Rethinking the TSH Test: An Interview with David Derry, M.D., Ph.D.
The History of Thyroid Testing, Why the TSH Test Needs to Be Abandoned, and the Return to Symptoms-Based Thyroid Diagnosis and Treatment (excerpts)
The History of Thyroid Testing, Why the TSH Test Needs to Be Abandoned, and the Return to Symptoms-Based Thyroid Diagnosis and Treatment (excerpts)
When I came back into General Practice I had in mind a saying I attribute to Dr. Wilder Penfield which was (paraphrasing) "If you listen to a patient carefully the patient will tell you the diagnosis and if you listen even more carefully they will tell you the most appropriate treatment". Before I went back into practice I had taken courses in interpersonal relationships and how to communicate and listen better. Since I entered General Practice I have taken more courses in personal development. My idea was to learn more and more how to listen carefully and how to get my personality (ego) out of the way of the conversation with the patient. Because I was armed with this approach I developed, I have been able to learn much in the last 28 years in practice.
The consensus of thyroidologists decided in 1973 that the TSH was the blood test they had been looking for all through the years. This was about two years after I started practice. Having been taught how to diagnose hypothyroid conditions clinically I was in a position to watch to see what the relation of the TSH was to the onset of hypothyroidism. What I found was many people would develop classic signs and symptoms of hypothyroidism but the TSH was ever so slow to become abnormal, rise and confirm the clinical diagnosis. Sometimes it never did. Finally I began treat patients with thyroid in the normal manner I was taught. I could not see why I had to wait for the TSH to rise for me to be able to treat them.
The main ingredient of thyroid hormone, which distinguishes it from other molecules of similar size (molecular size), was the element which made thyroid hormone namely iodine. So I did a thorough search of the literatureon iodine. This review led me to try to use iodine and thyroid therapeutically. The TSH had caused all research on the therapeutic use of both of these substances to stop dead. My biochemical and pharmacological background has allowed me to search in areas of the literature that are impossible for a normal physician or even a specialist to explore.
The main ingredient of thyroid hormone, which distinguishes it from other molecules of similar size (molecular size), was the element which made thyroid hormone namely iodine. So I did a thorough search of the literatureon iodine. This review led me to try to use iodine and thyroid therapeutically. The TSH had caused all research on the therapeutic use of both of these substances to stop dead. My biochemical and pharmacological background has allowed me to search in areas of the literature that are impossible for a normal physician or even a specialist to explore.
The TSH had a ring of scientific rigor for those who have a smattering of knowledge about thyroid metabolism. It was part of the pituitary feed back mechanism for monitoring the output of the thyroid gland. There is no doubt that it does accomplish this job. But unfortunately the TSH value has no clinical correlation except at absolute extremes with the clinical signs or symptoms of the patient.
But because of the all inclusiveness of the TSH medical students are not taught or only superficially taught the symptoms of low thyroid. The TSH was "scientific" and held all the answers to thyroid disease. If you have not lived through several versions of the ultimate test for thyroid then it is harder to grasp this phenomenon.
The clinicians of the past (before the TSH) were astute and very observant and were able to diagnose and treat hypothyroidism correctly without the TSH for 80 years-- why do we need it now? They would be aghast at the total missing of the diagnosis of chronic fatigue and fibromyalgia.
All who want to come can do so by booking through the office, at (250) 478-8388. [Victoria, British Columbia, Canada] I would be too flooded to answer much over the phone. Also I am sure I couldn't diagnose and or treat anyone without meeting with them I need to follow people for several months after seeing them-- but not often after that--as the thyroid works so slowly that you have to give it time
David M. Derry M.D., Ph.D.
E-Mail dderry@shaw.ca
E-Mail dderry@shaw.ca
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Dr. Bell has made the same observation about physicians in the past being able to make a diagnosis just from listening to the patient, whereas doctors today don't believe their eyes or ears, only lab tests. For someone with CFS or fibromyalgia, for which there is no specific blood test, this makes it easy for the doctor to say "nothing wrong" and difficult for the patient to convince the doctor that, as Dr. Starlanyl says, "if all blood tests are normal, the correct tests haven't been done".
In my case, my TSH test was right smack in the middle of the normal range. Some of my symptoms were on the list for those of hyperthyroid, and some were on the list for those of hypothyroid, i.e., since you cannot be both hyper and hypo at the same time, thyroid probably was not at the root of my problem. A one-month trial of Synthroid didn't improve my symptoms one iota. My thyroid results have remained fairly consistent over the years, regardless of whether I felt awful or felt like I was improving.
What helped me was exactly what I had asked for from the very beginning: a sleeping pill that was just a sleeping pill, not an anti-depressant that "might" help me sleep. When I got a sleeping pill that worked, my immune system was able to regenerate, and launched a six-month fever to fight back the virus. A 101 fever is an objective symptom, and one that goes on for 6 months non-stop is a sign that something was very wrong to start with.
All tests may have been normal, but that prolonged fever proved that the patient was not normal. A doctor who was diagnosing on symptoms, not on "all tests are normal", would not have been looking for reasons to discount the fever because the tests said the patient shouldn't have a fever; it would have been one more factor to take into consideration in making an accurate diagnosis.
Notwithstanding my experience, some patients diagnosed with CFS have responded to thyroid supplementation, and I would say that if your doctor wants to try it, go along with it for a month or two. (I've been warned that long-term use of thyroid supplementation can make a healthy thyroid shut down.) We can never discount the possibility that CFS was a misdiagnosis and you really have something else, like hypothyroid.
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