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

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 …

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Several fallacies in the TSH-T4 paradigm of thyroid therapy

When you are steeped in a medical paradigm, its fallacies can be as comfortable and taken for granted as an old pair of sneakers. In this post, I'll take apart several thyroid therapy fallacies, starting with the fallacy "description is not prescription." I will investigate many of the ways in which patients on T4 monotherapy …

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TSH “can be very misleading” during thyroid therapy, say researchers

How many treated hypothyroid patients' TSH has fallen below range even when both their thyroid hormones are in normal range and when they have no symptoms or signs of hyperactivity or hypermetabolism? In my observation on thyroid patient forums, the answer is "too many." It's common among thyroid patients to resort to such forums for …

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Thyrotoxicosis can occur with high or normal TSH?

Table 17.1 in Braverman & Cooper's 2013 chapter in Werner & Ingbar's The Thyroid textbook, 10th edition, lists many causes of thyrotoxicosis. The only time the TSH _hormone_ is listed as a cause of thyrotoxicosis is in the case of "Inappropriate TSH hypersecretion." If thyrotoxicosis can occur when TSH is inappropriately _high_ or non-suppressed in …

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Thyrotoxicosis: Symptoms and signs

Much confusion exists about the value of symptoms and signs in the diagnosis of thyrotoxicosis. The most common view is to dismiss symptoms entirely because each, considered separately, is "nonspecific" to thyrotoxicosis. However, there is no such thing as a "thyroid-specific" symptom because thyroid hormones have their effects in every organ and system of the body.  What's …

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Letter on diagnosis published on British Medical Journal website

Today, the British Medical Journal's website published my "rapid response" letter: How can truly hypothyroid patients be accurately diagnosed within the enlarged subclinical category? Link to full text: https://www.bmj.com/content/365/bmj.l2006/rr-6 It is a response to the new guidelines for subclinical hypothyroidism: Bekkering, G. E., Agoritsas, T., Lytvyn, L., Heen, A. F., Feller, M., Moutzouri, E., … …

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A Thyroid Patients Manifesto

Manifesto: "a written statement declaring publicly the intentions, motives, or views of its issuer" (Merriam-Webster) I humbly offer the following manifesto for us as thyroid patients. WE, as citizens maintained by thyroid hormone therapy, declare our equal rights to health and well being. We have the right to agency and choice within our thyroid therapy. …

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