Overreliance on TSH is a thyroid therapy policy that fails to detect its own failure

overreliance on tsh

In standard T4 thyroid therapy, TSH normalization is so easy to achieve that it is almost impossible to fail.

  • First, TSH out of range is the judge of an initial DIAGNOSIS.
  • Next, normal TSH becomes the sole TARGET of therapy.
  • Finally, normal TSH becomes the sole JUDGE of therapy success.

This is faulty reasoning.

There are no checks or balances to verify whether normalizing the TSH is a valid target or the correct judge.

It’s a system that is set up to fail at detecting its own failure.


“Whenever I fail on an exam, I know it’s likely I didn’t study hard enough”

“I will always try to study at least 5 hours for every exam, since that will protect me from failure.”

“I studied 5 hours for this exam, therefore I passed, no matter what my actual grade is.”


“Having a good turnover rate of inventory in the warehouse of our store can be an indicator of whether we’re having business failure or success.”

“We’ll keep our eyes firmly fixed on this indicator, trying our best to improve it. It has become our sole target as a business. Customer satisfaction is unimportant and should not be examined.”

“I have achieved a good inventory rate. Therefore I have a successful business.”


TSH-centrism and TSH-monotesting policy in thyroid therapy is a falsely self-justifying system because it disallows other criteria from ever equalling or overwhelming its authority.

It is a system that continually demeans, belittles, minimizes and excludes as valid any factors and voices that could prove it incorrect, especially a thyroid patient’s own voice.

As a physician, you certainly don’t want to fail at treating a thyroid patient. That would be very embarrassing given how easy everyone knows it should be.

As an endocrinology society, you certainly want to make it look like thyroid patients are being taken care of and that your guidelines look like they are 100% evidence-based.

As endocrinology researchers, if you continue to use TSH as a sole or primary index of thyroid hormone sufficiency in all health-outcome studies, never comparatively testing other biochemical indicators or other thyroid therapies with different therapeutic targets, you can provide a lot of self-affirming “evidence” that supports the current “evidence-based” guidelines set up by your colleagues.

Which kinds of research studies are likely to be designed by endocrinologists, and then approved by peer reviewers of research proposals, who are likely also endocrinologists, and then offered supplies and funding for research — Would those be studies that examine FT3 and FT4 and their ratios in treated thyroid patients in relation to long term health outcomes? Or would they be studies that use TSH alone as a surrogate marker? Which studies are likely to be simpler in their design and easier to yield “statistically significant” results that affirm the current paradigm?

Besides, how are the researchers going to study FT3 data at a population wide level if the Canadian endocrinology society actively supports testing prohibition policies that forbid thyroid hormones, especially Free T3, from being tested in a treated thyroid patient whenever their TSH is normal?

Now let’s consider the TSH test manufacturers and the laboratories. They also have a stake in the TSH-first and/or TSH-monotesting economy.

Using the test for everything related to thyroid hormones appears to validate all the hard work of those historically involved in research and development of TSH testing technologies — all those people that have refined the test’s ability to detect extremely small changes in serum levels and very low concentrations. 


Normalized TSH is a shield.

It’s not a shield to treated thyroid patients’ health, but to those who trust in it as a guide and judge of a favorite therapeutic model.

It’s a favored model because it is cheap, easy, and simple.

It affirms egos, institutions, paradigms, and industries.

It keeps them from facing their ultimate fear and shame: that they are systemically harming vulnerable patients’ health and quality of life for the remainder of their lifelong therapy.

Normalized TSH has become an excuse.

A normalized TSH is a guidelines-approved excuse for negligence whenever symptoms should warrant further investigation.”We have obediently followed the therapy guidelines.”

It has become an excuse for any and all patients’ symptoms and health problems that may occur during lifelong thyroid therapy.

If these problems MIGHT also be caused by other diseases, then we’ll say they always MUST be caused by non-thyroid-hormone related factors when our favorite god and oracle, the omniscient TSH, is within a statistically normal range.

A normalized TSH could potentially cover a multitude of sins — medical, scientific, and ethical — but we can’t measure how badly it’s failed because the system has forbidden us from using or validating measures other than the TSH.

This is not evidence-based medicine or science, this is like religion and blind faith.

These self-interested parties are all repeating a mantra: “All hail, praise and glorify the almighty TSH… we sacrifice our hard-earned scientific knowledge and critical thinking to thy powerful, single voice. We offer up our thyroid patients’ lifelong suffering to thee and ask you alone to judge their validity. We thank thee for the absolution and atonement thy authority has offered for our many sins and imperfections as human beings.”

Now do you see why we need the Free T3 and Free T4 test, at bare minimum, to give the rest of our body’s thyroid hormone supply a voice of authority.  Often it’s the best evidence that can talk back to the TSH and hold it to account.

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