Hypothyroidism: How Dr. Richard Haber's Article Misinforms Patients

Examining the Research Says

Some doctors and the media are perpetuating misinformation and confusion about hypothyroidism diagnosis and treatment. istockphoto

In an article in the Huffington Post, Dr. Richard S. Haber, a New York-based endocrinologist from Mt. Sinai, perpetuated a number of common misconceptions and myths about hypothyroidism (an underactive thyroid). Given Huffington Post's wide readership and the general lack of public and media understanding of hypothyroidism, it's important to address some of the scientific claims made in the article.

1. Inaccuracies in the Estimated Number of People with Hypothyroidism

The article is titled Hypothyroidism: A Common Hormonal Imbalance Affecting Several Million Americans. It may be an issue of semantics, but even that title itself is incorrect, as the American Thyroid Association (ATA) has estimated that "20 million Americans have some form of thyroid disease." — some experts estimate the number is even greater. The vast majority of people with thyroid disease in the U.S. have an underactive thyroid or end up hypothyroid. Even using the ATA's estimate, Dr. Haber's article downplays the prevalence of the condition, as "several" million does not equal a substantial percentage of 20 million.

2. All Symptoms Are Not Reversed With Hormone Replacement Therapy

In the first paragraph, the statement "...major symptoms of thyroid hormone deficiency, which can be reversed with hormone replacement therapy..." is misleading because research has shown that even with treatment, and in particular, with the "standard" hormone replacement therapy preferred by endocrinologists — levothyroxine, which is a T4 only treatment — some patients do not experience the reversal of symptoms.

A 2009 Danish study published in the European Journal of Endocrinology reported that using a combination of T4/T3 treatment is superior to a T4 only treatment for hypothyroidism.

3. The TSH Test is Not Simple, and Is Sometimes Inaccurate

The article states that diagnosis should depend on thyroid blood tests, which Dr. Haber claims are "simple, highly accurate, and able to diagnose even the mildest forms of hypothyroidism before severe symptoms occur." He then goes on to say that "the best test to screen for the disorder is TSH (thyroid stimulating hormone)....and "Sometimes measurement of thyroid hormone in the blood (T4, free T4) is also included."

Interestingly, research shows that the most common form of hypothyroidism — which is caused by autoimmune Hashimoto's disease — often causes symptoms long before it is reflected in the Thyroid Stimulating Hormone (TSH) test. It is, however, usually identifiable by the Thyroid Peroxidase (TPO) antibodies test, a test that is not even mentioned. In fact, research has also shown that in patients with elevated TPO antibodies and "normal" levels on other thyroid tests, thyroid treatment may lower antibodies, and prevent progression to overt hypothyroidism.

There is also no mention of the fact that even among conventional endocrinologists, there is a controversy and disagreement over the reference range for the TSH test. Some experts believe that TSH levels must exceed the top end of the reference range — typically 4.5 or higher — for hypothyroidism to be diagnosed. Others believe the top end of the range is lower, from 2.5 to 3.0 for example. This makes the TSH test and diagnosis process far from "simple."

The T4/Free T4 tests are mentioned, but another crucial test, the Free T3, is left out. T3 is the active thyroid hormone, and some patients have TSH and T4/Free T4 levels in the so-called "normal reference range," but have low or low-normal Free T3 levels, along with significant symptoms of hypothyroidism.

Integrative hormone experts believe that a complete thyroid panel includes TSH, Free T4, and Free T3 and that any irregularities in any of these levels can be indicative of hypothyroidism.

4.The Goal of Treatment is NOT Just a Normal TSH Level

In the article, Dr. Haber stated that "the goal" of hypothyroidism treatment is "a normal TSH level." In this telling statement, one of the biggest failures of conventional medicine and one of the biggest failings of the endocrinology community is revealed. The goal of hypothyroidism treatment should be the resolution of symptoms along with optimal thyroid levels.

As a thyroid patient advocate, I have been criticized for calling endocrinologists the "accountants of medicine," but the idea that a treatment goal has nothing to do with the patient, and everything to do with a lab result, reinforces my concerns. As I've said for two decades, we are patients, NOT lab values, and the continued spread of misinformation by endocrinologists and the media does a disservice to the more than 20 million Americans with thyroid conditions.

5. Levothyroxine is Not the "Preferred" Patient Therapy for Hypothyroidism

It is then stated that levothyroxine (synthetic T4-only therapy) is the "preferred treatment," and "with an adequate dose, all symptoms of hypothyroidism are reversed and normal health is restored." I wish it were as easy as that, but the research does not back up Dr. Haber's opinion. Once again, there is failure of mentioning research that has shown that the majority of patients prefer a T4-T3 combination therapy, and not levothyroxine alone. Also, millions of patients are being treated with prescription natural desiccated thyroid and that a 2013 study found that natural desiccated thyroid drugs were found to be are a safe alternative to levothyroxine — but both facts are omitted in the article.

Why Single Dr. Richard Haber out for Hypothyroidism Misinformation?

By perpetuating the "easy to diagnose, easy to treat" myth of hypothyroidism, and failing to mention important information about Hashimoto's disease, as well as preferred hypothyroidism treatment options and their safety, Dr. Haber and the Huffington Post have done a major disservice to thyroid patients.

When supposed experts, and major media, seriously downplay the very real complexities of thyroid disease diagnosis and treatment, and the difficulties many patients encounter in living with hypothyroidism, they are propagating archaic ways of thinking and dogma that make it harder for thyroid patients to get optimal treatment and enjoy good health.

It is also no surprise that Mount Sinai, which employs Dr. Haber, has been a long time major recipient of funding from levothyroxine drug maker Pfizer, according to the ProPublica Dollars for Docs database. The article carried no such disclosures, despite Dr. Haber's promotion of levothyroxine as the "preferred" treatment.

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