Atlantic Magazine Article Misses Some Key Thyroid Points

Critiquing Olga Khazan's February 2015 Article "Sleepy, Stressed, or Sick?"

Olga Khazan's article in the Atlantic got some things right, but still missed some key points.

The Atlantic published an article on February 9, 2015, by writer Olga Khazan, titled "Sleepy, Stressed, or Sick? Why thyroid diseases are so common—and still so mysterious."

Khazan chronicles her own experience of being told that she's hypothyroid, trying to decide whether to take thyroid medication and learning about the controversy regarding the issue of hypothyroidism diagnosis and treatment.

The article goes further than most -- by acknowledging that there's even a controversy regarding diagnosis and treatment of hypothyroidism, and the thyroid stimulating hormone (TSH) reference range.

Khazan also includes the perspective of patient advocate Dana Trentini, founder of ​

The Atlantic article, however, is still unclear -- or wrong -- about some key aspects of thyroid disease. Here are some of the issues and concerns regarding the article.

Normal Levels

At one point, Khazan says "...the blood test showed I had normal levels of the thyroid hormones T3 and T4..." As empowered and educated thyroid patients well know, "normal" levels of thyroid hormone that are within the reference range do not necessarily represent good thyroid health or optimal hypothyroidism treatment.

TSH of 3.5

Khazan writes that her endocrinologist said: "Well, a family doctor might not treat you for a 3.5, but an endocrinologist would."

This endocrinologist is absolutely, unequivocally wrong. Most endocrinologists are strict followers of the official guidelines from the various endocrine organizations, which consider thyroid levels within the reference range -- basically, TSH levels under 4.5 or so -- to be normal, and won't even consider hypothyroidism unless the TSH goes above 10.

There actually is very little controversy among endocrinologists about this issue.

Integrative doctors, holistic physicians and other physicians specializing in hormonal health are far more likely to treat patients with TSH levels in the reference range than endocrinologists.

2 Million Undiagnosed

Khazan writes: "Many people—possibly up to 2 million—who have a thyroid disorder haven't been diagnosed.


I have NO idea where Khazan got this number, but it's significantly lower than most of the estimates from the research community.

For example, according to the American Thyroid Association, "an estimated 20 million Americans have some form of thyroid disease" and "Up to 60 percent of those with thyroid disease are unaware of their condition." That would be 12 million people. And the 20 million number is often considered an underestimate, with other sources suggesting 35, or even as many as 60 million Americans with thyroid conditions.

So, at a minimum, if we're talking about undiagnosed thyroid patients, Khazan is about 10 million people short!

When it comes to her estimate of undiagnosed patients with thyroid disease, Khazan is about 10 million people short!

"True" Hypothyroidism?

Khazan quotes endocrinologist Martin Surks as saying that "endocrinologists shouldn't be too eager to scribble levothyroxine prescriptions for patients without true hypothyroidism. He wouldn't suggest treating a patient with Hashimoto's, normal T4 and T3, and a slightly elevated TSH, for example."

Dr. Surks is clearly not up on the literature, which shows that in patients who have "euthyroid" Hashimoto's disease thyroid antibodies, but otherwise normal thyroid hormone levels -- early preventative thyroid treatment can slow or stop the progression of Hashimoto's disease.

This was reported in research going back more than ten years, and more recently in a 2013 reliable double-blind, peer-reviewed Taiwanese study.

Khazan should have asked Dr. Surks why he wouldn't treat a patient with Hashimoto's disease if that treatment could not only relieve symptoms, but lower antibodies, stall the progression of the Hashimoto's, and help prevent progression to overt hypothyroidism?

"See a Psychiatrist"

Khazan quotes Georgia endocrinologist Scott Isaacs as saying, "It's always easier to prescribe a pill for someone versus saying, 'you need to see a psychiatrist or have a sleep study.' If you can fix a problem with one pill, that's the Holy Grail."

Unfortunately, Isaacs reveals quite a bit about how doctors often misdiagnose thyroid problems by dismissing symptoms such as fatigue, depression, weight gain, and cognitive issues as psychiatric problems. Doctors also frequently undertreat hypothyroidism, preferring to refer hypothyroid symptomatic patients to psychiatrists rather than optimize TSH, Free T4, and Free T3 levels. The 2014 Hypothyroidism Guidelines even make this a recommended practice.

Dr. Isaacs sounds unfortunately far too much like the UK's Anthony Weetman, who said that patients with "normal" thyroid levels yet suspect a thyroid problem -- given symptoms and family history -- have psychiatric problems.

Going Forward

It's 2015, and we're still waiting for a mainstream magazine to do a piece on hypothyroidism that:

  • talks about optimal TSH levels -- and not just the "normal range
  • talks about the important role of optimal Free T4 and Free T3 levels
  • explores and explains the benefits of T4/T3, T3-only, and natural desiccated thyroid treatment without deriding any of these valid options
  • does NOT mention psychiatrists, or fixing a thyroid problem with "one pill"

I'm not holding my breath.

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