Why is Thyroid so under treated?

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Doctor: “My hair is falling out”; “I’m cold all the time”; “I’m so tired and fatigued, I want to take a nap at 3:00 in the afternoon”; “My skin is dry”; “My fingernails are cracking”; “I can’t think straight”.  How many of you experience some of these symptoms or know someone who does??  These are symptoms of thyroid insufficiency. And all too often this condition goes undiagnosed and untreated.  So many people suffer from symptoms like these and these symptoms can be alleviated.  But, all to commonly, they are just overlooked and neglected by far too many everyday doctors.  Why?  Because too many doctors rely on blood tests rather than listening to and understanding the patient.

I remember early in Medical School.  I was in a class on physical diagnosis and my professors made it perfectly clear: “listen to the patient and he will tell you want is wrong.  Labs tests are for confirmation and monitoring of the diagnosis and should not be solely relied upon to make the diagnosis”.  Where did the medical profession go wrong?  All too often these days, the opposite happens: look at the lab test and then tell the patient the diagnosis.

The condition in which this conundrum happens most frequently is “hypothyroidism”.  It is true, the “classic” definition of hypothyroidism is a collection of typical thyroid symptoms AND an abnormal blood test.  The blood test in question is called TSH (Thyroid Stimulating Hormone).  TSH is produced by the pituitary gland (a small pea sized gland located in the brain, often called the ‘master gland’).  When thyroid hormones (triiodothyronine – T3 and Thyroxine – T4) decrease in amount, the pituitary senses this and will produce more TSH to signal the thyroid gland to produce more thyroid hormones.  So, in “classic” hypothyroidism (low thyroid) the TSH level rises as the pituitary gland signals the thyroid to produce more.  The opposite is true in hyperthyroidism.  When the thyroid is overactive, the excess amounts of thyroid hormone influence the pituitary to produce less TSH and thereby lower the influence on the thyroid gland to produce T4 and T3.  However, the actual appearance of true hypothyroid is far lower than the number of patients presenting today with hypothyroid symptoms and NORMAL thyroid levels.  These poor patients are suffering, and many traditional doctors are simply overlooking them and not treating them adequately.

Why does this happen?

There are several reasons for this.  Time and insurance pressures are causing doctors to improperly rely more and more on blood tests to diagnose and treat patients.  As a result, despite the high degree of symptoms, patients with “normal” blood levels are not treated for symptoms of low thyroid.  In fact, even the American Academy of Clinical Endocrinology practice guidelines state that otherwise normal patients with “normal” levels of TSH should not be treated for hypothyroidism.  The clinical application of such a “strict’ guideline, many times, leaves patients with uncomfortable and sometimes debilitating symptoms.  Endocrinologists will insist that the symptoms are due to something else.  Just what that “something else” is often remains elusive or is something that “your primary doctor should investigate”

In actual practice and from my experience with hundreds of patients with low thyroid symptoms, treating symptoms will result in more healthy and vital patients.  And there is substantial medical evidence for this.  I refer to a paper published in 2012 by the National Academy of Hypothyroidism.  That paper stated “it becomes clear that standard blood tests, including the TSH and T4 levels, cannot be used to accurately determine … thyroid level in the presence of a wide range of common conditions, including … dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, hyperlipidemia (high cholesterol and triglycerides), chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and aging” further “the pituitary has different [response to thyroid hormone] than every other tissue in the body; the thyroid [response by other tissues in the body is] affected by numerous conditions while the pituitary is minimally affected.

What this means is that the symptoms a person feels regarding thyroid depend on so many different factors; that simply measuring a blood level that reflects the pituitary response may not tell the entire story in the patient as a whole.  Going back to my medical school directive: Patient’s must be asked how they feel and what symptoms they are having and then a preliminary diagnosis can be made. Once the diagnosis is presumed, the blood work should be properly used to monitor the results of treatment as long as the blood levels are carefully coordinated with the patient’s clinical response and not used in lieu of the patient’s symptoms.

While patient’s with thyroid symptoms and normal levels of thyroid hormones do not technically have “hypothyroidism”, the medical literature clearly makes the point that using thyroid as an “off label” supplement can reduce their symptoms, improve their physiology, aid their well-being and substantially improve their quality of life.

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