Q&A with Dr. Richard Shames: Hypothyroidism Guidelines

ATA Guidelines are a "Last-Ditch Attempt for a Total Power Grab"

richard shames
Richard Shames, MD says that new ATA hypothyroidism guidelines push old, outdated ideas. Richard Shames
Richard Shames, MD is a physician who has treated thyroid patients for over 35 years, and a published author who has written a number of well-received books about thyroid disease, including Thyroid Mind Power, ThyroidPower, and Fat, Fuzzy or Frazzled. Dr. Shames shared his thoughts about the American Thyroid Association (ATA) new "Guidelines for the Treatment of Hypothyroidism." I had an opportunity to do this Q&A interview with Dr. Shames, regarding his thoughts and concerns about the new guidelines.


Mary Shomon: Dr. Shames, you have been following the recent controversy resulting from the American Thyroid Association (ATA) rolling out its new guidelines for hypothyroidism treatment. What are your overall opinion of these new guidelines?

Dr. Shames: In general, I am extremely disappointed in my medical colleagues who put out this distressing denial of every thyroid remedy except levothyroxine. It is a good day for Synthroid and other levothyroxine makers, BUT a very bad day for thyroid patients.

Mary Shomon: What specifically do you find objectionable?

Dr. Shames: First, I am distressed that an organization that gets substantial funding from levothyroxine manufacturers can publish over 200 pages of medical-ese, mainly intended to browbeat every doctor in the country into treating a complex, chronic, autoimmune, hormonal illness like hypothyroidism with simple levothyroxine alone. It's a bit like Washington, DC's "K-Street tactics," where the government regulators writing the rules are former and future industry employees.

Mary Shomon: Beyond obvious concerns about the conflict of interest and potential bias, what is your opinion as to the scientific justification of their guidelines?

Dr. Shames: I've been reading scientific literature for almost 40 years. I've comfortably followed the thread of medical science from one journal to the next in heavily documenting my three published thyroid books.

I am not at all impressed that there is sufficient scientific justification for using levothyroxine alone on all hypothyroid patients.

Mary Shomon: Could you elaborate?

Dr. Shames: Here is just one example. In many fields of medicine in the past, it was the object of therapy to find the one best medicine. What was the one best medicine for everybody's high blood pressure? What was the one best medicine for everybody's depression? What was the one best medicine for everybody's diabetes? These are all questions that are no longer asked by medical doctors. Instead, people with hypertension, depression, and diabetes, etc. are now treated with a variety of medicines, sometimes two or three used concurrently.

That is today's national standard of all medical practice… except for hypothyroidism, says the ATA. They are still insisting on one 'so-called' best medicine for everybody. It just doesn't compute.

Mary Shomon: So you're saying that these guidelines go against a general historical scientific trend in the field of medicine?

Dr. Shames: Absolutely. These guidelines are desperately pushing an old, outdated idea. For a great many thyroid patients, "levothyroxine alone" is a bad idea whose time has passed. More and more doctors all over the world are discovering the substantial benefits of using a T3 drug like Cytomel, or a desiccated product like Nature-throid, or compounded versions of these, in many cases added to the levothyroxine dose, and sometimes used instead of the levothyroxine dose.

Mary Shomon: My focus has been for thyroid patients and their practitioners to have freedom of choice among the treatment options available. How do you feel the new guidelines affect that freedom of choice?

Dr. Shames: It is one powerful industry's last-ditch attempt for a total power grab, plain and simple. It's not just Cytomel, Armour, and Nature-throid that are being "forbidden." It's not just patients being referred to psychiatry when levothyroxine alone doesn't work well enough to relieve their thyroid condition's psychological symptoms. It's not just the threat of legal action for doctors who don't see fit to follow the outdated guidelines.

It is, in fact, a repudiation of all nutritional and over-the-counter therapies that science has found supportive of good thyroid care.

Mary Shomon: Was there any mention of issues like the importance of Vitamin D or selenium for thyroid patients?

Dr. Shames: I tried reading all 200 pages, and amid the trashing of all things over-the-counter, I recall no favorable mention of either of these crucial thyroid nutrients. It does not seem to matter to the "T4–only" pushers, that the T4 to T3 conversion process (for turning their beloved levothyroxine into active usable T3 thyroid hormone) needs to utilize a-dependent enzymes. Nor did it seem worthy of mention that a molecule of active thyroid hormone itself does not work inside the body, unless combined with a molecule of Vitamin D.

Mary Shomon: What do you suggest people do about these new recommendations?

Dr. Shames: For thyroid patients I suggest that you join with others and continue fighting for your rights to have optimal treatment of your condition. This, in my opinion, means fighting back against these guidelines. Remember, even the British Medical Journal is on your side in their recent article, "Evidence-Based Medicine: Why We Can't Trust Clinical Guidelines." As for what exactly to do: call people, write people, post on Facebook and Twitter. Raise some hell if you are being denied access to the full-range of treatment options by a bunch of narrow-minded, pharmaceutical-industry bullies.

Mary Shomon: What can sympathetic open-minded doctors do?

Dr. Shames: They can join a large group of us, who are starting a new association. It's called the ITA, not ATA. This stands for the International Thyroid Association, which is a group of thyroid-friendly doctors from all over the world. Doctors in this new group see the ATA guidelines for what they are, and are joining together to create their own more sensible guidelines.

For instance, ITA guidelines for better thyroid care will include recommendations for treating low thyroid with several good evidence-based medical interventions, not just levothyroxine alone. They will emphasize the importance for patients to have freedom of choice among the wide variety of medicines and nonprescription remedies available.

Mary Shomon: How do you think that will change the situation?

Dr. Shames: I believe it will work surprisingly well. For instance, the state of Arizona once had a medical board that behaved a bit like the Gestapo when it came to nontraditional and integrative practitioners. However, when there was formed in Arizona an alternative to the main medical board, things changed for the better. Not only could doctors become members of and be regulated by the new statewide Homeopathic Medical Board, but even doctors, and especially patients, who were not members had some encouragement that nutritional, complementary, and alternative remedies could be a viable part of mainstream medical practice.

A set of alternative, competing guidelines from the new "International Thyroid Association" could help temper the ATA's constraining effect on doctors and patients, by countering their efforts to infringe on freedom of choice in health care with sensible and creative options.

Richard Shames, M.D. graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for thirty-five years. Dr. Shames practices holistic medicine -- with a focus on thyroid and autoimmune conditions. His website is ThyroidMindPower.com

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