Everyone is Hypothyroid

I give up. Like Danny Glover’s iconic character in Lethal Weapon:

via GIPHY

You win, alt med – everyone is hypothyroid. Lab testing in the evaluation of hypothyroidism is worthless, unless it shows low T3 or high reverse T3 levels, in which case it’s highly reliable. If a thermometer waved somewhere in the neighborhood of one’s tongue, ear, forehead, or axilla shows a value < 98.6 degrees F (37.0 C), that’s good enough for me to say the thyroid just ain’t right. Depressed? Hypothyroid. Weight gain? Hypothyroid. Fatigue? Hypothyroid. Alive? Definitely hypothyroid.

I’ve so often lamented the misguided attribution of nonspecific “symptoms of life” to the thyroid, that I thought I’d stop writing about it someday. Apparently, that day is not today. For as long as there are charlatans preying on vulnerable patients, I suppose I will continue to burn copious amounts of ATP counteracting the cacophony of crazy.

When Medical Doctors Go Rogue

What has me all lathered up this time, you ask? I received the following email from an actual Doctor of Medicine in the United States (below). Before I get to it, let me point out a few things.

First, this is just one example of similar messages I’ve received over the years from other alt-leaning physicians. These messages are always rambling, barely coherent, and make me absolutely frightened for the patients being counseled by these folks.

Second, the author of this email is not an Endocrinologist. She’s not even an internist or family practitioner.

Third, after some light googling, I was able to discern that (a) she believes that diabetes, hypothyroidism, and other diseases are all caused by mineral imbalances; (b) she runs a supplement company that will sell you minerals to rebalance you; and (c) she offers phone consultations at a “reasonable” price, during which she will tell you how to figure out what you’re deficient in so that you can…see (b).

Without further delay, here is the barely-edited email. The only changes I made were inserting paragraphing for readability and redacting all identifying details. Any attempt to identify this practitioner in the Comments will be deleted.

Please understand I am also an expert on Hypothyroidism. Please read chapter 5 of [redacted] and watch the book lecture online [redacted] click on watch lecture or U-tube my name and watch it to learn more.


Also, I have a lecture on Hypothyroidism recorded available through [redacted] Conference 2019.


You have left out a tremendous amount of literature on this subject, but first you must understand that the TSH used as the standard of care and for all conclusions you made, is NOT reliable. I have at least 13 studies and counting. Therefore, all assumptions of adequate care are unreliable and lack of basic physiologic interactions, biochemistry and physiology, as you state, are unreliable. Also, I have significant research information that shows the T3 is not 24 hours, but it has a much lower half-life of around 8-12 hours.


Only basal body temperatures taken reliably sublingual with a reliable thermometer, taken on wake up only after 5 or more hours of sleep, is reliable for the diagnosis of Hypothyroidism. This temperature must be 97.8 or greater to be normal thyroid. Yes, nearly everyone is Hypothyroid, nearly 90-95% [HD: bolding is mine]. This conclusion is after over 11 years of clinical research using BBT’s and appropriate testing.


Clearly, you do not understand the diagnosis or management of this illness, but very few do.


I appreciate your reading and research into this area, but the pitfalls are too numerous and the current standard of poor care is too ridiculous to get proper research done.


Dr. Barnes have the right approach. He concluded less than 5% reliability of TSH. I would allow possibly 10% reliability, mostly only if elevated or suppressed not on any therapy. Outside of these groups, the current levels of TSH norms are completely unreliable for the diagnosis or management of hypothyroidism.


You miss completely the significance and reasons for rT3 elevation and the whys. But you should know, it is the ratio that matters, not the absolute levels. This ratio changes more significantly with physiologic issues, but it still reveals Hypothyroidism when correlated with BBT’s with 95% reliability.


Once one understands the symptoms of Hypothyroidism more clearly and bases the treatment on the BBT’s correction, and doing the appropriate TT3 and rT3 use, FT3 in pregnancy only, then one can begin to make sense of the confusing and contradicting nonsense you espouse from the general Hypothyroid literature.


I hope you continue to grow in your understanding of Integrative Medicine. It is NOT alternative as you espouse. It is good care, trying to get it right all the time with less toxicity, reversing and preventing illness, not just treating the symptoms. It is not drug dealing as is the typical doctor care. It is caring, compassionate, and compelling once one gains more understanding of the pitfalls and ignorance continually being espoused by AEA and ATA, e.g., 2012 “Position Paper on Hypothyroidism” where it specifically states, “signs and symptoms do not matter since only 25% of these patients will have an abnormal TSH.” That is an appalling statement of ignorance and represents a separation from the reality of medicine. Who gave those doctors the right to suspend symptoms in the practice of medicine due to their ignorance. Appalling to be sure!


Blessings,
[redacted]

And…breathe. Did you actually make it through the entire thing? If not, don’t feel bad. It’s a painful read and I had to skim it the first time through to avoid banging my head against my laptop. Normally, I don’t give these diatribes such a prominent platform on my blog, as there are already enough of them in the Comments sections of my other posts. One, I view addressing them head-on as punching down, which does not further the mission of Hormones Demystified. Two, it’s impossible to argue with someone like this. It’s like locking a rabid pro-choice person and an equally rabid anti-abortion person in a small room and instructing each of them to convince the other her position is correct. They’ll scream at each other for eternity, never getting any closer to common ground.

Quackery is not Exclusive to Naturopathy

I decided to shine a light on this particular email, however, to illustrate a critical point that does further the mission of this blog. Many of my non-physician readers land here because they are desperate for answers. In many cases, they have been unwell for a long time. They often feel dismissed or condescended to by their doctors; they no longer care who will fix them or how – they just want to be fixed.

Patients turn to alternative medicine physicians – like the author of the above email – believing that her medical degree confers credibility upon her unconventional approach. After all, this is not some naturopath espousing all kinds of quackery that sounds plausible to the layperson – this is coming from a real doctor. More than that, though, people’s desire to believe is strong and leads smart people to become incredibly stupid when it comes to their health.

Based on comments on my posts and emails I receive, I know that many – if not most – of my readers are highly intelligent. I’d like to think that they perused the above email and were horrified that an actual physician who is responsible for people’s lives couldn’t craft a message with a semblance of coherence. Not to mention that there are factual inaccuracies and outright misrepresentations of mainstream medicine throughout.

But I’m not so sure that everyone will read it that way. The author of that email is a self-professed expert, references her book and lectures, and uses a lot of technical jargon. To people who don’t know much about thyroidology, they might simply assume that this physician is, indeed, an expert. People might believe the author when she claims that “nearly everyone is [h]ypothyroid, 90-95%.”

It’s also possible that this doctor talks a better game than she writes. What if she’s charming, a good listener, and validates patients’ concerns? Is it possible that even intelligent folks could be duped into believing whatever nonsense she’s slinging? Absolutely.

On the spectrum of “danger to public health,” I still believe that slick alt med sites like the one I wrote about in Alternative Medicine is Kicking Our Ass occupy the high end. But it is equally important for the individual consumer of healthcare to be vigilant when seeing a practitioner who expresses ideas unlike anything she has previously heard. Further, if said practitioner offers copious testing followed by recommendations to purchase hundreds of dollars worth of supplements, something may be rotten in the state of Denmark.

Everyone is not Hypothyroid

Let me be clear: I am not minimizing the suffering of people with un-, under-, or over-treated hypothyroidism. Rather, I am taking issue with alt med’s rampant over-diagnosing of the condition. I have written these words dozens of times, but I guess I need to keep saying it: if you’ve been spinning your wheels for more than a year, tried multiple thyroid hormone cocktails, have had a TSH in every part of the range, and you still don’t feel well, it’s time to consider the possibility It’s Not Your Thyroid.

By reading this site and interacting with me in the Comments, you agree to abide by my Disclaimer.

Image Credit: Photo by Paolo Nicolello on Unsplash

22 Replies to “Everyone is Hypothyroid”

      1. Except I’ve been spinning my wheels for over a year dealing with all these crazy symptoms because my doctors refuse to figure out what the heck is actually wrong… My thyroid was removed Nov 2017…2018 went fairly smooth…2019 has been hell. Even if it is not my T3 you would think that my doctors would be concerned that my inflammation markers are unexplainably high and I keep complaining of severe pain, chills, crushing fatigue to where I am unbalanced and faint, my hair is thining along with my nails and yet I take my levothyroxine diligently like a good girl. I have increased collagen, I am on anti inflammatory diet, I exercise, I am active, I take my vitamins and I don’t consume sugars and everytime I try to research what the heck is wrong and what I can do to help one I’m already doing it and 2 majority points to T3 issues. I don’t understand why my doctors won’t even bother checking. That is the really frustrating part. Instead I get, “You’re fine you TSH and T4 are in optimal range, see you next year!”

  1. I have recently had an opportunity to talk to an Integrative Medicine practitioner. This physician reached out ot me , querying if I might “squeeze” his rather complicated patient population in immeadiately, as his patient population apparently has more challenges waiting in a lobby full of patient’s than the average. After discussing the potential differential on a particular patient who sounded alot like she had Adrenal Insufficiency, I became alarmed that said physician did not “consider” use of Hydrocortisone as he did not do pharmaceutical prescribing. As your typification of an Integrative Medical practitioner illustrates, it is dangerous to completely disregard 100’s of years of discovery in the vast challenges of Clinical Medicince and especially the field of Endocrinology, which is by in large about synthesising and measuring hormones (bioidentical pharmaceuticals) and attempts to find the “normal” is a sea of abnormal.

  2. Cancer Should Have a Cure by Now

    As a lay person, thank you for this eye opener about alt med “experts” which further confirms my suspicions and validates many of my experiences over my life. I am 70 now.

    I have come to understand the advancement of science in medicine and in many other scientific fields has been distorted, crippled and therefore slowed down to a snails pace by corruption led by wrong ideas about morality – that everyone is entitled to the fruits of others ideas and production in pursuit of “equality”. But most would agree reaching equality for all is an impossible goal. Without the interference of misguided public policy, happily led by gov force (regulation, subsidies, cronyism etc.) a cure for Cancer and many other severe ailments like debilitating headaches (I suffered for ~30 years) could be cured by now.

    I think you would agree a physicians goal should be principled, not pragmatic. Symptoms of any disease should not be treated with a bandaid approach but rather by searching for the source and root cause with a goal toward a cure. But this requires a dedication to reason, logic and men or women who are willing to think in pursuit of scientific truths.

    I think the highest point of the age of enlightenment where great flourishing of new ideas manifested in the likes of Newton, Salk, Edison, etc. resulting in a dramatic rise in human life expectancy, has been severely stifled by relativism, skepticism and the misguided philosophy of the altruism.

    I considered your example of two people put into a room who have extreme opposing ideas fighting it out but could never find “common ground”. In my opinion, finding “common ground”, a compromise, should not be their goal. Finding truth should be the ultimate goal based on the ideas needed for man to flourish.

  3. I had previously subscribed to comments on your post about T3 or not to T3….and they just keep coming! Even coming from your site I’m getting bombarded (at my own doing) by comments about needing rT3 testing and T3 supplementation 😉

    I’ve been seeing a lot about temperature in the thyroid patient facebook world. It cracks me up that all of these mentions about temperature ignore the fluctuations women have over their menstrual cycles. My temps sit below 36.4C (97.5F) for about half my cycle. Based on these groups OMG I NEED TO HAVE MORE T3….conveniently ignoring that my temps are over 37.1C (98.8F) for much of the second half of my cycle.

  4. Well, this is one situation where I have to agree with you. I actually got booted off a FB group because I disagreed that the gal with a 2.5 TSH didn’t need to start taking Levo (prescribed by her normal doctor. Her numbers were not great, but barely not great. I had suggested she consider exercise, sleep, diet changes, stress reduction. All too often the vocal folks on that group give advice that is not even normal among alternative medicine folks. Now, I have heard of people using blood pressure, temperature, heart rate before. Certainly I have experienced some of this (have not checked temperature much though). But I can say my heart rate was very low at times. Some of my doctors said I was just in good shape. Well, when you can barely walk, I don’t think that’s accurate. Same with blood pressure. At first it was fairly high. Eventually it got pretty low. Anyways…I agree with the thoughts here. But I also think the TSH range maybe a bit too relaxed on the high end. I can tell you for myself there is a BIG difference between my TSH at 5 and now at 2.5. That being said I am on medication for it.

  5. HD

    Thanks for your post . I am a busy FP . I have well over 100 pt s that I maintain on T4 Rx. Most of them are started by physicians other than myself and for quite a variety of reasons. I ask many of them , do they recall what life was like BEFORE their T4 regimen ? Almost all reply that they never noticed a difference . They state that somebody just ” told them to take the replacement med ” and they dutifully did so. These are generally cooperative and compliant individuals with no secondary motives . They fail to “feel” the benefit of T4 replacement .
    That tells me that the benefits of T4 are either very subtle most often or , and this is probably more likely , non existent ( i.e. they were given the med before they truly need it ) .
    Sometimes to simplify their meds I will “de-prescribe” knowing full well that I can “re-prescribe” easily at a later point .
    Disclaimer – I am NOT saying that some patients are in critical need of the replacement . Of course they are . But many are overdiagnosed or overtreated .

    Michael McEvoy , MD

    1. Absolutely. I take at least one or two patients off of thyroid hormone every week. The one thing I love about our cumbersome EMR is the portal that allows me to access records from every other organization that uses the same EMR. I can often see that the labs were totally normal pre-treatment, suggesting that the patient has been misdiagnosed.

      1. Hi HD,
        Can you elaborate on the typical types of patients who you are able to successfully take off of thyroid hormone? I ask this because it is my (probably far-fetched) dream to get off thyroid hormones! I always wonder if it was the right decision to be medicated in the first place, although I was pregnant at the time when my TSH was found to be slightly elevated (7.1), so I know it was necessary for the health of baby. I came off thyroid hormones after swinging hyper post-partum, and then went back on thyroid hormone months later when I was found with a TSH of 14, and on a full replacement dose ever since (7 years ago). Is it typically the patients on lower thyroid hormone doses who had lower TSH readings to begin with that are able to come off?

        1. The pre-test probability is high – in my practice – for being able to discontinue thyroid hormone if one or more of the following apply:

          – The original diagnosis was made by a naturopath, functional medicine doctor, or other fringe practitioner.
          – TPO antibody testing is negative.
          – Levothyroxine dose is <= 75mcg or Armour dose is <= 60mg. - The original, pre-treatment thyroid function testing showed a normal or near-normal TSH.

  6. Hi HD, Ok, you’ve convinced my that my alt med script of compounded slow release 25ug T3 may not be a helpful addition to my 100ug of Levo. Does one need medical supervision to go off the T3? Is it done gradually or not? I will need to find an appropriately trained person to advise- would that need to be an endo or GP?
    Thanks

    1. Although I can’t speak to your situation, I can say that most people on that much T3 – assuming they’ve been on it for months or longer – will appreciate tapering as opposed to stopping cold turkey. This should usually be done with a doctor’s guidance – an Endo if one is available or a general doc if not.

  7. Human experimentation is to be done under clinical trials with patient consent. Why doesn’t this quackery have to be done under clinical trials? Who is protecting patients from side effects of thyroid medication? Who is documenting the side effects? I was misdiagnosed hypo for 5 1/2 years, I really had celiac disease. I never had a positive physical exam, she diagnosed hypo with ONE normal lab report. She advertises she was trained by Mayo Clinic. She said “In America they want you to be sick to sell you medicine”. How ironic, she sells her supplements and makes up diseases that follow no diagnostic protocol. She is a danger to the public and everyone she treats with her quackery. I had side effects more so after gf diet. Assume I really began to absorb the medication. The internist/licensed M.D then told me the celiac disease caused the hypothyroidism. I was a trusting patient and believed her. When she was tired of me she told her receptionist to tell me over the phone “There is nothing wrong with you!” She covered up her misdiagnoses and sent me away on my medical nightmare journey. No doctor could figure it out. It lasted 5 1/2 years until I stopped taking it. I had profound soothing relief in my stomach that lasted for days. Messing with thyroid hormones altered digestive hormones to be released, gastrin. I will continue to report her, all her patients need to be checked. Five lady friends saw her, 3 of us overweight, we all got thyroid medicine after one lab report. She switched one hypo lady to Armour, said never take synthetic. The fifth lady has died, thin, she didn’t give her thyroid medicine, she really had ALS. This internist couldn’t diagnose celiac disease, PCOS, unicornate uterus, ALS, she’s to busy selling supplements. I had been on her $100 HCG cream just before my positive celiac labs. The public is in danger, medical ethics are not followed.

  8. In 2012, both my parents, age 70 and 72, were diagnosed with hypothyroidism on the same day by their internist M.D who sells hormone pellets. She also sends her lab work out of state to some specialty lab, emphasis on heart labs. Both my parents were normal on doctors, out of state, specialty labs on the thyroid, NO borderline results, they were in the excellent range! Dad in low tsh 3 and mom tsh 2.99. Can other doctors see her ordered specialty labs? How does thyroid supplementation affect the parathyroid? Cancer patients? Degenerative bone disease? Heart health? I researched some clinical trials for hypothyroidism, my disease, celiac and my father’s, multiple myeloma were excluded from participating even if we had out of range labs, is it because it’s autoimmune diseases?
    My father had multiple myeloma cancer, had his (own) bone marrow transplant at university hospital. The university hospital never said my father had thyroid disease. I read a research article implying subclinical hypothyroïdism may be beneficial to multiple myeloma patients. Something about slowing the cancer cells reproduction. He took thyroid supplementation until he died. Endocrinologist was called in to see my father in the hospital weeks before he died, he had never seen one. Endocrinologist never knew his initial tsh labs were normal before being dosed with daily thyroid supplementation. He had hyperparathyroidism, hypercalcemia, had blood transfusions, was delirious at times. My sister and I, and family members never left his side while in the hospital. We took him home to die. Gave him his thyroid meds the day he died. The morning of the day he died he was fighting to get out of bed, he said “Put the coffee on, I’ve got to get to work”. Hardest part of his death was, he wanted to live, work another day.
    This same internist, M.D had my 72 year old mom on daily thyroid medication because of tsh 2.99, along with 22 other medications, supplements, ex. Fentanyl patch, pain pills. two cholesterol meds etc. We had to get her into a detox hospital, she was breaking down, tongue even quivering in her mouth. This same doctor had told my mom that my dad needed to die with some dignity, that the oncologist was giving my dad treatments for the money. Mom broke down, told my dad what she said, they stopped seeing original ocologist, new oncologist never gave another treatment, he was too sick. My dad took the treatments because he wanted to live, he trusted his first oncologist. We need clinical trials with consent to allow M.Ds to prescribe thyroid supplementation without out of range readings, we need research, we need patient education, we need transparency for ER’s, hospitalist, specialist to see what’s going on with sick patients.

  9. In addition to above comment:
    I did not mention that my Mom’s cardiologist took her off Synthroid and put her on Armour at a higher dose. She was pushed into hyperthyroidism for months. She was reporting heart, chest pain, pressure. The internist saw she was hyperthyroid at a checkup and switched her back to lower dose synthroid. Why would a cardiologist be switching, increasing thyroid supplementation? We need standards of care enforced and ethic inquiries.

  10. That list of endocrine disrupters the WHO release every once and a while keeps getting longer, yet we are to believe that hormonal disorders are rare?

    That symptoms which are so common now such as fatigue, obesity, depression, anxiety (all of which can be produced by hypothyroidism) are mostly the products of ‘something else’ that the medical community admits it ‘doesn’t know much about’, and not hypothyroidism because the TSH test is beyond question?

    That seems a bit convenient.

    I don’t see it as unreasonable to start with the thyroid when those symptoms are present. It certainly beats the alternative of a)nothing b) being administered junk like SSRIs and other toxic drugs or embarking upon neurotic diets and punishing exercise.

    1. That list of endocrine disrupters the WHO release every once and a while keeps getting longer, yet we are to believe that hormonal disorders are rare?

      You’re misrepresenting my argument. Hypothyroidism is a fairly common hormonal disorder, but it is not present in 90-95% of people. Nor is it present in the general population with sufficient prevalence to warrant its diagnosis in the majority of patients who walk into an alt med provider’s office thinking they have a thyroid problem.

      That symptoms which are so common now such as fatigue, obesity, depression, anxiety (all of which can be produced by hypothyroidism) are mostly the products of ‘something else’ that the medical community admits it ‘doesn’t know much about’, and not hypothyroidism because the TSH test is beyond question?

      Again, misrepresentation. We know a lot about what causes those symptoms, and it’s often poor lifestyle. Could it be thyroid? Sure. But if the thyroid function tests are clearly normal, it’s probably not the thyroid: Is TSH the Best Test?

  11. “We know a lot about what causes those symptoms”

    From the Mayo Clinic:
    “Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition.

    The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors.”

    So with respect your’s doesn’t seem a great characterization of orthodox thinking on the subject and it’s certainly been my experience to get more shrugged shoulders and experimental/sledgehammer treatments, than solid explanations and approaches that yield decent results.

    Taking into account that:
    -thyroid is key to energy production
    -thyroid appears to work quite well for people with depression and fatigue
    -TSH test has come under a lot of scrutiny (I saw that even you thought that Midgley paper made some good points)
    -psychological and psychiatric approaches are largely failures

    I don’t see why it’s reasonable to have such unwavering faith in the TSH.

    The history of thyroid treatment appears riddled with confident statements of fact that don’t endure scrutiny- the PBI test, now the TSH test and people asking what physiological sense it makes to give somebody not just t4 only, but a large dose of at once.

    1. Let’s not conflate CFS, which I don’t treat nor have expertise in, with hypothyroidism. That said, I agree with you that we change our beliefs as research evolves.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.