Today Show Doctor's Thyroid Mixups

December 1, 2002 -- Television news is where the majority of Americans get their medical and health news information. Unfortunately, the accuracy of television health reports is frequently in question. The concern over accuracy was in evidence this past weekend, when NBC's "Today" show contributor, Judith Reichman, MD, appeared on the "Weekend Today" show to do a segment titled, "Thyroid or Menopause."

It's truly commendable that Weekend Today tackled the often overlooked topic of hypothyroidism. Unfortunately, while the Today show web site claims that Dr. Reichman "helps to sort through the confusion," Dr. Reichman has actually added to the confusion by presenting incorrect information in both her television segment, and in the NBC news web article.

Just a TSH Test, Forget the "Fancy-Schmancy Tests?"

First, Dr. Reichman said: "If the TSH is high, some doctors will want to proceed further and check all of the thyroid hormones (T3, T4 and Free Thyroxin Index), but those are fancy-schmanzy (sic) tests which just confirm what the TSH has already told us."

Actually, the T3, T4, Free T4, and Free T3 tests are used to diagnose and confirm various forms of secondary and tertiary hypothyroidism, as well as thyroid disorders caused by pituitary or hypothalamic dysfunction. Since the topic was hypothyroidism and menopause, Dr. Reichman will also want to make her viewers and readers aware that the use of estrogen -- whether via the pill, or hormone replacement therapy -- can affect T4 and TSH levels.¹ Dr. Reichman also failed to mention thyroid antibody tests, which are used to diagnose Hashimoto's and Graves' disease, autoimmune conditions that are the two most common causes of all thyroid conditions.

The Right Thyroid Dose Doesn't Change?

Second, Dr. Reichman says: "The good news is that once you settle on the right dose, it generally doesn't change."

In fact, Dr. Reichman is incorrect, and many factors can cause a dosage change. According to the medical literature, dosage requirements can change from winter to summer, during and after pregnancy, with weight gain or weight loss, when starting or stopping a high-fiber diet, when starting or stopping estrogen medications, when starting or stopping anti-depressant medications, when starting or stopping a high-isoflavone/soy diet, or when in perimenopause or menopause. It can also change in response to use of supplements containing calcium or iron, among other interactions.

Levothyroxin? Levoxil?

Third, in the original version of the web article, Dr. Reichman misspelled several names of medications. The generic term is levothyroxine, not "levothyroxin" as Dr. Reichman wrote. Also, one brand name of levothyroxine is Levoxyl, not "Levoxil" as she wrote in her article. These errors have since been corrected.

Natural Thyroid is Made from Cows?

Fourth, in the original version of her article, Dr. Reichman states: "'Natural' thyroid is made of desiccated thyroid that is collected from cows at slaughter houses."

Dr. Reichman is wrong. Natural thyroid has not been derived from cows for decades. The key brands of natural thyroid, including Armour, Naturthroid and Biotech, are all derived from porcine (pig) thyroid. This can be confirmed by reviewing the website of the top selling natural thyroid product, Armour Thyroid, at www.armourthyroid.com. After being notified about this error, it was corrected several days later.

Natural Thyroid's Purity and Activity Can Vary?

Fifth, Dr. Reichman also states regarding natural thyroid that "some clinicians are concerned that the purity and activity can vary."

Dr. Reichman may be unaware that to ensure that these products are consistently potent from tablet to tablet and lot to lot, analytical tests are performed on the thyroid powder raw material and on the actual tablets to measure actual thyroid hormone levels. Various lots of thyroid powder are then mixed together and analyzed to achieve the desired ratio of T4 to T3 in each lot of tablets. This method ensures consistency according to the United States Pharmacopoeia (USP) official standards and specifications for desiccated thyroid consistency. Dr. Reichman may also not be aware of the purity and consistency problems that besieged the levothyroxine products for decades until the recent drug approval process mandated by the FDA.