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.
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!
Image: NBC Today Show / screen capture