Overall, the TSH paradigm tends to see thyroid therapy from the perspective of the health care system, the doctor, and the pituitary gland as a biochemical condition that must be safely and efficiently managed.
In contrast, the T3 paradigm sees thyroid hormone sufficiency from the perspective of each patient and from the perspective of each organ and tissue’s need for optimal T3, and then considers how the health care system and doctor can support thyroid hormone health in the tissues and organs of those patients.
Arising from these two perspectives, the two paradigms have a different focus and priority list.
The TSH paradigm focuses more on normalizing hormones within population reference ranges, prioritizing the TSH hormone and the T4 hormone over T3, and prioritizing efficiency by guiding decision-making with easy flowcharts and guidelines.
The T3 paradigm focuses on optimizing the interaction between T3 hormone levels and T3:T4 ratios, within the context of thyroid symptoms, overall health, and a wide range of specific diseases. The priority is on understanding these complex interactions to make good clinical decisions.
The two paradigms see the relationships between TSH, T4, and T3 entirely differently.
The TSH paradigm trusts the body’s conversion of T4 to adjust T3 levels as it sees fit, viewing T3 as the mere tail of the dog, led by the TSH brain and the T4 muscle and bone of the dog.
The T3 paradigm sees T3 as the central focus of the thyroid hormone system around which TSH and T4 adjust in order to protect T3 levels in blood and tissues. In the context of thyroid therapy, the T3 paradigm correctly views TSH as the tail of the dog. TSH is a responsive element rather than an overcontrolling one. It is a signal that requires cautious interpretation, while T3 and organ and tissue response to T3 is the heart of the dog.
The two paradigms view population reference ranges differently.
In the TSH paradigm, keeping all three hormones anywhere in the population reference range is seen as validating the success of therapy and as the ultimate achievement of euthyroidism.
In the T3 paradigm, reference ranges are not discarded. However, the reference range is just the larger context in which optimal levels and ratios may be found, and it is neither a hard boundary nor an end goal to keep hormones in their ranges. This paradigm acknowledges that subtle shifts in T3 levels and T3:T4 ratios even within reference range can have significant impacts on health, and that therapeutic interventions require cost-benefit assessment of hormone levels beyond the ranges.
Naturally, they have different views of thyroid hormone pharmaceuticals.
The TSH paradigm values T4 monotherapy above all, because it has the power to control and normalize TSH secretion and to place T4 and T3 within the reference range. It carefully guards and protects T4 monotherapy and considers all T3-based therapies with suspicion as experimental and potentially dangerous.
The T3 paradigm is NOT anti-levothyroxine. Instead, it is open-minded and non-prejudicial about all forms of thyroid hormone pharmaceuticals as long as they are used wisely to “optimize” a person’s T3 levels.
“Evidence-based medicine” is vastly different in the T3 paradigm versus the TSH paradigm.
The TSH paradigm has the strength of funded research behind many large studies of TSH and T4 hormones in therapy and overall health. It draws on this body of research evidence to maintain its dominance through medical guidelines and policies. Of course, it often dismisses T3 data, choosing to focus on the surrogate marker of TSH, which has now gained the social power to define hypo, hyper, and euthyroid status. Some research is entirely focused on numerical averages and ranges and presumes that any value within reference has positive health outcomes and values outside of reference have negative health outcomes.
There is no doubt that the T3 paradigm’s research strength is in scientific literature before the 1970s rise of the TSH paradigm. It is also found in a growing body of endocrinology research since 2011. However, some endocrinology journals and peer reviewers are unwilling to embrace a radical shift of paradigm unless it is championed by a leader. As a result, the T3 paradigm’s research makes its progress across multiple medical disciplines, not just endocrinology. The T3 paradigm by definition embraces a wider range of scientific evidence by not only considering TSH and T4 data but also including T3 data, autoimmune disease data, and health outcome data that goes beyond mere laboratory test numbers and ranges.
Beyond the collection of evidence, the two paradigms also rely on different values and assumptions to interpret and reason about evidence in different ways.
The TSH paradigm tends to see health and disease as “associated with” TSH and values TSH normalization as a sign of “adequate” dosing, whereas the T3 paradigm justly views health outcome associations as more likely to be direct cause-effect relationships between T3 and organ or tissue function.
Each paradigm has its downsides or costs.
The TSH paradigm fails many patients by viewing thyroid therapy as a way of cheaply and efficiently managing a faceless mass population at a distance from the individual patient’s unique needs for thyroid hormone. The TSH paradigm does not consider T3 levels and patients’ symptoms as important evidence compared with the TSH level. In the TSH paradigm, whenever a patient’s TSH is within the laboratory reference range, all other evidence of hypothyroidism is discounted as irrelevant, and symptoms are attributed to other health conditions. This often costs the patient their dignity and throws their the data of their experience into the dustbin.
The T3 paradigm’s main cost at this time is the difficulty of operating within a system that is still dominated by the TSH paradigm. As a result of being the paradigm in the minority, it bears the burden of proof — it always has to prove that it is evidence based, so it has to know more. Its broad view of evidence is a challenge for the brain-fogged and symptomatic patient and the busy and career-focused physician. In terms of money and time, the T3 paradigm physician must continually navigate the risks to his or her career of swimming upstream against anti-T3 testing policies and anti-T3 pharmaceutical prejudice, while the patient struggles to find a good doctor an often ends up paying out of pocket for practitioners and tests. T3 paradigm advocates must be strategic, pick their battles, protect and defend themselves, and persuade, and accept the slimmer chances of winning and persuading.
Our campaign obviously champions the T3 paradigm despite the costs and risks.
We are patients running this campaign, so of course we value the paradigm that is more capable of achieving thyroid hormone health in the individual patient, and we don’t want any patient to be left behind. Whatever it takes, no matter what thyroid pharmaceutical or combination is required to achieve that goal, the patient’s health matters.
We not only have sufficient scientific evidence supporting our position but we truly have the ethical high ground.
The goal of thyroid therapy in the T3 paradigm is to ensure that the person is neither overdosed nor underdosed according to multiple biochemical measures and symptoms, not just population reference ranges. Who can argue with that goal?
The mode of therapy is flexible. Optimal T3 is unique for each person. Each person responds differently to each pharmaceutical at different levels and ratios.
We don’t leave behind TSH and T4. We don’t exclude. We include.
T3 paradigm patients are generally less complacent due to the experience of suffering during diagnosis and therapy. Some patients who have achieved therapeutic goals have the energy and mental acuity to lead the struggle for those who are not well enough to fight.
The practitioner is highly regarded for their expertise. Managing therapy is a healing art that requires knowledge and discernment, not just robotically following a flowchart.
In the T3 paradigm, individualized medicine combines with scientific research to achieve therapeutic success even in difficult and complicated cases.
We believe in taking the high road to health and a better society.
We are growing in power and numbers, and we won’t back down.
Full text of the infographic:
1) The most important, most active thyroid hormone. Required by every organ and tissue. T3 insufficiency is hypothyroidism.
2) Its primary usefulness is in optimizing thyroid hormone therapy to provide sufficient T3 in bloodstream.
3) The paradigm interprets the 3-way relationship between T3, T4, and TSH in the context of symptoms and signs to discover a patient’s optimal T3 set-point for health. 4) Any mode of thyroid therapy including T4 monotherapy, desiccated thyroid, and T3 therapy may be tools to achieve optimal T3 levels.
1) Pituitary TSH regulates the healthy thyroid gland and responds to T4 and T3 levels in the pituitary. TSH is associated with thyroid status.
2) Its primary usefulness is in screening and diagnosis of thyroid gland failure and T4 insufficiency — before therapy begins.
3) The paradigm relies on population-wide statistical reference ranges to determine acceptable levels of TSH, T4, and T3 in bloodstream, but prioritizes TSH above all. 4) Only T4 monotherapy is permitted. The goal is to keep TSH within the laboratory reference range, regardless of symptoms, T3 or T4.
Categories: Therapy paradigms