The Elephant in The Room – Also Known as: I Know I Have a Thyroid Problem, Why Can’t You Believe Me?

He has never told me his first name. I just have to call him by the name that fits him best!

I call him ‘The Elephant in the Room’. How do I describe him to you?

Many endocrinologists and doctors hang on to the belief that synthetic T4 (Levothyroxine / Synthroid) is always an effective treatment for hypothyroidism.

I began to see this as an incorrect but strongly held view by some of the doctors that I visited. I had to give this a name. I wanted to find a name/image for the wrong view or lie or bad assumption or flawed belief. I ended up calling this ‘The Elephant in the Room’.

Thyroid patients who feel desperately ill on T4 replacement therapy often appear to be the only group of people who know that synthetic T4 is not working for them. These patients can see the elephant. 

Many thyroid patients go along to visit their family doctor or endocrinologist and they sit down in the doctor’s waiting room and quietly rehearse what they are going to say, in order to try to get a more effective treatment than the T4 replacement therapy that is not working. Often the preparation for these encounters and the appointments themselves are hugely stressful for the patient. They have often had bad experiences before.

Thyroid patients know that their thyroid blood test results are not showing the whole story.

For many of these patients the elephant in the room is clearly visible.

The large grey beast may be sitting in one of the waiting room chairs, in heavy disguise. It may be wearing an extra large pair of shoes, a nice suit and a large hat and be reading a newspaper. The elephant’s trunk may be tucked behind the newspaper! 

However, some thyroid patients are able to see the elephant very clearly, even though every attempt has been made to not draw attention to it.

Very few other patients appear to realise that the elephant is there.

The doctor’s office staff and nurses do not appear to have a clue that there is an elephant in the room. They do not think there is a false belief, a bad assumption, a flawed paradigm or anything incorrect at all about the idea that T4/Synthroid is always sufficient for all patients! 

If the patient were to ask the doctor or one of his staff about the elephant directly, a range of reactions might be elicited, from total denial through to irritation for describing one of the doctor’s most valuable assistants as some sort of beast. The patient may even be ‘diagnosed’ as having a psychological problem and be offered anti-depressants!

However, make no mistake, the elephant is there!

Once a patient has recognised the elephant in the room, it is very easy to spot from that point onwards!

I just got to the point that I could see the non-speaking, large, grey animal whenever I visited another doctor.

I got to the point when I expected to see the elephant. I often heard an endocrinologist speak the inevitable sentences indicating that my thyroid hormones were normal,  and I could actually see the elephant sitting in the endo’s office – grinning at me! 

The above simple analogy is very relevant.

So, many thyroid patients feel that they understand what is happening to them and yet no doctors or nurses appear to recognise it. For many thyroid patients, the elephant is very clearly visible!

The Recovering with T3  and The Thyroid Patient’s Manual books will explain why some patients can see the elephant, and why some doctors cannot.

These books may also help some thyroid patients to recover from hypothyroidism and not have to worry about the elephant in the room again.

Best wishes,


(Updated in March 2020)

Paul Robinson

Paul Robinson is a British author and thyroid patient advocate. The focus of his books and work is on helping patients recover from hypothyroidism. Paul has accumulated a wealth of knowledge on thyroid and adrenal dysfunction and their treatment. His three books cover all of this.

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