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Resistance from the Medical Mainstream

This part article reprinted from Sub-laboratory” Hypothyroidism and the Empirical use of Armour Thyroid. Alan R Gaby MD, Thorn Research, Inc.

The reaction of the conventional medical community to the empirical use of thyroid hormone has ranged from skepticism to derision and outright hostility. One editorial described this approach as bizarre and talked about practitioners who dish out (rather than prescribe) thyroid hormone. A letter printed in a major medical journal referred to the notorious work of Barnes. Others cite the indiscriminate use of thyroid doses, to treat obesity or as a general tonic for tiredness. Several physicians have been accused by state medical boards of practicing substandard medicine, merely because they diagnosed hypothyroidism on clinical grounds or prescribed desiccated thyroid instead of levothyroxine. The emotional negativity that surrounds this controversy is reminiscent of academic medicines resistance to the concept that supplementation with vitamins and minerals might have health benefits.

Goodwin and Tangum noted in an editorial in Archives of Internal Medicine that the medical mainstream has a history of uncritically accepting reports of micronutrient toxicity, using an angry and scornful tone in discussions of micronutrient supplementation, and ignoring evidence of possible efficacy.The debate surrounding micronutrient supplementation and that regarding the empirical use of thyroid hormone share two characteristics that, according to Goodwin and Tangum, tend to raise the ire of the medical establishment:

(1) the ideas originated primarily from outside of the academic medical community, and

(2) proponents often bypassed conventional medical channels and took their ideas directly to the public.

Whatever the reason, it appears that conventional medicine has not made a serious attempt to evaluate the evidence regarding the empirical use of thyroid hormone, and that its wholesale dismissal of the concept represents, at least in part, a biased attitude.A typical response to the anecdotal evidence is, Of course, tired people are going to feel better if you crank up their metabolism with thyroid hormone; but, that doesnt mean they are hypothyroid. That argument overlooks two important points. First, tired people who are not clinically hypothyroid often feel worse, not better, when they take thyroid hormone.

Second, a very specific set of symptoms, not just fatigue or depression, usually improves when clinical hypothyroidism is treated. The firmness with which most physicians assert that a normal TSH level proves euthyroidism is surprising, considering such a notion is based largely on circular reasoning. Ever since the discovery in 1892 that an extract of animal thyroid tissue could cure myxedema, hypothyroidism has been defined as a clinical syndrome that responds to treatment with thyroid hormone. While various laboratory tests have been developed that correlate with thyroid status, hypothyroidism remains a clinical syndrome, and no clear reason has emerged to redefine it in terms of its laboratory correlates.

That laboratory testing provides a less-than perfect picture is suggested by the number of different thyroid-function tests that have been abandonedover the years after being hailed initially as the new diagnostic gold standard. One of the earliest such tests, the basal metabolic rate, was potentially one of the best, since it measured the effect of thyroid hormone in the body. This test, however, was subject to error, because metabolic rate is influenced by the emotional state of the person being tested. Later came the protein-bound iodine test, then the serum T4 and free-T4 index, and most recently the TSH. There is no question that TSH levels go up when thyroid hormone levels go down, and vice versa. There is also no question that extremely high and extremely low TSH values correlate well with hypothyroidism and hyperthyroidism, respectively.

However, there is no a priori reason to assume aTSH value within or just outside the normal range always (or even usually) gives an exact indication of thyroid hormone status. Computer software-like precision is probably more the exception than the rule in biological systems, particularly in systems that are subjected to the disruptive influences of emotional stress, environmental pollution, chronic illness, suboptimal nutrition, genetic polymorphisms, and autoantibodies.


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