the trouble with blood tests is that what's optimum for you doesn't bear any relation to what's good for or, in range for anyone else.. we're all different... The only really valuable blood test is a test for absolutely everything when you feel totally fabulous because only THAT will tell you what's right for you...
TSH testing is fundamentally flawed because if you can't convert T4 to T3 then you could have normal or even supressed TSH and actually still be very hypo and poorly... so a low TSH means NOTHING.. A high TSH however.. is a valuable test but still no good without an accompanying low temperature.
this is from a Dr SHAMES (I know!) but he's a good guy.. the 5 myths of hypothyroidism
I recently had the opportunity to interview Richard Shames, MD about his new lecture series on common thyroid misconceptions. Dr. Shames, whose credentials include Harvard, University of Pennsylvania, and National Institutes of Health, is a practitioner and author with over thirty years experience in developing better thyroid care.
Mary Shomon: Why, Dr. Shames, do you categorize certain common practices as "myths"?
Dr. Shames: Mary, when the incorrect belief is so widely and stubbornly held by both practitioners and consumers, it needs a special name. Health information alone is not sufficient. One needs to know the quality of that information, to best use it. Misinformation can be very harmful.
Mary Shomon: What in your opinion is the leading thyroid myth today?
Dr. Shames: Thyroid Myth Number 1 is TSH IS THE ONLY TEST NEEDED TO GUIDE BOTH DIAGNOSIS AND TREATMENT OF THYROID IMBALANCES.
Total unshakable faith in this one, simple, over-rated blood test has caused years of untold harm to millions of people. Based on the tyranny of that one test, doctors refuse treatment to a great many who need it, AND keep others on too low a dose of medicine once they do get treated.
Mary Shomon: Many thyroid patients are aware that recent research studies have seriously questioned the absolute validity, as well as the excessively broad normal range, for TSH testing. Even the endocrinology community is not in agreement over the "normal reference range" for TSH tests.
Dr. Shames: Definitely. But the overwhelming majority of doctors, clinics, laboratories, and insurance companies are still not swayed by that compelling research. Instead, the idea is even more entrenched. But for many thyroid sufferers and practitioners, that idea is not science. It is a myth.
Mary Shomon: What is the next thyroid myth?
Dr. Shames: Thyroid Myth Number 2 is LEVOTHYROXINE IS THE ONE AND ONLY TREATMENT MOST ALL THYROID PATIENTS WILL EVER NEED.
Once again, multiple research studies and numerous practice experiences have shown this to be a potentially harmful myth. Yet it's surprising how completely sold on this myth most doctors and patients are around the country. I constantly hear about it in my telephone coaching with thyroid patients across the nation.
Mary Shomon: What about the patients needing complementary thyroid support for adrenal function, progesterone, and vitamin D?
Dr. Shames: Luckily vitamin D's importance is lately getting good traction, in both the patient and doctor populations.
But something else is unfortunately getting less traction. And that is Thyroid Myth Number 3: NATURAL DESICCATED THYROID IS UNSAFE BECAUSE OF ITS VARIABLE POTENCY.
Here is the truth. Natural desiccated thyroid drugs (Armour Thyroid and Nature-throid are two common brand names of natural desiccated thyroid in the US) are known to be safe and effective. In some patients, they are superior to levothyroxine, even when the T3 medications are combined with the standard T4 (levothyroxine).
The accusation of variability in natural thyroid drugs is an example of an enduring myth. Actually, the FDA has repeatedly found synthetic thyroid (levothyroxine) to be variable in dose per pill.
Unfortunately, insurance companies are now on this mythology bandwagon. Some have recently begun writing to patients and doctors saying they will no longer cover natural desiccated thyroid prescriptions. They recommend a switch to levothyroxine, even though it is more expensive. This is a strange choice for insurance companies to make, but they are starting to do it. They have obviously bought into the mythology, perhaps because of influence from large drug manufacturers who seek to reduce competition from less expensive natural thyroid.
Mary Shomon: What is your next thyroid myth?
Dr. Shames: Thyroid Myth Number 4 - KEEP DOSES OF THYROID MEDICINE LOW, TO REDUCE THE RISK OF OSTEOPOROSIS AND HEART PROBLEMS.
This is an unfortunately persistent myth, based on outdated research. More recent studies clearly show that thyroid medicine, in doses people actually need, is not harmful to the heart or bones.
This myth is particularly problematic, because when this advice is followed, people end up at greater risk of osteoporosis and heart problems. Under-medicated hypothyroidism is a common unrecognized cause of low bone density and heart palpitations, and subclinical hypothyroidism has been linked to various heart problems. Too little thyroid also can result in compensatory high adrenaline levels, which makes the heart very jumpy.
Mary Shomon: What's your final thyroid myth?
Dr. Shames: Thyroid Myth Number 5: ONCE YOU START THYROID MEDICINE, YOU NEED TO STAY ON IT FOREVER.
This is one of my all-time favorites, and is an example of a myth originating from a partial truth. If your thyroid gland has been entirely ablated by radioactive iodine or removed by thyroid surgery, then this advice is true for you. On the other hand, for the large majority of thyroid patients who still have a functioning thyroid gland, this advice is a potentially harmful myth.
For example, many people need thyroid medicine due to a temporary autoimmune flareup during puberty, postpartum, or menopause. These patients may not need to stay on thyroid medicine for the rest of their lives.
In fact, it might be better for many of them to carefully wean off. Yet, they end up staying on thyroid pills forever, because they or their doctors have bought into the mythology.
Also it takes some ongoing care to wean off thyroid medication properly, and to know when to go back on it, if need be. In today's rapid-fire, quick visit type of health care, a supervised trial of discontinuing thyroid is frequently avoided by busy practitioners.
Forcing potentially healthy people into forever needing to see doctors and pharmacists is not in the long run a wise use of precious health care dollars.
Dr. Richard Shames is author of a number of books on thyroid disease and health. His most recent book, Thyroid Mind Power, explores the connection between thyroid disease and mental health.