A number of innovative experts on hormonal health have shared their thoughts about what constitutes optimal treatment for hypothyroidism, and their approaches to providing optimal treatment for people with an underactive thyroid. The varying approaches represent a variety of conventional, holistic and integrative ways to diagnose and treat hypothyroidism.
A normal TSH does not rule out thyroid dysfunction and a low TSH is shown to be an indication of excessive tissue thyroid levels only 20% of the time (80% of the time that is not the case). The TSH becomes an extremely poor marker for tissue thyroid levels if there is any inflammation, depression, chronic illness, chronic dieting, obesity, stress, chronic fatigue syndrome, fibromyalgia, diabetes, insulin resistance, leptin resistance present.
-- Kent Holtorf, MD
Using an arbitrarily determined, absurdly broad range blood test (TSH) as the primary and often sole marker and decision maker for the diagnosis and treatment of hypothyroidism doesn't work and is illogical if we are looking to help patients feel better...
-- Erika Schwartz, MD
An excerpt from the information on Dr. Friedman:
[Optimal] thyroid hormone replacement [is] based on three factors: how the patient is feeling, the patient's thyroid function tests, and side effect profile.
-- Theodore Friedman, MD, PhD
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.
-- Richard Shames, MD, Karilee Shames, RN, PhD
Regardless of "normal labs," when there aren't other obvious causes of troublesome symptoms that are likely caused by hypothyroidism, I will empirically treat the patient with thyroid hormone to free her/him from their suffering.
-- Ken Woliner, MD
A key point from his article:
Clinicians or patients should order the tests, but if the tests are all in range, a patient shouldn’t accept that he or she is negative for hypothyroidism. If the patient has symptoms and signs characteristic of hypothyroidism, a trial of thyroid hormone therapy is proper.
-- Dr. John Lowe
Since I believe that hypothyroidism is a clinical diagnosis, the lab values are not the determining factor for me. Many clinically hypothyroid patients have test results within the reference range and yet respond beautifully to treatment.
-- Robban Sica, MD
It is not simple, quick, or easy, and it most often involves lifelong dietary and lifestyle changes, but a faltering thyroid is a warning that must be heeded before the person's health deteriorates further.
-- Dr. Datis Kharrazian
A key point:
So many of my hypothyroid patients also have adrenal dysregulation, and don't feel better on thyroid augmentation unless their adrenals are optimized simultaneously.
-- Sara Gottfried, MD
Many times patients can have a "normal" TSH test and yet sit there in front of the doctor with physical signs such as, dry parchment-like skin, thinning of the outer third of the eyebrows, dry straw-like hair or thinning of the hair on the scalp and extremities...
-- Ron Manzanero, MD
11. Mark Starr, MD
A central point:
The majority of patients I see have mild to moderate adrenal deficiency that must be addressed before starting thyroid hormones.
-- Mark Starr, MD