To describe optimal thyroid treatment, Richard Shames, MD and Karilee Shames, RN, PhD want to first describe what is likely NOT optimal.
Have you ever had a practitioner tell you "Your tests show that you are on the optimal dose right now. I won't be able to increase you any further." Frustrated, you realize that despite several increases, you've had barely any improvement in symptoms, and feel like what you're on now is just barely working, and explain to your practitioner that you are sure you need more medicine. Your practitioner apologizes, and says "Your thyroid treatment is optimized. A larger dose could be harmful in the long run. Although your improvement on this dose might become somewhat better over time, it may be that in your particular case, this is as good as it gets." There are several things wrong with this type of approach.Error #1 -- The Wrong Dose: The Shames believe that a common mistake is when a practitioner prematurely stops upward dosing, based solely on the blood tests. Their take: "Often the deciding blood test is a TSH level, but even a full panel of thyroid tests is overrated. Blood tests alone, whatever ranges of normal are used, should not be the sole arbiter of therapy. They are just not reliable enough."
The Shames believe that practitioners need to base recovery partly on the improvement of initial physical exam signs such as slow pulse, low blood pressure, fluid retention in the lids or tongue, poor heart sounds, diminished muscle strength, decreased knee and ankle reflexes, chilliness of skin, decreased basal temperature. And primarily, they believe that a thyroid dose is not correct until the patient feels substantially better. They say: "We believe that thyroid treatment is not optimal unless patients' major thyroid symptoms are relieved to their satisfaction. Thus, it should not be up to the practitioner to say when a patient's status is optimized."
Error #2 – Lack of True Partnership: According to the Shames, in many exchanges, it is clear who has the absolute power of decision-making, and it is not the patient. They believe that a very different power sharing would be much better suited for optimizing thyroid care.
We believe there will be greatly improved patient outcomes when more practitioners cultivate the mindset of being a hired tour guide -- with the ability to write prescriptions. Patients get to choose their destination and mode of travel, while the guide figures out the best route of getting there and watches out for trouble along the way.Error #3 – Diminished Freedom of Choice: According to the Shames, they have seen a great many patients overcome illness and adversity by tapping into a deep sense of personal empowerment. Research shows that when dealing with autoimmune related illness like thyroid imbalance, patients do best when allowed to be captain of their own ship. This means freedom of choice amid the wide variety of diagnostic and therapeutic modalities. In the conversation above, the patient was most likely taking thyroid medicine of the practitioner's choosing, probably a T4/levothyroxine drug like Synthroid.
Says Dr. Richard Shames:
I believe that if the patient deep down wanted to be on desiccated thyroid (like Armour or Nature-Throid), then that may well have been a more favorable choice. I further feel that if this patient were to now make the sensible request of adding 5 micrograms of T3 (Cytomel or generic liothyronine) to their T4, the practitioner could promote further healing by honoring that choice. Some patients know enough about their own allergies to want hypoallergenic compounded thyroid capsules. Others know enough about their sensitive digestive tracts to want compounded transdermal thyroid creams. We practitioners could grow and learn by more often trying to honor our patient's choices. For example, many of the patients at our clinic express interest in thyroid-friendly mind-body therapies, such as massage, biofeedback, stress reduction training, energetic healing, imagery, deep-tissue bodywork, and emotional release. We honor that interest, either by my prescribing visits with local practitioners or by Karilee directly providing the service on site. Either way, we often find that our thyroid patients experience surprisingly good results.Error #4 - Fearful, Pessimistic Attitude: The Shames believe that medical schools and HMOs need an improved approach to the power of positive thinking.
"We've found that these days, far too many health providers seem worried that their next prescription will cause someone's osteoporosis or heart attack. Research does not at all support these fears. Yet this negativity persists, and has become a self-fulfilling prophecy. Large numbers of thyroid patients are currently under-medicated, due to subtle practitioner fear combined with the tyranny of overrated tests. Under-medicated patients often feel terrible. Pessimism reigns when it comes to planning "optimal" treatment outcomes for hypothyroidism. These days we seldom hear a standard practitioner say, "We're going to keep treating and curing that thyroid condition till you are as good as new. And then you won't need that thyroid medicine anymore." The good news is that cures can and do happen. They would happen more often, with more positivity and courage on the part of us practitioners, as well as our patients.