I’m not the first doctor to criticize modern hypothyroidism diagnosis and treatment. In 1976, when I was in medical school, the pioneering Broda Barnes, MD, published his groundbreaking book, Hypothyroidism, the Unsuspected Illness. During my medical training, Dr. Barnes’ book was never mentioned, but I now consider his work pivotal to understanding the proper way to diagnose and treat hypothyroidism.
 

I hope this book, inspired by Dr. Barnes’ influential work, will add to the vital understanding of hypothyroidism and serve as a useful ‘How To” manual for today’s practitioners and patients.
 

Guided by the knowledge I gained from Dr. Barnes – and the experience of working with thousands of women with hypothyroidism – I’ve learned that no two individuals are hormonally alike. And hypothyroidism manifests itself in many different ways in different people. Consequently, rather than following strict and narrow lab-based guidelines for thyroid replacement, the best results for patients come from individualizing treatment for each patient via careful clinical assessment.

This book offers practical guidance on how to choose a thyroid medication and how much of it to use to replace thyroid hormone in each patient properly. We will also discuss common problems and complicating factors that can occur during this process and how to deal with them – or better yet, how to avoid them.

Again, not every patient fits neatly into a particular diagnostic code box. And no two thyroid patients are the same. Consequently, no “one size fits all” protocol will help all hypothyroid patients get well. Thus, we will continue to need dedicated and caring clinicians willing and able to use their clinical skills to successfully evaluate and manage hypothyroid patients.

Without clinicians who are able to do clinical assessments and see past the misleading laboratory tests, health care for these patients will remain ridiculously complex, expensive, and inefficient. Patients will continue to suffer needlessly, despite taking multiple medications. With more reliance on clinical assessment and much less on laboratory testing, the cost and the quality of care for hypothyroid patients can be dramatically improved. Both have certainly been true in my practice, and I am tremendously thankful for that!

One final note: As a gynecologist, my entire clinical frame of reference has centered on caring for female patients. So please realize that this book describes the management of hypothyroidism in women. That said, having treated hypothyroidism in a few male friends, I have observed that most of their symptoms were the same. Like women with hypothyroidism, the men were often sluggish, struggling with weight gain, and had a depressed mood. There are a few points of departure, however.

For example, the men rarely complained of cold intolerance. And when they had hair loss, they typically accepted it as normal. And the most significant difference was that, as men are often inclined, they rarely went to the doctor to seek help for these symptoms. Instead, they assumed that their symptoms were a normal part of life that they had to accept. So please accept my apologies for my lack of expertise with male patients. That said, it’s safe to assume that this book's general approach to diagnosing and managing hypothyroidism will also apply to men.

Optimal management of hypothyroidism is an art, and now, in retirement, I feel compelled to pass on the techniques I have learned along the way. I hope my book can help clinicians help their patients and help patients get the best possible care, in the same way that Dr. Barnes’ book has helped so many. I hope that at least some physicians will feel validated and continue to practice the true art of medicine, despite the pressures of modern corporate medicine to abandon the art and follow protocols and “best practices” that simply don’t serve patients.

I wish you all good health and optimal wellness!

Donna G. Hurlock, MD