Oh how I wish the good old days of hypothyroidism, when doctors really listened to a patient’s symptoms, would come back again. Let me be blunt. The modern way of treating hypothyroidism sucks.

Written by Hugh Melnick, MD

Hypothyroidism was described in the 1850’s and was first successfully treated in the 1890’s with a preparation of pig’s thyroid gland, much like today’s Armour thyroid. Prior to the advent of blood testing, physicians diagnosed illnesses clinically, from a person’s symptoms.  As you well may know from your own personal experience with it, hypothyroidism is a condition that presents itself with a wide variety of many troublesome symptoms.  All a physician had to do is take the time to listen to a patient’s symptoms, and to ask questions about other symptoms that are possibly related to hypothyroidism and a diagnosis could be made by deduction. 

A therapeutic trial of pigs’ thyroid glands

Once a diagnosis was made, a patient was given a therapeutic trial of a medication made from pigs’ thyroid glands, which was known to have been used successfully in the treatment of goiters and provided relief to people having symptoms of hypothyroidism. The dose was gradually increased and the patients were observed for regression of their symptoms.  This approach worked particularly well for people with hypothyroidism, since it is a common condition that causes people to experience many clinical symptoms and can be successfully treated with a therapeutic trial of a safe, natural medication. 

I learned the “old school” approach when I was a medical student in the late 1960’s. In my earliest clinical experiences, it seemed that the old school diagnostic process was accurate and that most symptomatic hypothyroidism patients improved clinically after having been treated with Armour Thyroid (NDT natural desiccated thyroid) at doses of 120mg to 240 mg.

Then came the TSH test and Synthroid

This was also a time of transition in both medical education and medical practice.  In the early 1970’s, the TSH test and Synthroid came on the market simultaneously and there was a sudden shift from the “old school” approach to the new “scientific” approach to hypothyroidism.  In 1972, to  a young doctor such as myself, the new approach was very appealing because it was novel and it was “scientific.”  It was also highly promoted by Big Pharma.  The physicians’ role was transformed virtually overnight from being a clinician, dealing with patient’s symptoms, to a scientist basing hypothyroidism diagnosis and treatment on thyroid blood test results instead of listening to their patient’s symptoms.   

I found out rather some years later as I started out in private practice that this transition did not work out well for many people suffering with the symptoms of hypothyroidism. In my experience, the use of the TSH test and treatment with synthetic thyroid medication left many people incorrectly diagnosed and symptomatic despite treatment.  Despite its simple, non-scientific approach, in my experience the old school approach works better than the current treatment model employed by the vast majority of endocrinologists practicing today.

Hypothyroidism symptoms are the key

Since every cell type in the human body depends upon thyroid hormone as its energy source, there is a very large number of diverse and seemingly unrelated symptoms that people with hypothyroidism may experience.  In addition to the most common symptoms of hypothyroidism, such as fatigue, weight gain and low body temperature, which are all caused by a slow cellular metabolism ultimately resulting from low intracellular T3, the following examples illustrate the biological relationship between thyroid hormones and other less known symptoms experienced by people having hypothyroidism. 

Of the many diverse symptoms caused by hypothyroidism, hair loss is probably one of the most disturbing. There are two distinct types of hair loss caused by hypothyroidism.  One type is associated with low T3 levels in which there is frontal and diffuse hair loss. Its appearance is totally different than male pattern baldness, in which hair loss starts in the crown area. If hair follicles do not get enough intracellular T3, a hypothyroid individual commonly experiences diffuse hair loss and thinning and is characterized by excessive shedding. This is usually reversed with adequate treatment with the proper dose of T3 containing thyroid medication.  Hair loss usually stops when a person’s dosage of thyroid medicine is optimal.

The other type of hair loss, called alopecia areata, is most often found in hypothyroid individuals having Hashimoto’s autoimmune thyroiditis. People with this condition have patches of baldness that are surrounded by areas of perfectly normal scalp having full hair growth. Hair regrowth can occur spontaneously in the bald patches, but most dermatologists recommend cortisone injections to accelerate regrowth.

Hypothyroidism can cause a wide variety of psychological symptoms and intellectual deficiency states when the cells of the brain do not get adequate amounts of thyroid hormone inside of its cells.  People with hypothyroidism may experience various types of cognitive and psychiatric symptoms ranging from depression to Attention Deficit Disorder (ADD), to generalized “brain fog”, loss of recent memory, dementia, panic attacks and can even possibly be related to the development of autism in children.  The specific type of symptoms depends upon the area of the brain affected and the neurotransmitters involved.

There are 200-300 symptoms related to hypothyroidism that I look for in patients.  Some related conditions and symptoms include:

Restless Leg Syndrome

Raynaud’s Syndrome

Fibromyalgia

Vertigo

Premature Graying

Vitiligo

Sleep Apnea

Psoriasis

Chronic Hives

Insomnia

Premature Menopause

Panic attacks

When an individual has multiple, yet apparently unrelated symptoms, a physician must always consider hypothyroidism as a likely diagnosis. Whether the diagnosis is substantiated by blood test results or not, my experience is always listen to the patient and go with symptoms over thyroid lab numbers.

About Hugh Melnick, MD

Dr. Hugh Melnick is a reproductive endocrinologist who has been treating patients with hormonal and fertility problems since 1976. In 1983, Dr. Melnick founded Advanced Fertility Services, which was the first free standing In Vitro Fertilization Center in New York City and is still its medical director. Dr. Melnick’s vast clinical experience along with his own personal experience with hypothyroidism has enabled him to develop a unique approach to the diagnosis and treatment of hypothyroidism. During his many years of clinical practice, he has recognized how hypothyroidism can adversely affect every part of the human body which inevitably interferes with a productive and enjoyable quality of life. In addition to his fertility services, Dr. Melnick specializes in hypothyroidism treatment for men and women of all ages.

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