An Interview With Glenn Rothfeld, MD

By Mary Shomon

Glenn Rothfeld, M.D. is founder and medical director of WholeHealth New England, an integrative medicine practice. He has practiced both conventional family medicine, and complementary therapies since 1977. He is Clinical Assistant Professor of Family Medicine at Tufts University School of Medicine, where he teaches. He holds one of the nation’s first Masters’ Degrees in acupuncture, and has practiced acupuncture since 1985. Dr. Rothfeld is the author of 8 books on natural medicine topics, the most recent being Thyroid Balance, which was published in 2003. In July of 2003, I had an opportunity to ask Dr. Rothfeld about his approaches to thyroid treatment, and some of the theories he discusses in his book.

1. You talk in the book about the "find it, fix it" mentality we see among many medical practitioners. Can you describe a bit more what this is, and why it's such a problem for thyroid patients?

"Find it, fix it" is the prevailing attitude in much of conventional medicine, and leads toward a very restricted view of health and disease. The psychologist Larry LeShan has written about "the Mechanic" and "the Gardener." Conventional, modern doctors are like mechanics; they look for specific problems (usually abnormal laboratory tests) and take measures to correct them, without much attention to the overall picture or how that problem developed. A gardener doesn't only attack problems themselves (imagine going out to the garden with a knife and cutting out all the black spots on your tomatoes!) but considers the weather, condition of the soil, watches the growth pattern, and comes to understand why the plant grows like it does. In medicine, this means taking a "holistic" look at the patient, including the diet and nutritional status, the genetics, the effects of environment, and thereby understanding why certain symptoms occur.

In conventional medicine, we spend a lot of time chasing down lab numbers and treating them. The current rage of treating serum cholesterols of barely over 200 with drugs is one example. Certainly a very common example is the reliance on TSH measurements as the sole determinant of thyroid function.

This mindset has prevented thousands of people from getting the proper hormonal support that they need, and has ignored the fact that the thyroid is intimately connected to the other hormonal and organ systems. And, it controls metabolism in all the cells. If the metabolism is sluggish, the thyroid function has to be considered, whether the test is "normal" or not.

Do you feel that the "find it, fix it" mentality toward thyroid disease is changing for the better?

I think this "find it, fix it" mentality is still pretty ingrained in the medical system. While I think that liberalizing the rigid definition of a TSH of 5.5 or below as "normal" is helpful, we remain with a system that looks at a single number for the choice of treatment or not, instead of taking a broad look at metabolism and the factors that can affect it.

2. What are your thoughts about the that are looking to revise normal range to .3 to 3.0?

In the past, BMR (basal metabolism rate) was replaced by T3 and T4, then by TSH as the true measurement of thyroid function. Each time, a group of people not previously defined as low thyroid were included in the new definitions. Revising the TSH normals to define anything over 3.0 as hypothyroid will help some of the patients who have previously gone untreated, and I support it.

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