Many thyroid patients today report being dissatisfied with their care. They also feel that very often their concerns are dismissed or chalked up things like non-compliance, depression, or not getting enough exercise. A few exact quotes from doctors to hypothyroid patients who were frustrated with their ongoing symptoms include “just buy some bigger clothes” (in response to weight gain) or “maybe it’s time to see a bariatric doctor” (to a patient who is not obese, but hasn’t able to reach her ideal weight since having a thyroidectomy). And while these factors may play a role for some patients, the majority say it’s not the case for them – and they want answers.
On the other hand, there are some thyroid patients who do feel better with treatment. Why do treatment outcomes vary? Aside from taking individual bio-chemistry into consideration, a big reason why many patients do not get well is simply this – their doctors are practicing outdated medicine. How can this be, you say? Let’s take a look at why many thyroid doctors are not up to speed with scientific advancements and what areas of thyroid treatment need to be re-examined. Most likely, those patients getting well have physicians who make it a priority to listen to their patients’ concerns, find effective treatments, and who are committed to staying current in their field.
The Gap between Research & Practice
It is not just speculation that physicians, including many endocrinologists, are not integrating new scientific findings into their practices. It’s also not just “alternative” doctors that are making this claim. There have been many articles in well-respected medical journals on this topic and even some that have reached mainstream media, including one written by a former American Heart Association president and published in the Wall Street Journal back in 2003. He argued that patients are not benefiting from new research findings because “doctors think the way they’ve always done things is best.”
In 2009, a study published in the Journal of the American Medical Association found that only 11% of practice guidelines and consensus statements put out by the American College of Cardiology were actually based on quality evidence in the literature. There is evidence of similar shortcomings within endocrinology groups, such as the Endocrine Society, The American Association of Clinical Endocrinologists, and the American Thyroid Association. When it comes to testing, for example, many endocrinologists conclude that a “normal” Thyroid Stimulating Hormone (TSH) test alone rules out thyroid dysfunction, despite an abundance of literature showing that is not always the case.
Many physicians do not realize that guidelines are based largely on opinion of those on the board of an organization rather than a thorough review of all relevant and current data. So when doctors choose to base their recommendations solely on these guidelines and without using other tools, such as clinical aspects of the patient, intuition, and experience – it’s a recipe for disaster. While running busy practices, many doctors simply don’t have much time to devote to reading medical journals. This lack of taking personal responsibility for staying up-to-date with current research, combined with a “this is how I’ve always done it” or “this is what I learned in med school” mentality leads to many doctors practicing 10-20 years behind the research in a particular field. That’s one to two decades! Several sources have published similar estimates including the New England Journal of Medicine in an article called “Clinical Research to Clinical Practice: Lost in Translation.” Author Claude Lenfant, MD concludes that doctors often rely on what they learned 20 years ago. And a review in the Annals of Internal Medicine takes it one step further to point out that it just gets worse the longer a provider is in practice! Another article points out that the quality of care is suffering to the point where all socioeconomic groups are feeling the effects, not just those with lower socioeconomic status.
The Missing Pieces in Thyroid Care
While many endocrinologists and primary care physicians have been asleep at the wheel, a select few have paid attention to new thyroid research and integrated it into the framework of clinical experience and treating each patient as an individual. These types of physicians not only have much better outcomes for their patients, they also report having more job satisfaction. But what exactly are they doing differently?
For one, they don’t rely on TSH values alone to diagnose and treat thyroid dysfunction. They realize there are instances where TSH is inadequate for a complete evaluation, such as in cases of autoimmune thyroid conditions or “tissue hypothyroidism.” Tissue hypothyroidism occurs when there are adequate levels of circulating thyroid hormones, but they are not able to enter the tissues to be used. A more complete thyroid panel includes testing of thyroid antibodies, levels of free T4 and T3, and reverse T3. Other tests and clinical symptoms can also be used if even more information is needed.
Secondly, many of these doctors have a more diverse tool bag of thyroid medications they prescribe, instead of just levothyroxine. The problem with levothyroxine (Synthroid) is that it consists of T4 only and yet research has repeatedly shown that some thyroid patients see better results with a combination T4/T3 medication or even T3 alone, depending on what they have going on. Another difference is when it comes to treating thyroid nodules. Removing the thyroid means having to medically manage hypothyroidism for life – not something you want to do if you don’t have to. And newer technology has made it possible to detect thyroid cancer with more accuracy and differentiate benign from cancerous nodules with more certainty. Unfortunately, many doctors are still over-treating thyroid nodules because of their lack of knowledge about this new testing and about more conservative approaches being discussed in the literature.
While it’s hard to say just how long it will take for more thyroid doctors to get up to speed on new testing and treatment options, being an informed patient can help you receive better care. If necessary, find a new thyroid doctor who is open-minded and determined to get to the root of your lingering thyroid symptoms.
For even more information on how far behind doctors are treating, watch this.