[Anonymous August 28, 1998 at 3:04 pm Post count: 93172]

#1148125

While I can’t make any contradictory remarks concerning the
overall gist of this article, I did want to ask a question
that someone might be able to shed some light on. It sounds
like Dr. Volpe is a firm believer in the TSH test. Okay,
it is recognized as the most “sensitive” of the thyroid
hormone tests. However, docs I have talked with have
told me that it takes a minimum of 6 weeks for changes in
my TSH to show up in a bloodtest. Wouldn’t this fact make
TSH as “weak” as tests for Free T4 and T3 then? Isn’t it
possible that changes in FT4 (at least) levels could be able to
react to the increased/decreased TSH levels by the time
the TSH changes show up in a bloodtest result?? Well, anyway,
I think I’m getting too technical for a Friday afternoon.
Anyone else heard about the “lag time” for TSH changes
to show in bloodtests though?

Sheila H.

[Anonymous August 28, 1998 at 3:27 pm Post count: 93172]

#1049932

‘thyrobulletin’ Summer 1998 Volume 19, No.2

Dr. Volpe Speaks:

Misinformation on diagnosis and treatment

There is a great deal of misinformation
being spread by alternative medicine
regarding the diagnosis and manage-
ment of hypothyroidism. In a recent publica-
tion by a drug firm, the tradition continues as
they have published an article by the Broda
Barnes Research Foundation which is essen-
tially without foundation.

The article states that determining the
standard thyroid function tests “fails to do
what really counts”. This is simply incorrect.
The authors instead state that a simple basal
axillary temperature test would determine
thyroid status. In fact, the temperature range
for axillary thermometry varies quite widely
and the use of such a procedure would pro-
vide a completely erroneous idea as to who
has thyroid disease.

We now have extremely sensitive tests
which measure thyroid stimulating hormone
(TSH). The results of this test will be elevat-
ed even before the serum free thyroxine or
triiodothyronine values decline as patients
are becoming hypothyroid. Thus, we often
are able to diagnose what is termed compen-
sated hypothyroidism while patients have no
symptoms whatsoever. In such circum-
stances, the TSH has already risen but the
levels of thyroxine (T4) or triiodothyronine
(T3) are still normal at this point.
Conversely the TSH will fall even before the
levels of T4 and T3 rise and this is termed
subclinical hyperthyroidism.

It is thus clear that the TSH is the most
sensitive test of thyroid function. Indeed, if it
is normal, one simply cannot make a diagno-
sis of primary hypothyroidism or for that
matter hyperthyroidism.

Of course, there are some people who
feel that one can have thyroid function
abnormalities even with completely normal
thyroid function tests. However, there is no
objective evidence for this whatsoever, and
the consensus amongst thyroidologists,
including members of the American Thyroid
Association, is that patients who have vari-
ous symptoms but normal thyroid function
including a normal TSH simply do not have
thyroid dysfunction.

Another point raised by The Broda
Barnes Research Foundation is the measure-
ment of a 24 hour urine test for T4 and T3.
No endocrinologist in the academic world
would use such a test when we have
available the very sensitive TSH determina-
tions. Once again, there is no credence in
such a test and it is never even mentioned at
national and international thyroid meetings.

Finally, there is no evidence that natural
preparations have any advantage whatsoever
over synthetic thyroxine. There is no evi-
dence that they (i.e. synthetic thyroxine
preparations) are “very poor replacement
therapy” and there is no evidence that natural
desiccated thyroid hormone has proven to be
much more “bio-equivalent in the body” as
stated in the article in the drug brochure.
These represent merely empiric statements
without any scientific support and should be
given no credibility.

—-end of article—

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