Dick Guttler doesn't want you to get a TRH test. And while he's at it, he doesn't want you to get Armour Thyroid either.
Guttler's main claim to thyroid fame has been owning the thyroid.com domain, and starting his own medical society so that he could award himself credentials as a "thyroidologist" (an artificial term that doesn't exist among legitimate endocrinologists) and therefore make himself president of his ersatz "Academy of Clinical Thyroidologists."
Now, he wants to eliminate some testing and treatment options for patients, including the TRH test, a stimulation/challenge test that measures the thyroid's ability to respond when stimulated.
The TRH test is s considered by some practitioners to be the best way to identify functional hypothyroidism -- an inability to produce thyroid hormone when needed -- in people who appear to have normal circulating thyroid levels.
Commenting on my recent article "Return of the TRH Test", Guttler, at his thyroid.com site blog, said:
"...there is no need for it [the TRH] now that it's [sic] value as a sensitive testing agent has been replaced by a newer, better baseline TSH."
Guttler also later goes on to say:
"TRH is similar to museum quality drugs such desicated [sic] thyroid. They have served their purpose well, but are outdated and not needed anymore."Actually, Guttler has resorted to his favorite fall-back approach when faced with the truth about thyroid treatment -- he hands down his opinions, rather than providing any medical facts or information that will help patients get well.
For example, Guttler ignores the fact that medical stimulation tests are becoming increasingly popular to measure the effectiveness of other glands and organs in action, particularly in endocrinology. By his logic, Guttler could argue because insulin tests are so accurate, that fasting insulin levels -- the measure of the pancreas' response at one single moment in time -- is a better measure of potential diabetes than a glucose tolerance/challenge test that shows what happens over time?
And by his logic, Guttler could suggest that an EKG given to someone lying on a table is a better way to measure heart attack risk than a cardiac treadmill stress test.
These sorts of ideas are, of course, medically unacceptable.
Understanding how a gland functions under stress and stimulation -- in action, when secreting hormone -- may give a far better picture of problems, especially subtle ones, than a test of circulating hormone levels from one static moment in time.
Guttler's deriding the test as "outdated" is simply opinion -- it's not medical fact. Where is the peer-reviewed, double-blind studies that establish that desiccated thyroid and the TRH test are outdated and not needed?
We have an endocrinology community that can't even agree about how to use and interpret their beloved TSH test, and even then, there are some 30 million people who aren't even yet diagnosed. Where are the studies that show that the TSH test is more capable of and effective at picking up subtle -- but symptomatic and treatable -- hypothyroidism, versus the TRH test?
As for desiccated thyroid, more than 2 million prescriptions for Armour were written last year. I think if you talked with the hundreds of thousands of patients taking Armour, and the many doctors prescribing it for them, they'd all agree that the drug is very much needed.
As for his continuous antipathy to Armour desiccated thyroid, a prescription drug that has been safely available for 100 years, there's no need to look further than his sponsor's list -- with Abbott Labs, maker of Synthroid, at the top of the list -- to explain his slavish and self-interested devotion to levothyroxine.
Simply because a test or medication fell out of favor with Dr. Guttler does not mean that it's not effective, valuable, or worthwhile for patients, as well as the compassionate, innovative physicians who truly care about the health and quality of life of those patients.
I don't expect Dick Guttler to respond, because when asked to actually back up his opinions, he never does. Because to borrow his words, he is, as usual, wrong again.
May 8 '06 Update: Gutter's rambling, ranting, typo-filled response
Read More About Thyroid.com's Dick Guttler:
- Fighting the Dogma of Dr. Richard Guttler and the "Real Thyroid Experts"
- Is Thyroid.com's Richard Guttler Becoming Unhinged?