Clinical challenges in thyroid disease: Time for a new approach?

• Thyroid disease is common, and increasing in prevalence.
• Traditional approach to diagnosis and treatment is not helpful for all patients.
• An holistic, individualized approach is beneficial, especially in “non-responders”.
• Both over and under treatment are associated with risks.
• Thyroid disease may be a sign of other undiagnosed co-morbidities.

Thyroid disease is common, and the prevalence is rising. Traditional diagnosis and monitoring relies on thyroid stimulating hormone (TSH) levels. This does not always result in symptomatic improvement in hypothyroid symptoms, to the disappointment of both patients and physicians. A non-traditional therapeutic approach would include evaluation of GI function as well as a dietary history and micronutrient evaluation. This approach also includes assessment of thyroid peroxidase (TPO) antibodies, T3, T4, and reverse T3 levels, and in some cases may require specific T3 supplementation in addition to standard T4 therapy. Both high and low TSH levels on treatment are associated with particular medical risks. In the case of high TSH this is primarily cardiac, whereas for low TSH it is predominantly bone health. This article discusses these important clinical issues in more detail, with some practical tips especially for an approach to the “non-responders” to the current traditional therapeutic approach.