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Dr. John Dommisse's Publication Addresses Optimal Treatment For Hypothyroidism |
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Part 3: Diagnosing Hypothyroidism at TSH Above 1
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Join the Discussion
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"Has anyone tried, either as a patient of Dr. Dommisse, or by following his
recommended protocol, the Free T4/Free T3 management he recommends at his
site and in his paper?"
Mary
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An interview by Mary Shomon
Mary Shomon: This is a fairly medically-focused paper, and would certainly be of interest to medical practitioners working with thyroid treatment. How do you envision patients being able to use this paper?
Dr. Dommisse: In two ways: Either (1) passing a copy of the paper on to
their treating physician and asking him/ her to read it and consider
applying my method to their treatment of this patient; or (2) studying
the paper themselves and then attempting to get their FT4 and FT3 levels
to always be measured, at least, and ultimately to get them both optimized
by their treatment, regardless of whether their TSH level is then way
below its so-called 'normal range' or not.
Let me clarify why I keep referring to the TSH 'normal range' in
quotes, or as the 'so-called' normal range. When I started to treat
hypothyroid patients, back in 1988/9, I found several whose TSH level
was within its normal range but the patients had classic symptoms and signs
of hypothyroidism, including very high cholesterol levels, etc., etc.,
etc.. So I tried to find out how this 'normal range' was ascertained; I could
not find the answer to my question but determined, on my own, that the range
is actually much too high. I did discover two facts that supported my
decision: (1) Textbooks of thyroidology, particularly 'Werner &
Ingbar's The Thyroid, talked about a mild grade of hypothyroidism, grade-3, in which FT4 and FT3 levels are low-normal and the TSH is in the upper portion (undefined) of its normal range; and (2) I called a physician who had published a paper on grade-3 hypothyroidism: He and his colleagues had
defined grade-3 or 'subclinical' hypothyroidism as "Normal T4, T3 AND
TSH levels but in which there is an exaggerated jump in the TSH level after
A standardized length of time after a standardized dose of TSH-Releasing
Hormone (TRH) is injected into the patient": I asked him whether the
patients in whom this exaggerated 'jump' was found in the
post-TRH-stimulated TSH level were not actually also the same patients
in
whom the original, 'basal' sensitive TSH level was in the upper portion
of
its normal range: His answer was in the affirmative. At that time, the
TRH-stimulated TSH level was a $600 test. So I decided to simply bypass
this test in my patients and treat all those whose TSH level was above
2.0
mIU (in the presence of Low-normal FT4 and FT3 levels).
As time went on, I found that some patients whose TSH was even
below
2.0 (and whose FT4 and FT3 levels were low-normal) had classic
hypothyroid
symptoms and signs. So I started treating all those with TSH >1.5 (and
low FT4 and FT3). Eventually, I have ended up at 1.0 as my cut-off point
for the 3rd-generation TSH (when FT4 and FT3 are low-normal); I don't believe
I will ever go below 1.0 for a diagnosis of primary hypothyroidism
(meaning the deficit is in the thyroid gland). This does not by any means
exclude cases of secondary (pituitary), tertiary (hypothalamic) and nonthyroidal
hypothyroidism, in which the TSH is below that - or even below the lower
limit of its normal range - while the FT4 and/ or FT3 levels are below
their normal ranges.
Recently, on May 13 of this year, Dr Denis O'Reilly, of Glasgow, published a paper ( Thyroid function tests: time for a reassessment ) in the British Medical Journal on the unreliability of thyroid function tests (mainly the TSH), and revealed how the TSH
'normal range' was obtained. Apparently, 28 people who were presumed to be
euthyroid (have normal thyroid function), had their TSH levels measured.
When the small percentage of them whose TSH were at the low and high
extremes were removed, and the average range of the remainder
calculated, the world was provided with a range of 0.4-5.0. This range varies
slightly in different labs where it is measured, but within fairly close
approximation to this range. When it is realized how many people are
walking around with undiagnosed hypothyroidism, it can also readily be
realized that that original 'normal range' probably included people who
were hypothyroid, and therefore that 'normal range' is too high. Be that as
it may, and regardless of whether the sample did include patients who it
can now be agreed upon to be hypothyroid, or not, my judgment is that
patients whose 3rd-generation TSH level is above 1.0 (in the presence of
low-normal FT4 and FT3 levels) have grade-3, the mildest grade of, primary
hypothyroidism - and in every such case it has been my experience that
treatment has greatly benefited the patient and removed all the classic
symptoms and signs of hypothyroidism that they had previously exhibited.
Mary Shomon: How can readers obtain their own copy of this paper?
Dr. Dommisse: As I explained, because of the problems with getting this
leaked paper into a medical journal, I decided to simply copyright it
and e-publish it on my own website. So that is where it is available for
your readers right now. I believe it is easier and cheaper to obtain this
paper than any recently published medical journal article, so that is actually
an advantage for your readership. Of course, the more true my claim is
proven to be in the future (namely that this is the best way to approach the
diagnosis and treatment of all types and grades of hypothyroidism), the
more of an advantage it will be to them.
Note: To order the paper, which is $10, visit the order page at Dr. Dommisse's website.
> Page 1, 2, 3
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