My beefs with endocrinologists pretty much center on how they manage thyroid gland concerns, though they rarely win prizes for managing adrenal issues either. I don’t know any endocrinologists personally and rarely refer my patients to them. Occasionally, a patient with newly diagnosed hypothyroidism (low thyroid) will want to confirm the diagnosis with an endocrinologist. I suggest she prepare for a scolding if she’s taking natural thyroid rather than the synthetic (Synthroid).
One endocrinologist over at Northwestern examined the natural thyroid pill bottle my patient brought in, dumped the contents into the trash, and wrote a Synthroid prescription.
Now how could I not have a problem with that?
Diagnosis Endocrinologists rely exclusively on test results to make a diagnosis of either underactive or overactive thyroid when they should be taking much more into consideration. In fact, they rely on a single test, the one that measures thyroid-stimulating hormone (TSH). TSH doesn’t measure actual thyroid hormone levels. Instead, it measures a pituitary gland hormone that only indirectly reveals your thyroid’s activity.
–High TSH means your pituitary is sending out loads of TSH, struggling to stimulate your sluggish thyroid.
— Low TSH means too much thyroid hormone is present and it’s turning off the action of your pituitary.
Oddly enough, endocrinologists discourage ordering tests that directly measure actual thyroid hormones (T3,T4) or that measure antibodies against the thyroid gland. These antibodies occur in a condition called Hashimoto’s disease, in which the thyroid is attacked by the immune system, leading to an underactive thyroid. The rationale is that the TSH test is sufficient.
But the TSH test alone is insufficient for a couple of reasons. First, the endocrinologist is assuming the pituitary gland is functioning normally. Understand, though, that an underfunctioning pituitary cannot produce enough TSH for the thyroid to function normally. This is called secondary hypothyroidism. There’s nothing actually wrong with the thyroid itself. The low thyroid is secondary to the underfunctioning pituitary.
In addition, the so-called normal range for TSH test results has been the victim of medical flip-flopping. Some laboratories call any TSH above 5.0 low thyroid. Other labs call any TSH above 3.5 low thyroid. Not surprisingly, the group really pushing to use the TSH test only have been insurance companies, making more profit the less they spend on your care.
In the end, thyroid conditions are best diagnosed by listening to the patient. If a doctor listens carefully, her patient will tell her if she has an underactive thyroid by describing the symptoms that accompany it. Lab tests may confirm the diagnosis, but then again they may not. If a listening doctor is hearing her patient describe low thyroid, she should treat it.
Here’s a case history that’s typical of the many thyroid patients we see at WholeHealth Chicago each month.
Linda, an accomplished woman in her late 30s, was not a happy camper. She arrived for the first time at WholeHealth Chicago certain that she had an underactive thyroid gland. Linda had read all the websites, especially Janie A. Bowthorpe’s Stop the Thyroid Madness, and was becoming increasingly exasperated with conventional medicine.
“Here,” she said, handing me a well-worn list that looked like it had been in other medical offices, “I’ve written down all my symptoms. I’m tired and cold. My skin is flaky and my shower drain is clogged with hair. I eat barely anything, gain weight, and then can’t lose it. Look at this list please. Constipation. Bloating. Heartburn. Brain fog. See my eyebrows? See?
“And it’s because of these…” she pawed through the chambers of a large satchel and extracted some papers, “…these goddamn normal lab tests that no one will prescribe me some thyroid.”
Indeed, her tests were normal. Linda didn’t even have the antibodies that would lead to a diagnosis of Hashimoto’s disease. There are some doctors who will now prescribe thyroid hormone based on the presence of Hashimoto antibodies alone.
Low basal temperature (your temperature as you emerge from sleep, before you even move from bed) has been linked to underactive thyroid for 100 years. But because conventional medicine is fixated on blood tests, measuring basal temperatures has become an under-appreciated diagnostic tool. Instructions for taking your basal temperatures are all over the internet, including here at our WHC website.
When I asked Linda if she’d taken her basal temperatures she replied, “Of course…right here.” She palpably refrained from blurting out “Do you think I’m an idiot? Of course I took my basals!”
Her temperature records showed she was cold as ice, leaving no question she had an underactive thyroid. The exhausted and sluggish Linda finally smiled as she left our office and headed to the CVS with my prescription for desiccated thyroid, a completely natural thyroid product, same as the old Armour thyroid before Big Pharma mucked it up. I asked her to keep in touch by email if she experienced any problems and to come back in a month.
One month later Linda was dramatically better. A little thyroid goes a long way.
Endocrinologists are, and have been, suckers for Big Pharma salespeople.
Natural desiccated thyroid (which I prescribed for Linda) comes from the dried thyroid gland of pigs. It has been used successfully for underactive thyroid since 1891. Levothyroxine (Synthroid) is a manufactured synthetic form of one of the thyroid hormones (T4). First synthesized in 1927, it is also used successfully to treat hypothyroidism.
Both forms work, though for some people the natural thyroid works better than the synthetic. This is because the natural thyroid contains a bit of the active form of the thyroid hormone T3, while the synthetic, which is pure T4, requires your body to make a conversion to T3.
Some people convert better than others. It’s as simple as that.
In the 1960s, use of the synthetic product, Synthroid, exploded because one of the Big Pharma companies, Abbott Labs (now called AbbVie), spread the word among doctors that prescribing Armour natural thyroid was dangerous and/or ineffective and a sign that you weren’t up-to-date. They were later fined by the FDA for this untruth.
This Big Pharma lie and conventional medicine gullibility explains why patients seeking natural thyroid have so much difficulty finding a physician to prescribe it.
By the way, even though Synthroid has been generic for 30 years, AbbVie decided to re-market the brand-name drug because of name recognition.
And also, most likely, because of price. 90 tablets of brand-name Synthroid will cost you $189 ($2.00 per tablet) while 90 tablets of generic Levoxyl (completely identical product) cost $20 (22 cents per tablet).
When the drug rep visited WHC, he told us he was pleased to report that endocrinologists were “happy to see Synthroid back and were switching their patients to it.”
Endocrinologists aren’t much better with hyperthyroidism (overactive thyroid).
Thyroid overactivity is pretty easy to diagnose. There are several obvious physical signs (tremulousness, rapid heart rate, weight loss, nervousness) and blood test results (very low TSH, high T3, high T4) that are clear indicators.
Of course, there are always a couple of challenging situations in which a patient is clinically hyperthyroid (meaning she has all the physical signs), but has normal test results. If you’re wondering, I do treat these patients for overactive thyroid in spite of their tests.
In typical cases of overactive thyroid, patients begin taking a couple of meds (one slows thyroid hormone production and the other reduces the symptoms of tremor and rapid heart rate) and most feel better within days. In addition, most people who have hyperthyroidism find it clears up in a year or so, at which point the meds can be discontinued.
Interestingly, both traditional Chinese medicine and homeopathy speed the healing process.
But endocrinologists want things done quickly and far too often suggest that you get your thyroid gland zapped with radiation to completely destroy it. If you consent to this, you are 100% guaranteed to have low thyroid for the rest of your life. Your blood will need frequent testing and your medication dose may need readjusting.
I’ve heard this sentence far too often to just let it go: “The worst mistake I ever made in my life was to allow them to destroy my thyroid gland. I’ve never felt the same.”
So you can see my position. Aren’t I entitled to some beefs here?
David Edelberg, MD
13 thoughts on “Issues with Endocrinologists: Thyroid Approaches and Big Pharma”
I had a total thyroidectomy in March 2022. At my request I was prescribed armour thyroid because I knew the difference between a drug and a natural substance. Now the doctors in my area are refusing to prescribe that unless I also take levothyroxine because Endocrine Society Guidelines don’t recommend anything but the drug company product. Making things more complicated,I live in Costa Rica though I am an American and eligible for Medicare. Can I see the doctor via zoom?
Please give WholeHealth Chicago a call at 773-296-6700. We can discuss different options for your care.
I have been on Synthroid for approximately 15 years. I have done fine until March 2020. At that time I got my Synthroid refilled and since then I have had breathing issues. I believe there is something wrong with the Synthroid manufactured by AbbVie but I cannot prove it. The problem started suddenly a few days into taking the refilled Synthroid. I thought it could not be coincidence so I experimented with not taking here and there. The days I took it I experienced breathing issues. The days I did not take the Synthroid, I had no breathing issues. Has anyone else experienced this? I really think there is an issue with Synthroid manufactured by AbbVie.
Briefing on my rollercoaster thyroid storm:
Endo doc had me on levothyroxine (for hypothyroid) from 34-44yrs.
At 45yo I went from hypo to hyoer. Not sure how or why…started losing weight and I attributed it to my new found love for hot yoga. Until one day my heart rate monitor read 140 as my resting heart rate! So I went to the ER where they said I have an “undetectable TSH level” Then went back to my endo; he did an ultrasound and found a nodule on my thyroid. Then went to an ENT doc for a FNA and found the nodule was cancer. Yep, Full thyroidectomy @ 45yo and then back to levo. At 51 started feeling foggy, sluggish coupled with high anxiety. Thankfully found Dr Edelberg. I’m now on 1 NP (for thyroid) daily and 1 bio identical hormone at night! I FEEL SOOO MUCH BETTER! Thank you Dr. Edelberg.
Fantastic article! Back in 1995, after seeing 17 different doctors (3 endocrinologists), and having thyroids tests that were all in the “normal range”, Dr E listed to me describe my symptoms of weight loss, feeling my heart beat and jitteriness and concluded that I was hyperthroid. He prescribed Thyroid medication and it changed my life. Every TSH thyroid test taken since comes back in the predetermined “abnormal range” but it’s perfect for what works for me. I try to tell this story to everyone in the medical profession in order to pass along the knowledge that sometimes the “normal” blood test range doesn’t apply to every individual. Thanks Dr E for taking care of me for the past 25 years.
Like many people who have hashimotos I also experienced what Dr, E describes and more…
1) Delayed/missed diagnosis (42 years to get a hypothyroid/Hashimotos diagnosis)
2) Wrong treatment (three years after diagnosis to finally get NDT and T3)
3) Misinformed (to put it nicely) endocrinologists who will not prescribe thyroid hormones unless someone is “out of range” and believe NDT is not “standardized” and ineffective.
4) Big pharma — not only corrupting endos but buying up desiccated thyroid manufacturers, changing formulas to the point that people relapse to the point they can barely function.
5) Greed from all sides: big pharma, insurance companies, laboratories and even a few “thyroid knowledgeable” doctors cashing-in on patient’s lack of competent care from “conventionally trained physicians.” (Please note: I am Not referring to WHC but other practitioners that don’t accept insurance and are charging exorbitant amounts knowing that desperate people who need their thyroid issues corrected will pay.)
One doctor would not even refill my Rx unless I paid a $400 office visit despite the fact that my thyroid labs taken a month earlier indicated I was still “optimal.”
6) Broken healthcare/insurance systems resulting in sky-high premiums, ever-shrinking coverage, discrimination and healthcare inequality–If you’re poor and in a “marketplace plan” you’re s***t out of luck.
It’s not just the lifetime of being unwell and not being treated. It’s years of lost income and nearly bankrupting me in the process.
Dear Dr. Edelberg,
You’re just what I’ve been looking for.
I had the thyroid radiated many years ago and have never felt good.
Gave up with endocrinologists.
General MD does not bother with adjusting med to how I feel.
Thank you for this! It is in your office that my poor conversion of T4 to T3 was pinpointed and I was able to get at it naturally with adding Zinc changing my nutrition and slowing my lifestyle a bit. Listening to the patient will always prevail. We know when we aren’t right. Thank you for writing this.
Pascale G. Petro
Excellent and brave post! I am an example of “in range” FT4 and FT3. However, I was not adequately converting the T4 into T3. Looking back over the years of blood work, even 15 years prior to thyroid cancer (2012), my FT4 was at the very high end of range. FT3 was not tested.
After the thyroid cancer, I educated myself in thyroid hormone replacement levels and choices. I had to beg to test the FT3. I saw that it was at the low end of range. No amount of synthetic T4 helped. No amount of synthetic T3 helped.
Figuring out the issue was not “rocket science”, yet I had a very difficult time finding an “endo” that was knowledgeable, willing, (even permitted by their practice) in testing my FT3 and RT3 and in dosing Desiccated (DTE).
So many people are misdiagnosed and mistreated for issues that are really high/low thyroid hormones and lack of adequate conversion of the T4 hormone. I have “counseled” a number of people that felt horrible and were ready to just stop their hormone replacement. So sad that they are that desperate.
There is a lot behind the scenes that goes on in the world of thyroid hormone replacement. IMO, the negative fallacy issues associated with use of T3 and DTE include greed, monopoly, control, old-world-no-time to learn.
Can we get the manufacturers of the DTEs to further teach about their product? How can we teach the ATA, med students, the practitioners, patients about all this? Studies are needed that the ATA has to issue? At least that is what I was told by a prominent ATA member. Maybe, but not really. Money is needed? Of course. Always. Who gets it, who gives it, who keeps it. Care and compassion is needed.
I applaud your efforts, Dr. E (as well as all the other clinicians) as you care about your patients, continue to learn, to work with us, advocate for us. I would gladly help you spread the word.
Dear Dr. Edelberg, I take Nature-Throid you prescribed for many years. RLC does not manufacture Nature-Throid anymore
and I have to search for my dosage all over the country. What do you prescribe now?
Working in an ICU where so much is about the tests and results, our medical director constantly reminded us to “treat the patient, not the numbers”.
At a recent conference I asked a well known endocrinologist why we don’t evaluate thyroid cancer patients’ (I.e. no longer having a thyroid) response to thyroid replacement hormone based on objective functional criteria he responded “it’s too difficult”.
Test results are clues, not directives.
IF YOU ARE ALREADY ON SYNTHROID – WAHT ARE YOUR THOUGHTS OF ADDING ALSO desiccated thyroid TO A REGIME. I DO NOT HAVE A THYROID – HAD A FOLLICULAR TUMOR SO IT WAS REMOVED 25+ YEARS AGO
Thank you so much for your article. My experience has been similar, which is why I did some research into functional medicine and found your all at WHC. I saw a doctor once to review a thyroid scan I had done, and he actually yelled at me for taking desiccated thyroid medicine. He said “why would you want to take a product from an animal” Unreal! Naturally, I never went to that office again. I am so glad to be under the care of Dr. Caley Scott.