In the course of successfully treating hypothyroidism (as well as most any other disease), Dr. John Lowe believes that relevant outcome measures are crucial. He says: "How else does the patient or clinician know with reasonable accuracy how well—or whether at all—the treatment regimen is working?"
According to Dr. Lowe, diagnosis comes first. In some venues, the clinician is limited in the number of blood tests he or she can order. This may be true, for example, in managed care or socialized medicine. When this is the case, he believes the clinician should order antithyroid antibodies.
Says Dr. Lowe:
Endocrinologist Dr. Robert Volpé made this clear to me. He wrote that a patient may be hypothyroid due to antithyroid antibodies for a few years before the TSH rises and thyroid hormone levels decline. Among people who consume enough iodine, the most common cause of hypothyroidism is autoimmune thyroiditis. Because the TSH and thyroid hormone levels may reveal the hypothyroidism only years after a person develops autoimmune thyroiditis, the proper protocol is clear to me: test thyroid peroxidase and thyroglobulin antibody levels before concerning oneself with the TSH and thyroid hormone levels. If the clinician is free to order these latter tests, that’s fine, but the antithyroid antibodies, to me, are far more important.Dr. Lowe still believes that clinicians or patients should order the tests, but if the tests are all in range, he feels a patient shouldn’t accept that he or she is negative for hypothyroidism. If the patient has symptoms and signs characteristic of hypothyroidism, he feels that a trial of thyroid hormone therapy is proper. According to Dr. Lowe, many patients, after beginning thyroid hormone therapy, recover from their symptoms and have a higher level of well-being. They improve despite never having had any lab test results that were consistent with hypothyroidism. For many patients, that is enough for them; they are satisfied with their treatment results.
However, as Dr. Bo Wikland has shown in Thyroid Science, many patients with hypothyroid symptoms caused by autoimmune thyroid disease do not have high antithyroid antibody levels. These patients may also have in-range TSH and thyroid hormone levels. Yet thyroid fine-needle aspiration shows that the patients’ thyroid glands are festering with inflamed and antithyroid antibodies. Laboratory tests, then, including antithyroid antibodies, are not particularly reliable.
According to Dr. Lowe, achieving optimal therapeutic results for many patients depends on them rejecting T4 replacement. Says Dr. Lowe:
Instead of using that commercially-driven alternative, they should use one of the generally more effective alternatives. These include T4/T3 combination therapy (with either synthetic or natural thyroid hormones), or T3 alone. And they should ignore their TSH levels when searching for the dosages that are optimal for them—“optimal” in the sense of relieving their symptoms without overstimulation of their tissues. As I said, relief of symptoms and better well-being are sufficient for many patients. However, some patients get optimal results only when they also include physiological measures in their treatment regimen. I know some patients who obtain hand-held indirect calorimeters and actually measure their own basal metabolic rates. I know of no other physiological measurement that is more meaningful and useful. There are other relevant and useful measures, though, such as the basal body temperature, basal pulse rate, body weight, and perhaps the voltage of the R-wave on one’s ECGs/EKGs.In finding their safe and effective (optimal) thyroid hormone dosage, some patients use all of these physiological measures and they estimate of the intensity of their hypothyroid symptoms at close intervals to learn whether a particular thyroid hormone dosage is moving them in the right direction. And if they started out with high antithyroid antibody levels, they measure these again at intervals to ensure that their thyroid hormone therapy has acceptably lowered the levels. For Dr. Lowe, patients monitoring their responses to thyroid hormone therapy with these tools constitutes the best of outcome testing, which, in his experience, is more likely to provide patients with optimal treatment results.
Dr. John Lowe is a long-time thyroid and fibromyalgia researcher and practitioner, and Editor of the journal "Thyroid Science."
Source: Email interview with John Lowe - December 2010