that undiagnosed thyroid dysfunction is a significant problem. I have heard thou- sands of stories from patients all over the world who continue to exhibit classic symptoms of the disorder yet go untreated. Their own physician will often discount a thyroid dysfunction based on a single test. Patients continue to suffer and grow in- creasingly frustrated as their health de- clines, physicians are frustrated in their desire to relieve this suffering, and no one wins.
I believe this stems from a misunder- standing of thyroid dysfunction and the limits of the TSH test. Currently, there exists an unquestioning belief in, and reliance on one test in order to identify all cases of hypothyroidism. As a physician, I am thankful for all the hard work and creative research that has resulted in being able to identify and verify a diagnosis for a patient. However, some diseases are a little less clear cut than we would like. The TSH test is a quick, inexpensive
first step in evaluating thyroid disorder, but, it is just not comprehensive enough to identify all cases. When this test is taught and used as the sole method to identify hypothyroidism, it leaves thousands, and perhaps millions of patients undiagnosed. We have replaced time-honored practices
of listening to patients and the diagnosis skill developed in clinical experience with one blood test, the TSH, to determine someone's thyroid status. When it returns a "normal" result but the patient continues to suffer from thyroid dysfunction symp- toms, we can be more effective physicians if we "listen" (to our patients and our ex- perience) and investigate further. How common is this problem? Well, one of the leading integrative thyroid phy- sicians in the country, Dr. Bornstein, esti- mates that about 40% of the population has hypothyroidism. If this statistic is true, then that would mean that there are over 120 million people that have thyroid dys- function and do not realize it. Another leading hormone expert, Dr. Jacques Her- toghe believes that up to 80% of the gen- eral population has thyroid dysfunction. Though I don’t think I can extrapolate for the general population, in my experience, most patients I see who have multiple symptoms of thyroid dysfunction, have some form of hypothyroidism.
Why is the TSH test an inconclusive indicator? Though we are now taught in medical
school, residency and fellowship that the TSH test is the most definitive test to iden-
tify hypothyroidism, I am going to go against the grain and explain why it is probably not the best way to identify thy- roid dysfunction. The test itself is not at fault. The TSH
is an accurate and reliable measurement of a pituitary hormone. What is faulty is the exclusive reliance on and use of its results as a definitive and conclusive indi- cator of hypothyroidism. The main objection for why the TSH
test should not be used as an exclusive and conclusive diagnosis of hypothyroidism is that there are a lot of things that I call “THYROID DISRUPTORS” that all affect thyroid regulation and the TSH test making it unreliable. These thyroid disruptors in- clude:
• Stress
• Inflammation • Dieting • Diseases • Vitamin and mineral deficiencies • Toxins
The reason why I call these things “THYROID DISRUPTORS” is because they affect different parts of thyroid regulation. They irritate the hypothalamus, confuse the pituitary, and affect thyroid hormone conversion. Since they affect all these
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