(original article here.)
Suzy is a 59 year old post menopausal woman with low thyroid function. About three months ago, she started her bio-identical hormone program which included natural thyroid pills. After starting the program, she was doing well with more energy, better sleep, improved appearance of skin and hair, and resolution of her menopausal symptoms of flashes and sweats.
A New Set Of Thyroid Labs
However about 12 weeks into her program, Suzy had a visit with her primary care doctor who did a follow up thyroid panel. Her primary care doctor informed Suzy that her TSH test result was outside of the normal range, and therefore, her thyroid dose was too high, and should be reduced. (Note TSH stands for Thyroid Stimulating Hormone and is made by the pituitary gland)
Too Many Doctors Spoil the Soup
Suzy called me at the office distraught and confused. Two doctors were telling her two different things and she didn't know who to believe. Her primary care doctor was telling her one thing and I was telling her another.
I explained to Suzy that her primary care doctor was incorrect in relying slavishly on the TSH test. Even though her TSH test was 0.15 which is below the lab reference range of .3, this was perfectly acceptable and indicated her thyroid medicine was suppressing the TSH to a low level which was perfectly fine.
No Clinical Evidence of Thyrotoxicosis
This scenario is repeated about once a week at my office.
Conventional Docs Slavishly Rely on the TSH
Conventional primary care doctors use a different lab panel from mine. They never do a Free T3 test which is the most informative thyroid lab test, and instead rely on the TSH which is not a direct measure of thyroid function and can in fact be unreliable. Most conventional doctors are unfamiliar with the use of natural thyroid which contains both T3 and T4, and instead use Synthroid which is quite different, containing only T4.
No Time for Explanations
Since the Primary care doctors bill the health insurance for the office visit and payment is only a few dollars, the office visit is brief, 3-5 minutes. In this short time, Primary care doctors can provide only the most basic care, which is a quick look at the TSH lab test. If the TSH is below the lab reference range the doctor gives a new prescription for Synthroid with a reduced dosage. If the TSH is above the reference range, the primary care doctor will increase the Synthroid dosage.
The Cleveland Clinic Chimes In
Why Thyroid Blood Testing is Unreliable.
I recommend to you a book by Barry Durrant Peatfield, "Your Thyroid and How to Keep It Healthy". A general practitioner in the British National Health Service, Peatfield came to the US to train at the Broda Barnes Institute. He later returned to England and started his own thyroid clinic. His book contains the wisdom of 25 years of diagnosing and treating thyroid conditions. One section of the book is devoted to the question,