Replacing thyroid hormone should be done with optimal doses, and not the lowest possible dose that keeps people alive.
BioBalance Health®, Dr. Kathy Maupin and Dr. Rachel Sullivan have a combined total of 42 years of successfully treating hypothyroidism in women and in men. Because we live in an iodine desert in the Midwest (often called the Goiter Belt), we are confronted with a higher-than-average number of hypothyroid patients in our practice. Both Dr. Sullivan and I have been diagnosed and treated for hypothyroidism since we were young adults (17, and 23 yearn old). We understand the importance of replacing thyroid hormone at optimal doses and not the lowest possible dose that keeps people alive, like current medical practice dictates.
The pieces of the puzzle that explain why hypothyroidism is currently inadequately treated is hidden in traditional medical practice that should have been discarded years ago. We train young doctors based on how we were trained years ago whether it makes sense based on current research and information.
- Initial Dosage: MDs refuse to use the information from the pharmaceutical companies, choosing incorrect information they learned 30 years ago. For example, the Synthroid and levothyroxine insert in each prescription from the pharmaceutical company list three things that MDs ignore: The initial dose should be based on body weight. The makers of these medications even give us a formula to follow:
Thyroid dose = Weight in pounds/ 2.2. X 1.7= mcg of levothyroxine or Synthroid®.
After the initial dose the following dose can be adjusted based on symptoms and blood work. I rarely see a patient who has been given a proper dose by their MD PCP, yet DO physicians are taught to begin treatment by following this formula.
In either case I adjust the dose based on the blood work and symptom relief. The blood levels can be affected by time the patient takes her last dose, her other medications, her other diseases, level of activity, and liver metabolism (genetics).
- Another guideline in the medication inserts from the pharmaceutical company making Levothyroxine and Synthroid state that TSH levels should be suppressed to less than 1.0 if the dose of thyroid is correct.
When I use this guideline as one of the determinants to guide my dosage of thyroid replacement, the current MD physicians tell my patients that I don’t know what I am doing!
- Inaccurate Reference Ranges by the big labs (Quest and Labcorp) and followed by the smaller labs.
It is impossible to follow blood levels that are not healthy and based on a group of people who are not picked for youth, lack of thyroid disease or even other diseases that affect thyroid diseases, or medications that lower or raise the thyroid level..basically young healthy people is the group we study to obtain a reference range, but Quest and Labcorp do not use scientifically obtained reference ranges. The reference ranges created by Quest and Labcorp have been dropping with the number of sick people that go to these labs, and the labs use sick, old, and hypothyroid patients to achieve their reference ranges. They use the thyroid tests done in a year and no matter who the patient is and make a bell curve out of it and adjust the reference ranges?
If you use bad numbers, you get inaccurate diagnoses, especially if you ignore the symptoms of your patients.
Correct “reference range” numbers come from gathering blood levels scientifically. Scientists use a group of normal young healthy people who are without thyroid disease, or any other disease for that matter. By using the thyroid tests from patients who have a medical problem they are being evaluated for at Quest, is not scientific and should not be used to determine the blood level we are using to represent a healthy thyroid. The reference range that should be used is the normal range from 20 years ago when the “normals” were obtained scientifically, by testing young healthy people without disease. Diagnosis of thyroid disease based on “bad numbers” is inaccurate and many women are going without thyroid replacement because of it.
As accountants say, “Garbage in, Garbage out!”. The Reference ranges for thyroid disease that doctors follow without thinking are based on blood levels of sick people getting blood tests at Quest or Labcorp over the course of a year, not blood levels of young healthy people. The reference ranges for these tests that doctors go by to represent normal, these have been the same for the last 45 years since I started practicing medicine. Why does the reference range for thyroid blood levels decrease every year, while the ranges of standard tests have been the same for years?
- Patients are not directed to take thyroid medication with water only, on an empty stomach, and to wait to eat or drink for 20 minutes after taking Levothyroxine, Synthroid, or Armour Thyroid. Patients are often handed a script without these instructions, so they often take it with their supplements, or other meds and food or coffee which destroys the thyroid medication. All patients should be told these instructions verbally, and it should be written on their script.
- Blood tests are often drawn in the morning right after thyroid medication is taken. which makes the blood level l of T4 and T3 look unusually high. Doctors who don’t think about the unusually high blood level of hormones several hours after an oral dose, mistakenly drop the thyroid dose, making patients hypothyroid again. In the care of thyroid, which is taken first thing in the morning, a morning blood draw should be taken before the medication is taken.
- Symptoms of hypothyroid patients are often not considered when lowering or raising thyroid dosages. Blood tests obviously don’t always represent the true blood level of a patient and are not the only factor to consider when increasing and decreasing dosage. Symptoms of hypothyroidism must always be considered when adjusting thyroid dose.
We at BioBalance Health® diagnose and treat our patients based on properly obtained lab when a patient is taking her thyroid medication combined with her symptoms of hypothyroidism, and initial thyroid dose should be based on body weight and a trial of thyroid medication.
Other diseases can be caused or worsened by hypothyroidism. These conditions and the lab values that indicate worsening of these diseases are listed below. When thyroid is replaced appropriately these conditions and blood tests normalize.
- High total and LDL cholesterol
- High Triglycerides
- Heart disease
- Slow pulse
- Full body swelling
Therefore, when your doctor tells you to decrease your thyroid dose that we have determined is the right dose for you, you have the facts that defend your current thyroid dose. This handout gives you a written basis for your argument and you can hand him/her a copy.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. www.BioBalanceHealth.com (314) 993-0963
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