Low thyroid, or hypothyroidism, is a ubiquitous and growing health problem that now affects tens of millions of people nationwide.

Conventional thyroid treatment leaves a yawning gap that falls short of restoring perfect thyroid health, consigning millions to lives of low energy, leg edema, foggy thinking, weight gain, and long-term health struggles. Conventional practitioners neglect many aspects of thyroid health due to the drug-focused nature of conventional medical practice and the reluctance to regard fatigue and similar non-catastrophic complaints as medical conditions.


Thermoregulation

You have, literally at your fingertips, an easy, safe, reliable gauge of thyroid function.

First-a.m. oral (“basal”) temperatures can serve as a gauge of thyroid function that can be used to diagnose and track the adequacy of thyroid status.

The thyroid gland is the body's thermoregulatory center, the organ that acts like a thermostat to maintain body temperature within the normal healthy range. But, if the thermostat malfunctions for one reason or another, temperature control--thermoregulation--can be disrupted.

Body temperature normally displays a predictable cycling pattern through the day and night, or circadian rhythm. The typical temperature variation of humans shows the following pattern (rectal temperatures):



From Duffy JF et al 1998. Core (rectal) body temperatures for young and older subjects. Solid circles = Older subjects (n =43); open circles = young subjects (n = 97); solid bar, usual sleep episode of older subjects; open bar, usual sleep episode of young subjects. Data are plotted with respect to actual time of day.

Taking your first-upon-awakening oral temperature therefore provides an estimate of your body's lowest temperature.


At-home thyroid testing

Thanks to direct-to-consumer laboratory testing (performed in the comfort of your home with a finger prick), thyroid dysfunction can be identified, steps taken to correct it.

The tests you can obtain on your own are the very same tests that your doctor would perform to evaluate your thyroid status: free T3, free T4, and TSH. (More on the ABC's of thyroid testing in a future post.)

In fact, an individual’s self-management of thyroid can be superior to that provided by the majority of physicians.

One interesting facet of thyroid health is the recent resurgence of iodine deficiency, since most healthy people are now avoiding iodized salt; iodine replacement can restore normal thyroid function in some people. More on that also in a future post.

The investment industry: Model of self-directed behavior

Up until the 1980s, individual investment was managed by a stockbroker or other money manager.

Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, bonds, and derivatives.

Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. They had no choice but to engage the services of a professional investor.

That has all changed. Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that were not even in existence 20 years ago. Companies that serve individual investors like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the near future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will spread more vigorously through our lives, since health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need. Nonetheless, the emergence of health directed by the individual, just as the emergence of self-directed investment, will explode over the coming years.

The irresistible itch

The prospect of self-managing aspects of health is tantalizing to a lot of people.

Self-directed health conceivably means that cholesterol abnormalities can be identified and managed without a doctor; blood pressure reduced without seeing a doctor; early osteoporosis corrected using commonly available nutritional supplements and exercise; vitamin D blood levels can be self-measured and self-corrected; low thyroid underlying fatigue can be identified and corrected.

When people begin to realize just how much they are capable of in directing their own health, an amazing spark of interest ignites and they develop a deep fascination with learning more⎯a stark contrast with the conventional health interaction.

Self-directed health is a phenomenon that will stretch far and wide into human health. It will encompass preventive practices, diagnostic testing, and therapeutic strategies. Self-directed health will grow to include heart disease, cancer prevention and identification, diabetes and pre-diabetes identification and management; osteoporosis identification and correction; genetic testing; issues peculiar to men, issues peculiar to women.

Self-directed health will dramatically shift the landscape of healthcare, change the economics of payment for healthcare, and revolutionize health for millions. This is not a concept, but the start of a movement.

Critics will say this is hazardous. In our drive-thru, just-add-water-and-microwave world of instant gratification, critics will warn that potential for danger is prohibitive. They fear that people will misdiagnose, misinterpret, or fail to recognize health conditions, choose the wrong diagnostic test, institute the wrong treatment. Chaos will result, unnecessary or unwise treatments instituted.

I disagree.

Surely, increased freedom necessitates increased responsibility. Boundaries will need to be established, rules followed, guidelines provided, guidance available.

But I predict that self-directed health will, on the whole, improve health⎯enormously.

I’m going to make a bold proposal, one you may find farfetched, even irresponsible.

I propose that much of human health can be managed without a doctor or hospital, but by individuals, on their own.

Sure, you could remove a wart using the cider vinegar recipe your grandmother gave you⎯big deal. But I’m referring to something much more substantial. And I don’t mean removing your own appendix, or self-splinting a leg fracture in your garage.

What I mean is that many health conditions can be safely, effectively, and inexpensively managed by an individual without a doctor’s guidance, without a doctor’s diagnosis, and without need for prescription medication.

It’s already happening. And it’s already happening on an incredible scale, not just by the eccentric doctor-phobe bearing acupuncture needles along meridian lines. It is a philosophy already embraced by tens of millions of people, although they may have done so unknowingly.

I call this phenomenon self-directed health: health practices and disease treatment that are self-managed.

You might already recognize a rudimentary form of self-directed health in its predecessor, “wellness,” the healthy-eating, exercise-break, check-your-blood-pressure and know-your-cholesterol practices followed at workplaces to reduce healthcare costs. But the concept is evolving rapidly from this humble start. And it’s going to grow much bigger.

To view evidence of self-directed health at work on a large scale, look no farther than nutritional supplements, the wildly popular $21 billion confirmation that people desire self-managed health solutions. Though we may dispute the wisdom and effectiveness of some of it, there is no doubt that options in nutritional supplements have exploded over the past two decades⎯and the public has embraced them enthusiastically. Lax regulation imposed by the 1994 Dietary Supplement Health and Education Act has allowed the definition of “nutritional supplement” to be stretched to the limit and includes obviously non-nutritional (though still potentially interesting) products like the hormones pregnenolone, dehydroepiandrosterone (DHEA), and melatonin to be sold on the same shelf as vitamin C, “nutritional supplements” that fill the growing public appetite for self-directed health.

Though still in its infancy, direct-to-consumer access to medical imaging is yet another facet of the phenomenon of self-directed health. Today, it is possible to diagnose your own coronary disease (CT heart scan), measure bone density for osteoporosis (DEXA, ultrasound, or bone densitometry), or quantify the severity of carotid atherosclerosis (ultrasound) with tests available to the consumer⎯directly, without a doctor’s involvement. A number of market forces in healthcare (including increasing exposure to large insurance deductibles) are converging to make direct-to-consumer medical imaging an appealing option.

Direct-to-consumer laboratory testing, a silent but substantial phenomenon, has emerged only in the last few years, largely in response to physician reluctance to order tests requested by individuals eager to explore health. Cost awareness to the price of lab testing is growing as more people are being exposed to health costs through larger insurance deductibles. The competitive pricing that develops naturally in a direct-to-consumer retail service yields substantial cost savings. (50% is not uncommon.) A mind-boggling array of self-directed tests is now available, from advanced markers for heart disease, to genetic cancer markers, to hormonal assessments.

Undoctored Health is going to chart these explorations in self-directed health. I invite you to follow along.