. Much much dental work, constant decay/root canals etc.

Severe depression: SSRIs for a decade, none of great help

High cholesterol: Lipitor did not help. Osteoporosis: Fosomax was a monster.

Although I was told Hypoglycemia was an entirely separate disease, after an uncle’s surgery for type II,

Diagnosed type II diabetic at 55: Luckily found and followed Dr. Richard Bernstein’s Diabetic Solution low-carb which controls blood sugar and weight. Also follow Atkins, Eades’ Protein Power, etc.

Migraines made it impossible to take hormone replacement, even bioidentical.

BECAME INCAPACITATED WITH CHILLS IN 2000. After being ignored for several years by several doctors (TSH=1=normal) an integrative doctor prescribed natural thyroid replacement which helps about 80%.

Still constantly exhausted (Chronic Fatigue Immune Dysfunction), arthritis hands and feet, many aches/pains, frequent anemia, poor digestion – few foods or drugs or supplements, poor sleep, multiple chemical/environmental sensitivities, extremely noise sensitive, many allergies, hives. No wonder we are exhausted and depressed, more and more all the time.

“From Fatigued to Fantastic” by Dr Jacob Teitelbaum explains some of this.

I’ve found a private doctor who is prescribing very small amounts of bioidentical estrogen, progesterone, DHEA (to try to sneak past my migraines) as well as increased amounts of natural thyroid hormone. Fingers crossed as well as they can with arthritis disfigurement.

January 29, 2010 at 10:53 am
(24) Kathleen says:

One thing I’m noticing here is about 99% of the comments are from women and about how their concerns are NOT being addressed. We need to sue to educational system for instructing physicians during their training that women only suffer from anxiety and typically don’t have any real illness at all – yes, that is in their training.
Next, we need to sue the health care of North America for NOT addressing primarily an issue that has plagued women. We need to get the issue addressed. We can complain and state our stories all we want but unless we hit them in the pocketbooks and make them stand up and listen and CHANGE!, in 50 years we will still be at this point. We also need to demand that the endocrine disrupting hormones in our food supply and water be removed – plane and simple. And they can start with Fluoride which takes the place of iodine on the exchange site in our bodies.
I gave up trying to get endo’s and regular GP’s in the Canadian health care system to address my adrenal issues including thyroid and I doctor myself as much as I can, eat healthy, force myself to exercise, get rid of the foods that my body is allergic to (which is just about everything), etc. Its all I can do for the time until the system is changed.

January 29, 2010 at 11:04 am
(25) Shelly says:

After many years of suffering from hypothyroid symptoms and only having TSH checked by my doctor.
I finally was sent to a neurologist for MRI on brain looking for multiple sclerosis. After I insisted an MRI to be done on my neck, a small nodule was found on my thyroid. It turned out to be cancer, and my thyroid was removed. Had the proper thyroid test’s been checked I and my family would not have sufferd emotionally and financially for over 10 years to get the proper diagnosis.

January 29, 2010 at 11:11 am
(26) Patricia Barriball says:

Denis is correct — TSH is produced by the pituitary, NOT the thyroid. And if your pituitary is faulty, the feedback system will be too. With that said, TSH would still not be an accurate test for thyroid function. The former test -TRH, thyroid releasing hormone, used be used and does measure thyroid output, but some dimwit like Dr. Singer came along and spun straw into “gold” when they replaced the TRH test with the TSH. My blood is boiling from Dr. Singer’s comments. It is doctors like him who keep so many of us sick and leading poor quality lives. And just for the record, Dr. Singer, blood-letting used to be the scientific gold-standard as well.

January 29, 2010 at 11:44 am
(27) Nancy, Ph.D. says:

As a professional and also a suffering thyroid patient, I am continuously shocked at the closed minded attitude of endocrinologists like Dr. Singer. There are way too many examples of patients whose symptoms have been relieved with thyroid hormone therapy even though their TSH did not indicate hypothyroidism. His comments about the “placebo” effect and “laying on hands” were an insult to all those suffering from mis-diagnosis and inadequate treatment of hypothyroidism. Thank you Mary and thank you Dr. Holtorf.

January 29, 2010 at 11:53 am
(28) Layne says:

Like many people, I had classic symptoms and the TSH my GP ran was “normal” and I got a pat on the head and was sent home. My fatigue in particular continued to worsen to where I barely made it out of bed. Finally I went to a local imaging center just to see if they might find something odd that was contributing. Everything was fine….with the exception of an enlarged thyroid. They sent me to my doctor to evalaute. Oddly, now the test the GP ran came back showing hypothyroid.

Unfortunately, I was one of those people that got little relief from thyroid replacement. With much research, I found Dr. Holtorf. His office ran a battery of tests and found that I also had fibromyalgia and chronic fatigue syndrome. Adding the new supplements made a significant difference over several months. I am now back at work, not taking ANY naps (had gone up to 3 naps a day!). Energy, brain fog are all so much better. The weight is the last thing for me to work on. Had hoped it would magically disappear as the fatigue did. But now at least I have the energy to start working out!


January 29, 2010 at 12:38 pm
(29) Linda says:

I am so confused. I am going on 71 years old and took 50 mcg thyriod for years but the doctor I go to now increased it over the last few years to 112 mcg. thyroid a day but am hot most of the time. So I tried Bio-identical hormones and now am trying the Women to Women natural vit. How do I know if it is thyroid or hormones that is making me soooo hot all the time? Sometimes I think about stopping my thyroid just to see if I get cold. If you are low thyroid aren’t you supposed to be cold? HELP

January 29, 2010 at 12:43 pm
(30) Carolyn Collen-DuBose says:

I have had experiences and symptoms and frustrations just like all of the people above whose comments I just read. What bothers me the most is the attitudes of the “traditional” doctors. I was also treated in a patronizing manner by an endocrinologist. It’s like they are defensive of the thyroid for fear that women will blame the thyroid for all of their ills: especially weight gain. It’s easier to label them as women’s health issues. It’s rather sexist, I think.
So, my question is: what do endocrinologists study for 6-8 years? Shouldn’t we be going back to the medical schools to see what the curricula contain as far as diagnosis and treatments are concerned?

January 29, 2010 at 1:22 pm
(31) Tara says:

I am shocked that Dr.Singer would make jokes about a condition that can be so debilitating if not properly treated. An underactive thyroid can lead to so many other problems if not treated, for example the weight gain can eventually pre dispose someone to type 2 diabetes. I just don’t understand why so many physician’s take this condition so lightly. I’ve been having symptoms for 11 yrs. now, it took 5 yrs. before anyone finally checked it and then they were just treating numbers (my labs) not me. I still suffered, and found out just this last year that it’s related to hashimotos disease. I got referred to an endocrinologist, and he still could care less, he was just anxious to diagnose with pre-diabetes and start me on glucophage! I wish he would look at what the underlying problem is and help me get it better treated so I could start feeling better and have more energy, maybe then I could lose some weight-hmmmm…. Point is, I haven’t felt “good” in 11 yrs.

January 29, 2010 at 1:30 pm
(32) sal says:

Its shocking we have to fight for our health with the doctors in 21st century. Science is a little overrated here when they turn a deaf ear to our symptoms. I had thyroid symptoms for the longest time in 20s but no doctor recommended tests. MY GP had no idea- have dry vagina? Goto OB/Gyn, dry skin? skin specialist, dry eyes? Opthalmogist. By luck I got the TSH test done outside USA, that came to 5.6.”It was too much on the borderline” for my GP to prescribe any meds. She took 6 months to refer me to an Endo who met me 2 months later. I had lost 4 years of my young married life to the whims of these practicioners. Within 3 weeks of starting Synthroid 25mcg, I conceived with pregnancy. (Coincidence?!) And, guess what? My ob/gyn never suggested me once that I should let my endocronologist know. Next thing? I miscarry at 10 weeks of pregnancy. Nobody thinks thyroid might be a reason, I am just another statistic of miscarriages. And GP is not in the picture to connect the dots, maybe because she can’t see them.
I really feel for you all women out there who are unheard. Its definitely high time we make noise for the profession to acknowledge that our body sends us signals that may not show in blood tests.

January 29, 2010 at 1:33 pm
(33) Alison says:

Thank God for the Dr. Holtorf’s of the medical world!!! At least he listened to his patient Eola and worked with her to make her feel better!!! Dr. Singer’s comments are insulting, almost sounds like he’ll run the TSH test for you but won’t go beyond that to help you if you are still having problems!! I don’t understand why Doctors wouldn’t want to see what is cause of their patients problems. Don’t you want to make your patients better?

As for the Today show, I hope they do a follow up with Eola Force and see how that “placebo” and “laying hands on” effect is still working!!!

January 29, 2010 at 1:48 pm
(34) JxG says:

I am going to my doc and demanding prescription of Armour now

January 29, 2010 at 2:02 pm
(35) Deborah Slager says:

I suffered from flooding periods, migraines, general fatigue and hands full of hair falling out. My TSH was so called normal at 10. I fought for treatment only to be told I needed antidepressants not thyroid meds. This went on for a couple of years. I suddenly gained 60 pounds in three months but was told I just needed to eat less and exercise more. I was already on a 500-800 calorie diet and frankly could not eat any less and had no energy to exercise more than I was doing. I was gaining 2-3 lbs a day on less than 800 calories a day. I was accused of cheating on the diet or eating in my sleep. Neither of which was true. I literally felt myself dying a little each day as I got worse. I was so frustrated. Again antidepressants were suggested but I was not depressed, just sick and tired of being sick and tired. I refused the antidepressants.
The fatigue got so bad I could not get up off the floor. My legs would not hold me because I was so weak and painful. I was diagnosed with fibromyalgia. Every single muscle in my body hurt. I was sleeping 18 hours a day. I had at most a couple of hours of energy to spend and it was used quickly. The brain fog was terrible. I lost the ability to look at a glass of milk and be able to call it a glass of milk. I lost words and thoughts. I thought I might be getting alzheimers. My husband was worried. I was offered a low dose of thyroid meds and told that was all I was going to get. Told to lose weight, eat less, exercise more and told I needed antidepressants. I got mad, my husband told the Doc that I didn’t need antidepressants that I needed medical care. I ask to be sent somewhere if he wasn’t going to fix me.
By this time I was also freezing to death. My temps were 93-95 degrees and I would sit and shiver uncontrollably. Even when presented with these life threatening temp charts the Doc threw up his hands and said there was nothing wrong with me that antidepressants wouldn’t fix. He finally sent me to an Endo.
I took my temp charts, my symptoms and my weight charts and was fully prepared to hear the same song and dance. Amazingly he heard me out and ran tests and announced that I did indeed have big problems and had Hashimotos Thyroiditis. He kept upping my thyroid meds into the mega dose range that should have had me Hyperthyroid. It helped some but wasn’t the answer. We went on for many months. The temps continued in the 93-95 range and the weight kept piling on. I went on Levoxyl and Cytomel and made some progress.
I did some research on the causes for low body temp and found Wilson’s Temperature Syndrome. Armed with the Wilson’s Doctor Guide I went back to the Endo and presented it. I ask if he would consider a trial run. He agreed for a trial.
What a difference this had made in my life. Two years later and still on the Wilson’s program, the brain fog has cleared completely, no Alzheimers symptoms, all the muscle pain was nearly eliminated, the weight stabilized and started to go down slowly. By this time I had gained 80 lbs in 6 months time. I could finally eat a normal diet of 2000+ calories a day. My hair started coming back in, the migraines stopped, my periods became “normal” again. The temps still went up and down but repeated rounds of the compounded time release T-3 was working. Today my temp is 97.4 and I have ENERGY. Being in charge of my own meds within an agreed upon range has helped to stabilize the body temp and other symptoms. I love my Endo in Rockford, IL. I am a success story and I take it personally when uninformed Doc’s call us wackos and the unconventional treatments that are working as vodoo or fringe medicine. Shame on them for pushing antidepressants for every problem we complain of. Shame on Oprah for not coming to our aid and investigating alternative treatments that are working and might work for her. Shame on Docs who believe that the TSH test is the only way to detect serious thyroid problems and unresolved symptoms. In my case it was useless. Shame on our medical teaching collages that aren’t on the cutting edge and keep old and outdated thinking being put out as gospel to young doctors. Stop demeaning us and open your mind and your heart to the possible. Thank You Dr. Wilson and thank you Dr. Hovis. I have my life back.

January 29, 2010 at 2:10 pm
(36) Mary says:

I went undiagnosed for 20+ years for hashimoto’s and pituitary damage. Although I had significant and obvious hypo symptoms my TSH never went above 1.8. FINALLY one doc tested my FT4 and it was low. He started me on 25mcg Synthroid and gradually raised it to 100mcg. NOTHING happened. I kept gaining, my body temp was 97 on a good day, my LDL chloresterol kept going up and none of my hypo symptoms resolved. I was told it was not my thyroid, put on Zoloft, and pressured to start statins for my chloresterol. Then I moved across country and the it’s all in your head mantra started again.

I started with a small lump that was watched and watched until it was the size of a golf ball before any doc tested beyond my TSH. I was sent for a US of my neck and FNI of the lump. The biopsy showed many hurthle cells and thyroiditis. But with my perfect 1.8 TSH it was
decided I was not hypo, TPO antibodies were not tested,
and I was still in hypo hades with no medication.

Finally, with the lump growing, I was referred to a surgeon to have half of my thyroid removed. Then to another endo who also recommended that half of my thyroid be removed and with a half a thyroid I would probably not need medication.

It was my surgeon who tested my TPO antibodies, they were 6500, and my FT3, it was over a point subnormal.
He recommended a total thyroidectomy as it was obvious I had advanced hashimoto’s and my thyroid was full of hurthle cells. Still, he said hurthle cells are often, at worst, only adenoma’s and not cancer so my chances of cancer were about 2%.

After the surgery I found out I had a hurthle cell carcinoma with multiple vascular invasion and capsular invasion. This is a rare thyroid cancer that is not treatable with radio iodine and is very aggressive. My chances of recurrence are 98%.

But why I am writing. If it were not for the TSH being the gold standard and if the long list of doctors and endo’s
had bothered to test further, like FT3 and antibodies,
I may have been diagnosed in time so that the hurthle cell adenoma’s never grew into a carcinoma. If they had tested further they would have known I had Sheehan’s Syndrome, pituitary damage from hemmorhage at child birth and my TSH would never go above 1.8. If If If.

January 29, 2010 at 2:46 pm
(37) Cheri De La Rosa says:

In taking thyroid medication my TSH has become very low -0.1- so I am outside that range. Dr. Holtorf in the interview you had, let me understand that that is because my leptin and reverse T3 are very very high. I had a doctor who, after I was feeling just great on the amount of natural thyroid I was taking kept prescribing less and less in order to raise my TSH, which didn’t happen, and I was feeling worse and worse. He was SO SURE he was right. Yes I never went back, and I feel resentful that doctors like him have such closed minds.

January 29, 2010 at 2:55 pm
(38) Ali says:

I’ve been taking thyroid medicine for two years.I still feel so sick..no energy,brain fog.Lost my job and I haven’t been able to find another one.I’ve changed doctors…help

January 29, 2010 at 3:02 pm
(39) Ed Arnold says:

I suspect most of us here know that one single test can never be a “gold standard”. The “gold standard” is at least T3,FT3,T4,FT4,TPO,rT3 and an intelligent doctor who knows what all those numbers mean.

What this incident really demonstrates is that “health reform” in the USA (as now thought of) will never work until stupid doctors stop prolonging the chronic illnesses of patients as demonstrated by the “Today” show. The diabetes wave is bad enough all by itself. But the inability of American doctors to properly diagnose and treat the root cause of a variety of treatable conditions (rather than just treating symptoms with Big Pharma drug$), will mean the eventual bankruptcy of the US health-care system.

January 29, 2010 at 3:13 pm
(40) frances says:

I think the medical field and our own government is failing us all… our water is so polluted our food is too and i agree with kathleen 100% on this “demand that the endocrine disrupting hormones in our food supply and water be removed – plane and simple. And they can start with Fluoride which takes the place of iodine on the exchange site in our bodies.” Ive suffered with weight gain, sleeping all day,fibromyalgia,debilitating migraines for years, and when put on synthroid almost all of my hair fell out in a week from a allergic reaction to the synthetics. I had to actually argue with my dr’s to put me on armour, after that some symptoms abated but it took them so long to find a decent dose!! Now there is a nation wide shortage of armour and all of the natural thyroid medications and NO ONE is addressing it or helping the hundreds of thousands of people like us who are in serious need of our medication, pharmcys are switching people to synthroid wich is toxic as any one who goes online to google it can find out.. This is a crime why isnt anyone being punished?!!!! we are like test subjects as our lives and well being goes down the tubes we are being told its all in our heads or we are Premenapause how about treating us? correctly!! our bodies tell us when the right mix is made in medications actually listen to us dr’s and write your governemnt people tell them! “WE ARE IN THIS SITUATION BECAUSE OF THE CHEMICAL POLLUTANTS YOU EXPOSE US TO… do something about it!! stop this madness do something…”

January 29, 2010 at 3:47 pm
(41) carolyn hunter says:

I’ll tell you ALL WHY the defective “Gold Standard” is in place !!!

It’s because the Drug industries have most of the Endocrinologists in a hypnotic MONEY trance….. of some “under the table” money deals….. and bribes….to insure that they, the drug companies………. make HUGE profits from forcing patients to use SYNTHETIC thyroid meds…if in fact they even are diagnosed correctly.

It all STARTS with the pharmaceutical companies Paying off the medical schools to train new doctors…with GRANTS and contributions….to PUSH their concepts of WHAT is the gold standard.

Sadly, the Endocrinological Society is also party to that conspiracy………. It takes real courage for the doctors like Dr Holtorf , to scour the valid world-wide researchers …..and scientific papers that abound, with evidence that his perspective, world-wide, is coming out,……….. IN SPITE OF THE ENDOCRINOLOGICAL SOCIETY’S efforts to hide the scientific evidence, with a smug “head in the sand: attitude.

The TSH is a PITUITARY , NOT THYROID secretion. If you went to a gas station to fill your tank, and there was no gas coming out of the nozzle, you wouldnt blame the car’s gas tank, …….you’d blame the pump that raises up gas out of the underground storage at the station…..If the pituitary is damaged, it canNOT send messages to the hypothalmus and thyroid,……….. which are part of the AXIS….of which all three parts must be performing properly,…. for ALL to function as originally designed.

Before the TSH so-called gold standard was designed in the ’70′s, ……………..thyroid sufferers were ALL treated ONLY by signs and symptoms of the patient….and sucessfully I might add, …..with natural dessicated thyroid from porcine origins.

January 29, 2010 at 7:22 pm
(42) Diane J. Marie says:

I didn’t see the show, but from what I’ve seen here, I think today’s sound bite did a whole lot more good than harm. Bravo!

In the sound bite world, I think it’s most important to get the following across, with gusto: If a patient has signs and symptoms of beginning hypothyroisism, then treat with a trial of thyroid hormones, to see if they improve.

The viewer could see that as rational and compassionate–and short and sweet, for an easy take-away thought for viewers.

It could encourage entering keywords on their computer … and if persistent, they’d find their way to Mary’s sites. Or if persistent, they’d find Mary’s book, Living Well With Hypothyroidism, at bookstores and many libraries.

Good was done today!

Diane Marie

January 29, 2010 at 8:40 pm
(43) Bette says:

I have had hypothyroidism since I was 37. Every doctor has tested my TSH and gone on this alone to prescribe my replacement either levothyroxine9never works) or synthroid.
When they retest I am either “normal” or not and the dose is increased or not. Either way, I continue to gain weight no matter what I eat or how much I exercise. I am 57 now and have decided that I will be obese until I die as I can no longer run, do aerobic classes, lift weights or walk long distances. My knees hurt, my hips hurt and I am tired but my thyroid is “normal” so it must be something else. Not willing to accept that I am depressed and need psychiatric medications as I work in that field and have read the criteria for clinical depression and I do not meet any of the real criteria.

January 29, 2010 at 9:41 pm
(44) Sick and Tired says:

I have been asking the same question in post #30 by Carolyn: What is a Medical Student required to learn and what kind of training/residency is required before being an Endocrinologist in the US? I had to go to a Rheumathologist because of extreme musche cramps and joint pain just to find that my TPO was extremely high (over 1,000 with high normal at 76) – thern referred to an “Endocrinologist” who did not even want to prescribe any medication even when the TSH was close to 5. Went to another “Endocrinologist” who at my request prescribed Armour (No longer available anywhere) – went w/out meds for almost one month just to see my TSH jump to over 30 and T4 under .6. I thought I was dying during the holidays – finally got Synthroid and can barely get to work every day so I don’t lose my job (and medical insurance) that pays the visits to the so called “Endocrinologist”. He never checked any of the other hormones – the visit is probably less than 5 minutes every 6 months and always complains that “there is an epidamic of thyroid conditions” I gave up thinking that there is any US physician who uses a holistic approach to the Endocrine system health and has adequate medical training. I think the entire population of Endocrinologists (actually ALL MDs ) should go back to school and the so called “Health Care System” should get a checkup soon. It seems to me that Medical Schools (especially USC) only train medical students in the business aspect of medicine and PR.

January 29, 2010 at 9:46 pm
(45) Sarah says:

One test should not be the only “standard” that diagnosis thyroid disease. The casual attitudes that many doctors have about this disease worries me. How many people suffer needlessly because a doctor does not take seriously the symptoms a patient has complained about. I was diagnosed with that “gold standard” test, however, I still have symptoms even though I do take medication. Yes, the medication has helped but it has not stopped the times that the symptoms come back with a vengience.

January 29, 2010 at 10:43 pm
(46) Maureen Robinson says:

Three generations of women in my family were practically comatose before a physician would treat us for hypothyroid conditions. Family history and symptoms were ignored. I honestly don’t know whether to laugh or cry when a pompous doctor who does NOT experience hypothyroid symptoms writes us off as just fat, lazy, etc. I looked for 30 years before I found an old fashioned physician willing to ignore TSH levels and treat according to symptoms.

January 30, 2010 at 12:05 am
(47) Dave says:

Reading these comments is stunning to me. My wife has been experiencing much of the same problems for virtually the entire time we have been married — over 12 years now — and much of the time she was afraid to go to the doctor because she was tired of being told it was “all in her head”. She was originally investigated for fibromyalgia, and even put on SSRI briefly. They tried to put her on anti-anxiety meds but she refused, and then she was told she should take the psych drugs because everything was all in her head. She has had intense muscle and joint pain, headaches, mental fog (just like the “can’t call a glass of milk a glass of milk” statement earlier), fatigue, lack of coordination, hair loss, hot flashes, low body temperature, you name it she has had most of the symptoms others have listed.

Now she is facing thyroid and parathyroid surgery for hyperparathyroidism. The hypothyroidism still hasn’t been officially diagnosed even though she has a significant cold nodule on one side and a “mass” on the other side. Now we are afraid it is cancerous and we could have avoided ALL of this if someone had just listened to her ten years ago!!! She actually knows medicine and can communicate clearly with the doctor, as long as they aren’t closed-minded!!

She used to be able to walk 5 miles a day and do 75 pushups military style without being on her knees without breaking a sweat. After the symptoms started she couldn’t stay coordinated enough to do basic aerobics and barely had the energy to walk up an average hill. But her symptoms were “all in her head”?!

We finally stumbled upon a GP who prescribed 25mcg levothyroxin and after a couple of months the result is unbelievable. She’s almost like a different person, the symptoms are largely gone or at least much better, and she is happy and has tons of energy and a vibrancy for life that she has missed for a full decade.

The arrogance and pig-headedness of so many doctors is ridiculous. I am ashamed that I’ve put so much trust in them for so long.

This is a message to any man who reads this: If your wife is feeling this way, LISTEN. Don’t assume that the doctor knows best, because he probably DOES NOT CARE. No one will care for your wife better than you and herself, so it is up to you to support her and listen to her and help her get the help she needs.

January 30, 2010 at 6:39 am
(48) stela says:

Hey Kathleen, i liked your reply..in fact i am the one with same problem.

January 30, 2010 at 10:55 am
(49) Linda says:

I had my thyroid removed about 1 1/2 years ago. I had Hashimoto’s Disease. I felt better for awhile but now I have good days and not so good days. I am hoping that no one will be upset because this is a thyroid blog, but I have 2 daughters 1 grand daughter and 1 niece with Lyme Disease. Some of the symptoms that are described can also be attributed to Lyme. It is also underdiagnosed and treated very lightly. My daughters and my niece all have thyroid issues too. So if anyone is wondering if all of the symptoms you are facing could be thyroid only please be sure that Lyme Disease id not involved.

January 30, 2010 at 11:38 am
(50) Lisa says:

I’m just glad that thyroid problems are in the news at all. For something that affects so many, it gets far too little attention. I hope that some of the many people struggling found the first step to answers.

January 30, 2010 at 2:10 pm
(51) Mary says:

About the drug company influence on prescribing T4 only meds. Prior to my thyroidectomy I was on Synthroid and felt terrible. It was my surgeon who switched me to Armour because on 100mcg Synthroid my FT3 was over a point subnormal. 1.2 (range 2.4-4.2). My surgeon told me not to go to back to my endo because he was very anti-Armour and in fact, did not believe anyone needs Cytomel, that EVERYONE converts T4 into FT3. Anyway… my biopsy came back as hurthle cell carcinoma and I had to go back to the endo to prepare for RAI to kill off any remaining thyroid cells.

The first thing this “endo from hades” said as he walked into the room is “I know your surgeon prescribes Armour and if you do not stop I refuse to treat you.” He got fired and I went to UCSD, Moores Cancer Center in San Diego.

This endo gave me a weak argument about Armour being unstable, having potency problems, etc. etc. … the anti Armour mantra most endo’s use. But when I presented her with well documented proof that her claims about Armour were lies she immediately backed down. Then admitted she has other thyroid patients who do better on Armour. But that UCSD protocol is to switch thyroid patients off of natural thyroid meds.

UCSD is a teaching hospital and they are taught all the anti Armour garbage. She said they receive heavy funding from Abbott Labs, maker of Synthroid. Also that
what thyroid medication is being prescribed by the endo’s is also monitored if the script is filled at the hospitals pharmacy.

Another endo cited me a study by AACE and one of the study results was that Armour is not recommended for TSH suppression. So, I looked up the study. It was funded by Abbott Labs, the study did not include natural thyroid medications, but was primarily a study to prove that generic T4 meds are inferior to Synthroid for TSH suppression. So that endo did not actually lie to me since Armour was not in the study.

As I scrolled through the AACE studies guess who funded most of them? Abbott Labs.

Since switching to Armour from Synthroid my LDL chloresterol has dropped 78 points, I am no longer depressed, my brain fog is gone, and my constant battle with weight has resolved. No, I cannot eat unrestricted calories, but for the first time in 20 years I am not gaining weight if I dare to go over 1000 to 1200 calories a day.
On Armour I MUST eat the recommended caloric intake for my age, size and activity level. I’m in “hog heaven”!

January 30, 2010 at 5:02 pm
(52) AmyB says:

So many problems coming from the misdiagnosis of the thyroid. Many of the same symptoms that I’ve complained to different drs. about with antidepressants being given. I now have nodules and cysts on the thyroid-was just told I’m developing a goiter. I will be seeing a thyroid dr. in a few days to get his take on it. Even tho the bloodwork came back “normal”, I can’t believe with the issues the US showed that my thyroid is functioning normally.

January 30, 2010 at 9:15 pm
(53) ginger says:

I have had Thyroid issues for over 20 years now. I had Hasimoto’s disease and numerous goiters on both sides of my thyroid. It was finally removed, though I beleive it has damaged my throat ( i have had a chronic cough for 9 nine years now that cannot get diagnosed or treated) due to waiting too long for surgery. I have never felt great. Talking with the endocrinologists-there response was “Well. Your numbers are good. That’s all I can do”. Due to fate(?), my coverage no longer covered my doctor and I had to find a new one. I am no on Bio Identical Thyroid Replacement and have felt the best ever! I actally have enery again! Unfortunately, all of this is now paid out of pocket. My insurance will not cover this medication. I called to discuss this. Basically, it doesn’t matter that you actually find something that works, its whats covered. Its probably not covered because its not a big pharmaceutical co. making the big bucks! Its so aggravating. Its so nice to read so many others out their having the same challenges-you feel like your all alone and after a while, you start even questioning yourself: Is it just me? AmI asking too much? Maybe I just can’t feel any better-that this is it. Mary, I love your site. PLease know that so many of us need you and appreciate all the info provided. May all of us continue to fight to get better care for ourselves and get these doctors to wake up

January 31, 2010 at 6:28 am
(54) ibivi says:

I’ve just read the comments since I posted and I notice that many female patients had male doctors. I am still seeing that paternalistic attitude towards women who have nebulous symptoms which doctors are unable to put together as a systemic illness caused by thyroid issues. I also was being for individual symptoms until my TSH level was out of normal ranges and T3 and T4 were low. Then my doctor put it together. Once she diagnosed me with hypothroidism she prescribed medication to treat that condition. However, I continue to have symptoms of hypothyroidism despite being told that my thyroid levels are back to normal.
To Bette, please seek treatment for your depression. Your quality of life will get better with therapy and an anti-depressant if necessary. There are lots of articles on line about thyroid depression and the types of treatment available. Best wishes to all.

January 31, 2010 at 1:18 pm
(55) grtgranny says:

To ibivi and anyone else who are still having horrible body aches and pains and taking thyroid meds. Please, please get your Vit. D checked, and consider taking magnesium for a month or so then start taking cal. Your story sounds like mine and it took 7 Drs. before one would give me Armour. I was not a converter. At 70 I feel better and do more work than I did at 50. You can feel better with the right thyroid meds. and vits. I am able to walk about 4 blocks now where before it was a few feet and I am improving daily. Good Luck grtgranny. And Mary helped me find out what was wrong with me and then I had to find a Dr. that would treat me. I have Hashimotos and had gained 100lbs. and was told I needed to exercise more. I tried to tell them I needed to be able to walk first. Got no where with that one.

January 31, 2010 at 3:31 pm
(56) Madeleine says:

I’ve been on thyroid medication for hypothyroidism since age 19, at which time I was prescribed 1 grain of Armour. I am now 68, and, at some point during my 30′s, my doctor switched me over to an equivalent dose of Synthroid. Two years ago, my GP gradually reduced my Synthroid prescription because my TSH result was .095 (way below the “Gold Standard” range). Because of that one test (my free T4 and total T3 counts were in the low normal range), she considered me to be “hyperthyroid.” She didn’t seem concerned that my many symptoms were getting worse, including a basal temperature in the morning averaging 2 degrees below normal, extreme hair thinning, dry, itchy scalp and skin, cold hands and feet, and suddenly contracting a head cold for the first time in many years. I decided to start researching thyroid disorders for answers and, after experiencing frustrating appointments with two different endocrinologists, I finally made an appointment to see an alternative doctor. I have to admit, I had been reluctant to go to this kind of doctor before. She looked over my thyroid panel blood test results and said the TSH test result was not a good indicator of what was actually going on with my thyroid function at the cellular level. After hearing about my many symptoms, she concluded that I needed more T3 and prescribed 1 ½ grains of Amour. My symptoms have since continued to improve, and I am still working with this alternative doctor for almost a year now to find the right balance for my prescription. It certainly hasn’t helped that Amour and other natural hormone medications suddenly became difficult to obtain. I’m now ordering from a compounding pharmacy that makes up an extended release, bio-identical Armour prescription for me. I also take a small amount of Cytomel to add more T3 to my prescription. My personal recommendation to low thyroid sufferers is to find a doctor who seriously considers your symptoms and doesn’t base a prescription on just one test (in this case the “Gold Standard” TSH test).

January 31, 2010 at 4:47 pm
(57) Karin says:

Thank you Mary Shoman, I have a comment about Thyroid and possible connection with the XMRV virus. Being 49 and not having any thyroid activity for forty years, and having a reliable TSH for most of that time. Several years ago, after having flu-like symptoms, my TSH dropped to almost nonexistant. The doctor I was seeing withheld a third of the dose I had been on for decades, and I plummetted into terible Hypo and myxedemic near coma, sleeping 23 hours a day dead out. My Question is if this virus that may cause ME and CFS, which causes neuro-cognitive disorders, does something to the Pituitary/and or Hypothalamus, thereby compromising the TSH response, and many many people are having a compromised TSH, possibly up to the 1 million estmated cases of XMRV in the U.S. what if this virus is compromising both the TSH, and thyroid, and as many doctors only will test the TSH, could there be an epedemic of HYPO out there?
I am in an unique position to know that my TSH is compromised, as I have blood tests that say my T-4, and T-3 are low, at the same time my TSH is .oo1, when it should be at least.3 Many people dont even know that a TSH can be compromised.
I have asked many doctors repeatedly for a TRH Thyrotropin-Releasing-Hormone test to test the pituitary, only to be told that they dont test that. “Not available.”
I would posit that if an estimated 1 million possible customers for this test asked for it, that it would be revived, and poor hypo, chronic fatigued, M.E. mayalgic Encephalomyelitis sufferers could show that their TSH is not a reliable test for them. At least they would have the dignity of being replaced by the actual blood levels of thyroid, and stand a chance of feeling better, rather than being told that the pituitary TSH test is wrong and the patient is just imagining things,

January 31, 2010 at 10:34 pm
(58) Donna Hurlock, MD says:

In answer to the first comment asking about a thyroid patch. I asked a VP from an estrogen patch company a number of years ago if they would consider manufacturing a thyroid patch. He actually looked into it but found from his science guys that the hormone is too big to fit through the skin. Darn. (Insulin also is too big to permeate skin.) It would be very handy however. But the dose that is used is way more important than anything else. So just make sure that your doc is giving you enough to make you well.

February 5, 2010 at 6:55 am
(59) Ayem says:

Linda at (50) raised a really important point. On its way to becoming a multi-system ravager, Lyme disease quite often wreaks havoc on your thyroid. Assemble a group of people with Lyme and you’ll find that 1/2 to 2/3 have had a previous hypothyroidism diagnosis. If you’ve been treated for hypothyroidism and continue to have a lot of problems, please consider the possibility that your thyroid is not your only problem, and don’t rely on a blood test to rule out Lyme, because even the good ones aren’t reliable. Learn more here: http://www.lymediseaseassociation.org/

February 5, 2010 at 9:53 am
(60) Mona says:

I feel so badly for the many readers/posters here that NEED help. Before I received proper treatment, my brain fog was so bad I couldn’t have followed the posts or fully comprehended what I was reading.

My best advice is look for the Top Docs in your area via Mary Shomons link and don’t stop until you get a doctor that listens. If you have a “hint” you aren’t being heard, you ARE not. Until your symptoms are addressed, keep talking to your doctor or another one until you’re fixed.

The suffering you describe is needless. People, even other thyroid patients, may not understand your personal journey. If you get nothing else from these posts, TSH doesn’t indicate anything significant; your symptoms do.

I am 56 years old. I suffered for 3 years until finding the right doc. I lost 35 pounds last year with proper medication; exercise; eating WAY less sugar; and regaining my right mind. (I also have Hashimotos Disease.)

For the poster who has resigned herself to being fat and having no energy for the rest of her life … Don’t give up on it, Baby!!! It doesn’t have to be that way!

February 5, 2010 at 10:03 am
(61) Aimee Harrington says:

Many women (and men) suffer needlessly from hypothyroidism! I am a patient of the HOTZE HEALTH & WELLNESS CENTER in Houston, Texas, where they treat for hypothyroidism with natural thyroid. Unlike most doctors, they actually listen to their patients! They treat based on a patient’s symptoms rather than using a lab’s “normal range” to make that determination. I’ve been a patient there for 5 years now and feel better than I have in my entire life! If you have doctors telling you “you’re normal” and everyone is telling you it’s just in your head, HELP IS OUT THERE! Do yourself a favor and call their office today! Their website is http://www.HotzeHWC.com!

February 5, 2010 at 10:04 am
(62) Christine says:

I am tired of not being heard. I got the RAI treatment done in 2003 (that is a story in and of itself on how I was treated through that, I was not a human being to anyone!), this is when I found out that I don’t trust doctors and I wondering what they learn through all their schooling. I have been fighting for a better quality of life since then and it is a battle. One I’m feeling very discouraged about lately. My doc has diagnosed me with Fibro a little while back (not convinced that’s what it is). I went to him recently about symptoms of debilitating fatigue, joint pain, muscle weakness, feeling like I have a low grade fever and chills. He did up my levothyroxine but I’m not convinced this is going to work. I have been yo-yoing for 7 years, I have had no consistency at all with my medication. Then he says to me this time, you want some uppers, are you feeling ok I could give you something. CAN YOU BELIEVE THIS!!!! ????? I am shocked. I told him I am fine mentally and emotionally and don’t need that, I need my body feeling better. He’s got samples all over his office from drug companies. Makes you wonder, is my health and my quality of life of any importance to this man??? or is he lining his pocket? What if I was someone that didn’t know what I’m knowing now. I live in Canada and I feel there are no options to what is talked about on the Thyroid sight. I don’t know where to go, or what to pursue. I have always wondered too, if I received RAI treatment and killed my thyroid how is just focusing on my TSH levels and not checking t3 and t4 a wholistic approach. Should that not be part of the knowing how a persons thryoid is functioning? I wonder if there are any advocates in Canada to help us in our healthcare system.

February 5, 2010 at 10:34 am
(63) Terry says:

if my family practice dr hadn’t listened to me and my symptoms and looked at the TSH test a little closer – he would have done as several of my past dr’s had done – dismissed my and my problem as “for a woman your age – you are fine (I was only 47!) – so he started me on a regimen of levoxryl and slowly increased the dosage until he and I both felt it was working – today I feel fine and I have become more knowlegeable for what the thyroid is responsible for doing in the body – I had a friend pass away from a stroke, which was attributed to her thyroid problem – so I am very aware of signs and symptoms of that problem. I also have thyroid nodules which have been ultrasound/biopsied to test for cancer. So get your blood test done and if your dr doesn’t listen – keep looking for one that will – endo docs are great and if you can (depending upon ins) go see one – they understand! It’s not just age and weight – so don’t let them tell you it is!

February 5, 2010 at 10:58 am
(64) Anonymous says:

I see Dr. Wightman – a doctor at Holtorf’s practice. He is treating me for PCOS, Hashi’s, Lyme disease, and type 2 diabetes.

I had been to countless doctors who offered substandard treatment. I was in constant pain and gaining weight very rapidly. My blood sugars were cazy and all I ever got was Levoxyl and lectures about lifestyle changes.

After running the right tests – Dr. Wightman discovered my Lyme (contracted 15 years ago) was back in full swing (5 other doctors refused to test me for Lyme saying my arthritis was untreatable anyhow.) I had adrenal insufficiency, high reverse T3 levels (so high he took me totally off Levoxyl and put me on pure T3), and he also found I had dangerously low levels of several very important hormones and vitamin D. My A1c was only 5.1 so he was the first doctor to believe me I was not stuffing my face with bad food.

I have been following his new regime for 2 months now (the right medications and supplements.) I have lost 20 lbs (no change in diet – my diet was fine) and am virtually pain free. Before, I could not pick up a coffee cup without extreme pain. Now I am back to lifting weights. Plus, my huge goiter of 20 years from Hashis is now totally gone – normal sized again – I can swallow!

I say out the window with “Gold Standard” testing – which we all know is run by the insurance companies. And hear hear to doctors that actually do not blame the patient for their problems but who look outside the box for answers and for treatment.

February 5, 2010 at 11:34 am
(65) Santa Fe says:

Thyroid Friends,

If you are raising your vitamin D intake, you need to monitor your thyroid levels carefully. Many of us on various health, thyroid, and osteoporosis forums are noticing that vitamin D is affecting our thyroid hormone levels. There have been two small studies on PubMed documenting that D raises TSH levels. Some people are reporting D is lowering their TSH. At this point all we know is that it is affecting many people’s thyroid levels up or down.

Since most primary care doctors are probably not going to make this association between raising vitamin D serum levels and thyroid, we need to get this information out to the thyroid community.

February 5, 2010 at 12:38 pm
(66) Pat Esborg says:

I am a nurse in advanced practice, 71 years old, and have had thyroid problems since I was 11. When I was in my early 30′s, I suffered from Hashimoto’s Thyroiditis. Somehow, after that was treated, my TSH was, and continues to be, markedly suppressed (around 0.8!). This has gone on for almost 40 years. Despite the TSH readings, my symptoms always veer toward HYPOthyroidism, never HYPER. Other lab tests accurately depict the clinical picture. Fortunately, I have found physicians who will treat the symptoms rather than rely solely on the TSH. If they were “gold standard” people, I would definitely be an invalid today, rather than the healthy and active person that I am. Since I’ve been in nursing for over 50 years, I’ve seen so many of these “gold standard” tests be debunked in all fields of medicine. When, oh when, are physicians going to start using their eyes, ears, brains and even intuition rather than relying on what are often totally misleading and highly limited test results? The more the practitioner can only see numbers on a test as the “gold standard” for what needs to be treated, the faster I run away. Instead of someone of unimaginative and tiny brain, give me a doc who can think outside the box any time! They are out there, but you have to work hard to find them. Mary, I love your site and have recommended it to countless folk. Please continue your excellent work! Thank you.

February 5, 2010 at 1:03 pm
(67) Kathryn Udrovich says:

In May 1992 after visiting the Carlsbad, N.M., WIPP Waste Isolation Pilot Plant with a college group, we actually were allowed to go down the shaft 2500′. In Nov 1992 I was diagnoised to be in a thyroid storm. I had to search for a doctor that would listen to me, finally was put on pills to assist. By 2004 it was on/off hyper/hypo, my Dr said I must have it radiated. So I did, I have felt much better since, I felt like I was constantly having a heart-attack, my legs were swollen, I was told my femurs have osteopenia now. I never saw a ‘fat’ person just gain like I did. Jan 2005-Feb 2005 I went from size 8 to 16. And was told to excerise! Finally this past October my family Dr raised my 112mcg to 125mcg and from levothyroxine to synthroid. I didn’t even know there was a difference. I have always needed to watch my sugars/fats, so I talked to a dietation and went on 1500/1600/cals day, lost 8lbs, and joined weight watchers. I have lost another 7.5lbs. Its slow going. I seem to have more energy, but really don’t know. Doctors seem to think its just sedentary overeating! I am learning about good eating, and appreciate support, but seriously, I don’t have trigger foods, I have never used food to comfort myself, or stress eat. I feel like an undercover agent in the weight watchers group. The instructor wears a badge of how much she lost. I feel bad if I brought before pictures, so mine would read I always was 125-135lbs, now I am 194lbs? Come on. I am going to discuss this latest article with the medical staff. Thanks for putting out the news!

February 5, 2010 at 11:11 pm
(68) Shelley B says:

When I’m “in love” I feel good, physically and mentally. My hypothyroid, even on medication, makes me feel awful. I’m missing Singer’s logic on this one.

February 6, 2010 at 9:36 pm
(69) Willa Cunningham says:

The TSH test is not always an indicator, my doc goes by the FT4 and so far that has worked for me. All of a sudden the TSH is not in sync with my FT4 result.

February 8, 2010 at 1:36 pm
(70) Ivy Palmer says:

Reading all of these posts and seeing the way Eola Force was suffering – makes me feel so angry at the medical community. I have been struggling with hypothyroidism for 5 years. I live in Savannah, GA – a terrible part of the country to try and find open minds and decent endocrinology care. I am on my 4th doctor and am taking a combination of synthroid and compounded T3. I continue to feel terrible – but not nearly as bad as some – I’ve only gained 20 pounds that I absolutely can not lose no matter how many hours I spend at the gym or if I starve myself. I keep fighting it because I am only 30 years old and have a 2 year old little boy to motivate and be strong for. I have read every thyroid book I can find – and at times have found that I know more about current events in the thyroid community than my doctors. I had one local endocrinologist tell me that “maybe I was depressed, your TSH levels are normal”. I struggle to get out of bed every morning, no matter how much or how little I sleep – not because I don’t want to – but because my eyelids are physically closing on me! I have been referred to a sleep doctor for a sleep study – though I did not proceed, because I believe in treating the root of the problem, not individual symptoms. My hair is falling out, my finger nails and hands are so dry that my nails and skin split and peel. I spin between 60 and 100 miles a week, am at the gym daily, and have cut my diet down to only a few select foods that I allow my self to eat. I can’t concentrate and lose focus easily. My memory is terrible. My little boy is 2 years old and there are parts of his infancy I can’t remember. I have no sex drive. Another doctor just referred me to a psychiatrist that I also plan not to see until the bigger problem is solved. I have spent thousands of dollars on blood work and office visits over the years that insurance will not cover. I shudder to think that there are people out there – both men and women – who have been put on antidepressents, shuffled from one doctor to another, been made to feel that something is wrong with their mental health, all because of a hormone imbalence that they have no control over. Unfortunately, even the Today Show piece is still a slap in the face to those struggling with hyper or hypo thyroidism. I’m a fighter and I’m not ready to give up. My next move will be to seek consultation out of state, even if it means I have to work three jobs to pay for it. Thank you Mary and everyone who contributes to these blogs. You are what motivates me and shows me a light in this darkened spot of despair in my life.

February 9, 2010 at 9:02 am
(71) Rhonda says:

How can we contact MSNBC and Ann Curry? I can’t find anything on the website. We need to let them know how we all feel so maybe they will take actual patients concerns more seriously as they produce segments.

February 10, 2010 at 6:19 pm
(72) Stephen says:

Denis #20 above, thank for your clarification about TSH, which yes is confusing.

Your clarification reminded of a paper written by my first Doctor, which in older age is not able to practice an long on …. Thyroid Physiology By Dr. Jerome Borochoff, MD.

Dr Borochoff gave this paper many years ago, and gave me permission to publish it online, which I have not done before. Her told me that he wrote it for one of his pregnant female patients whose gyno wanted her to STOP taking Armour thyroid medication.

Let me post it here as I think can help many thyroid patients and their doctors….

Thyroid Physiology
By Dr. Jerome Borochoff, MD

The brief discussion below may help to better understand why TSH is of little if any help in determining thyroid status if the patient is already on thyroid medication.

The chain of sequence starts by the brain sensing the thyroid “level” in the blood. There are 4 thyroid hormones released by the thyroid gland, and exactly which (or combination thereof) hormones that are sensed by the brain hypothalamus is not clear. So we will just refer to it as thyroid “level” in the blood.

In the normal thyroid functioning person, the following sequence of events takes place:

(1) Thyroid blood level sensed by the hypothalamus in the brain
(2) Hypothalamus sends signal (via Thyrotropin releasing hormone, TRH) to the pituitary
(3) Pituitary sends signal (via Thyroid stimulating hormone, TSH) to the thyroid gland
(4) Thyroid gland starts making and releasing T1, T2, T3, and T4 to the blood* (T3 released by the pituitary in step 3 above, converts to Free T3 in parallel with step 7 below).
(5) T4 converts to Free T4
(6) Free T4 converts to T3
(7) T3 converts to Free T3 (Free T3 is the bottom line active hormone that acts on all the body tissues to give the thyroid effect)

*As far as anyone has determined, T1 and T2 are not active in humans. However, some hypothyroid patients when put on T3 and T4 (Synthroid and Cytomel) are still not quite normal. But when put on desiccated thyroid (Armour for instance) which contains all 4 hormones, they respond very favorably, indicating that T1 and T2 must play a role in humans.

Sometimes people put on T4 (Synthroid) only, seem to do quite well. Sometimes the same is also true for T3 (Cytomel) only.

Unfortunately all the biochemistry and physiology of the thyroid gland has not been completely worked out. So hypothyroid has to be diagnosed more on a clinical level than a laboratory level. However, Free T3 is the single best laboratory test to look at, as easily seen from the 7 steps above. It is the single most informative test since it is closest to the bottom line that we can get as far as it goes. It is not totally diagnostic by it self, however, since it does not address tissue resistance to thyroid hormone. So again, hypothyroid needs to be diagnosed on a clinical level, rather than a laboratory test, the least being TSH.

In the normal person (all 7 steps above are intact), if too much thyroid appears in the blood (due to Graves disease or a very high dose of thyroid medication), a very low TSH results (step 1 through 3), indicating a too high blood thyroid “level”. The low TSH shuts down the thyroid gland to try to lower or normalize the blood thyroid “level”. If a lower thyroid blood “level” does not happen, the TSH stays extremely low and the person remains hyperthyroid.
Remember this occurs in someone where all 7 steps above are intact, which is not the case in many hypothyroid patients.

However, a lot of doctors falsely assume that a low TSH automatically always means hyperthyroid, which is not true.

Now let’s assume the thyroid gland is not putting out enough thyroid hormone which can be due to any one or more of the following:
(a) The hypothalamus (in step 1 and/or 2 above) is not correctly sensing and “interpreting” a low thyroid blood “level” and/or is incorrectly sending out an improper level of TRH (no increase) to the pituitary. Due to the lack of TRH, the pituitary is incorrectly sending out an improper level of TSH (no increase) to the thyroid gland, which in turn gives no stimulus to the Thyroid gland to put out any additional hormone.

(b) The hypothalamus (in step 1 and 2 above) is correctly sensing and “interpreting” a low thyroid blood “level” and is correctly sending out a high level of TRH to the pituitary. However, the pituitary (in step 3 above) is not correctly sensing and “interpreting” a high TRH “level” (from the hypothalamus) and/or is incorrectly sending out an improper level of TSH (no increase) to the thyroid. Due to the lack of TSH (no increase) to the thyroid gland, there is no stimulus to the thyroid to put out any additional hormone.

(c) The hypothalamus (in step 1 and 2 above) is correctly sensing and “interpreting” a low thyroid blood “level” and is correctly sending out a high level of TRH to the pituitary. The pituitary (in step 3 above) is correctly sensing and “interpreting” a high TRH “level” (from the hypothalamus) and is correctly sending out a proper level of TSH to the thyroid. However, the thyroid gland (in step 4 above) is not correctly sensing and “interpreting” a high TSH “level” (from the pituitary) or is otherwise unable to respond to the high TSH, consequently the thyroid gland does not put out any additional hormone. Therefore in this case, prior to giving thyroid medication, the high TSH level correctly diagnoses a hypothyroid status.

Now if a person is hypothyroid due to case (a) or (b) above, and thyroid medication is given, the TSH will remain at the same low level or be lowered even more.
Thus, the TSH level is worthless in determining thyroid status.

Now if a person is hypothyroid due to case (c) above (TSH would be high prior to medication) and thyroid medication is given, TSH will normally plummet. This is due to the fact that a slightly higher amount of thyroid medication is given than that minimum amount needed to put TSH level in the reference range, since this minimum amount requirement does not stay constant on a daily basis. The body tissues and organs very easily handles a mild increase of thyroid medication over and above that minimum amount required, so staying in the normal thyroid state all the time requires staying above that minimal requirement all the time.

The difference between just enough thyroid medication and barely over the minimum amount is so narrow (and as mentioned above, changes slightly on a daily basis), staying in the constant normal thyroid state requires an amount slightly over that minimal amount required.

So, once thyroid medication is given in any of the cases above, and you achieve a normal thyroid state, you will always see A LOW VALUE OF TSH IN THE FACE OF A NORMAL THYROID STATUS.

So, the TSH level is again worthless in determining a normal or high thyroid status after thyroid medication is given. Thus, the TSH level is not a viable parameter to follow in an attempt to titrate the amount of thyroid medication given.

In case (c) above, we see a high TSH level that correctly diagnoses a low thyroid status. Does this mean that a high TSH level always means a hypothyroid status. Well, yes and no. Whenever you see a high TSH level, you should immediately suspect a hypothyroid state and confirm it clinically and also with a Free T3. However, although I have never seen this, it is theoretically possible for the hypothalamus to lose its ability to detect a high thyroid level in the blood, or the pituitary to lose its ability to detect a low TRH level from the hypothalamus, and therefore an inappropriate high TSH would be produced. This would produce a hyperthyroid state in the face of a high TSH.

Most hypothyroid patients I see, have TSH values in the normal reference range but are definitely hypothyroid (for whatever reason). Putting these people on thyroid medication and getting them in a normal thyroid state, invariably plummets their TSH for reasons given above. So although a high TSH may initially arouse suspicion of a hypothyroid condition prior to treating the patient with any thyroid medication, a low TSH has little meaning after the patient is put on thyroid medication. However, the single laboratory parameter that carries the most weight over any other laboratory test and being the single most important diagnostic laboratory clue, is Free T3. The clinical status presentation of the patient, however, carries more weight.

February 18, 2010 at 2:59 pm
(73) Theresa says:

It’s taken me awhile to get around to commenting on this, but I feel it’s too important to let it pass without comment. I started having hyperthyroid symptoms in my late 20′s after giving birth to my third child. My mother-in-law noticed my eyes bulging, but doctor was not very interested. Blood test however, showed hyper. (About 20 years later, an endocrinologist confirmed Grave’s disease, no surprise to me). A year to two later, when I asked for thyroid testing, doctor again was not very interested, but did order it. This time, TSH was around 7, at that time a “gray area”, neither normal nor abnormal. I had to wait til it hit 10 to begin treatment. Then followed 15-18 years of hypo h#ll, with fatigue, weight gain, chronic pain, debilitating allergic reactions, etc. It was only when I found this site, and started collecting books by Mary Shomon and some of the experts mentioned here, that I learned enough to go to my doctor and ask for better treatment. It was not easy, but slowly he is accepting that what he was taught may not work for all patients. We are in the midst of a family doctor shortage, so I can’t go searching for the perfect doctor. But I’m finding that working with a willing doctor can help. Today, I had an appointment and my regular doctor was away. His replacement had never seen such a low TSH (0.03)! And to allay any concern about osteporosis now that I’m 50, I had a bone mineral density test that showed my bones as healthy as a 20 year old! Keep up the good fight, it may take time, but if enough of us go to our doctors with the information, they may just start to listen. It also would help to get the media involved, as long as we can leave out the naysayers who spout the “gold standard” dogma of TSH and ignore the patients they should be helping.

February 20, 2010 at 6:47 pm
(74) Diana says:

A “normal” TSH causedmy papilary thyroid cancer to go undiagnosed for several years until a HUGE lymph node showed it’s ugly self on the side ofmy neck. For years I was just fat, tired after all you are a mom of 7and why should it be anything else? When the thyroid and para thyroid were removed the edriconologist said I had cancer for about 8 years. Well now I can not be cured or cancer free another myth that thyroid cancer is not importwnt and totally treatable. But the doctor said with regular RAI and meds we can keep it “under control

March 24, 2010 at 10:10 pm
(75) Matty says:

Sadly, I am still suffering after fifteen years of not having enough thyroid medicine. One doctor was willing to give me more T4 and some T3 but when he left my HMO, I was left flat. For two years I knew what it was like to be almost painfree (fibromyalgia), I was also able to lose weight, and I was able to cut my celexa dose in half, my anxiety was definately better, my eye bags were gone, I was no longer exhausted but had enough energy to return to work , and my mind cleared so I could think well. I was able to work after several years of total exhaustion and confusion. It ruined us finanically not having been able to work those years.
My next doctor refused to let me stay on the dose as my tsh test showed o. I have a new doctor now who is at least willing to bring the tsh test result to .01. I am hoping that she will continue working with me so that I may be well some day. I am one that I believe had been suffering from hypothyroidism since birth, but had not been treated until about 40. I was extremely thin as a child and had debilitating anxiety. I don’t understand why most physicians would rather let you suffer horribly rather
then simply treat your symptoms?! I don’t care what they been taught; how cruel to allow people to suffer so much when they have it in their power to relieve their suffering.
Thanks Dr. Borochoff for your devotion to serving those with thyroid disease and for being good enough to share your information.

May 2, 2010 at 8:51 pm
(76) jls says:

Gold Standard for TSH delayed my diagnosis of thyroid cancer for over 2 years. Doctors with closed minds make me so mad, what did you go to med school for if you cannot or won’t listen to the patient?

May 7, 2010 at 10:40 pm
(77) RMS says:

Dr. Singer told my daughter that she did not have a thyroid problem last fall. Her TSH was in the normal range. She found a doctor that listened, read blood test results, and ordered some tests which she had begged Dr. Singer to do. The new doctor found both thyroid cancer that had spread to her lymph nodes and a parathyroid adenoma.
Dr. Singer is not an expert. He lets his personal biases affect his professional opinions and his patients. Fortunately,she found a doctor that listened and cared.

July 20, 2010 at 9:48 pm
(78) Rose W. says:

Last year I was diagnosed, finally, at the Holtorf Medical Group with subclinical hypothyroidism. For at least 15 years I had been telling my doctor that I was fatigued most of the time, had no energy or stamina. I chalked my symptoms up to a stressful teaching job even though I suspected there was more than this involved. I asked the doctor repeatedly to check my thyroid function– something wasn’t right. The answer was always the same: your test is normal. The only test done was for TSH! The Holtorf Group does a full panel including reverse T3 which hardly any doctor tests for because it is not part of the “gold standard”–the one-size-fits-all approach to medicine. The tests they did showed seriously low iodine, low cortisol, and extremely high reverse T3. The latter is gradually coming down. I take increasing levels of triiodoliothyronine until I get up to what is normal for me. When I showed my doctor the results of the lab tests from Holtorf, the only comment was,”I still think you’re normal.” Here I was presenting irrefutable evidence and was met with a closed mind. I was very disappointed in this attitude. I advised a friend to get a full thyroid panel as she has weight problems and disturbed sleep. Her doctor did the standard TSH, T3 and T4 tests and said her results were normal. I saw those results and one was out of range. I told her to demand a reverseT3 test which the doctor didn’t want to do, but she pressured him. The results are not yet in. I like two quotes from an interview that Dr. Holtorf did: l)”The days of trusting your doctor are long gone” and what all doctors are supposed to do 2):”Treat the patient not the lab work.” Medicine has become a matter of educating yourself; otherwise you are at the mercy of doctors who think they know everything ,and who believe without investigation what the pharmaceutical reps tell them. With the possibility of Obamacare looming, this self-education becomes critical.

August 21, 2012 at 4:39 pm
(79) deyanna says:

Placebo? Placebo? How come I never felt better while taking their placebo (synthroid) if I am so easily treated with a placebo? How come I never felt better trying so called thyroid supplements and all sorts of “natural cures” and taking vitamins if I am so easily fooled?

It seems the only one fooled by placebo’s is the one TSH loving doctor.

Treating with synthroid is like throwing money down a well for me. It does nothing. I still don’t have the right combination but I’m feeling better with a compound right now. We’ll see how long that lasts. I’m skeptical because I was doing T3/T4 for awhile (synthroid + cytomel) and felt great at first – but then that subsided too.

I still haven’t tried dessicated thryoid but that will be next.

January 31, 2013 at 3:03 pm
(80) Deborah says:

Dr. Holtorf is NO quack. He was the ONLY doctor that was savvy enough to provide me the proper “natural” type of Thyroid Medication that not only treats my thyroid issues, but also does not destroy my bones. If you take Synthroid, beware ladies, this medication is harmful to the bones. Dr. Holtorf provided me a compounded natural thyroid replacement that works better than synthroid ever did and is more natural to the body.

Also, every doctor I visited and that practiced the “Gold Standard” way of protocol, ONLY prescribed Synthroid, period, end of sentence. Dr. Holtorf not only had the knowledge and capabilities of prescribing a compounded thyroid med, he was THE ONLY DOCTOR WHO TOLD ME that I had HASHIMOTO’S disease, one of the most intense thyroid conditions that needs bi-annual blood panels to monitor. ONLY Holtorf diagnosed me properly. Funny someone just gave me Dr. Singers name as a referral for a second condition, after reading this article, I am throwing Dr. Singers name in the trash.

May 14, 2013 at 11:01 pm
(81) Bobbie Ingersoll says:

I have been through hell with thyroid disease over the past decade. The bottom line is: If a dosage and a type of thyroid medication (Armour, T4 with T3, T3 alone, etc.) allow one to feel normal and well, THAT’S ALL THAT MATTERS!!! If some of these doctors had to go through what these thyroid patients are going through, they would come to the same conclusion!

B. Ingersoll, M.S.

November 1, 2013 at 8:54 pm
(82) Jo Jo says:

I was dianosied with hyroid trouble in college. I gained 50 pounds in two weeks when I was a skinny and pretty little lady, but the condishion has been very weird they tell me it has always been borderline. I have it then I don’t . I took synthroid for a long time but they took me off of it, but now it seems I keep breaking out in sweats, and I can’t lose weight and im actually gaining weight. Bigger then I have ever been ever. Wish I knew what to do. I am also tired all the time. They say I suffer from bipolor disorder and they had me on Abilify, but I can’t afford the meds and I am afraid to take that now thinking that it will make me bigger weight gain is a side effect. They also told me I had P.C.A.O.S. at age 32 now I am turning 44, but again they say I no longer have this eigher . A doctor told me that I needed to see a nutritutionist and have gastotestial surgery if my insurance would cover it but mostly she said to exercise and diet. I have tired but it seems even if I eat salads for every meal I cant lose.

March 24, 2014 at 5:12 pm
(83) www.flickr.com says:

Thank you, I have just been looking for information about this subject for a while
and yours is the best I’ve discovered till now. But, what concerning the
bottom line? Are you positive concerning the source?

Leave a Comment

Line and paragraph breaks are automatic. Some HTML allowed: <a href="" title="">, <b>, <i>, <strike>

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.