Well the thyroid wars have entered a new stage. M.S. uses doctors to support her feeble claim to being a thyroid patient guru. M.S. has a medical doctor and his PHD wife coming out in support for her about.com website. The doctor spent a few paragraphs giving their credentials, before he proclaimed support for the self proclaimed "reporter" on thyroid.about.com. They have no research into thyroid related diseases. Popular culture Books are not research. Thyroid research is published in medical journals that are reviewed by other experts for accuracy. Then these are quoted in Thyroid textbooks. This doctor and wife have clearly stated on their website that people can be hypothyroid with normal tests! That is grounds for not paying any further attention to them as experts in thyroid disease.

Why should patients pay any further attention to any doctor who is selling 10 step programs, books, and advocating that, obese, fatigued, cold, and muscle aching people with 100% normal T4, T3, and TSH tests, are hypothyroid! That is scientifically impossible!

The other physician supporting M.S. is not a thyroid expert either. He has a website that is related to Chronic Fatigue/fibromyalgia. There is no relationship between that entity and Hypothyroidism. End of story.

Now to real thyroid issues:

Thyroid Surgery can be more risky, if you go with the average surgeon with their average complication rate. Do not believe everything you hear from your HMO family doctor or surgeon.

Surgery by surgeons with only limited experience can be hazardous to your health. What do you need to ask of your surgeon before you let them operate on your thyroid? How many did you do last year. What is the complication rate? Can they confirm it with hospital statistics? They need to show you a record of 50-150 thyroidectomies per year. The recurrent nerve that supplies your voice runs near the thyroid. Many variations of the nerve are seen. I have seen the nerve run into the body of the thyroid, circle back and leave at the same spot it entered. If the surgeon did not know of this variation, they would have cut the nerve And you would be hoarse for months, and have permanent damage. You need to insist that a specialist dose your surgery.

Recently, an attorney from a large HMO called to threaten me about some statements I made about the state of thyroid surgery at their HMO. " I will sue your ... off, and cost you thousands of dollars in legal. "That is libel". Lets us look at the problem. If a patient sees a private physician, and they find thyroid cancer, he has two choices. One, go with the community standard, and have surgery with a non-thyroid surgeon, who does less than 50 thyroidectomies a year, and on the average has a 4% chance of complications. Or look for a thyroid surgeon who does 50-150 cases a year, and with a lower complication rate, that is seen with specialists thyroid surgeons. HMO patients are not given that option. They get average care at the community standards level. When they ask for better, that are told they do not need a specialist. Why is thyroid surgery different than cardiac surgery? Both should be done by specialist surgeons. However it is potluck, rather than the best for the poor thyroid patients, and Rolls Royce treatment for the cardiac patients.

Think about that, and fight for a thyroid surgeon. It could save you unnecessary complications.

The Cancer patients: This is for you.

1. Low risk cancer patients with no evidence of disease, for 6-12 months diagnostic whole body scans add NO information when thyroglobulin is undetectable, and no antibodies are interfering. Get an independent opinion from a thyroidologist to see if further radiation for scanning is really necessary.
2. Recombinant human TSH is better in follow up because of less side effects, allows good quality of life by not allowing the cancer patient to become hypothyroid. You stay on Thyroxine while you are undergoing cancer testing.
3. Ultrasound, a safe and harmless testing procedure is the BEST test to look for local recurrence in the neck. Any nodule found by U.S. can be biopsied, and washings taken to see if Thyroglobulin is present. Cysts in the lateral neck will have few cells for diagnosis, but will have high levels of thyroglobulin. The days of knee jerk response following surgery of radio-iodine therapy is over. Insist on a second opinion before you allow anyone to treat you with radio-iodine therapy. There is no evidence it will cure you, or even do any good, but it will add to your radiation burden for then rest of your life.

Other thyroid notes:

More recent evidence against T4/T3 combination therapy. No matter what Mary and her army of combination T4 and T3 users say about how great they feel, there is more evidence that there is no scientific value to these therapies. Studies published in Journal of Clinical Endocrinology, by Walsh et. al. Vol.88 (10) 443-50 2003, confirm that no improvement in well being, cognitive function, or quality of life compared to T4 alone. That the feeling of well being noted by people on Armour , and Thyrolar, or Cytomel is due to periods of overdose by spiking T3 blood levels should be a reason to switch back to T4 only. The human thyroid makes T4 almost exclusively for export to the rest of the body. This is a buffer system. It then reaches the cells and the active T3 hormone is made locally. There is no blood spike as seen with oral T4/T3, or T3 alone.

They are allows talking about hypothyroidism as the cause of depression. Also that T4/T3 combos are better at fighting depressive symptoms. Wrong!

Sawka, et. al. from Canada, reported in Journal of Clinical Endocrinology (10) 4551-5 2003, that there was evidence that combo T4, T3 Did Not improve depression over T4 alone.

Dr. David Sarne, from my medical school, University of Illinois in Chicago recently reviewed the T4, T3 issue. The NEJM article by Buenevicus and his follow up article caused many to go to their doctors and demanded new combination therapy. Dr. Sarne stated the studies were flawed. The conclusions did not have enough positive results to justify the need for T4/T3 combination therapy. The other two studies came to the opposite conclusion. T4 alone was not inferior to combination therapy.

Then why do some feel better on Armour, Thyrolar, or T3?

1. The dose of T4 may be inadequate. TSH must be at 0.5-2.0 for maximum benefits. Many doctors consider TSH of 3-8 to be adequate. It is not.
2. Some people feel better overdosed to a hyperthyroid state, and complain when they are brought down to euthyroidism. There is a withdrawal symptoms with return to normal, that can be misunderstood by patient and doctor that the patient is hypothyroid with "normal" tests. This withdrawal occurs for a 4-8 weeks, but corrects if you keep the dose of T4 normal.
3. There is research needed to see if very small doses of T3 given by timed release can mimic normal thyroid secretion.

Yours truly, and goodbye,