From Mary Shomon,
Your Guide to Thyroid Disease.
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Despite treatment for hypothyroidism, many of you continue to have symptoms that may be related to your thyroid problem. Even after you've been diagnosed and are on thyroid hormone replacement drugs, you may have persistent symptoms such as continued weight gain or difficulty losing weight, depression, brain fog or difficulty concentrating, hair loss, hand/feet/facial swelling, intolerance to heat and cold, muscle aches and joint pains, constipation, carpal tunnel or tendonitis, high cholesterol levels, difficulty getting pregnancy, and more.

If you are hypothyroid, being treated, but still don't feel well, there are many resources here at the site to help you determine the path to getting well and living well.

Start by exploring 15 Ways to Feel Well and Live Well With Hypothyroidism, a series that helps you identify the many different approaches you can take to help you feel well with hypothyroidism.

A key step is to determine if too high or low a Thyroid Stimulating Hormone (TSH) level or a lack of T3 hormone is preventing you from feeling well. Does this sound confusing? It's all explained in my article, Is Your Hypothyroidism UNDERtreated?.

By way of overview, the first step for you is knowing your TSH (thyroid stimulating hormone) level, and other key thyroid levels such as T4 and T3. These levels allow you to help gauge where your doctor is in terms of treatment, and give you a common point of discussion.

More innovative doctors are beginning to believe that a TSH of around 1 - 2 --- in the low end of the normal range -- is optimal for most people to feel well and avoid having hypothyroid or hyperthyroid symptoms. I know I feel terrible at 4-5, and at .2, but pretty good at 1 - 2. (NOTE: this TSH is usually kept even lower than 1-2 for thyroid cancer survivors to help prevent recurrence.) Dr. David Derry, for example, is one doctor who believes that TSH levels aren't even relevant to diagnosing or treating hypothyroidism and its symptoms.

For some people, even if the TSH level is normal, or even in some bases, low normal, there may still be a situation where one is hypothyroid at a cellular level, due to conversion problems, inadequate T3 hormone, or other factors. Inability to properly convert T4 to T3 can also result in fluctuating TSH, as the system struggles to keep balancing an out of whack T4 and T3 level, sending TSH levels up and down to compensate. Drs. Dommisse and Mercola both have theories in this arena.

Some people also seem to need supplemental T3 to feel well. There was published February 11, 1999 in the New England Journal of Medicine a research report that says that many patients feel better on a combination of T4 and T3, not T4 (i.e., Synthroid) alone. Many people have a normal or even LOW-normal TSH level, yet still suffer continuing hypothyroidism symptoms. In these cases, the addition of T3 helped relieve depression, brain fog, fatigue and other symptoms. This information about T3 is groundbreaking and has major implications for people who don't feel well on their current thyroid therapies!!!

Personally, I am one of the people who does better on a T4/T3 drug than on pure synthetic T4 only (like Synthroid.) In the past, I have taken Thyrolar, and also levothyroxine plus separate T3, and they have worked far better for me than Synthroid. Some practitioners prefer to prescribe natural thyroid hormone replacement, which I have also taken.