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Fighting the Dogma of Dr. Guttler and the "Real Thyroid Experts"

Dr. John Lowe Publishes Scientific Critique

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Updated June 11, 2014

One of the key issues, since this site's start in 1997 as the first information/advocacy site for thyroid patients worldwide, has been my focus on ensuring patients receive the information they need to get the quality care they deserve. For hypothyroidism, that has been a controversial issue.

The prevailing dogma says that all you need to know is that the TSH test is the gold standard for diagnosis, and the only treatment is T4-replacement/levothyroxine. Even then, the dogma usually stipulates that you use Synthroid, the top-selling levothyroxine drug, the most expensive of all the brands, the one that has legions of drug reps in its employ, and the one that not coincidentally spreads around millions in research money, grants, honoraria, freebies, samples, and support to doctors, endocrinologists, professional groups and patient organizations each year.

But all along, I have maintained that patients deserve to know that:
  • there are other brands of levothyroxine than Synthroid, and despite a doctor's allegiance to one brand, another brand may work better for you (not to mention cost you far less)
  • some patients will not be relieved of their hypothyroidism symptoms -- such as fatigue, depression, weight gain -- despite treatment to the so-called "normal range," and will need additional treatment to regain their health
  • patients deserve to know that there are other thyroid medicines that for some, may better relieve their symptoms -- additional T3 as Cytomel or time-released T3, a synthetic T4/T3 combination Thyrolar, or the natural desiccated prescription thyroid drugs Armour and Nature-throid
  • the TSH test itself is one part of diagnosing thyroid problems, but T4, T3, free T4, free T3 tests, antibodies tests, clinical evaluation of signs and symptoms, and consideration of medical and family history, should also be part of a thorough diagnostic process for thyroid disease
  • The TSH "normal" range that is used to rule thyroid disease in and out may not be relevant on an individual basis, it may be flawed, and it is subject to change, making it a rocky foundation on which to base an entire diagnosis and treatment regimen
For continuing to provide this information to patients, I have been mocked, derided, and both publicly and privately attacked, by heads of medical groups, by pharmaceutical companies, and in particular, by some of the most dogmatic practitioners, who identify themselves as the "real thyroid experts." One in particular, Dr. Richard Guttler, who runs a for-profit "Second Opinion" service by phone and email out of his Thyroid.com site, has been particularly vehement in attacking me.

If you asked Dr. Richard Guttler, or others who identify themselves as "real thyroid experts," most would insist that I'm wrong, and that the following statements are true:
  • "Real thyroid experts" should restrict patients to ONLY T4-replacement
  • There is NO BENEFIT to using T3 in treating hypothyroidism, so the treatment should be T4-replacement
  • Most patients on T4-replacement after antithyroid therapy DON'T gain weight
  • Patients DON'T have chronic fatigue or depression after becoming hypothyroid despite using T4-replacement
  • TSH and free T4 levels CAN NOT possibly lead to different conclusions about a patient's thyroid status depending on when her blood is drawn
  • TSH and free T4 levels CORRESPOND to patients’ TRUE clinical status
But NOT SO, says the late researcher Dr. John Lowe, who in a detailed critique , systematically and scientifically debunked every one of these dogmas, citing recent research in the field of endocrinology to back up his discussion. Dr. Lowe explores how Dr. Guttler and many of his fellow "real thyroid experts" regularly fail to comply with the professional scientist's principle of evidence-driven medicine.

Says Dr. Lowe: "their beliefs aren't just dead, they're in rigor mortis..."

If you are dealing with doctors who are basing their treatment of you on out-of-date information about thyroid disease, or who feel that you don't have the right to the kind of information I provide you here at the site, this is a report you must read (PDF format). And don't forget to print out a copy for your doctor, who will find it hard to refute, given the more than 90 citations, many being references to their own most highly respected peer-reviewed, double-blind medical journals.

I wish to thank the late Dr. Lowe for so eloquently and intelligently laying out the argument for as to why our current crop of self-proclaimed "thyroid experts" need to have a major shift in their thinking about thyroid diagnosis and treatment. Dr. Lowe was truly on the side of the patients, and, like me, believes that we are people and patients...NOT lab values.

I urge you to read Dr. Richard Guttler and the "Real Thyroid Experts": Their False and Potentially Harmful Beliefs by Dr. John C. Lowe.

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