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Is Your Hypothyroidism UNDERtreated?
Dateline: 08/14/99, Updated March 2003

If you're on thyroid hormone replacement, have a TSH level that's in the normal range, and are still having a range of thyroid-related symptoms, you may be one of the millions of thyroid patients suffering from undertreated hypothyroidism and can benefit from a discussion with your doctor about optimum TSH levels and thyroid drug options.

What is undertreated hypothyroidism? It's hypothyroidism at the cellular level that means you still have hypothyroidism symptoms such as fatigue, weight gain, depression, fibromyalgia/muscle & joint aches and pains, hair loss or coarse/dry hair, infertility and more -- despite taking thyroid replacement and having a "normal" TSH level.

There are two reasons this can occur. First, some doctors believe that providing only enough thyroid hormone to get a patient to mid to high-normal TSH levels is sufficient. And second, the current standard treatment, levothyroxine (brand names include Synthroid, Levoxyl, Levothyroid, Eltroxin, Euthyrox) may not be enough for the majority of people to actually feel well, because the body also needs a small amount of the hormone T3 in addition to the levothyroxine in order to truly feel well.

TSH Levels

The endocrinologist I see periodically, as well as my regular physician, both believe that a TSH of around 1 to 2 is optimal for most people to feel well and avoid having hypothyroid or hyperthyroid symptoms. There is also research that suggests that values above TSH of 2 may actually even represent abnormal levels. See the British Medical Journal for more information on that research.

And as of March 2003, it is official position that the normal range for TSH levels is .3 to 3. Read the information here. I know I feel terrible at a TSH level of 4 to 5, I also feel bad when it drops too low to .2, but I pretty best at a TSH of between 1 and 2.

(NOTE: TSH levels are usually kept lower than 1 to 2 for thyroid cancer survivors -- a process known as thyroid suppression -- to help prevent cancer recurrence.)

TSH LevelInterpretation
Less than .5/.7This is considered hyperthyroid (too much thyroid hormone) at most labs in the U.S. You may be anxious, find it hard to sleep, hair falling out, diarrhea, and other symptoms
1 to 2The optimal normal level for most people. This is the TSH range where the majority of people feel best. It is sometimes considered "too low" by less-informed doctors.
2 to 4.7/5.5"Normal" range according to recent lab standards, but changed as of March 2003 to 2 to 3.0 Some people feel well in this range, but many suffer low-grade hypothyroidism symptoms at this level.
4.7/5.5 to 10Formerly considered "subclinical hypothyroidism" levels, but as of March 2003, above 3.0 is considered evidence of possible hypothyroidism. These levels show hypothyroidism, but amazingly, some doctors won't even treat these levels, and do not attribute hypothyroidism symptoms felt by patients at this level to the hypothyroidism itself. Many people have symptoms at these levels.
Above 10Considered hypothyroid that merits treatment by most doctors

The Need for T3

Some people do not feel well on a levothyroxine/T4 only drug (like Synthroid). I am one those people who feels far better taking T3. I take the drug Thyrolar, and it has worked far better for me than Synthroid. Others have had success adding T3, such as in the form of Cytomel or via compounded, time-released T3, to their levothyroxine. Finally, yet others have had success with Armour, the natural thyroid hormone replacement. For more information on the various thyroid drugs, see A Quick Look at Thyroid Hormone Replacement, and Armour Thyroid and Thyrolar: Alternatives to Synthroid and the Other T4-Only Drugs.

Surprisingly, It's still considered controversial to use T3 for people with hypothyroidism by the less innovative or accepting members of the medical world, despite research that clearly demonstrates the need for T3 in many thyroid patients. In February 11, 1999, the New England Journal of Medicine published a groundbreaking 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 quite revolutionary and has major implications for people who don't feel well on their current thyroid therapies!!! For more info, see my full report on this research.

Your Next Steps

If you're still suffering hypothyroidism symptoms despite treatment, your first step is to document this in a way that you can review easily with your doctor. A good tool to help is the Hypothyroidism Symptoms Checklist, which offers a checklist of risk factors and symptoms you can take to your doctor to help get a diagnosis, or make the argument that your hypothyroid symptoms are not resolved by your current treatment.

Before you have your discussion with the doctor, I'd also suggest you read two key articles: Six Questions You Ought to Ask Your Doctor...And How to Interpret the Answers, covers the six critical questions you really should ask your doctor about your hypothyroidism. Diagnosis: Hypothyroidism -- Answers to Some Common Questions, answers the main questions a newly diagnosed person with hypothyroidism often asks, such as how long it takes to feel better after starting treatment, long-term health risks, whether or not you'll get a goiter, fatigue and weight gain and how to combat them, and more.

Armed with information and your checklist, you should sit down and have a discussion with your doctor about your optimal TSH level, and whether or not you should be considering the addition of T3 to your thyroid hormone replacement therapy.

You may also need some ammunition in getting your doctor to listen and understand. To help, there's are various books that I recommend for all thyroid patients. See The Thyroid Bookstore for ideas.

If your doctor won't discuss options, or refuses to consider the T3 therapy without providing clear, valid, and substantiated reasons particular to your own medical situation, then you'll need to find a doctor who wants to be your partner in wellness. If you want to find the doctor to help, you can search for a good doctor recommended by our fellow thyroid patients at my Thyroid Top Doc Directory. The Directory features US and international doctors by state or country. If we don't have a doctor for your area, you can enter your request there as well. There are also other options for doctor referral described in a article I wrote on finding a Top Doc.

Other Resources

As you work towards getting properly treated, don't underestimate the value of support. You can meet and exchange info, experiences and support with me and other thyroid patients at my Thyroid Bulletin Boards, or at the Chatroom.

There are new developments happening all the time in the world of health, and even in conventional and alternative thyroid disease treatment. These developments are covered here at the site. To make sure you don't miss any new information that might help, I put out a regular About.com Thyroid Newsletter that provides free updates on new features and new information here at the website. It's the best way to keep up with what's new here at the About.com Thyroid Website. You can subscribe at the About.com Thyroid Site Newsletter Signup page.

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