Why Does Thyroid.com's Dick Guttler Want to Eliminate Tests and Treatments That Help Thyroid Patients?

You just have to love old Dick Guttler. He's bloviating right on schedule, and is unable to provide any medical information, supporting data, or journal citations to defend his latest suppositions. Instead, he resorts to a rambling, typo-filled rant condemning various thyroid tests and treatments, attacking the About.com Thyroid site, and personally attacking me.

To paraphrase Margaret Thatcher -- "I always cheer up immensely if they attack one personally, as it means they have not a single argument left."

So leaving his preference for personal attacks behind, I'd like to argue the facts.

1. FACT: Guttler regularly derides Armour thyroid and other natural desiccated thyroid drugs, but has never provided or cited scientific evidence or proof that supports his personal opinion.

After a thorough review of his website over the past 10 years, and a detailed Pubmed/Medline search I have yet to find the double-blind, peer-reviewed journal-published research that proves that, as Guttler states,"[levothyroxine] is the best and only therapy for hypothyroidism."

2. FACT: Guttler made up his own "professional organization" of "thyroidologists," then conveniently appointed himself the President, so he now identifies himself as "President of the Association of Clinical Thyroidologists."

(By comparison, I suppose I could make up a word, "Patientologist," and then create an "Association of Thyroid Patientologists," get a few friends of mine to join up, and then declare myself the President?)

The fact is, Guttler's term "thyroidologist," is not recognized by most of the medical world. For example:

• A search for the term thyroidologist brings up no results at the American Association of Clinical Endocrinologists website
• Thyroidologist is not a recognized word in Webster's Dictionary
• In a search at WebMD, there are no results for the term "thyroidologist"
• The top online medical dictionary does not contain the term thyroidologist

3. FACT: Guttler has attacked the TRH test, but he has not provided any scientific evidence or citations that prove that, as he says, the TRH test is unnecessary. (Actually, to be accurate, Guttler declares it "unnecessay" -- that's his spelling.)

Guttler does not address the facts about why or how a test that measures levels of a circulating pituitary hormone (TSH) at one fixed point in time is better than a challenge/stimulation test that measures that body's ability to respond to a call for increased thyroid function, under stress. (I would ask Guttler, is a one-time blood glucose measure better than a glucose challenge test? Is a one-time resting EKG better than a cardiac stress test?)

4. FACT: Guttler regularly suggests that people with thyroid disease use only endocrinologists, and rely only on TSH tests for diagnosis and treatment management, yet endocrinologists do not agree on even basic guidelines regarding how to interpret the TSH test.

A fact Guttler fails to mention, however, is that endocrinologists don't agree and can't seem to agree -- even after three years of arguing about it -- about the most basic aspect of thyroid disease to them: what is the normal test range for the TSH test?

Guttler offers no guidance or suggestions for patients who with a level of, for example, 4.0 on the TSH test -- a test he believes is "so good," -- might be given two different diagnoses by endocrinologists. Because the fact is that a patient with a TSH of 4.0 could be diagnosed with hypothyroidism by one endocrinologist, but another endocrinologist could make a diagnosis of "euthyroidism" (normal thyroid level) -- and perhaps tell the patient to see a psychiatrist, or take an antidepressant, or "get off the couch and start exercising!"

So, according to the current state of affairs, you can have one patient, one test result -- and two diametrically opposed diagnoses made by endocrinologists.

5. FACT: Guttler states that "Thyrolar, and Combo T4/T3...are usually useless," yet there are patients who successfully use both treatments.

Useless is not a scientific or medical term. In the vernacular, useless means that something is ineffective. There are many patients who have taken Thyrolar (liotrix) or combinations of T4 and T3 in proper, safe doses. Those patients have been and are currently monitored and regularly tested by medical doctors around the country, who are restoring most of these patients to euthyroidism. Hundreds of thousands of people in the U.S. take Thyrolar and other combinations of levothyroxine plus T3 (in the form of Cytomel , or compounded T3). To be "useless," these drugs would have to be ineffective. If they are able to cause euthyroidism and resolve symptoms without any measurable negative side effects in even some patients, they are, in fact, not "useless." Guttler is wrong.

6. FACT: Guttler accepts money from drug companies.

In particular, one company he accepts sponsorship money from is Abbott Labs, maker of Synthroid, the top-selling levothyroxine drug. A January 2006 study reported on in the Journal of the American Medical Association says that 90 percent of the $21 billion pharmaceutical companies spend on marketing goes directly to physicians. Doctor Guttler is getting a share.

In contrast, I don't receive drug company funding.

Yes, as Guttler says, this site has advertisers, but I don't have a financial relationship with advertisers. Guttler complaining about the advertisements at the About.com Thyroid site makes as little sense as maligning a writer because you don't like the advertisements that run on the same page with his or her newspaper column.

Dr. Guttler's dedication to promoting levothyroxine as the sole treatment available for thyroid patients certainly raises questions about the influence drug companies may have on his actions and decisions.

Find out more about the influence on doctors of accepting sponsorship money, gifts, and other items from drug companies:

• "How drug lobbyists influence doctors This article from The Boston Globe is by Dr. Jerome P. Kassirer, a distinguished professor at Tufts University School of Medicine, and author of On The Take: How Medicine's Complicity With Big Business Can Endanger Your Health. The article describes how "financial ties to the industry often create subtle (or even overt) biases"
• Prescribing Under the Influence -- is by E. Haavi Morreim, Professor of Human Values and Ethics at the College of Medicine, University of Tennessee, and talks about how "gifts to doctors from drug companies have implications for patient interests."
• The hidden big business behind your doctor's diagnosis -- is an article from the Seattle Times that talks about how, "for a broad spectrum of diseases, the experts writing the treatment guidelines had drug-company ties ranging from research contracts to consultancies to stock ownership."
• Distance Sought Between Doctors and Drug Industry is a Washington Post article that describes how "the pervasive influence of drug industry money is distorting doctors' treatment decisions and scientific findings,...and voluntary efforts to limit corporate inducements have failed..."

Read more about Dick Guttler and his site now

• Editorial: Dick Guttler's Museum-Quality Ideas About Thyroid Testing
• Fighting the Dogma of Dr. Richard Guttler and the "Real Thyroid Experts"
• Is Thyroid.com's Richard Guttler Becoming Unhinged?

Do you want to avoid ending up with a practitioner like Guttler? Find a caring, innovative, independent-thinking top thyroid doctor now at the Thyroid Top Doctors Directory

Mary Shomon, About.com's Thyroid Guide since 1997, is an internationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," "Living Well With Chronic Fatigue Syndrome and Fibromyalgia," and the "Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success." Click here for more information on Mary Shomon.