Hypothyroidism and TSH Levels: Interviews with Doctors

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. Unless otherwise indicated, the doctors were interviewed by Mary Shomon.

1. Alan Cohen, MD: "The Depression/Thyroid Disease Connection Explored" (May 2002)

Many patients seem to need replacement hormone sufficient to get the TSH down around 1.0 or less, even below .50....my impression is that most patients with fatigue, anergia and depression need TSH levels in the lower zone <1.0.

Online at <www.thyroid-info.com/articles/cohendepression.htm> (accessed 2003/09/02).

2. David Derry, MD, PhD: "Rethinking the TSH Test" (July 2000)

...many people would develop classic signs and symptoms of hypothyroidism but the TSH was ever so slow to become abnormal, rise and confirm the clinical diagnosis. Sometimes it never did. Finally I began treat patients with thyroid in the normal manner I was taught. I could not see why I had to wait for the TSH to rise for me to be able to treat them....

...the TSH can lag a long way behind the appearance of low thyroid symptoms.

Online at <www.thyroid-info.com/articles/david-derry.htm> (accessed 2003/09/02).

3. John Dommisse, MD: "Unique Theories About Hypothyroidism Treatment" (May 2002)

Endocrinologists are confusing the great sensitivity of the [TSH] test (for measuring the height of the thyroid stimulating hormone serum level) with the idea that it is therefore the most accurate and appropriate measure of T4 and T3 thyroid hormone function, which it is not — the free-T4 and free-T3 serum levels are the best arbiters of that!...

...I ran into too many patients who had classic hypothyroid symptoms, which cleared completely on appropriate thyroid treatment, and whose TSH was below 2.0 (but above 1.5) and with FT4 and FT3 levels in the low ends of their 'normal ranges'....Finally, I found some patients with several symptoms and signs of hypothyroidism whose TSH was between 1.0-1.5; so I lowered my range, for the last time, to 0.1-1.0; I now treat primary hypothyroidism with a TSH of >1.0 (if the FT4 and FT3 are low-normal, not above the middle of their 'normal ranges'). Some physicians are still waiting for the TSH to go above 6.0 or even 10.0 mIU before they'll agree that the patient's hypothyroidism needs treatment!

Online at <www.thyroid-info.com/articles/dommisse.htm> (accessed 2003/09/02).

4. Joseph Mercola, DO: "Hypothyroidism and the Role of Armour Thyroid, Seaweed, Exercise, and More" (June 2000)

I would say over 90% of the patients that I diagnose with underactive thyroids have a completely normal TSH level....most traditionally based physicians have long abandoned their physical examination and diagnosis skills and appear unwilling to believe that patients who complain of all the classic hypothyroid symptoms are in fact truly hypothyroid if their TSH is normal.

They would rather believe a lab test than the patient sitting in front of them.

Online at <www.thyroid-info.com/articles/mercola.htm> (accessed 2003/09/02).

5. Don "Doc Don" Michael, MD: "Getting What You Need from Your Doctor: Challenges of Thyroid Care" (December 2000)

Saying that your thyroid is healthy because your number is between the little number and the big number is easily as foolish as claiming that you are physically fit if your weight is between 75 and 260 pounds (That would probably cover 95.5% of the weights in the USA.) without knowing anything else.

Online at <www.thyroid-info.com/articles/docdon.htm> (accessed 2003/09/02).

6. Glenn Rothfeld, MD: "...author of Thyroid Balance" (July 2003)

While I think that liberalizing the rigid definition of a TSH of 5.5 or below as "normal" is helpful, we remain with a system that looks at a single number for the choice of treatment or not, instead of taking a broad look at metabolism and the factors that can affect it.

Online at <www./thyroid.about.com/cs/alternativehelp/a/thyroidbalance.htm> (accessed 2003/09/02).