Undiagnosed Dommisse

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V. Dommisse, MD, MBChB, FRCP©**Nutritional & Metabolic (Tele)Medicine, 1840 E. River Road, Suite 210, Tucson, AZ, 85718-5892Contact: www.DommisseMD.com @...

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Abstract. The hypothesis of this paper is that hypothyroidism (in its various forms and degrees) is often undiagnosed in its grade 3 primary, secondary (pituitary), tertiary (hypothalamic), and non-thyroidal illness hypothyroidism versions; and under-treated in all versions, including its grades 1 and 2 primary hypothyroidism versions. The current standard and alternative approaches to the diagnosis and management of hypothyroidism, and their logical inconsistencies and inadequacies, are discussed. The biggest losers in this neglectful situation are elderly, memory- loss, mood-disordered, chronically fatigued, or overweight patients.

An extensive review is presented, which is then coupled with logical argument and clinical experience to clarify the hypothesis. Methods employing the free thyroid hormone levels (FT4 and FT3), by the accurate direct- and tracer-dialysis methods, respectively, and a lower normal range for the thyroid stimulating hormone level are described. These help optimize the newly-developed diagnostic strategies. Their superiority over the standard conventional and alternative approaches are suggested by inferential argument and by the author’s personal experience of his own case of post-surgical (thyroglossal cystectomy) hypothyroidism—missed by the medical profession for 36 years—and his clinical experience with approximately 5,000 patients over a 19-year time period.

Diagnostic strategies and treatment methods are described which refute traditional objections to measuring the FT3 serum level—at least in the case of the serum test done by the dialysis method—and to treating with varying combinations of both T4 and either T3 or T4/T3 combination hormone preparations. The objections about aggressive thyroid treatment causing or aggravating osteoporosis and cardiac arrhythmias are found (in the author’s practice) to not only be overblown, but to be entirely non-existent when corrections are made for certain mineral, vitamin, amino acid, and sex- and growth-hormonal deficiencies.

Keywords: Absence of osteoporotic and cardiac-arrhythmic effects • Dialysis free T3 measurement andoptimal correction • Hypothyroidism • Optimal 24-hour T3 serum level correction • Types and grades

Dommisse, J.V.: Hypothyroidism: Sensitive Diagnosis and Optimal Treatment of All Typesand Grades—A Comprehensive Hypothesis Based on a Review of the Standard and "Alternative"Literature and Extensive Clinical Experience. Thyroid Science, 3(2):H1-14, 2008.© 2008 Thyroid Science