Recent Advances in Thyroid Hormone Regulation Toward a New Paradigm for Optimal Diagnosis and Treatment 2017

Dr. John Carrozzella LL Thyroid

It is an overwhelming fact that most traditional doctors will prescribe only synthetic thyroid (Synthroid® or Levothyroxine). In recent years, more and more has been written about the residual symptoms that occur in many patients even when their TSH (thyroid stimulating hormone – produced by the pituitary in response to serum levels of thyroid hormones) and the T4 (levothyroxine) levels are “in the normal range”. This article takes a look at the treatment of patients who are supposedly treated to “normal” levels, yet persist with thyroid symptoms. As the authors state: “we can no longer dismiss patient complaints when discrepancies arise between clinically ‘hypo-thyroid’ versus biochemically euthyroid states”. That is, we as physicians cannot dismiss patients thyroid symptom complaints just because their traditionally measured thyroid levels are “normal”. The authors note that as long as an eye is keep on managing symptoms and making sure symptoms of excess do not occur, treating to symptom improvement may be clinically allowable. Further, the authors note: “the … patient [with persistent thyroid symptoms] should not opt for under-treatment and forego symptom relief out of an exaggerated fear of over-treatment”. Again, that is, patients should be treated to symptom relief and it is an exaggerations to believe that just because the serum thyroid levels are “high” does not mean that there will be any harm. Finally, the authors go on to say: “The pituitary TSH response is too diverse to be viewed as a sensitive mirror image of thyroid function” meaning that just treating the thyroid by measuring the TSH is often not an adequate way to assess clinical response. This is an outstanding article the clearly states that listening to the patient and treating thyroid symptoms is allowable and is not necessarily associated with any harm and often results in far superior patient outcomes.