For over a decade, research by Jacob Teitelbaum M.D. author of the best-selling book “From Fatigued to Fantastic!”1 has shown that hypothyroidism, like most other illnesses that affect predominantly women, has been dramatically under diagnosed.2 3 The American Academy of Clinical Endocrinologists (AACE), the nation’s largest organization of thyroid specialists, has now confirmed this. After a recent meeting, the normal range for thyroid tests was dramatically narrowed. As noted in the AACE press release:
“Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now.”
“The prevalence of undiagnosed thyroid disease in the United States is shockingly high – particularly since it is a condition that is easy to diagnose and treat,” said Hossein Gharib, MD, FACE, and president of AACE. “The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient’s health – such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression.”4
Now, 6 months after the new directives have been given, doctors are still largely unaware of these new lab guidelines for diagnosis and treatment. Even the major labs doing thyroid testing have not bothered to change the now incorrect normal ranges for both diagnosis and treatment of thyroid disorders.
The normal range for thyroid hormone levels in the past have been based on statistical norms (called 2 standard deviations). This means that out of every 100 people, those with the 2 highest and lowest scores are considered abnormal and everyone else is defined as normal. That means if a problem affects over 2% of the population( and as many as 24% of women over 60 are hypothyroid5 and 12% of the population have abnormal antibodies attacking their thyroid6 ), then our testing system will still miss most of them. In addition, our testing system does not take biological individuality into account. To translate how poorly this “2%” system works, consider this. If we applied it to getting you a pair of shoes, any size between a 4 and 13 would be “medically normal.” If a man got a size 5 shoe or a woman a size 12, the doctor would say the shoe size they were given is “normal” and there is nothing wrong with it!
This increased the number of Americans with Thyroid illness from 13 million to approximately 27 million. Unfortunately, over 13 million Americans with thyroid disease remains undiagnosed4, and the majority of those receiving treatment are not being dosed appropriately5 6. Doctors do not know that they have not been adequately trained in the proper diagnosis or treatment of hypothyroidism, and the cost in human life and devastating illness is enormous. What makes this especially tragic is how easy treatment is if doctors were given the correct information. Even the major laboratories continue to give erroneous normal ranges for the tests, simply because they’re not aware of the guidelines of the AACE or the information put out by their National Association of Clinical Biochemistry.
WHAT IS THE COST OF MISSING HYPOTHYROIDISM?
- Over 30,000 preventable deaths/year from heart attacks. Women with untreated hypothyroidism are more than twice as likely to have a heart attack. A study in the prestigious Annals of Internal Medicine noted that hypothyroidism “contributed to 60 percent of cases of myocardial infarction [heart attacks] among women affected by subclinical [even mild] hypothyroidism”. It contributed more to causing heart attacks in these patients than smoking, elevated cholesterol, high blood pressure, or diabetes!7. Another new study supports this showing that Subclinical hypothyroidism was associated with a 2.6-fold increased prevalence of ischemic heart disease.7a
- Over 4600 miscarriages/yr after 15 weeks of pregnancy-countless more before. Six percent of miscarriages are associated with hypothyroidism. Undiagnosed hypothyroidism is also associated with infertility. In moderate to severely hypothyroid mothers, the baby was also over 6 times as likely to die soon after being born.8
- Learning disabilities – Children born to hypothyroid mothers have a lower IQ (average of 7 points). They are almost 4 times as likely to have an IQ under 85 and over twice as likely to have learning difficulties resulting in their having to repeat a grade.9
- Hypothyroidism contributes to millions being unnecessarily disabled. Over 6 million Americans have Fibromyalgia and tens of millions more have chronic muscle pain. Undiagnosed or inadequately treated thyroid disorders contribute to these unnecessarily disabling conditions1 2 3 . Our initial understanding of this was elucidated by Dr. Janet Travell, who was the white house physician for President Kennedy-who suffered from excruciating back pain.10 Dr. Teitelbaum’s recently published research shows that 91% of these patients can improve with proper treatment-especially including thyroid hormone.2
- Hypothyroidism is a major cause of gaining and being unable to lose weight. It causes fatigue, dry hair, coarse skin, depression, and “brain fog” as well. Americans are currently treating hypothyroidism, which is often confused as being depression, with Prozac! This is an even bigger problem in the elderly who are being misdiagnosed with depression or Alzheimer’s/ senility when what they have is hypothyroidism.
What makes this situation especially tragic is that, given the proper information, hypothyroidism is incredibly easy and inexpensive to diagnose and treat. Instead, because of lack of awareness on the part of physicians, Americans unnecessarily suffer with a major public health disaster.
1 From Fatigued to Fantastic! (Avery/Penguin Putnam 2001;1st edition 1995). Jacob Teitelbaum M.D.
2 Teitelbaum JE, Bird B, Greenfield RM ,Weiss A., Muenz L, Gould L. Effective Treatment of CFS and Fibromyalgia. A Randomized, Double-blind, Placebo-controlled, Intent to Treat Study. The Journal of Chronic Fatigue Syndrome. Volume 8(2), 2001,pg3-28.
3 Teitelbaum J, Bird B. Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients. J Musculoskeletal Pain 1995; 3 (4):91-110.
4 Press release on AACE web site: http://www.aace.com/pub/tam2003/press.php
5 Canaris GJ ,et al.The Colorado Thyroid Disease Prevalence Study :Archives of Internal Medicine, Feb 28,2000 p526-534.
6 National Assn of Clinical Biochemistry web site. http://www.nacb.org/lmpg/thyroid_LMPG_PDF.stm p31-46
7 HAK AS,Subclinical Hypothyroidism is an independent Risk Factor for Atherosclerosis and MI in Elderly Women. Annals of Internal Medicine 2000;132:p270-278.
7a J Clin Endocrinol Metab 2004;89:3365-3370
8 Allan WC,et al. Maternal Thyroid Deficiency and Pregnancy Complications; Implications for population Screening. J Medical Screening.2000 .Pg127-130
9 Haddow JE,et al. Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child. New England Journal Of Medicine 1999:P549-555.
10 Travell J, Simons DG, Simons L: Perpetuating Factors. Chapter 4. In: Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams and Wilkins, Baltimore MD,