Dateline: 6/1/98
A new Thyroid Disease Website reader, Karen, wrote me recently, and said something that just perfectly summed up exactly how many of us with thyroid disease feel.
I totally disagree with that scale [the TSH normal range] and how they tell me if I'm normal or not by that scale. It's like saying it's okay to be at a "D" because only "F" is failing. But why would I want to be at a "D" when I could be at an "A?!"
It's a really good question. Why would any of us want to be a "D" when we could be an "A?" Why would anyone want to settle for feeling lousy with a "normal range" TSH, when feeling good might be possible?
The problem is, we may not want to settle, but some of our doctors do.
Why are some doctors so quick to settle? Here, I speculate about some of the reasons.
They can only parrot back what they learn in medical school. And what the current generation of doctors has learned in medical school is that hypothyroidism is a simple, easily treated problem that requires giving the patient enough thyroid hormone replacement to get him or her into the normal range. Period. Once in normal range, a patient is considered euthyroid, (a fancy word for thyroid range is normal) and the doctor has fulfilled his/her treatment obligation. If a patient still complains of problems with weight, depression, exhaustion, fertility, hair, skin, libido etc., then the response is to attribute the problem to some other disease, or decide that it's emotional/psychosomatic/stress-related.
They only learned ONE way to treat hypothyroidism -- synthetic levothyroxine sodium, and, for some in particular, only the Synthroid brand. Synthroid's manufacturers are major grant-makers and funders of medical schools, endocrinological organizations, thyroid-related meetings and presentations, thyroid patient organizations, and any other place that doctors receive information about thyroid disease. Since the introduction of Synthroid as the first levothyroxine sodium product, there has been a frenzied need to create and build market major share for this product, and an effort that attempted to create the perception that this product alone is the best solution. And after many many millions of dollars a year in marketing and funding, the effort has worked. Synthroid is the top-selling thyroid drug in the U.S., and one of the top ten drugs sold in America.
The reality is that the majority of people with hypothyroidism DO respond well to conventional TSH-value treatment with levothyroxine sodium. Which brand, however, has more to do with the amount of marketing than quality or consistency. Levothyroid, Levoxyl, Euthyrox and Synthroid are all equivalent, and it's been proven in research that the Synthroid manufacturers attempted to suppress.
But if the company that makes Synthroid is integrally involved in the training of an entire generation of doctors, what else do you expect these doctors to tell you is the only way to treat hypothyroidism?
Their training, and the marketing juggernaut that is Synthroid, makes some doctors hostile to alternatives. Many conventional doctors are not only unwilling to discuss alternatives, but some are downright hostile when a patient asks about Thyrolar, Armour, Cytomel or Naturethroid. Where does this hostility come from? Most likely, from the before- mentioned inculcation into pharmaceutical-sponsored medical education and professional organizations, not to mention a fear of anything that isn't the latest. Many doctors claim that products like natural thyroid (Armour, Westhyroid) are antiquated, or inconsistent, or otherwise bad products. FDA sudies have shown that all the thyroid products, synthetic and natural, have fluctuations in consistency and potency, so that argument doesn't stand. Before Synthroid, these products were the ONLY treatment for hypothyroidism. Today, these alternative products are still sold, still available, and still approved by the FDA, and there's a simple reason why...they work better for some people. Many holistic MDs and osteopathic physicians prescribe the T4/T3 combinations, and natural thyroid drugs because they know that for some patients, these drugs are the only ones that truly work and resolve their patients' symptoms.
So don't expect to get a prescription from many mainstream doctors, and in fact, be warned that you may even get some abuse heaped your way. For example, Richard Guttler who labels himself a "thyroidologist" and charges patients hefty "payment required in advance" fees for his "Second Opinion" service on the Internet, tend to angrily dismiss patients who complain of unresolved symptoms and a desire to try alternative drugs. Recently, a website reader wrote to him to let him know that the absence of Synthroid after only three to four days relieved her of a persistent choking cough that she had been enduring for the past twenty (or more) years. She told him that she'd changed to Armour. He wrote back to her: "get a life! synthroid is not the cause of your problems."
Guttler has also graced me with his unique brand of "bedside manner" (lack of proper capitalization and punctuation is his):
"i'm glad all the "fringes" are filling up your e mail, not mine. it makes my life easier dealing with only the mainstream thyroid patients who would never think of taking armour or combo thyrolar or cytomel.what are you going to do when they finally take thyrolar off the market? next it will be natural designer organic bathtub thyroid personally brewed at your web site...dr.g"Unfortunately, there are others who work as doctors who have the same attitude as Guttler. He might be an extreme example, but I've heard from hundreds of people whose doctors laughed at them, derided them, or cancelled them as patients when they insisted on trying a different thyroid hormone replacement. When it comes to loyalty to the pharmaceutical companies, these fellows clearly know not to bite the hand that feeds them...
No one has studied in any meaningful way the implications of TSH values for different populations. Why is it that a doctor might be satisfied to get you into the normal range, and consider that all that's needed to treat you? Because they don't know WHERE in the normal range you actually belong, and they don't understand that there can be dramatic differences in how you feel based on where you are in the normal range.
For example, I feel TERRIBLE at 5, but pretty good around 1.5, but 1.5 might be too hyper for someone else. A normal RANGE is just that, a RANGE. It's not a fixed number, guaranteeing optimum health to anyone within the range.
What is the average TSH of a child, an adolescent girl, a 25 -year old man weighing 150 pounds, a pregnant woman, a menopausal overweight woman, a 75 year old diabetic man...WITHOUT thyroid disease? We don't know. We know the normal lab "range" may be anywhere from something like .5 to 5 or so, but we don't know the answers to these questions. Are there fluctuations in what the normal number is based on gender, age, hormonal status, weight, and presence of other diseases? Again, we don't know, because no one has studied this.
And among thyroid patients, WHERE in the normal range do they feel best? My endocrinologist firmly believes that most women thyroid patients feel best in the TSH of 1-2 range, and says above that level, there's difficulty in getting pregnant, losing weight, and getting rid of other symptoms. But this is her own anecdotal experience treating women with thyroid disease for 15 years. I asked her why there aren't any actual studies on this, and she said it's that thyroid disease simply isn't exciting enough to get research money.
Maybe if one of these medical organizations or "patient-oriented" groups actually funded this type of research, we'd know, and doctors wouldn't consider their job done when they medicate a patient to 4.9999999 TSH -- in the "NORMAL" range -- when over 5 is considered hypothyroid.
They simply don't understand the many implications of thyroid disease, but they just won't admit it. The basic problem is, once they've gotten you into normal range, offered or prescribed an anti- depressant, and told you to go on a low-fat diet and exercise more, they don't KNOW anything else to do to help relieve your symptoms. That is why some doctors are so quick to dismiss you, rush through your questions and shuffle you out, or keep trying various antidepressants, as if that were the real solution to your problems.
It'd be nice if the medical establishment and thyroid industry would admit it. They DON'T know the many ways that treated hypothyroidism STILL affects metabolism, mood, and bodily functions. They DON'T know how to resolve problems that still remain when TSH is normal, so they deny that the problems HAVE anything to do with the underlying thyroid disease. But WE KNOW it does. None of us had this litany of problems that can't be solved BEFORE the thyroid disease. It doesn't take a multi-million dollar double-blind study to tell ME that the health problems I'm dealing with now are because of my thyroid, normal rnage or no normal range!
As for the drug information, they ONLY know what they've been told by Synthroid-funded medical schools and studies. And they don't have the real hard data that will help them find the exact right dose for different types of people.
A "D" is NOT enough.
We ALL deserve to get an "A" when it comes to feeling well, and if your doctor's not the person to help you get that "A" then move on, and DON'T LOOK BACK.
If you have a doctor who laughs at you when you ask questions, derides you when you say you want to discuss alternatives, tells you to "Get a Life" when you are discussing your health, FIRE the doctor and get a new one! Write a letter to the HMO or health plan that employs the doctor. Send a copy to the American Medical Association, and the American Association of Clinical Endocrinologists and tell them how this doctor treated you and what he/she said.
Doctors are like plumbers. Would you keep using a plumber who laughed derisively at you if you asked him whether or not copper pipes might be good? No. You'd fire him and get a new plumber. A doctor is YOUR employee. If he/she doesn't do a good job, get RID of the doctor.
Find a doctor who listens, cares, has an open mind, and isn't some lemming, reciting pharmaceutical company literature by rote.
There are PLENTY of really good and caring doctors out there...we just need to find them, let people know about them, and stay away from people who seem to think heaping abuse on us or being narrow-minded and dictatorial is somehow a way to help us get well!
For help on finding a new doctor, you can check back issues of Sticking Out Our Necks, my news report for "Top Doc" listings. There may have been some Top Docs listed for your area. You can also post your request at my Bulletin Boards, located at You can also look for your own Top Doc using some of the referral options outlined in my article, Finding the Best Doctor Who's Right for YOU! -- Referral Sources.
Comment on what you've read here, and share questions, experiences and information with me and other readers and site visitors at the Thyroid Disease Bulletin Board. |
 | If you want to drop me a line, email me at thyroid.guide@about.com! |
 | A Great Idea!!! Subscribe to my Thyroid Disease News Report.
Thousands of people are already receiving Sticking Out Our Necks, my free, email news report on Thyroid Disease! Don't miss out on another information-packed issue!! Click here for more information and to subscribe! |
