DEAR THYROID^TM

In the August 2011 issue of Good Housekeeping, an article by Susan Carlton about being 40-something with fatigue, weight gain and brain fog has set off an avalanche of controversy (1).

Here’s what troubles me about Susan Carlton’s article: she one-sidedly portrays the opinions of doctors about what is considered “normal thyroid function.” Experts she interviewed don’t believe there is any proven benefit for treating women with mild-to-moderately underactive thyroid; that is, with a Thyroid Stimulating Hormone between 3 and 10 (higher TSH indicates your thyroid is underperforming). Yet they do recommend treating in this range if a woman is infertile or has miscarriages! That sounds to me, at best, like a double standard, and at worst, undermining to women with under-achieving thyroid glands.

In 2003, the American Association of Clinical Endocrinologists (AACE) changed the normal range to 0.3 to 3.0. Ms. Carlton quotes a Harvard doctor, Gilbert Daniels: “There’s no compelling evidence that medication helps patients whose TSH is in the 5.0 to 10.0 range.” In fact, Dr. Daniels wants to raise the upper limit of normal to 4.1. Why does one doctor’s opinion trump the evidence and consensus of an entire group of endocrinologists?

Furthermore, there is no mention of landmark studies proving the benefit of treatment in people with a TSH in the gray zone, between 3.0 and 10.0. Here are some examples:

• The HUNT study of 17,000 showed that women with intermediate (1.14-2.52) or high levels (2.5-3.5) of TSH had a 41% and 69% increased risk of heart attack death compared with women who had TSH levels in the lower range of normal (0.50-1.4 mIU/L). Remember that heart attack is the number one cause of death in the U.S.
• The Framingham study showed that a TSH above 2.0 is associated in women with a greater risk of Alzheimer’s disease.

To me, the monochromatic picture Ms. Carlton paints smacks of poor journalism by relying on “expert opinion” for reporting an important health issue, which is considered the most lowly of the broad spectrum of quality of evidence. Where’s the randomized, controlled trials, which report evidence with the least amount of bias and are considered the “gold standard” of evidence? But perhaps Ms. Carlton is not to blame. What I see is a woman who doesn’t feel her best, buying into the outdated and patriarchal message of authority figures, which is the madness we must stop in old-school, old-paradigm medicine. Plus when your TSH is high, one cannot think clearly.

What else is worrisome? This article is published in Good Housekeeping, a purported magazine that speaks to women and women’s issues in an empowering way. We women are more accustomed to patriarchal attitudes from old-school physicians; we hardly even notice any more when we are dismissed for feeling tired and gaining weight. But when we get the dismissive message from a women’s magazine, it feels incendiary.

I’m a board-certified gynecologist who has managed hypothyroidism, or low thyroid, in patients since I graduated from Harvard Medical School in 1994 . I see the benefit of treatment in women who feel the classic symptoms of hypothyroidism, namely sluggishness, weight gain, low sex drive and hair loss, every day in my practice. And treating the mildly-hypothyroid patient has proven benefits, including a lower risk of Alzheimer’s disease.

Here’s what troubles me most: the same doctors who won’t treat Ms. Carlton as a 40-something would treat her if she struggled also with infertility or difficulty staying pregnant. That makes my blood boil. The implicit message is this: if you are not reproductively viable, sit on the sidelines and suffer through your low-thyroid symptoms. Go to spin class and eat less. But if you’re making a baby, we will treat you.

This leaves women cold. That is misogyny, plain and simple. And I won’t have it. Women deserve better. Women are tired of being dismissed and marginalized.

It’s time to take our symptoms, from brain fog to low sex drive, seriously, especially after our reproductive years, and to offer effective and proven solutions. We need to call out the places where we still see misogyny telling women to buck up with less than what they need, unless of course they are trying to make a baby.  We need to get into the eye of the storm, the eye of this particular thyroid storm.

Written by, Dr. Sara Gottfried (Website/Facebook)

**

References

1. http://www.goodhousekeeping.com/health/diseases/thyroid-problems published August, 2011

2. Bjoro T, Holmen J, Krüger O, Midthjell K, Hunstad K, Schreiner T, Sandnes L, Brochmann H. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT). Eur J Endocrinol. 2000 Nov;143(5):639-47.

3. Tan ZS, Beiser A, Vasan RS, Au R, Auerbach S, Kiel DP, Wolf PA, Seshadri S.

Thyroid function and the risk of Alzheimer disease: the Framingham Study. Arch Intern Med. 2008 Jul 28;168(14):1514-20.

Tags: 40 something women with fatigue, AACE changed normal TSH range to 0.3 to 3.0, brain fog, Good Housekeeping's thyroid storm, high TSH increases miscarriages, high TSH increases risk of death heart attack in women, Hunt study, hypothyroidism and low thyroid, TSH controversy, weight gain, written by Dr. Sara Gottfried

Follow Dear Thyroid on Twitter/@DearThyroid | See our Facebook Page | Become a Fan on Facebook | Join our Facebook Group

You Can Create a Dear Thyroid Profile and share with friends!