Tips & Advice

From Dr. Liz Herself

April 28, 2017
Doctors should listen to their patients
Dr. Liz Listening to Her Patient

“New research gives patients — who often feel dismissed and forgotten — evidence that their persistent symptoms are not just in their heads.”

Last October, researchers at Rush University in Chicago published in the Journal of Clinical Endocrinology and Metabolism their findings that people who were on levothyroxine (the most common form of treatment for low thyroid function) with a normal TSH level also:

  • Were more likely to be on an antidepressant
  • Were less physically active
  • Weighed 10 pounds more, despite the same calorie intake
  • Were more likely to be on a beta-blocker (for lowering blood pressure)
  • Were more likely to be on a statin (for lowering cholesterol).

Dr. Antonio Bianco, one of the study authors, professor of Medicine at Rush University and the most recent past president of the American Thyroid Association, summarized the study findings by saying that, “These findings correlate with what patients have been telling us. This study documents for the first time, in an unbiased fashion, that patients on levothyroxine feel worse and are much less active than controls, exhibiting objective cardiometabolic abnormalities despite having normal TSH levels.


Doctors like myself who approach and treat patients based on the symptoms they describe and not their lab numbers have already known this for a long time.

What most caught my attention about this article is that this author, Dr. Bianco, is very influential in the world of thyroid treatment. The fact that he is not out to justify the disservice that doctors have been doing to patients for a long time is surprising and refreshing.

He goes on to say, that “Doctors should be telling their patients, ‘I’m going to normalize your TSH, but you’re going to be at a higher risk for gaining weight, experiencing depression and fatigue. It is also more likely that your cholesterol will go up.’ That’s what we should be telling patients, based on our study.”

The TSH (Thyroid Stimulating Hormone) test is the most common single test performed to check thyroid function. If it falls in “the normal range” the person is considered to have normal thyroid function, even if they have many symptoms of low thyroid function, including but not limited to fatigue, weight gain, hair loss, “brain fog”, cold hands/feet, constipation, and chronically dry skin.

In addition to these symptoms, a low level of active thyroid hormone inside your cells in the liver causes elevated cholesterol levels. Most people on statin medication to lower cholesterol level actually do not have enough thyroid hormone activity in their cells. I have brought patients’ cholesterol levels down from the 300’s with supplements and the right thyroid medication.

The treatment given to the patients in this study – levothyroxine – is the inactive form of thyroid hormone, and it has to convert in the body to the active form. Due to many factors, including malnutrition and stress, this conversion often does not happen properly.

This common thyroid medication does, however, make the TSH level look normal! Thus the all-too-common terrible scenario where the lab result is “normal” but the person still has significant symptoms.

As you can imagine, there is a lot more to this topic. The full web article is worth a read here.

Bottom line:

It’s a good thing the tail can wag the dog.

Even though this study is a step in the right direction, patients have to advocate for themselves.

Don’t take “it’s all in your head” for an answer, and look for a doctor until you find one who will listen, do the right tests, prescribe the right treatment, and actually help you feel better.

I welcome your comments!

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