Despite treatment for hypothyroidism, many patients continue to have symptoms that may be related to the underlying thyroid problem. Even after you've been diagnosed and prescribed thyroid hormone replacement drugs, you may have persistent symptoms, including 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 Free T4 and Free T3. These levels allow you to help gauge where you are in terms of treatment, and give you a common point of discussion with your physician.
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. Similarly, some practitioners feel that optimal hypothyroidism treatment includes Free T4 in the top half of the normal range, and Free T3 in the top 25th percentil of the normal range. A good cross-section of innovative thinking about hypothyroidism treatment is available in a series, Practitioners Share Their Approaches to Optimal Hypothyroidism Treatment.
I know I feel terrible at a TSH of 4 to 5, but feel well with a TSH around 1, and with the Free T4 and Free T3 in the "optimal" ranges.
(NOTE: TSH is usually kept even lower than 1 for thyroid cancer survivors to help prevent recurrence.)
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. Many of the integrative physicians practice according to this approach.
Some people also seem to need supplemental T3 to feel well. A 1999 study published in the New England Journal of Medicine found that many patients feel better on a combination of T4 and T3, not T4 (i.e., Synthroid) alone. A 2009 study also found improvement for patients taking T4 plus T3, versus T4-only treatments. This information about T3 is groundbreaking and has major implications for people who don't feel well on their current thyroid therapies!!!