Thyroid Science 6(4):H1-16, 2011
TSH is Not the
Rationale for a New Paradigm to Evaluate and
Treat Hypothyroidism, Particularly Associated with
Text Free in pdf format)
Carol N. Rowsemitt,
PhD, RN, FNP and Thomas Najarian, MD
Correspondence: Dr. Carol Rowsemitt, San Luis Obispo, CA,
Correspondence: Dr. Thomas Najarian, Incline Village, NV,
While many endocrinologists continue to
debate the appropriate levels of TSH to use as boundaries for normal
limits, we believe using TSH to assess thyroid function is
counterproductive, particularly in those patients attempting to lose
weight. From the published literature and our own clinical experience,
we have come to understand that the set point for metabolism is adjusted
downward in the hypocaloric state. The decrease in metabolism is often
referred to as part of the “famine response.” This metabolic response
has been documented in several major vertebrate classes demonstrating
its widespread importance in nature. In our current environment, the
famine response limits the patient’s ability to lose weight while
consuming a hypocaloric diet and performing modest levels of exercise.
Our own experience with the famine response is consistent with that
found in the literature. Treating to normalize thyroid hormone levels
and eliminate hypothyroid symptoms results in the suppression of TSH.
This is understood as a normal part of treatment once we accept that the
thyroid set point has been lowered. This is not an argument to use
thyroid hormones to increase metabolism above normal to achieve weight
loss. Our goal is to correct the hypothyroid response in a weight loss
patient and return him/her to normal metabolism so that the patient
feels normal and is better able to lose weight and maintain that loss.
Keywords ● Famine response ●
Hypocaloric state ● Hypothyroidism ● Reverse triiodothyronine ● rT3 ● T3
● TSH ● Triiodothyronine
Rowsemitt, C.N. and Najarian, T.: TSH is
the answer: Rationale for a new paradigm to evaluate and treat
hypothyroidism, particularly associated with weight loss.
Thyroid Science, 6(4):H1-16, 2011.
to Dr. Najarian and Dr. Rowsemitt's two papers
in pdf format)
© 2011 Thyroid Science