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Updated August 18, 2014.

Dr. Manzanero also finds the reliability of the TSH test to be problematic.

We "believe' that the test result is correct. However, what about fluctuations in the level, or poor lab calibration? I have found many cases where TSH levels from one day to the next were widely off. I have tested my own blood TSH samples drawn on the same day with three different labs, and had ranges that varied enough to cause concern!

Dr. Manzanero feels that in the end, the thyroid cannot be optimally understood in isolation from other hormone interactions. He is particularly interested in adrenal cortisol levels. One of his mentors, Dr. Datis Kharrazian, has a teaching approach that Dr. Manzanero especially admires, because it demonstrates the complex orchestral arrangement and interactions of all our hormones, foods, gut pathology, and emotional stresses. He also feels that genetics and xenobiotic pollutants that accumulate in our bodies have an impact on thyroid hormone production and/or activity.
Dr. Manzanero has said that some patients do not want to be on hormone therapy. While he recognizes that this is not always feasible, he does his best to look for underlying causes of low thyroid and tries to correct any nutritional deficiencies or imbalances that are in the way of optimal thyroid functioning. When he goes the route of thyroid replacement therapy, he believes in giving the patients as many options possible that get them to optimal functioning.

According to Dr. Manzanero:

I have some patients who feel optimal on Synthroid! In that case, it is not my role to interfere and add in Cytomel (synthetic T3) or switch them to Armour thyroid! I have found these rare individuals are able to optimally convert the synthetic T4 to T3. Others will need to go on a combination of synthetic T4 with Cytomel, while many do best by going on Armour or Nature-throid (standardized combinations of porcine derived T4 and T3). On some occasions, I may also use individualized combinations of T4 and T3 that have to be compounded.

Dr. Manzanero believes that as a physician, he needs to remain flexible enough to find the right combinations of thyroid hormone replacement to help the patients reclaim optimal health. He says:

If my mind is biased to one single approach, the losers in the equation are first the patient, who is deprived of discovering total wellness, and also the doctor. Why the doctor? I cannot imagine practicing medicine constantly having to tell people that nothing is wrong with them because their, TSH test is "normal," and then endure hearing their complaints of persistent suffering. I want all people with hypothyroidism to thoroughly learn about their condition and empower themselves with this knowledge – not settling for a suboptimal existence simply because of their doctor's lack of knowledge or bias.

Ron Manzanero, MD is an integrative physician with expertise in hormone balance and pain management. He is the founder of the Austin Integrative Medicine clinic in Austin, Texas.
Austin Integrative Medicine website: www.aimmd.com

_{Source: Email interview with Ron Manzanero, MD - December 2010}