Hypothyroidism and TSH Levels: Articles by Doctors

Symptoms versus "normal" test results

Purpose of this compilation

To show that using only the TSH (thyroid stimulating hormone) level as a diagnostic tool can miss many cases of hypothyroidism or result in undertreatment, and that if it is used, the current acceptable range is to be questioned.

1. Kenneth Blanchard, MD, PhD: "Hypothyroidism at Midlife"

Of the many standard teachings in this area [thyroid disorders], I believe the most common mistake physicians make in everyday practice is to "rule out" hypothyroidism on the basis of laboratory tests alone.

...In my practice, if the medical history and physical findings are highly suggestive of hypothyroidism, patients are treated with a therapeutic trial of thyroid hormone and the results are overwhelmingly positive. As of early 2001, opinion in this field is still that the TSH test is absolute, although the upper limit of normal has been questioned, so that more individuals are being included in this diagnosis.

Accessed 2003/09/09 at <www.menopause-consultant.com/MDs/kennethblanchard.html>, but no longer online as of 2003/10/12.

2. Ward Dean, MD: "The Underdiagnosed Epidemic"

Although many people exhibit symptoms of hypothyroidism, they usually don't receive treatment for this condition if they have normal blood test readings. Their physicians often tell them that their symptoms are due to other causes or that their problem is "all in their head." I have known many patients who were referred to psychiatrists to treat their so-called "psychosomatic" problems. However, when they were later given thyroid replacement therapy, they improved dramatically.

Online at <http://freespace.virgin.net/smokey.quartz/underdiagnosed.html> (accessed 2003/09/09).

3. Barry J. Durrant-Peatfield, MB, BS, LRCP, MRCS: "Suggestions for an Approach to the Management of Thyroid Deficiency"

That the diagnosis is all too frequently missed...is commonly the result of an incomplete clinical appraisal in favour of the standard thyroid function tests. These tests are the real problem in diagnostic failure since there are inherent problems in interpreting blood levels of thyroxine and/or thyroid stimulating hormone (TSH) when blood levels may differ widely from tissue blood levels. Since the diagnosis may very properly, and easily, be made clinically, unreliable blood levels should NOT take precedence over clinical judgment.

Online at <http://personal.atl.bellsouth.net/w/u/wurmstei/Peatfield_Suggest.htm> (accessed 2003/09/09).

4. Michael Lam, MD: "Hypothyroidism"

The myth that an elevated TSH level...is required, as prerequisite for diagnosis of hypothyroidism must be dispelled. There is little doubt that an elevated TSH signifies [an] under active thyroid as the pituitary gland secretes TSH in response to a low thyroid hormone level. The real question is: how high a TSH is considered high?...

Many patients with TSH level of 2.0 (not 4.5) or more have classic symptoms and signs of hypothyroidism.

Online at <www.lammd.com/A3R_brief_in_doc_format/hypothyroidism.cfm> (accessed 2003/10/12).

5. Edward M. Lichten, MD: "Natural Treatment of Thyroid Deficiency Syndrome: Are You Thyroid Deficient?"

Doctors have been taught to look for elevated levels of TSH....

But, those of us researching thyroid disease have learned that these thyroid tests are just 'tests at best.' If the patient complains of a low body temperature on awakening (basal body temperature) then there is inadequate thyroid hormone no matter what the blood tests show. If there is fatigue, dry skin, brittle hair and weight gain on a low calorie diet, then there is insufficient thyroid hormone.

Online at <www.usdoctor.com/thyroid.htm> (accessed 2003/10/12).

6. Patrick Magovern, MB, BCh, BAO, LMCC, DObst (RCPI), MICGP, DipMedAcp, CAFCI, PGCertNut Medicine: "Hypothyroidism and Underactive Thyroid"

My view is that there is a sub-group of patients who despite having 'normal' T4 and TSH may well have a thyroid problem....If I am seriously considering a diagnosis of hypothyroidism in the presence of 'normal' T4 and TSH (both of which investigations will usually have been carried out long before the patient arrives at my door) the first thing I do is to look at free T3 and free T4 levels along with another TSH and usually at thyroid antibody levels.

Online at <www.integrativemedonline.com/pages/thyroid.html> (accessed 2003/09/09).

7. Joseph Mercola, DO: "Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels"

Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly accurate measure of TSH but not of the height of thyroid hormone levels.

The basic problem that traditional medicine has with diagnosing hypothyroidism is the so called "normal range" of TSH is far too high: Many patients with [TSH levels] of greater than 1.5 (not 4.5) have classic symptoms and signs of hypothyroidism.

Online at <www.mercola.com/article/hypothyroid/diagnosis_comp.htm> (accessed 2003/09/09).

8. Joseph Mercola, DO: "Thyroid Disease Far More Widespread Than Originally Thought, 13 Million May Be At Risk"

...many people whose test results are dismissed as normal could continue to have symptoms of an underactive thyroid. Their moods, emotions, and overall well-being are affected by this imbalance, yet they are not receiving the care they need to get to the root of their problems....Even if the TSH level is in the lower segment of the normal range, a person may still be suffering from low-grade hypothyroidism.

Online at <www.mercola.com/2000/mar/5/thyroid%5Fupdate.htm> (accessed 2003/09/09).

9. Kenneth N. Woliner, MD, ABP: "Combined T4/T3 Therapy: Placebo or Tomato?"

...tailoring thyroid hormone therapy to normalize laboratory tests such as the TSH may not be the best approach to normalizing patient symptoms. Treating the wrong thing (the TSH versus the actual patient) can mislead the most well-intentioned of investigators. What if T4 is better at normalizing the TSH, but combination T4/T3 therapy is better at normalizing symptoms? What if the process of keeping the TSH "within normal limits" makes combination T4/T3 therapy less effective? It will be difficult to answer these as long as physicians hold onto the paradigm that the TSH test is infallible.

Online at <www.thyroid-info.com/articles/t4t3studies.htm> (accessed 2003/11/06).