The Mayo Clinic ‘Advancement’

That’s Kept Hypothyroid Treatment Stuck in the Dark Ages

by Jonathan V. Wright, MD

When student physicians are in medical school, they are usually told, “Treat the patient, not the lab.” Once they are in medical practice, this advice is all too frequently discarded. No matter what’s bothering you, if all your lab tests are normal, then you’re often told there’s nothing the matter – and frequently, you’re told you should consider an “antidepressant” patent medicine, even though there’s never, ever, been a proven case of “patent medicine deficiency.”

One area of medicine where “treating the lab, not the patient” happens all the time is in the diagnosis and treatment of weak thyroid gland function, technically termed hypothyroidism. According to nearly all MD-specialists in thyroid disease, you can’t possibly be hypothyroid – even if you have all the bodily signs and symptoms – unless your TSH (thyroid stimulating hormone) test is abnormally high.

However, as any “alternative” doctor will tell you, there is absolutely no basis for this mainstream misconception. Relying on the TSH test alone to determine if you’re hypothyroid could leave you misdiagnosed and mistreated. Fortunately, there is a better way to get to the bottom of hypothyroidism.

Doctors Persecuted for ‘Treating the Patient’

State medical boards seem to particularly delight in prosecuting “alternative” MDs for violation of this supposed “TSH must be high” rule. One of Washington State’s most prominent “alternative” MDs was hounded on repeated occasions about this issue for over 20 years by the “Medical ‘Quality’ Assurance Commission,” as he insisted on paying attention to patient’s symptoms and body signs of hypothyroidism first, and lab tests second.

I have heard from MDs and DOs from Oregon, California, Arizona, Texas, and Florida about similar state board investigations into “misuse” of thyroid hormone. In every case, no patients complained. In most cases, the patients were happy with the outcome of their treatment. The “misuse” of thyroid was just one of many excuses used by these state boards to try to put these physicians out of business.

So for these and other naturally inclined physicians – but even more for all of us who may have been or may someday be evaluated for hypothyroidism (a very common problem) – I’m very happy to share with you information from a recently published article that reviews the entire history of the TSH test, and makes it very clear that there is and has never been any proven correlation between a normal thyroid function and a “normal” TSH test.

Poking Holes in the ‘Gold Standard’ Thyroid Test

Let’s start with a citation to the article: O’Reilly D St J. Thyroid hormone replacement: an iatrogenic problem. Int J Clin Pract. June 2010;64(7):991–994.

I know we don’t usually start this way. Since citations take space, they’re usually posted online only. But this one is important to all those naturally oriented “alternative” physicians in Oregon, Arizona, California, Texas, Florida, and elsewhere to help them defend themselves against the medical boards who believe that the standard of care is treating the lab, and not the patient.

Next, a quote: “However, no studies have been published which demonstrate that hypothyroid patients treated with thyroxine are euthyroid [healthy thyroid function] when their serum TSH is within the reference range or, as it is more commonly referred to ‘the normal range.’ The use of serum TSH measurements to assess thyroid status in patients on thyroxine replacement could be considered as a classic example of the misapplication of a laboratory test.”

Strong language! “No studies … classic example of … misapplication …”

In this article, Dr. O’Reilly is focusing on individuals being treated for hypothyroidism, but we can also apply these statements to individuals not under such treatment. If we cannot rely on the TSH test (the supposed “gold standard”) to tell when patients who have been treated have the equivalent of their own healthy thyroid function, we can’t rely on it to tell us whether an untreated patient has healthy thyroid function, either.

Dr. O’Reilly backs up his assertions with a brief history of TSH testing and its application (or, as he says, misapplication).

He writes: “In the early 1970s … on theoretical grounds and without proper assessment, the serum TSH … was adopted as the means for assessing the adequacy of thyroxine replacement.”

He points out that the first “normal range” used for TSH was derived statistically (not taken from patient observation) and had an “upper limit of 5 mU/liter.”

He then points to two studies from the same time period, which found that some individuals had healthy thyroid function accompanied by TSH tests of 25 mU/liter, clearly outside the statistically derived range.

What Your Body Is Telling You About Your Thyroid

When treatment with thyroid got started in the 1890s, whole animal thyroid was used. Adequate dosage (or not) was judged by the clinical response: Did the symptoms and body signs of hypothyroidism go away?

In the 1940s, many physicians started replacing whole animal thyroid and started treatment with synthetic but bioidentical thyroxine alone. Natural thyroxine is only one of many hormones made by animal and human thyroid glands, but by the 1940s one or more patent medicine companies had obtained “process patents” for thyroxine, patents which covered how to synthesize it to be exactly like the natural version. Patent medicine companies “hard-sold” physicians about why their patented – and much more expensive – version was “better” than natural.

Dr. O’Reilly reports that from the 1940s through the 1960s, the average quantity of thyroxine prescribed was 200 to 300 micrograms daily. Adequate dosage (or not) was still determined by clinical response, with the then-available T3 and T4 (two of the major naturally secreted thyroid hormones) measurements as back-up.

Uncovering the Mayo Clinic Scandal

Dr. Reilly writes:

The first report on measurement of the serum TSH in patients on thyroxine replacement was in 1971 in a study by Cotton et al. from the Mayo Clinic, published in the New England Journal of Medicine. They reported that the serum TSH was restored to “normal” with 100 to 150 micrograms of thyroxine daily, i.e. half the dose established on clinical assessment. No details were given as to the patients’ clinical status. This was rapidly followed by a series of high impact publications from virtually all the major figures in the thyroid field confirming this observation. However, none of these publications gave any data as to the clinical status of patients on the lower dose of thyroxine replacement.

It’s a little-known scandal!

The switch from patient-based assessment of thyroid health to lab test-based assessment of thyroid function – in turn based on “statistical analysis” of the TSH test – was led by Mayo Clinic physicians and other “major figures” in the thyroid field.

Dr. O’Reilly continues to focus on the disconnect between TSH tests and clinical evaluation of thyroid health. He writes: “There are only two published reports that give details of the patients’ clinical assessment when the dose of thyroxine has been titrated [carefully adjusted] to return the TSH to the reference range.”

That’s two – 2! – in nearly 40 years. And neither published report found that “returning TSH to the reference range” was reliably associated with treatment-associated healthy thyroid function. In fact, he writes that these two reports were “widely misinterpreted.”

(The very technical details of these reports and their misinterpretation can be found in Dr. O’Reilly’s article.)

From then on, textbooks relied on the Mayo Clinic, other “major figures,” and these two misinterpreted reports, and the clinical evaluation for judging appropriate thyroxine dose went “out the window” in conventional medicine.

Lab Tests: When the Numbers Don’t Add Up

Dr. O’Reilly then explains another supposed anomaly found with TSH testing. The development of much more sensitive “third-generation” TSH tests led to the research discovery that up to 50% of individuals taking thyroxine replacement and achieving healthy thyroid function as judged by clinical evaluation also had “out of range” (in this case, low) TSH tests.

Based on “treat the lab,” not “treat the patient,” conventional physicians tell these patients to reduce their thyroxine dosage – and many redevelop some of the symptoms and body signs of hypothyroidism once more. But since the lab test (TSH) returns to the “normal range,” these patients are told to stay at these less-than-optimal doses!

Dr. O’Reilly points out that when individuals take replacement thyroxine, their free T4 often rises while their free T3 remains within its normal range. Free T3 (not free T4) stimulates the DNA receptors, which do all the “biochemical work” associated with healthy thyroid function. Free T4 (not free T3), on the other hand, directly stimulates the part of the pituitary gland, which produces TSH. This explains why an individual can have healthy thyroid function associated with thyroxine treatment even though his or her TSH test is (in this circumstance) below the range of normal.

Based on all the published evidence, Dr. O’Reilly concludes: “The adequacy of thyroxine replacement should be assessed clinically with the serum T3 being measured, when required, to detect over-replacement.”

More briefly put: Clinical evaluation first, lab second. The professors who tell medical students to “treat the patients, not the lab” are right, once again.

SIDEBAR

The Most Frequent Lab Abnormality in Hypothyroid Problems

You’ve read before about the importance of the “rT3” (reverse T3) lab test in evaluation of hypothyroidism. (Details are in the April 2009 issue of Nutrition & Healing.) Briefly, the rT3 test finds a reason for body signs and symptoms of weak thyroid much more often than all other thyroid lab tests put together.

The strong correlation between abnormal rT3 and weak thyroid was established in part by dozens of naturally oriented physicians whose clinical evaluations led them to suspect thyroid problems and then do a complete thyroid lab test panel. (At Meridian Valley Laboratory, the complete test panel includes not just TSH – which is all that many government programs and insurance companies will cover – but also total T4, free T4, total T3, free T3, and rT3.)

Clinical evaluation and observation by Davis Lamson, ND, and hard work by Angela Sadlon, ND (both Tahoma Clinic physicians) led to the firm conclusion that elevated rT3 was responsible for the discovery of more than twice as many hypothyroid problems as any laboratory test, including the TSH test. (Remember, this does not include the clinical evaluation, strictly laboratory evaluation.)

It’s been the further clinical observation of Dr. Lamson and all the other Tahoma Clinic physicians that individuals with elevated rT3 test almost always have elevated levels of toxic metals – lead, cadmium, mercury, arsenic, nickel, and others – and when these toxic metals are removed by chelation therapy, the rT3 tests return to normal.

But most importantly, the body signs and symptoms of weak thyroid disappear – and the clinical evaluation, the all-too-often neglected clinical evaluation – returns to normal.

Editor’s

note

: This article first appeared in Dr. Jonathan V. Wright’s Nutrition & Healing newsletter. May 2011;18(3).

Jonathan V. Wright, MD, has degrees from both Harvard University (cum laude) and the University of Michigan. More than any other doctor, he practically invented the modern science of applied nutritional biochemistry, and he has advanced nutritional medicine for nearly three decades. Dr. Wright is credited with introducing the nutritional remedy for benign prostate disease (BPH), the first successful treatment to reverse macular degeneration, the safe medical use of DHEA therapy, natural hormone replacement therapy for women, and many other revolutionary natural cures.

To learn more about Dr. Wright’s seven-volume Library of Nutritional Cures and his newsletter Nutrition & Healing and/or to subscribe to the newsletter, please visit www.wrightnewsletter.com, or call 888-213-0685.