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The Hidden Thyroid Epidemic and the Routine
Thyroid Blood Test That Fails to Detect It

by Raphael Kellman, M.D. • New York City


If you complain of fatigue, difficulty losing weight, weight gain, hair loss, difficulty concentrating or depression, and thought your thyroid might be low but routine thyroid blood tests were normal, you’re not alone. An untold number of people experience the same problem and it’s due to the fact that we are in the midst of a thyroid epidemic – and the routine thyroid blood test frequently fails to detect it.

According to recent estimates, as much as 20% of the American population (mostly women) could have a low thyroid, and a large percentage might not even know it. Additionally, thyroid cancer has doubled in the past 10 years. What is causing this epidemic? According to scientists, the overwhelming amount of toxins in the environment such as PCBs, dioxin, perchlorate, lead and mercury can easily damage the thyroid and are a major cause of this epidemic. Also, immunological dysfunction and stress are playing a role as well.

What is most troubling is that many people that have a low thyroid are being misled and told that their thyroid is normal because doctors are relying on the routine thyroid blood test. More and more doctors are beginning to question the validity of these tests. Even the American Association of Clinical Endocrinologists (AACE) have realized that the TSH reference range (the most relied upon thyroid test) has been too wide and has missed detecting low thyroid in a large percentage of patients. What experts have come to realize was that the upper TSH normal range has included people who actually have mild thyroid disease and their higher TSH levels skewed the curve. This understanding led to the recommendation in January 2003, by the AACE that doctors consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of .3 to 3.0. The American Association for Clinical Chemistry, or AACC, feels that the upper limit of the TSH range should be reduced to 2.5. Yet most doctors are unaware of these new guidelines.

There is another more sensitive thyroid test called the TRH stimulation test that in the past was the standard thyroid test. This test uses a hormone called TRH which stimulates the pituitary gland. The pituitary makes a hormone called TSH which stimulates the thyroid to produce thyroid hormone. If the thyroid is low, one would expect that the pituitary would be producing a lot of TSH which would be reflected in the blood as high TSH. However, frequently due to various mechanisms, even if one has hypothyroidism the TSH does not go up in the blood, rendering the routine thyroid blood test inadequate in a significant percentage of patients. Even if the blood levels of TSH can be normal in hypothyroidism, unequivocally the TSH will be high in the pituitary gland itself. Upon stimulation with TRH the TSH would be released on the spot, rising to high levels, allowing us to make the diagnosis. This avoids the pitfalls of measuring routine blood levels that can be misleading and inaccurate.

I have used the TRH test in over 15,000 patients with symptoms of hypothyroidism and have diagnosed hypothyroidism in a large percentage. With treatment they experienced significant improvement. Without this test the diagnosis would have been missed. Additionally, based on the TRH stimulation test in hundreds of children with autism, ASD, PDD, and other developmental disorders I have found that 75% have hypothyroidism that was missed by the routine test. With treatment using thyroid hormone the children experienced significant improvement in focus, speech, eye contact, interaction with others, attention, cognition, and mood. From my experience, there is no other treatment for autism that is as effective as thyroid hormone.

According to a study published in Clinical Medicine and Research in 2007, titled “TRH Stimulation when Basal TSH is within the Normal Range; Is there “Sub-Biochemical Hypothyroidism?” researchers concluded “we document that an exaggerated TRH response indeed occurs in many patients with a normal biochemistry … Even though the TRH test is seldom used in clinical practice at present, a larger prospective study is in order. Until then, physicians may once again need access to TRH for diagnostic use.”

Carol, a 49 year old woman has been complaining of fatigue for over 3 years. Additionally, she complained of hair loss and difficulty losing weight. Irrespective of how little she ate, she still was unable to lose weight. All her blood tests came out normal and her doctors had nothing to offer her. When I saw her I did the TRH stimulation test and detected an underactive thyroid. I treated her with compounded thyroid hormone. Within a few weeks her energy came back to normal. Within a few months her hair began to grow back. She now feels better than she ever felt.

Joan had a similar story, but in addition to being tired she also suffered from depression. She was put on anti-depressants. When I saw her, I picked up a low thyroid based on the TRH stimulation test. I treated her with compounded thyroid hormone. Her depression lifted within days and her energy improved within a few weeks. Commenting on the TRH stimulation test, Joan echoed the conviction of so many of our patients: This one test changed my life.


Raphael Kellman, M.D. is an internist and pioneer in holistic medicine and has been in private practice specializing in holistic medicine since 1995. He is the author of Gut Reactions and Matrix Healing. Dr. Kellman is Defeat Autism Now! Certified. He has offices in Manhattan and Hartsdale, NY. 212-717-1118. www.raphaelkellmanmd.com.