The Thyroid Myth that Doctors Still Believe

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The thyroid gland is the most important gland to human life.


I have had hypothyroidism since I was 23, so I have had an interest in the thyroid gland, how it works and what treatments work and which ones don’t for my entire adult life.  In medical school in the 70s I was told that the thyroid was easy to diagnose, all you had to do was draw one test, the TSH (Thyroid Stimulating Hormone) and if the TSH was high, the thyroid was underactive, and if it was high the thyroid was overactive. Like many medical myths, this myth has been repeated to all medical students for the last 50 years without question, and subsequently millions of women have been under-treated or left untreated secondary to this Medical Lie repeated in every medical school.

The information I reveal in this Healthcast will support the above allegations by way of my 40 years of experience as a physician, 50 years as a hypothyroid patient and the new book Lies My Doctor Told Me, by a physician named Dr. Berry, who uncovers all the outdated and untrue misinformation doctors were taught in medical school and residency.  His book confirms what I have been telling patients, contrary to common medical practice, for over 40 years. He quotes and recommends my book, The Secret Female Hormone, to his readers because my book uncovers the lies about what hormones women need and don’t need at menopause.

Today I would like to base our discussion on the information in both of our books and support the true information with my medical experience.

I hope you learn several things about one of the most important glands in your body, the Thyroid:

  • Thyroid function is complicated and the most direct blood tests are the free T4 and free T3. These two tests are not infallible, but they generally parallel a patient’s symptoms. Free T3 and Free T4 are repeatable which means the test is consistent. However, resolution of hypothyroid symptoms is the best sign that your thyroid is working properly. Following the TSH alone is absolutely the worst way to manage your thyroid!
  • Thyroid disease predominantly attacks women and therefore is not a priority for medical doctors (DO Doctors of Osteopathy are trained with less sexual inequity than MDs) as most women’s diseases are considered second class, because MDs still instruct their doctors that women are all crazy and that women are always looking for a way to lose weight without effort. These false negative generalizations remain as an undercurrent in medical education even though women are finally almost 50% of the medical school classes. For example, doctors often tell women they are imagining their symptoms if they are still hypothyroid when the doctor has given them inadequate doses of thyroid replacement medicines.
  • Thyroid replacement must be taken in a specific way to be effective (alone on an empty stomach) and absorption in the intestines require good gut bacteria, adequate iodine, adequate sex hormones and normal cortisol to be completely effective.
  • Endocrinologists are not your best choice in doctors to manage your thyroid. They are the specialty in charge of the thyroid, but their management hasn’t changed in 50 years. Endocrine Society does the research that confirms and publishes articles that use multiple tests including free T3 and free T4, plus positive hypothyroid symptoms to diagnose hypothyroidism. Endocrine journals teach the opposite:  they tell their doctors that the non-specialist order too many tests and criticizing the use of Armour Thyroid® the best replacement for women. Endocrinologists dismiss most female patients with true thyroid disease if their TSH is normal.  My advice is to find a doctor who listens to and reviews your hypothyroid symptoms as well as your lab work including free T3 and free T4 tests.
  • The best thyroid replacement is determined by your gender. Women respond better to Armour Thyroid® (pig thyroid) than Synthroid® or levothyroxine (generic Synthroid). Men respond better to the two synthetic thyroids, Synthroid® and levothyroxine better than natural thyroids.

The thyroid gland is located in the lower third of the neck just above the collar bone. It is shaped like a large butterfly. If healthy, it isn’t obvious when looking at someone except if it is abnormal and swollen which is what we call a goiter.  The thyroid gland is essential to life and affects every cell in the body regulating cellular and physiologic rate of metabolism and burning of calories. When the thyroid gland is underactive it causes severe fatigue, weight gain, swelling throughout the body, memory loss, hair loss, dry skin, goiter, lack of the outer third of eyebrows, constipation, feels cold all the time when everyone else is comfortable, and memory loss and confusion.  If the thyroid is not working at all it causes a condition called myxedema which results in severe swelling, confusion, and coma.  The thyroid gland is the most important gland to human life.

How the thyroid gland works is complicated.  The pituitary gland in your brain is the quarterback making “calls” to the glands to stimulate all of the endocrine glands in the body.  The pituitary gland produces TSH (Thyroid Stimulating Hormone) which stimulates the thyroid gland to make T3 and T4.  There are 4 types of thyroid hormone produced by the thyroid gland, but the most important and plentiful are T3 and T4. These hormones produced by the thyroid gland enter the blood stream and travel to every cell, attach to thyroid receptors on cells, and turn the cells on to burn calories and make energy. T3 and T4 are made from one amino acid (a piece of a protein), called Tyrosine, and three or four Iodine molecules, so the intake of iodine is vital to the normal production of thyroid hormone.  Each cell also requires ample iodine to facilitate the cell’s receptor sites to bind and accept the thyroid hormone which stimulates the activity of the many types of cells to activate the production of heat and use of glucose.

Deficient iodine in the diet is one of the reasons thyroid’s fail.  When the thyroid is deficient, the TSH increases to stimulate the thyroid gland to make more T4 and T3, but the TSH is not a very accurate or specific test to determine the activity of the thyroid gland.  The actual T3 and T4 are much more accurate as long as you test the “free” T3 and T4, which is the active portion of both thyroid hormones.

Measuring the free T3 and free T4 are the obvious ways to test the thyroid, I believe it is the initial however 40 years ago it took weeks to get these tests back, and they were very expensive. I believe it was because of the difficulty running the lab tests for free T3 and T4 in the 70s led to the belief that one test was all you need. This made sense then but not now when. I think of ordering TSH like looking in a mirror instead of looking directly at a person.  Now the Free T3 and Free T4 as well as TSH are done by a multi-test machine and are quite affordable.  There is no reason to continue the outdated method of diagnosing and managing thyroid with a mere TSH test anymore. However, endocrinologists (the “kings” of non-sex hormones) still teach this outdated method from the dark ages (the 60s and 70s). They generally don’t talk to patients about how they feel and their remaining symptoms because it doesn’t change their treatment plan. They draw only a TSH, while ignoring physical signs (dry skin, goiter, brittle nails, hair loss, swelling, loss of outer eyebrows), symptoms of hypothyroidism (fatigue, constipation, brittle nails, hair loss, depression, poor motivation, slow pulse, low blood pressure causing fainting when patients stand up, and many others.

The obvious blood tests like free T3, Free T4, as well as high lipids (LDL cholesterol and triglycerides) when you have low hypothyroidism, iodine, and thyroid antibodies which can be elevated in the case of autoimmune hypothyroidism like Grave’s disease and Hashimoto’s thyroiditis.

Dr Berry in his book Lies My Doctor Told Me calls the use of only TSH as the “Lie” in the face of new information, more accurate testing and more complete examination. Primary care doctors should complete a symptom history, as well as take BP, pulse and Temperature, all of which in the case of hypothyroidism are low.  Many research papers have been published since the 70s which tout the benefit of modern testing to diagnose and maintain patients on thyroid supplementation. It doesn’t seem to be changing anything in the practice of endocrinology.

It almost seems that doctors of endocrinology have closed their minds after medical school and refuse to change how they practice in the face of solid evidence.  They are clearly angry when one of my patients sees them after I have diagnosed and treated them, and they are better!  I have treated hundreds, thousands of women in my years of OBGYN practice and now replacing postmenopausal hormones with estradiol and testosterone pellets along with their thyroids.

Diagnosis and treatment for hypothyroidism for physicians is relatively simple:

  1. Take an inventory of a patient’s hypothyroidism symptoms,
  2. Ask about or test pulse, blood pressure and basal body temperature
  3. Draw Blood tests for free T3, free T4, TSH, iodine when necessary, thyroid peroxidase antibodies, thyroglobulin antibodies, Cardiac CRP and fasting lipids to diagnose hypothyroidism and determine the cause (low iodine, autoimmune thyroid disease, trauma, or unknown) and then treat the patient with the most effective thyroid replacement for their gender based on body weight.

To manage established hypothyroid patients who are on thyroid replacement, lab should include free T3, free T4, and TSH.   If blood is drawn in the am, no thyroid should be taken before the blood draw, skewing the results to high levels. When a patient is on thyroid replacement the TSH should be below 1. If it is over 1.0, then the patient isn’t taking a high enough thyroid medication dose, or they are failing to absorb the medications. The If a patient’s lab looks fairly normal, free T3 (3-4.5). and free T4 (1-2.5) with a TSH below 1, but their symptoms, signs or vital signs are still unchanged or only slightly changed the patient may be resistant to the medication, may be lacking iodine, or may have malabsorption in the intestines.  Endocrinologists stop increasing dosage when the TSH is below 4.5 the normal for patients not on thyroid, no matter how the patient feels.

There is yet another problem with receiving a valid diagnosis of hypothyroidism.  The thyroid lab tests have been lowering ever since the beginning of the last decade.  When I noticed that the range for women’s thyroid free hormones free t3 and free t4 were decreasing every year, I talked to two of the large labs in our area, Labcorp and Quest.  They had no answer for me.

It wasn’t until this year (2021) that I discovered how they determine the reference range, which is the “ideal range” of free T3 and Free T4. The labs have changed from the expensive process of testing young healthy women who have no symptoms of hypothyroidism and normal vital signs, to the short cut of using all the results they obtain from all the patients who get their blood drawn in their lab.  This isn’t statistically valid because most of the patients getting thyroids tested are sick or have pre-existing diseases that alter the thyroid level. , That is shocking to me and of course the blood levels of ill patient are lower than they should be because when you are sick your thyroid conserves energy by shutting down and becoming hypothyroid during the illness.

My answer to using this abnormal sample of patients to determine desirable thyroid levels I go by the levels of free T3 and Free T4 that were reported by the labs over a decade ago, those listed three paragraphs above. My patients are so grateful that I have diagnosed and treated their lifelong symptoms and fatigue as well as depression and obesity.  Many had already developed other diseases because of their thyroid not being replaced, and diagnosis delayed, but they are still grateful that I cared enough to ask about their symptoms and vital signs.

Medical doctors should make a diagnosis based on the interview with the patient and obvious physical signs of disease (LIKE GOITER) 90% of the time, and lab work and physical exam the other 10%. Somewhere in the last 50 years we have lost the art of communication in medicine and most doctors have shut their minds off to new information after they left medical school. I am not proud of the disintegration of my profession, but I do wish we would choose inquisitive and creative people to be doctors with good communication and assessment skills in the future, which would greatly improve the profession.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author.  (314) 993-0963

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