Why don’t all doctors take the same approach when diagnosing and treating thyroid issues?
#1 Doctors Look at the Wrong Hormone to Determine Thyroid Activity
Thyroid replacement is a difficult process primarily because doctors have been trained for decades to make a decision about thyroid replacement by looking at just one lab, TSH. TSH is the thyroid-stimulating hormone that stimulates the thyroid to make T3 and T4. TSH is from the pituitary and is not a measurement of the REAL thyroid hormone, but the hormone that stimulates the thyroid, not the thyroid hormone itself! Doctors were taught this method of thyroid replacement, that a high TSH means low thyroid and a low TSH means a high thyroid activity, but that is rarely a dependable way to measure true thyroid activity. Most doctors don’t question this method and keep making the same mistake, by following the advice of their older peers.
Doctors who know that thyroid testing has become more accurate and repeatable in the last 40-50 years should question why we still use an undependable method of judging the health one of the most important hormones to human endocrine activity. Doctors should therefore discard the archaic method of diagnosing thyroid hormone dysfunction and order blood levels of the actual thyroid hormones T3 and T4 in addition to the TSH. Mystifyingly the practice of Endocrinology has clung to the wrong test to measure whether a patient needs thyroid hormone replacement for decades without even questioning the outdated practice!
Let me compare the way we diagnose Thyroid deficiency with Testosterone deficiency. Earlier in this book we described how doctors diagnose testosterone deficiency by measuring the hormone in question, testosterone, and the active portion of that hormone (free testosterone). By testing these two tests of the actual hormone doctors make a decision about whether a man needs testosterone replacement, based on whether the actual hormone in question is high/low, or normal compared to young healthy adults. If we were to measure a man’s need for testosterone by only measuring the stimulating hormone, LH, we would be wrong more times than we are right.
What should doctors test to determine thyroid health?
- T4 is the thyroid hormone—tyrosine + 4 Iodines—that tells us part of the story about thyroid health in men. “Free” T4 is the active portion of the hormone that your body feels.
Free T4 0.9-1.4 is a normal level
Free T4 < 0.9 is Low thyroid
Free T4 > 1.4 is hyperthyroid
- T3 is a thyroid hormone, the most active form of thyroid-tyrosine + 3 Iodines-that tells us part of the story about thyroid health. “Free” T3 is the active portion of the hormone that your body feels.
Free T3 3.0-4.5 is normal
Free T3 < 3.0 is low thyroid
Free T3 > 4.5 is hyperthyroid
- TSH normal for men is 0.3-4.4 is normal functional thyroid
TSH > 4.5 is Low thyroid—hypothyroid
TSH < 0.3 is hyperthyroidism
#2 Mistake Doctors Make is they Just Look at the TSH Level When Determining Whether the Proper Dose of Thyroid is Given
Endocrinologists and PCPs just monitor the TSH level when testing whether a man has enough thyroid hormone. They think that replacement is measured just like the patient is making it themselves. Granted, we use the same blood test, but we must look at it differently when a man is on thyroid medication.
Most doctors use the thyroid panel in the same way as they do when looking at a patient who is NOT on thyroid replacement. They think that if a man’s TSH is less than 0.3 then he is over replaced and decreases the dose of medication without looking at the thyroid hormones free T3 and free T4, and those are they true measure of the thyroid hormone’s effectiveness. The free T3 and T4 should be within normal limits and the TSH can be low because it is not needed if you are taking thyroid hormone and not making it. Limiting your lab to just the TSH when adjusting the dose of the thyroid medication is the only lab current doctors look at and managing thyroid like that is wrong!
When adjusting thyroid medication dose a doctor must look at the same tests differently, than when a patient is making his own thyroid.
#3 Doctors Don’t Have their Patients Refrain from Taking the Thyroid Hormone Right Before their Blood Test
When a man is on thyroid, we must make sure the man didn’t take his thyroid medication immediately before blood testing. For a few hours following thyroid ingestion the T3 and T4 will be very high and the TSH very low, but that surge does not represent the thyroid levels for the rest of the day. A patient must hold their thyroid dose until after the blood test.
#4 Patient’s Symptoms are Ignored
Why do doctors fail to treat hypothyroidism at all or undertreat men with too little thyroid? This is because doctors don’t ask patients the right questions because looking at numbers is quicker. So if you are suffering from depression, you are more likely to get an antidepressant than thyroid medication, even if you have undiagnosed hypothyroidism. If your hair is falling out and your eyebrows are not growing, you will be put on Rogaine instead of thyroid. You are gaining weight you will be told to stop eating junk food even if you don’t eat any!
If any of the following list of symptoms for hypothyroidism is causing you to feel terrible you are less likely to get the thyroid hormone that you need than 2 or 3 other drugs to just treat your symptoms:
- Swelling water-retention
- Weight gain
- Loss of hair and eyebrows
- Hair breakage and brittle nails
- Feeling cold all the time
- Cold hands and feet
- Inability to think
- Dry skin, dry eyes
- Low pulse
- Low blood pressure
- Goiter in your neck
These symptoms should always be discussed if your doctor is trying to diagnose you or if you are symptomatic when you are on thyroid medication. If you have these symptoms and your thyroid tests are normal, you still could have low thyroid! A trial of thyroid medications should be started.
This Healthcast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC.,Family Counselor, Presenter and Author. www.BioBalanceHealth.com.