In Thyroid Treatment, Does One Size Fit All?

When it comes to thyroid treatment, patients often come up against the idea that "one size fits all."

Most commonly, we see this in the attitude some doctors have regarding the TSH test and their faith in the idea that it is the only way to diagnose a thyroid problem. Many of those doctors also believe that if you are hyperthyroid, you must immediately schedule radioactive iodine treatment (RAI), or if you are hypothyroid, you should be taking Synthroid, and only Synthroid, period, end of discussion.

But it's not just conventional doctors who tend to get dogmatic and narrow minded like this, however. Now, we're seeing it among patients. A patient finds that a particular option works for him or her, and then extrapolates that experience into some sort of truism for everyone. The next thing you know, you have patients declaring unequivocally that they know the answer: "All thyroid patients need T3," or "everyone who is hypothyroid needs to be on Armour Thyroid" or "all thyroid patients have a candida problem," or "everyone who is hypothyroid should eat kelp or coconut oil" or "all thyroid patients should take iodine, or selenium, or progesterone, etc. etc." It never ends.

Mary Shomon recently asked Drs. Rich and Karilee Shames, noted thyroid practitioners, and authors of the books Thyroid Power, Fat, Fuzzy and Frazzled, and Thyroid Mind Power (2011) about this tendency for doctors, and now patients, to buy into a particular dogma, and then turn around and insist that it's the answer for everyone else.

MS: What in particular is concerning you about some of the dialog you're hearing about thyroid disease?

RS/KS: In our 30 years of shared medical practice (that's 60 yrs total!) the biggest mistake we've seen from both practitioners, and now patients, is to assume that if a diagnostic or therapeutic approach is good for some people, then it good for everyone. Despite the popularity of this logic, "one size fits all" medicine is far from optimal care.

MS: Isn't it reasonable for a patient to claim that a particular approach works if there is medical research to back it up?

RS/KS: You have to be careful, because if a treatment approach or procedure has a favorable outcome in one or even several research studies, that doesn't mean that it is the best choice for everyone. In our view, trying to apply the same, cookie-cutter treatment approaches to everyone with a thyroid problem is like suggesting that each person has the same genetic material, the same exposures, the same experiences, or the same potential. And of course, that is clearly not true.

MS: I've always felt that the best thyroid medicine is the one that safely works best for each patient. So I've always argued against the whole "Synthroid is the best medicine for everyone who is low thyroid" idea. And I know many patients who, like me, find that sort of thinking very narrow. Yet, it's not clear to me why some of those same patients feel that an alternative approach that works for them is somehow the answer for everyone. For example, I hear a lot of "Armour is the one best medicine for everyone who is hypothyroid." And that's ridiculous. It works better for some people, absolutely. But to suggest it works for everyone, or is best for everyone, is just wrong.

RS/KS: Exactly. This is the problem. Armour might be better than Synthroid for many people with hypothyroidism, and could be especially helpful for those post thyroidectomy or radiation, but that doesn't mean it is the one and only "best medicine" for anyone who is hypothyroid. The thyroid system is just too complex, physiology is too complex, and people's responses to medications are so individual -- there's no way anyone can say "one size fits all."

In fact, suppose one of our patients asks us, "What is the best medicine for this condition?" We always say that this is NOT the right question, because it leads some people in the wrong direction. A better question is, "Which of all the available, useful therapies might be a good one for me to start with in my situation?"

MS: There's clearly a desire to come up with one "standardized" magic bullet treatment, though, whether for conventional endocrinologists, or on the holistic end, right?

RS/KS: Over the years, we've seen some of our medical colleagues take strong stands for one particular therapy or another. Some say Synthroid is best for everyone, others that everyone should be on the active hormone T3, like in Cytomel. When Dr. Broda Barnes' work became popular, some colleagues felt that everyone should be on Armour thyroid. There are adherents to the T4/T3 combination, and even to particular ratios of T4/T3. Then it was compounded thyroid. Of course, along the way we heard that everyone could improve their thyroid problems with coconut oil. More recently, we have been told that everyone with a thyroid problem should should be on high doses of iodine, to fix not only the thyroid, but also fibrocystic breasts and even thyroid cancer.

But after working with thousands of thyroid patients, it's clear. Some people do best on standard thyroid drugs, others seem to do better with compounded mixtures. Some people are fine on Synthroid, others do best with Armour, or Thyrolar, or Naturethroid, or combinations of various drugs. Some people will thrive on 98% T4, 2% T3, others need a different ratio to feel well. Some people need iodine, others don't. The truth is -- no one treatment approach is a panacea for everyone.

MS: So, what you're saying is presenting a one-size-fits-all solution -- whether it's conventional or holistic, and whether it's coming from practitioners or other patients -- is not really in the best interest of patients?

RS/KS: That's right. The one thing we know is that "absolutes" are not trustworthy. It is unlikely that any one of our present therapies will be viewed in the future as "the one best thing for everyone." We've seen all of the above therapies do well for some people, but not for others. No one therapy is ever likely to be right for everyone.

MS: So, how can patients be sure that they are making smart decisions? They hear one thing from doctors, and another from friends or support groups. Everyone is equally adamant that they know best what the patient should do.

RS/KS: We all have been trying to educate patients that they will frequently encounter doctors who have the very narrow view that TSH tests and Synthroid are the only solution for hypothyroidism diagnosis and treatment. I think the word is getting out, and patients are increasingly knowledgeable, and looking for practitioners who take a less dogmatic view of thyroid disease.

But at the same time, patients need to realize that their friends, relatives, fellow thyroid patients, and thyroid support group leaders and members can be equally dogmatic. While well-meaning, these folks often have strong opinions about what is good for you, and what works and doesn't work and are unafraid to tell you exactly what treatment you must pursue, how to do it, and even going so far as to tell you where to buy prescription drugs abroad so you can bypass doctors completely, and how much of those drugs to take. This sort of approach can lead to serious consequences.

MS: So what do you recommend patients do when they are evaluating recommendations from anyone -- whether it be from a doctor or a fellow patient?

RS/KS: We urge thyroid patients and their practitioners to be interested and open-minded regarding each other's therapies. Any one of them might be the exact best medicine for a particular sufferer, or might not be. And we urge all who suffer from thyroid problems to become more acquainted with the wide variety of available options, and embrace those practitioners/advisors who will further explain those options to you, help you make your own informed choice, and work with you to safely carry out your chosen options.

And in support groups or with fellow thyroid patients, share your stories, but not your dogma. Recognize that what worked for you might be valuable for the next person, or it could lead to harm. Don't tell others what to do, tell them what you did and how it worked for you. Trust them to be the best healer for themselves, knowing all they know about their own lives and story. Let them make their own best decisions, and when they have questions, concerns, fears or challenges, keep an open mind. Don't try to shame others for not thinking as you do, respect each other. The ability to think for ourselves is what makes our world so special, so magnificent, so diverse. Don't try to box others in; instead, help them to expand.

MS: So what you are saying is that whether you're coming from the practitioner or patient perspective, it's still useful to take a "holistic" approach to thyroid disease?

RS/KS: Definitely. When trying to re-balance the delicate, complex thyroid system, it is not the job of the practitioner/advisor to have one favorite therapy, or a pat answer that applies to everyone. Instead, the practitioner/advisor does best by helping patients find out what actually works well in their own unique bodies. Our job is to listen, to love, to care, and to inspire. Working holistically has expanded our medical practice, with the understanding that each person is a unique combination of body, mind and spirit. Each person deserves to be honored and cherished for who she or he is. Finding balance for the challenges of the body is an integral part of each soul's journey. For those reading this today, may your journey be blessed with the support you need to find your own best path to health.

Drs. Richard and Karilee Shames are co-authors of three books on thyroid disease, Thyroid Power, Fat, Fuzzy, Frazzled? and Thyroid Mind power. Richard Shames, MD graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for more than twenty five years. Karilee Shames, RN, PhD is a Certified Clinical Specialist in Psychiatric Nursing and in Holistic Nursing. Both doctors offer holistic medicine practice and coaching -- with a focus on thyroid, autoimmune and hormonal balance issues.



Drs. Richard and Karilee Shames Interviewed by Mary Shoman


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The Canary Club is an educational advisory group with a team of medical advisors headed by Richard Shames, M.D.