Why is There so Much Controversy Surrounding Thyroid Treatment?
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(Thyroid Beginner series #2) Why is There so Much Controversy Surrounding Thyroid Treatment?

This is lesson #2 in my thyroid beginner series which is primarily designed for those who are building a foundation of knowledge in thyroid dysfunction or for those who have recently been diagnosed. 

Today we will be discussing why there is so much controversy surrounding thyroid treatment and why it can be difficult to get your doctor "on board". 

Watch the video above for more info or read the text below if you prefer as well!

Please leave your questions in the comment section below so I can go over them in the next video!

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Thyroid Controversy: Integrative vs Conventional Treatment

Why are so many thyroid patients unhappy with their current treatment?

Is it possible that our current approach or understanding of thyroid management is flawed?

I think this answer can be addressed by simply looking at how we approach and manage thyroid dysfunction and comparing that to other ways that we look at hormone imbalance in the body. 

Patients often find themselves in an unfortunate situation:

They have been diagnosed with thyroid issues and are experiencing thyroid symptoms even though they are already taking thyroid medication

If you fall into this situation you might be asking yourself this question... 

How is it possible for me to feel so terrible when my Doctor keeps telling me that my thyroid is "normal"?

And this is the thyroid controversy in a nutshell and it comes down to how Doctors look at and manage the thyroid.  

This approach to thyroid management has left thyroid patients frustrated which leads them to seek help on the internet, on forums and on facebook groups. 

With this in mind let's take a look at how conventional doctors approach thyroid management and compare that to integrative doctors. 

How Conventional Doctors Look at Thyroid Treatment

The standard and conventional approach, the approach that is taught in medical schools and residencies, is actually quite simple. 

I'll outline it to you below (this is the way that I was taught and the way that most doctors are taught): 

  • If thyroid disease is suspected then check for a lab known as the TSH (thyroid stimulating hormone). 
  • If the TSH is high (defined as outside of the lab reference range) then initiate treatment. 
  • Treatment should always be done with T4 only thyroid medications such as Levothyroxine, Synthroid or Tirosint
  • Adjust medication until the TSH is somewhere around 1.0 to 2.0. 
  • Any other symptoms related to thyroid disease (such as fatigue, weight gain, depression, constipation, cold skin, etc.) must be related to some other cause if the TSH is normal
  • Make adjustments to thyroid medication based on the TSH which is tested every 2-3 months. 

The main problem with this approach is that it is too rigid to allow for variability among patients. 

For instance:

How is it possible that all thyroid patients can do well on one medication?

Even when treating diseases such as cholesterol and high blood pressure Doctors have several sets of medications (1) that they will use and play around with but when it comes to the thyroid they are set on using one medication. 

Is it possible that some patients differ in their ability to utilize thyroid medication?

Some patients may react to the fillers or dyes in certain medications or vary in their ability to absorb medication from gastrointestinal issues. 

T3 conversion booster results

Problems such as lactose intolerance, Celiac disease or SIBO (2) can all influence how the body absorbs these medications. 

Is it possible that genetics may play a role in which medication works best for each person?

Doctors have no problem ordering genetic tests which outline how you metabolize anti-depressants, but they fail to consider that individuals can vary in how they metabolize hormones in the body. 

It is well known that individual genetics impact the pharmacokinetics and pharmacodynamics of medications and hormones in the body! (3)

These are just some of the reasons that taking such a rigid approach doesn't make sense from a logical standpoint, but there are other reasons as well. 

Does Focusing on the TSH Make Sense?

The reliance upon TSH as a sole marker for thyroid function may not make sense when you compare it to other pituitary hormones and how Doctors treat those issues. 

To understand this let's briefly discuss what TSH is and how it works:

TSH is known as thyroid stimulating hormone and it is secreted by the pituitary gland in your brain. 

TSH acts directly on the thyroid gland to stimulate the release of thyroid hormone. (4)

So the higher your TSH is the more "stimulation" your thyroid gland gets and the more hormone your produce. 

But TSH isn't the only hormone which is secreted by the pituitary gland which acts in a similar way. 

Hormones such as LH, FSH and ACTH all act to "stimulate" other organs to release their target hormones

But what's interesting here is that whenever we look other hormones, such as testosterone, we don't care what the pituitary stimulating hormone level is, we care about the level of the hormone in the body! (5)

For instance:

If you feel that you have low testosterone in your body would it make sense for your Doctor to check your pituitary stimulating testosterone hormone or to directly check testosterone levels in the body?

Logically, it makes sense to check for the hormone. 

But that's not what we do with the thyroid. 

Instead of looking at the hormone levels in your body we check for the pituitary stimulating hormone TSH. 

And instead of adjusting the dose based on how much hormone is in your blood conventional doctors adjust it based on the TSH. 

But there's a problem with that:

Studies have shown that patients who are treated with T4 thyroid medication to a "normal" TSH still have lower than normal free thyroid hormone levels which may account for the trouble that many patients experience. 

This can largely be solved with the use of both T4 and T3, but physicians still refuse to use these medications.

But back to the way that physicians normally dose and look at other hormones in the body for a minute. 

Consider these examples:

The TSH still has value and still should be checked in patients, but it may not be the single best marker to assess thyroid function in your body. 

How Integrative Doctors Look at Thyroid Treatment

So now that you understand how conventional Doctors (endocrinologists and primary care physicians) look at thyroid management we can compare that to how more integrative doctors evaluate patients with thyroid disease. 

And by integrative doctors, I am referring to doctors that may have extra training (outside of residency) in anti-aging medicine, integrative medicine or functional medicine. 

The problem with this type of training is that it is not "standardized" which means that not all "integrative doctors" look at each patient the same. 

Some doctors have used the term functional or integrative as a marketing tactic to simply get more patients even though they may not use a different approach from conventional physicians. 

But in an ideal world, your doctor should be evaluating you in the following way: 

  • Test for more than just the TSH - When evaluating your thyroid your free thyroid hormones (T3 and T4) give valuable insight as to how your body is absorbing and converting thyroid hormone. These free thyroid hormones (according to newer studies) track more closely with better outcomes when compared to other factors. 
  • Take into account individual genetics and preferences - Certain individuals are not able to convert or activate thyroid hormone at the same rate as others. SNP's in genes which control deiodinase enzymes can impact how you respond to T4 only thyroid medication. (9) It is estimated that up to 15% of the population varies in their ability to convert T4 into the active T3 thyroid hormone. 
  • Take into account environmental factors such as stress, sleep and diet - Lifestyle factors impact not only your thyroid but other hormones in your body as well! Your doctor should be treating you with more than just medications and supplements and should focus on the food that you put in your mouth and how you manage your stress. If they don't address or ask about these questions then it may be time to seek a second opinion. 
  • Use more than just T4 only thyroid medications - In terms of thyroid medications, there is much more than just Synthroid and Levothyroxine. Other medications include NDT and T3/cytomel/liothyronine. These thyroid hormones can be safe and incredibly effective if used appropriately. 

As a patient, which approach would you rather have?

The rigid approach of conventional medicine which is algorithmic, or the more individualized approach which is fluid and dynamic. 

So What are you Supposed to Do? 

So what are you supposed to do if you feel terrible and your Doctor isn't willing to work with you?

Learning and reading is a step in the right direction but it's not a substitute for a knowledgeable doctor who can guide you through the process. 

Your best bet is to seek out a physician who can help you and one who takes this more integrative approach. 

Unfortunately, these types of doctors can be very difficult to find and they often don't take insurance. 

In order for these doctors to obtain this type of knowledge they usually have to do extra work and training after residency. 

This means that not all physicians are equal in their understanding of these concepts which means they can be difficult to find. 

I've put together a resource here which you can use to help find a knowledgeable physician in your area

Before you ask, I don't know any or have personal recommendations to give you or I would do so happily!

Because physicians have to learn this on their own we don't have a secret group where we all talk or discuss patients. 

Conclusion

If you are struggling with your current thyroid management then it may be time to seek out a second opinion. 

Patients who have gone this route often report an increase in quality of life, an increase in energy, a reduction in weight and many other benefits. 

Don't waste the best years of your life with physicians who don't take your complaints and symptoms seriously!

Life is too short and your health is too important. 

Now I want to hear from you:

Are you struggling with the current conventional approach?

Do you have questions about the integrative approach?

Which has worked for you? Which hasn't?

Leave your comments below! 

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

Click Here to Leave a Comment Below 12 comments
Peggy Hamill - June 26, 2018

I’ve been Hashimoto’s for years. 5 years ago I started seeing an endocrinologist . I have been not feeling so well. I tell my doc I have horrible insomnia and losing my hair and fatigued. I keep up with my numbers but he says my numbers are great and my symptoms are probably my change in life. Pfffft. I’m 50, personal trainer, excellent weight. I feel I’m overmedicated he says no. I would like your opinion on my numbers, I am looking for a new doctor. He is kind but kind of ignores what I’m saying. Here’s the numbers.. t 4 free direct 1.43, t3 3.5,. And my TSH is .006, yep .006! He feels that because my other two numbers are good, must be perimenopause. Oh, also losing my lashes and brows. Thank you so much. Just wanted your opinion. Thanks for all you do.

Reply
    Westin Childs - June 26, 2018

    Hi Peggy,

    It’s certainly possible, and even probable, that you are being overmedicated especially if you have symptoms of hyperthyroidism. Hope this helps!

    Reply
      Peggy Hamill - June 26, 2018

      Thank you.

      Reply
        Westin Childs - June 26, 2018

        Hi Peggy,

        You’re welcome!

        Reply
Jilrene - June 26, 2018

I have been on Synthroid for 50 years. My thyroid gland, when scanned, is almost gone at this point. Two years ago I added T3, about 21/21 (am/pm). I felt good! My TSH measure; however, is consistently .01. Two conventional doctors have told me to immediately half my Synthroid dose, and throw out the “dangerous” T3. I tried cutting down the Synthorid and tossed the T3. I felt terrible for weeks – depression, fatigue and weight gain. I am back on the Synthroid .1 and the T3. I haven’t lost the weight, but again, I feel fine — no jitters, sweats, palpitations, bno bone loss – and except for the TSH reading, my tests, Thyroid, Bone, CBC are perfect. The weight is still an issue, but no other complaints. Is it possible that the TSH means nothing in my case?
Thank you.
J

Reply
Dhyanna Goulet - June 28, 2018

Dear Dr. Childs,

If my cortisol is low what is good to take instead of cortisol. I took cortisol before and after a month my skin was so thin that if I tapped my hand on something the skin split open. I stopped taking the cortisol and after a month the skin went back to normal. I would love to have some suggestions on what to take instead of cortisol if cortisol is low?

Thank you for your expertise

Reply
Debra - July 1, 2018

Hi Dr. Childs,

I started feeling horrible in later 2014 and early 2015: dry skin, hair, nails, low energy, heaviness in my legs, weight loss and then started neck pain and felt like fever. A doctor diagnosed me with a sinus infection(I tried to tell him something was wrong with me but he ignored me); I took the antibiotics and I ended up in the ER for the neck pain and was diagnosed with a nodule on the thyroid. This was so new to me. I was referred to an endocrinologist. I don’t know the count but he said my levels were extremely high and gave me a regimen for hyperthyroid. I believe it was a couple of weeks the levels slowly were coming down, he slowly decreased the regimen until I was at a normal level and finally scheduled me to come back in a month. But after another a couple of weeks I returned feeling extremely lethargic and having much joint pains. He checked my levels and he said this time I was extremely low. I was diagnosed hypothyroid and given Levothyroxin and told it would take time to feel better. It took a few months to feel better and I developed a torn rotator cuff. I healed and then I was also treated for a sleeping TB infection. I began to get better altogether. Not having consistent insurance, I visited different doctors who gave me either Synthroid or Levothyroxin. They routinely check levels and it is always normal, but I experience symptoms that they just pass off as all thyroid related. I am concerned about symptoms like parts of my body going numb, weight gain, much cellulite, joint pain, abdomen pain, and lumps around my collar bone among others. At times I feel great but others I feel bad. My question is why don’t the doctors check the thyroid nodule? Since they xrayed it, it has never been looked at again and my symptoms go unnoticed but I do not feel right.

Thank you for your time,
Deb

Reply
    Westin Childs - July 3, 2018

    Hi Deb,

    Thyroid nodules generally do not interfere with thyroid function which is most likely why they aren’t concerned. You’re experiencing the problem with thyroid-related care which focuses solely on the TSH as a marker of euthyroidism (normal thyroid function).

    Reply
Beverly - September 12, 2018

What a great blog! I’m glad I found you. About 10 years ago I had a complete hysterectomy one of the biggest mistakes I have ever made. So many crazy things started happening to my body I could not manage them. It was terrible. The worst being I gained 40lbs in 8 months. I was at a normal weight (145) the morning I had the surgery. Like I said it was a nightmare. Anyway, I was not put on HRT because I had breast cancer a few years before that. I had figure out how to manage all the symptoms I was having on my own. however, the weight gain is another story no matter what I do I cannot get the weight off. I was thinking of trying your Thyroid Adrenal Reset Complex to see if that helps. All of my blood work for my thyroid always comes back normal. Not sure what to do. Sure would like your opinion.

Reply
    Westin Childs - September 12, 2018

    Hi Beverly,

    I’m glad you like the blog! You’ll want to take a look at this blog post which will help you understand the importance of your thyroid in losing weight: https://www.restartmed.com/free-t3/

    Thyroid adrenal reset complex may help but I don’t really consider it a standalone weight loss supplement, though it has helped some people lose weight.

    Reply

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