Debunking Internet Myths: What Is the Best Approach?

  • Deirdre Cocks Eschler
  • Jonathan D. LeffertEmail author


The Internet has become a common resource of health information for the public across the world. People turn to the Internet to self-diagnose and, sometimes, self-treat. It can lead patients with oftentimes vague symptoms to turn to a primary care doctor or endocrinologist with a perceived diagnosis of hypothyroidism, low testosterone (or low T), or “adrenal fatigue.” It is the physician’s responsibility to listen to the frequently frustrated patient, do a complete history and physical, educate them on the true way to diagnose and treat the presumed condition, and direct them toward a possible etiology of their symptoms.


Internet myths Adrenal fatigue Hypothyroidism Low T syndrome 


  1. 1.
    Smiths A. What percentage of people in this world have a computer? How many of them are connected to the Internet? How many of them know how to code? 2017 [updated 2017, Sept 13]. Available from:
  2. 2.
    Fox S, Duggan M. Health online 2013. Pew Research Center; 2013.Google Scholar
  3. 3.
    Mueller J, Jay C, Harper S, Davies A, Vega J, Todd C. Web use for symptom appraisal of physical health conditions: a systematic review. J Med Internet Res. 2017;19(6):e202.CrossRefGoogle Scholar
  4. 4.
    Tan SS, Goonawardene N. Internet health information seeking and the patient-physician relationship: a systematic review. J Med Internet Res. 2017;19(1):e9.CrossRefGoogle Scholar
  5. 5.
    Kuecuekbalaban P, Schmidt S, Muehlan H. The offer of medical-diagnostic self-tests on german language websites: results of a systematic internet search. Gesundheitswesen. 2018;80(3):240–6.PubMedGoogle Scholar
  6. 6.
    How do I get bioidentical hormones? Available from:
  7. 7.
    Shmerling R. Dr. Google: the top 10 health searches in 2017. 2017 [updated 2018, Feb 26]. Available from:
  8. 8.
    Neuberg GW, Stephenson KE, Sears DA, McConnell RJ. Internet-enabled thyroid hormone abuse. Ann Intern Med. 2009;150(1):60–1.CrossRefGoogle Scholar
  9. 9.
    Kang GY, Parks JR, Fileta B, Chang A, Abdel-Rahim MM, Burch HB, et al. Thyroxine and triiodothyronine content in commercially available thyroid health supplements. Thyroid. 2013;23(10):1233–7.CrossRefGoogle Scholar
  10. 10.
    Thyroid health – Understanding reverse T3 2017, Apr 20. Available from:
  11. 11.
    Bowthorpe J. Reverse T3 (also called Reverse Triiodothyronine) 2009, Jan 7 [cited 2018 May 1]. Available from:
  12. 12.
    Osborne P. How diet and nutrition can help your thyroid 2017, July 26 [cited 2018 May 1]. Available from:
  13. 13.
    Hedberg N. Searching for the causes of Hashimoto’s disease. The key to healing 2017, Jan 1. Available from:
  14. 14.
    Fallis J. 13 Things helped this hypothyroid man beat chronic mental illness 2016, Sept 19. Available from:
  15. 15.
    Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670–751.CrossRefGoogle Scholar
  16. 16.
    Engler D, Burger AG. The deiodination of the iodothyronines and of their derivatives in man. Endocr Rev. 1984;5(2):151–84.CrossRefGoogle Scholar
  17. 17.
    Schmidt RL, LoPresti JS, McDermott MT, Zick SM, Straseski JA. Does reverse triiodothyronine testing have clinical utility? An analysis of practice variation based on order data from a national reference laboratory. Thyroid. 2018;28(7):842–8.CrossRefGoogle Scholar
  18. 18.
    Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988–1028.CrossRefGoogle Scholar
  19. 19.
    Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med. 1997;12(9):544–50.CrossRefGoogle Scholar
  20. 20.
    Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, et al. Hypothyroid symptoms fail to predict thyroid insufficiency in old people: a population-based case-control study. Am J Med. 2016;129(10):1082–92.CrossRefGoogle Scholar
  21. 21.
    Pollock MA, Sturrock A, Marshall K, Davidson KM, Kelly CJ, McMahon AD, et al. Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomized double-blind placebo controlled crossover trial. BMJ. 2001;323(7318):891–5.CrossRefGoogle Scholar
  22. 22.
    Dubois S, Abraham P, Rohmer V, Rodien P, Audran M, Dumas JF, et al. Thyroxine therapy in euthyroid patients does not affect body composition or muscular function. Thyroid. 2008;18(1):13–9.CrossRefGoogle Scholar
  23. 23.
    Samuels MH, Kolobova I, Smeraglio A, Peters D, Purnell JQ, Schuff KG. Effects of levothyroxine replacement or suppressive therapy on energy expenditure and body composition. Thyroid. 2016;26(3):347–55.CrossRefGoogle Scholar
  24. 24.
    Handelsman DJ. Global trends in testosterone prescribing, 2000–2011: expanding the spectrum of prescription drug misuse. Med J Aust. 2013;199(8):548–51.CrossRefGoogle Scholar
  25. 25.
    Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173(15):1465–6.CrossRefGoogle Scholar
  26. 26.
    Handelsman DJ. Androgen physiology, pharmacology, and abuse. In: DeGroot LJ, Jameson JL, editors. Endocrinology. 6th ed. Philadelphia: Elsevier Saunders; 2010. p. 2469–98.Google Scholar
  27. 27.
    Bandari J, Ayyash OM, Emery SL, Wessel CB, Davies BJ. Marketing and testosterone treatment in the USA: a systematic review. Eur Urol Focus. 2017;3(4–5):395–402.CrossRefGoogle Scholar
  28. 28.
    McBride JA, Carson CC, Coward RM. Readability, credibility, and quality of patient information for hypogonadism and testosterone replacement therapy on the Internet. Int J Impot Res. 2017;29(3):110–4.CrossRefGoogle Scholar
  29. 29.
    Oberlin DT, Masson P, Brannigan RE. Testosterone replacement therapy and the internet: an assessment of providers’ health-related web site information content. Urology. 2015;85(4):814–8.CrossRefGoogle Scholar
  30. 30.
    McBride JA, Carson CC 3rd, Coward M. The availability and acquisition of illicit anabolic androgenic steroids and testosterone preparations on the internet. Am J Mens Health. 2018;12:1352–7.CrossRefGoogle Scholar
  31. 31.
    Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103:1715–44.CrossRefGoogle Scholar
  32. 32.
    Mulhall JP, Valenzuela R, Aviv N, Parker M. Effect of testosterone supplementation on sexual function in hypogonadal men with erectile dysfunction. Urology. 2004;63(2):348–52; discussion 52–3.CrossRefGoogle Scholar
  33. 33.
    Spitzer M, Basaria S, Travison TG, Davda MN, Paley A, Cohen B, et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med. 2012;157(10):681–91.CrossRefGoogle Scholar
  34. 34.
    Akturk HK, Chindris AM, Hines JM, Singh RJ, Bernet VJ. Over-the-counter “adrenal support” supplements contain thyroid and steroid-based adrenal hormones. Mayo Clin Proc. 2018;93(3):284–90.CrossRefGoogle Scholar
  35. 35.
    Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16(1):48.CrossRefGoogle Scholar
  36. 36.
    Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364–89.CrossRefGoogle Scholar
  37. 37.
    Vosoughi S, Roy D, Aral S. The spread of true and false news online. Science. 2018;359(6380):1146–51.CrossRefGoogle Scholar
  38. 38.
    Heymann P. “Keep Internet Neighborhoods Safe” a proposal for preventing the illegal internet sales of controlled substances to minors 2006 July 13. Available from:

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Renaissance School of Medicine at Stony Brook UniversityStony BrookUSA
  2. 2.Health Sciences Center, Level 16, Department of MedicineStony BrookUSA
  3. 3.North Texas Endocrine CenterDallasUSA

Personalised recommendations