Optimal Treatment of Hypothyroidism?
A Matter of Clinical Common Sense
Text Free in pdf format)
Bo Wikland, MD*
*Hötorget Medical Centre,
Sveavägen 13, SE-111 57 Stockholm, Sweden
John C. Lowe, MA, DC: Editor-in-Chief
In this paper, Dr.
Bo Wikland of Stockholm, Sweden proposes two valuable hypotheses. The
first is that most hypothyroid patients must suppress their TSH levels to
recover from their symptoms and have a good quality of life. My own
clinical experience, as well as his, and my clinical trials fail to refute
this hypothesis. In the vernacular of medical
research, this means these experiences strongly support his first
Dr. Wikland's second hypothesis proposes why most
hypothyroid patients must suppress their TSH levels with thyroid hormone for therapeutic success:
first, autoimmune thyroiditis is the most common cause of hypothyroidism;
second, the TSH
triggers and maintains autoimmune activity; and third, consequently, a low TSH is
a prerequisite to patients reducing or stopping altogether the pathological
activity in the thyroid gland.
The research literature
has long shown that TSH suppression is necessary if patients with partial
peripheral resistance to thyroid hormone are to recover their health. However,
like Dr. Wikland, other clinicians and I have long observed that
most hypothyroid patients, too, must suppress their TSH levels if they
are to recover from their symptoms.
Medical hypotheses that are not falsified by our
current bank of knowledge warrant being
subjected to rigorous experimental testing. The reason is, if we find
that the hypotheses are true (that is, if testing fails to refute them), clinicians can use the information to
further the health and well-being of the patients we are here to serve.
Dr. Wikland's hypotheses
are not falsified by our current knowledge, making it highly likely that
they are true. Because of this, in view of the widespread dissatisfaction
with the conventional approach to diagnosing and treating hypothyroid patients, I
believe experimental testing of his hypotheses is imperative. I
firmly believe such testing will fail to refute his
hypotheses. If I am right, the new paradigm of the diagnosis of hypothyroidism—which he called for in a recent
Thyroid Science—will have a sound scientific foundation. From
that foundation, the paradigm should, in the interest of hypothyroid patients' health,
begin to rise and revise the current conventional practice of the diagnosis and treatment of
We thank Dr. Bo Wikland and his colleagues for
contributing to the advancement of clinical thyroidology, and Dr. Wikland
for his valued contributions to Thyroid Science.
Key Words. Autoimmune thyroid
disease • B12 deficiency • Clinical symptoms • Criterion of optimal
treatment • Fine-needle aspiration • Free T4 • Hypothyroidism • Quality
of life • Subclinical hypothyroidism • Thyroid antibodies • TSH
Wikland, B.: What is
Optimal Treatment of Hypothyroidism? A matter of clinical
common sense. Thyroid Science, 3(1):H1, 2008.
in pdf format)
© 2008 Thyroid Science