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Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do
In this primer for patients, their families, and their doctors, a leading physician and scientist explains why the standard treatment for hypothyroidism fails many—and offers an empowering call for change.
Hypothyroidism, also commonly referred to as Hashimoto’s disease, affects millions in the United States alone. It occurs when the thyroid—the butterfly-shaped gland that sits in your neck right above the front of your shirt collar—malfunctions or after thyroid surgery, causing thyroid hormone levels in circulation to drop below normal. Thus, treatment is aimed at bringing these hormone levels back to normal. This is done with daily tablets of thyroxine or T4. Because hypothyroidism is so common, we likely know someone who is on this type of medication. While most patients respond well to this standard treatment, about ten to twenty percent (some two to three million individuals in the United States) are far from living a typical life. They exhibit “foggy brain”—low energy, confusion, and poor memory. Many doctors have shrugged off their complaints, believing these symptoms to be unrelated to the thyroid disease. In Rethinking Hypothyroidism , Dr. Antonio C. Bianco, a physician and a scientist who has studied hypothyroidism and thyroid hormones for decades, offers an accessible overview of the disease’s treatment and the role of big pharma in shaping it, making the case that the current approach is failing many patients. But more than this, Bianco calls for alternatives to improve lives, and he equips patients and their families with the tools to advocate for other treatments.
Hypothyroidism, also commonly referred to as Hashimoto’s disease, affects millions in the United States alone. It occurs when the thyroid—the butterfly-shaped gland that sits in your neck right above the front of your shirt collar—malfunctions or after thyroid surgery, causing thyroid hormone levels in circulation to drop below normal. Thus, treatment is aimed at bringing these hormone levels back to normal. This is done with daily tablets of thyroxine or T4. Because hypothyroidism is so common, we likely know someone who is on this type of medication. While most patients respond well to this standard treatment, about ten to twenty percent (some two to three million individuals in the United States) are far from living a typical life. They exhibit “foggy brain”—low energy, confusion, and poor memory. Many doctors have shrugged off their complaints, believing these symptoms to be unrelated to the thyroid disease. In Rethinking Hypothyroidism , Dr. Antonio C. Bianco, a physician and a scientist who has studied hypothyroidism and thyroid hormones for decades, offers an accessible overview of the disease’s treatment and the role of big pharma in shaping it, making the case that the current approach is failing many patients. But more than this, Bianco calls for alternatives to improve lives, and he equips patients and their families with the tools to advocate for other treatments.
311 pages, Paperback
Published November 24, 2022
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Displaying 1 - 5 of 5 reviews
November 15, 2023
When I first saw this announced I was astonished! I had heard of Bianco from my endocrinologist and after asking him many questions- he said that no answers to my questions were to be had but he knew someone (Bianco) who was asking the same things and was seeking answers. Basically this book reflects a huge amount of work- as well as - highlighting some of the glaring holes in research and treatments in the past. Also, he shows the work done by pharmaceutical companies to crush a bunch of research as well.
This book is written so you can see all the steps of the past, and the mistakes made, and also to show how each sliver of trying to find out more about how the Thyroid system works and the levels of dysfunction that exist. Did this book answer many questions I had - yes! Did Bianco present solutions - yes, and he also lists even more specific solutions that others are working on that may be even more effective. So if you suffer from not responding to the one size fits all treatment of the past, you will find out a lot of what is going on and what can be done. Does this mean your doctor will be all up on this- maybe not, probably not - sigh. I'm lucky but then I have switched through various doctors to find one that is at hearing me. I'm actually thinking of getting another copy of this book and give it to my internist- just so she can see what I'm seeing.
Extremely useful to have this book especially if you have Hashimoto's disease; and are having continued symptoms after having the standard treatment with T4.
It may take a while for the doctors in the US & Europe to change their procedures - the the process is starting. There is also a youtube video where Bianco is being interviewed as well.
This book is written so you can see all the steps of the past, and the mistakes made, and also to show how each sliver of trying to find out more about how the Thyroid system works and the levels of dysfunction that exist. Did this book answer many questions I had - yes! Did Bianco present solutions - yes, and he also lists even more specific solutions that others are working on that may be even more effective. So if you suffer from not responding to the one size fits all treatment of the past, you will find out a lot of what is going on and what can be done. Does this mean your doctor will be all up on this- maybe not, probably not - sigh. I'm lucky but then I have switched through various doctors to find one that is at hearing me. I'm actually thinking of getting another copy of this book and give it to my internist- just so she can see what I'm seeing.
Extremely useful to have this book especially if you have Hashimoto's disease; and are having continued symptoms after having the standard treatment with T4.
It may take a while for the doctors in the US & Europe to change their procedures - the the process is starting. There is also a youtube video where Bianco is being interviewed as well.
October 25, 2023
I have to admit I had never heard Dr. Bianco's name before I read his book, but that's not saying much. "Rethinking Hypothyroidism" was recommended by Rachel Hill, the creator of the Invisible Hypothyroidism blog. I read all books on hypothyroidism I can get my hands on, because this is such an important topic for me, being hypothyroid myself. And the "rethinking" part of the title definitely caught my eye. But alas, the book has been something of a disappointment. Yes, Dr. Bianco really knows how to tell a story and he tells the story of the treatment of hypothyroidism in a fascinating way. And to his credit I have to say that he thinks many patients have been treated unfairly by doctors who have ignored their symptoms and that patients deserve an apology. Thank you for that, Dr. Bianco. But I didn't learn much from your book - at least not things I didn't already know. You have come to the conclusion that some patients do experience residual symptoms on T4-only treatment, but you claim it's only 10-20% of all patients. I have to disagree with you on this one, even though I have no statistical data to back up my claim. Anyway, thank you for recognizing that many patients suffer.
Dr. Bianco, you also think that TSH is a wonderful diagnostic tool, but it's not ideal in treatment management. However, patients know that you can have both a low TSH and a low FT4 (or FT3) - according to you, Dr. Bianco, this patient would not qualify for treatment, which is profoundly wrong and disappointing. And there are many people with this problem.
You think that TSH levels should always be kept in range - yet another mistake and yet another disappointment.
A good point you make is that T4 to T3 conversion doesn't work well in all patients and these are the patients with residual symptoms (brain fog, concentration difficulties, depression, weight gain, high cholesterol levels). You conclude that T3 levels have to be taken into consideration and brought up, so you prescribe T3 to your patients along with T4 - this is admirable, but you still insist that their TSH levels have to stay in range. And you wonder why this approach only helps about half of the patients you prescribe it to. Perhaps one more thing about the treatment of hypothyroidism to question?
And yes, you shine a ray of hope - you tell your readers that new treatments are in the pipeline and that more and more doctors are becoming aware of the need to prescribe T3 to symptomatic patients on T4. Alas, I don't think we are going to see a lot of development in this respect any time soon.
All in all, a book that is very readable and full of references, but of little practical value, at least to old thyroid sufferers. I gave it 4 stars though, because it is indeed well writen and could be useful to someone who is only embarking on this journey.
Dr. Bianco, you also think that TSH is a wonderful diagnostic tool, but it's not ideal in treatment management. However, patients know that you can have both a low TSH and a low FT4 (or FT3) - according to you, Dr. Bianco, this patient would not qualify for treatment, which is profoundly wrong and disappointing. And there are many people with this problem.
You think that TSH levels should always be kept in range - yet another mistake and yet another disappointment.
A good point you make is that T4 to T3 conversion doesn't work well in all patients and these are the patients with residual symptoms (brain fog, concentration difficulties, depression, weight gain, high cholesterol levels). You conclude that T3 levels have to be taken into consideration and brought up, so you prescribe T3 to your patients along with T4 - this is admirable, but you still insist that their TSH levels have to stay in range. And you wonder why this approach only helps about half of the patients you prescribe it to. Perhaps one more thing about the treatment of hypothyroidism to question?
And yes, you shine a ray of hope - you tell your readers that new treatments are in the pipeline and that more and more doctors are becoming aware of the need to prescribe T3 to symptomatic patients on T4. Alas, I don't think we are going to see a lot of development in this respect any time soon.
All in all, a book that is very readable and full of references, but of little practical value, at least to old thyroid sufferers. I gave it 4 stars though, because it is indeed well writen and could be useful to someone who is only embarking on this journey.
March 20, 2023
Amazing book! Anyone with Hashimoto’s on T4 therapy with residual symptoms would find this book fascinating, useful and most importantly hopeful. I’m excited to have been able to meet with a doctor mentioned in this book that is following the science. I’m embarking on a new journey to better my Hashimoto condition and this book really helped me understand this complicated issue.
May 31, 2024
The best overview I’ve found of the history and biology of hypothyroidism and current available treatments with particular attention to people with residual mental symptoms of hypothyroidism. His explanations of how past research has been done and the mindset of many physicians are also very helpful context.
A book and researcher cannot be all things to all people, but I will note a few things that aren’t included. Bianco does not get into the idea that patients might want to address the autoimmune element of Hashimoto’s to protect remaining Thyroid functioning or that there might be symptoms associated directly with autoimmunity, though he does mention Hashimoto’s being associated with other autoimmune conditions with their own symptoms. Despite being nuanced about TSH level in treatment, he does not acknowledge the controversy around TSH ‘normal range’. Bianco also does not really talk about some of the less well-known symptoms of hypothyroidism, such as myopathy.
A book and researcher cannot be all things to all people, but I will note a few things that aren’t included. Bianco does not get into the idea that patients might want to address the autoimmune element of Hashimoto’s to protect remaining Thyroid functioning or that there might be symptoms associated directly with autoimmunity, though he does mention Hashimoto’s being associated with other autoimmune conditions with their own symptoms. Despite being nuanced about TSH level in treatment, he does not acknowledge the controversy around TSH ‘normal range’. Bianco also does not really talk about some of the less well-known symptoms of hypothyroidism, such as myopathy.
September 4, 2024
This book tells the story of how Big Pharma standardized treatment for hypothyroid patients by giving us T4 and how we’ve suffered ever since. Actually, the amount of corruption and the lack of ethics Big Pharma displays is disgusting. 🤮🤮🤮. Meanwhile, no one cares because it’s mostly just women getting extremely sick and having their lives broken.
Maybe this book should be called “The T4 mistake”. That’s its main focus: how patients supplemented with T4 don’t make it. I’m curently on very expensive pig thyroid, but it’s not enough for me either so that’s why I picked this one up.
There’s a very interesting chapter on the history of how hypothyroid hormones and pig thyroid were discovered and developed.
Maybe this book should be called “The T4 mistake”. That’s its main focus: how patients supplemented with T4 don’t make it. I’m curently on very expensive pig thyroid, but it’s not enough for me either so that’s why I picked this one up.
There’s a very interesting chapter on the history of how hypothyroid hormones and pig thyroid were discovered and developed.
Displaying 1 - 5 of 5 reviews