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Practitioners Share Their Approaches to Optimal Hypothyroidism Treatment

Treating an Underactive Thyroid


Updated June 18, 2014

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. 

1. Kent Holtorf, MD on Optimal Treatment for Hypothyroidism

Kent Holtorf, MD
In this article, Kent Holtorf, MD discusses his approach to optimal hypothyroidism treatment. Dr. Holtorf is the founder of the California-based Holtorf Medical Group, which specializes in treating complex endocrine, hormonal and other illnesses.

A highlight:
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

2. Erika Schwartz, MD

Erika Schwartz, MD
Erika Schwartz, MD shares her thoughts on how to optimally treat an underactive thyroid. Dr. Schwartz is a holistic physician, founding director of the Bioidentical Hormone Initiative, and Chief Medical Officer for AgeMD: The Age Management Institute, a practice in New York City that focuses on hormone treatment, nutrition, and integrative health approaches.

An excerpt:
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

3. Theodore Friedman, MD, PhD

Theodore Friedman, MD, PhD
Theodore Friedman, MD, PhD looks at how he diagnoses and treats hypothyroidism in his patients. Dr. Friedman is a practicing endocrinologist in the Los Angeles area, Chairman of the Department of Internal Medicine, and Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Endowed Professor of Cardio-Metabolic Medicine, and Professor of Medicine at The Charles Drew University of Medicine & Sciences in Los Angeles, and a Professor of Medicine at UCLA.

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

4. Richard Shames, MD and Karilee Shames, RN, PhD

Richard Shames, MD / Karilee Shames, RN, PhD
Richard Shames, MD and Karilee Shames, RN, PhD share their ideas on optimal treatment of hypothyroidism. They are the authors of two books on thyroid disease, "ThyroidPower" and "Fat, Fuzzy and Frazzled," and are in practice in San Rafael, California.

An excerpt:
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

5. Ken Woliner, MD

Ken Woliner, MD
Ken Woliner, MD explores his perspectives on the optimal treatment of the underactive thyroid condition known as hypothyroidism. Dr. Woliner is board-certified holistic physician and his practice, Holistic Family Medicine, is located in Boca Raton, Florida.

A highlight:
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

6. John Lowe, DC

Dr. John Lowe
John Lowe, DC shares his viewpoints and approach to diagnosing and optimally treating hypothyroidism. Dr. Lowe is a long-time thyroid and fibromyalgia researcher and practitioner, and editor of the journal Thyroid Science.

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

7. Robban Sica, MD

Robban Sica, MD
Robban Sica, MD explores her perspective on how to optimally treat hypothyroidism. Dr. Sica is an integrative physician, President of the International College of Integrative Medicine, and a member of the Board of Directors at Alliance for Natural Health. Her practice, the Center for the Healing Arts, is located in Orange, CT.

An excerpt:
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

8. Datis Kharrazian, DHSc, DC, MNeuroSci

Dr. Datis Kharrazian
Datis Kharrazian, DHSc, DC shares his approach to optimally treating a hypothyroid condition. Dr. Kharrazian is author of the book Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?

A highlight:
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

9. Sara Gottfried, MD

Sara Gottfried, MD
Sara Gottfried, MD discusses her approach to providing optimal care for her hypothyroid patients. Dr. Gottfried is an integrative physician and holistic gynecologist, and founder of the Gottfried Center in Oakland, California.

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

10. Ron Manzanero, MD

Ron Manzanero, MD
Ron Manzanero, MD explores his ideas on optimal treatment of hypothyroidism. Dr. Manzanero is an integrative physician with expertise in hormone balance and pain management. He is the founder of the Austin Integrative Medicine clinic in Austin, Texas.

A highlight:
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

Mark Starr, MD
Mark Starr, MD expands on his approach to optimal hypothyroidism treatment. Dr. Starr is author of the book Type 2 Hypothyroidism and founder of the 21st Century Medical practice in Paradise Valley, Arizona.

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
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