An article in Nature Reviews Endocrinology titled “Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism” reviewed studies in which patients received standard thyroxine (T4) therapy or a combination of T4 and l-tyronine (T3). While some studies showed poor resolution of various symptoms with T4 only, and some studies showed that patients prefer the combined therapies, the conclusion the authors came to is that T4 supplementation with thyroid-stimulating hormone (TSH) monitoring is still the standard course of treatment for hypothyroidism. That’s not much of a paradigm shift.

Dr. Steven Hotze, author of Hypothyroidism, Health and Happiness, tells us that hypothyroidism is epidemic. He is an unabashed fan of treating hypothyroidism with whole glandular thyroid, which doesn’t seem to be up for discussion within the established medical groups.

When a patient presents with signs and symptoms associated with hypothyroidism, such as congestive heart failure, hypertension, high cholesterol levels, decreased fertility, depression, impaired immune system, sleeplessness, and digestive disorders, to name just a few of the manifestations, Dr. Hotze notes that it is easy to see why doctors often turn to prescribing a drug to treat the symptoms. He laments the fact that, while well meaning, doctors are no longer taught to understand the underlying causes of these symptoms, but are now taught to simply choose a drug from their armamentarium.

A great deal of difficulty lies with the reliance on testing. Dr. Hotze asks, if we are only going to rely on testing, what is the purpose of seeing the patient? We can save a lot of time and expense if the tests are always going to trump the patient’s signs and symptoms.

The gold standard for testing thyroid function is TSH , which is not a thyroid hormone at all, but a pituitary hormone. Theoretically, TSH levels respond to the production of thyroid hormone. However, Dr. Hotze clearly describes the problems with this test and other thyroid testing.

The normal ranges for this test are much too wide. When a lab establishes a standard, they rely on the test results for the previous people they tested. A range is artificially created that deems 95% of the population must be normal. Only if you fall outside of the 95%, will you be recognized to have a thyroid problem. However, nothing outside of agreeing on convention, establishes that the 95% actually have healthy thyroid function. Indeed, when care is taken to understand the symptoms of hypothyroidism, a very large percent of “normal” are really not.

Dr. Hotze notes that the normal range for laboratory tests for T4 has been lowered by 15% between 1991 and 2012. What this means is that a person who would be identified as hypothyroid in 1991 could end up being “normal” today. The clinical presentation of the suffering patients has not changed, only the convention. Healthy people do not generally get their thyroid levels tested, so the data that labs rely on for their “normal” range is primarily from people who are compromised enough that hypothyroidism is suspected.

Lab testing, in and of itself, is also not without error. In a trial with 40 of his patients, Dr. Hotze sent two samples from each patient to separate labs and found variations as high as 50%. Moreover, the amount of thyroid hormones circulating in the blood varies throughout the day, and it is affected by disease, prescription drugs, stress and environmental factors. Finally, thyroid hormone test results can appear perfectly normal, but the problem stems from low pituitary hormones, a fact that is too often overlooked by medical practitioners.

Along with his first book, Hormones, Health, and Happiness: A Natural Medical Formula for Rediscovering Youth with Bioidentical Hormones, which covers issues like diet, treatment of allergies, nutritional and lifestyle support, Dr. Hotze is leading a wellness revolution. Patients become guests in his practice, emulating the customer service offered by the best hotels. Wouldn’t this be a wonderful model to have available for all of us looking for a healthier, happy life?