- Some doctors feel that T4, T3, Free T4 and Free T3 tests must be done in addition to TSH in order to make a diagnosis.
- Some doctors test for antibodies, and even in the face of normal thyroid blood work, they will treat patients with symptomatic autoimmune disease, a practice which has been shown in studies to actually prevent progression to overt hypothyroidism. and reduce autoimmunity.
- Some doctors believe that taking the patient and family history, and performing a clinical examination for symptoms such as goiter, loss of eyebrow hair, slow Achilles reflex, and edema are as important -- if not more so -- in making a diagnosis of thyroid disease as blood tests.
- Despite pointing to several studies that show no benefits to treating subclinical hypothyroidism, there are as many studies that show benefits of treatment of subclinical hypothyroidism as far as effects on heart disease. Doctors are clearly not in agreement as to the pros and cons of treatment for subclinical hypothyroidism. There IS, however, conclusive evidence regarding the benefits of treatment of subclinical hypothyroidism as relate to fertility, ability to maintain a pregnancy, and fetal health and cognitive and developmental outcome of the child.
What Endocrinologists Don't Know
By Weetman's standards, nearly anyone can be an endocrinologist. Give me a TSH chart, and I'm off and running. Frankly, by Weetman's standards, you don't even need an endocrinologist. Just punch in a TSH level, and out comes the diagnosis: Thyroid Disease (if you're outside the normal range) or Somatoform Disorders (if you're symptomatic but in the normal range.) If it's this simple, actually, no one with hypothyroidism would even need to ever see an endocrinologist. Your GP, or primary care doc, nurse practitioner, school nurse -- heck, the volunteer manning the booth at the neighborhood health fair can do this! Weetman may be arguing himself out of a job!
But in the meantime, why don't endocrinologists seem to be able to understand that thyroid diagnosis and treatment is in fact complex? Perhaps, because they haven't studied it properly. For example, there are some very important things that endocrinologists don't know:
Endocrinologists don't know what the results would be if there were large-scale studies looking at dozens of quality of life and health factors as relate to optimal TSH levels by gender, age and hormonal status
Endocrinologists don't know what the results would be if there were large-scale studies comparing levothyroxine, levothyroxine plus synthetic T3 drugs, and desiccated natural thyroid drugs
Endocrinologists don't know what the results would be if there were studies on the ability of TRH Stimulation Test to detect subtle, functional hypothyroidism, compared to the TSH test. Cardiologists do not rely on an EKG when a cardiac stress test is needed to challenge the heart in action. Endocrinologists do not rely on a fasting glucose level when a glucose challenge test is needed to challenge the pancreas in action. Why is testing the thyroid in action -- as in a TRH Stimulation Test -- only done by a handful of practitioners in the U.S. and derided as "old-fashioned" and "unnecessary" by the rest?
Endocrinologists don't know that making patients "euthyroid" -- in the "normal range" -- is not the same as treating patients, healing patients, and making them well. Many of them seem to have forgotten that we are patients, and NOT lab values.
Endocrinologists don't know -- or don't want you to know -- that much of the thyroid disease research grants, event funding, educational materials and "latest knowledge" -- not to mention swag, freebies, samples, and golf trips -- come from the pharmaceutical companies, whose focus is on maintaining the dominance of the highly profitable synthetic levothyroxine, and keeping market share for a whole host of other profitable drugs -- cholesterol-lowering drugs, blood-pressure lowering drugs, antidepressants, and drugs for obesity.
Endocrinologists don't know that they are exhibiting the same sort of intellectual laziness and overt sexism that we've seen in doctors throughout history. Whenever there were perplexing illnesses and diseases that primarily affected women, women were written off as "hysterical" or "psychosomatic" before doctors discovered that there was a physiological basis.
History repeats itself, unfortunately.
Healthism is Here to Stay, Weetman
Weetman arrogantly blames what he calls "the rise of 'healthism.'" Weetman describes "healthism" as:
