Chances are, you've heard this proclamation more than once in your search for answers to your health problems. Even after 11 years of effectively treating fibromyalgia, hypothyroid, and thyroid resistance patients using metabolic rehabilitation, I still cringe when I hear this. You're probably even more frustrated than I am with this false belief because your life is disrupted and you're suffering because of it. I certainly want to see the TSH, free T3, free T4 as essential pieces of the initial diagnostic puzzle. We also need a thyroid antibody group to either detect or rule out autoimmune thyroiditis.

The TSH, free T3, and free T4 levels can give us valuable information about your production of thyroid hormone. Also, the use of thyroid medication will predictably alter these test results. However, the TSH, free T4 and free T3 cannot give us information about how your tissues utilize or respond to thyroid hormone. This is the fundamental concept that most doctors, including endocrinologists, still do not consider when evaluating patients for thyroid disease. Patients ask me why, and as best I can tell, this essential idea is not generally taught in medical school or during their residencies.

Most people want to collaborate with their other doctors but don't know how to approach this dilemma. Ask your reluctant doctors this question, "How can my TSH, free T3, or free T4 levels indicate what my tissues' responses are to the thyroid hormone circulating in my blood?" The feedback I get from my patients who have asked this question varies. Some doctors get defensive, others ignore it, but a few get curious and will discuss the idea. More and more of my patients' prescribing doctors are consulting with me to discuss my recommendations and most are eager to share ideas. Occasionally someone wants to point out how foolish I am to reject the "standard of care". When I ask this same question it may end the telephone call, but it may also plant the seed of an idea.

Please know that when enough people persist in asking the same question, there can be a tipping point that changes consciousness, so keep asking!

Many doctors don't seem to know what metabolic rate is or what it means to their patients needing diagnosis and treatment of thyroid disease. Back in the 1950-60's, basal metabolic rate (BMR) was routinely measured when doctors suspected a thyroid problem. It required an overnight stay in the hospital and was expensive, but it worked well. People with a low BMR were prescribed enough thyroid hormone to bring the BMR up to normal. Effective doses of T4, such as Synthroid, were in the range of 200-400 micrograms. Resting metabolic rate (RMR) is measured using indirect calorimetry, just like basal metabolic rate (BMR). The difference is that RMR is offered on an outpatient basis and BMR is hospital-based.

This highly effective system got disrupted when the TSH test assay was developed by a group of endocrinologists in the late 1960's. These influential doctors convinced insurance companies that the TSH level was sufficient evidence to diagnose hypothyroidism and manage dosage adjustments of thyroid medication. It was then decreed that TSH be kept in the middle of the reference range. Now, the insurance companies could pay for an inexpensive blood test rather than BMR testing. How tragic that an economic decision has sent doctors in a direction that is not necessarily in the best interests of their patients.

I've asked several medical doctors if metabolic rate testing was presented in their training. The consensus is that they were taught to keep the TSH midrange and even measuring free T3 and free T4 were not so important. Our physiology books describe thyroid hormone and it's relationship to metabolic rate in great detail, but the clinical application of this basic science seems to have gotten lost.

My goal for my patients is to find the cause of their health problems and design the treatment strategy to deal with that cause. When you're sure that you have a thyroid problem even when your thyroid blood tests are normal, measuring your RMR is the way to gather definitive information to diagnose your suspected thyroid problem.

Several people have reported problems with the order form page when they click on "How to order the book". This link goes to the order form page of drlowe.com. Please be sure to scroll down to the bottom of the page to find the link to click to order "Your Guide to Metabolic Health".

My emphasis at the Center for Metabolic Health remains on high-precision metabolic rehabilitation, metabolic evaluations, and telephone consultations. We're available Monday through Thursday from 9:00 am until 5:00 pm and Friday from 9:00 am until 1:00 pm, MST. Please call the clinic at 303-413-9100 for information and to schedule appointments.