I've been a patient of Lemmerman, who is in private practice in Northern Virginia, for more than 15 years. "Dr. Kate," as she likes to be called by all her patients, was conventionally trained as a physician. But she quickly realized that she was drawn to a more integrative approach and added acupuncture and osteopathy to her family medicine and general practice approach. In the tradition of integrative medicine, Dr. Kate brings the best of both worlds -- conventional and holistic medicine -- to her hands-on, empathetic approach to patient care. In recent years, she has been caring for a growing subset of patients with thyroid, hormone, and adrenal disorders, and has successfully worked with many patients to help treat these chronic conditions and imbalances.
Dr. Kate has been an integral part of my diagnosis and treatment. Working with her has given me the confidence to ask questions, trust my instincts, and take the time to study and understand new ideas before jumping into trying something untested or alternative. I wouldn't have learned how to be an advocate for myself in all facets of my health care without the partnership I've developed with Dr. Kate.
Since I'm always the first person to suggest that patients go doctor shopping -- (Don't believe me? See my article, Ten Signs You Need a New Doctor) -- I feel quite fortunate to have such a long-standing relationship with a physician I trust. I'm pleased, therefore, to have this opportunity to interview her and share her thoughts with my readers.
Mary Shomon: How do you think thyroid diagnosis and treatment has changed since you first went into practice?
Kate Lemmerman, MD: When I first started practicing, Synthroid was the drug to use...period. A few doctors used Armour thyroid and a few used Cytomel, but it was rare. Since that time, there has been some research showing how helpful the addition of T3 is to many patients. While many endocrinologists still take a dim view of Armour thyroid -- we were all taught in medical school that its potency was unreliable -- I find that more and more patients are being tried on a variety of thyroid preparations. We are also realizing for autoimmune thyroid conditions that it is especially helpful to work with T3 and to treat until the TSH is close to 0.5, rather than being satisfied with a TSH of 3 or 4.
Mary Shomon: What do you feel that a holistic or integrative doctor like yourself brings to thyroid care that patients find unique, or possibly better, compared to a purely conventional practitioner?
Kate Lemmerman, MD: I find the holistic way of looking at thyroid disease to be quite important. We take into consideration factors such as adrenal stress and its role in driving up Reverse T3, as well as the use of supplements such as DHEA, licorice root extract, phosphatidyl serine, magnesium, and B vitamins, which support the adrenals. Many of my patients who still feel fatigued and rundown despite good readings on TSH, T3 and T4 improve when I add the appropriate amount of the above supplements. Also, looking at diet, exercise, life stressors and sleep patterns makes a tremendous difference. In addition, I've found that the use of acupuncture can help with many of the problems associated with thyroid disease.
Mary Shomon: Do you feel like the current way of diagnosing thyroid disease -- the TSH test with the "official" normal range of .5 to 5.0 -- is adequate, or is it missing people who have thyroid disease?
Kate Lemmerman, MD: I think the ideal TSH is probably closer to 0.5 to 3.0, and this is increasingly becoming the accepted numbers among thyroid specialists. If someone has autoimmune disease of any sort, for example lupus or rheumatoid arthritis, then I find targeting them toward a TSH of 0.3 to 1.0 will generally improve energy level and a sense of well-being.
Mary Shomon: When you suspect someone is hypothyroid, what tests do you consider essential in order to make -- or rule out --a thyroid diagnosis?
Kate Lemmerman, MD: To begin with, I order a panel of labs, including TSH, Free T4, Free T3 (not total T3 and definitely not T3RU, which I find useless). If these are normal, but the patient has a number of symptoms pointing to thyroid disease, then I will add the more expensive tests for thyroid antibodies, Reverse T3, cortisol and DHEA-Sulfate.
Mary Shomon: What else do you feel is particularly important to your thyroid evaluation of patients?
Kate Lemmerman, MD: The most important part of the diagnosis is a thorough history: What is your family history of thyroid disease and autoimmune diseases? Did your symptoms begin at a time of other hormonal changes, such as childbirth or menopause? (These periods can affect the thyroid, as the whole endocrine system is interrelated.) Is there a history of radiation to the thyroid area? (I have seen women become hypothyroid after radiation for breast cancer, especially those cancers high on the chest wall). The physical exam is also very important: Dry skin, thinning hair, puffy eyes, fluid retention, overly slow or overly fast reflexes -- the latter often shows up when people have a combination of hypothyroidism, low magnesium ,and adrenal dysfunction.