Dr. Sara Gottfried sets two intentions for "optimization" with her patients - first, to feel 80% better or more with the symptoms they're tracking -- i.e., lousy energy, weight gain, irregular cycles, hair loss, low libido, geriatric joints, etc. -- and second, a TSH between 0.3-1.0 and free T3 in the top half of the normal range for the lab.
Says Dr. Gottfried:
Not all my patients can tolerate such an aggressive goal with TSH, but I find that range is the sweet spot for surfing the hormonal upheaval of perimenopause and menopause.Sara Gottfried, MD is an integrative physician and holistic gynecologist, and founder of the Gottfried Center in Oakland, California.
Another key aspect of optimization is that the adrenal function, meaning cortisol and DHEA-S, are in the normal range. So many of my hypothyroid patients also have adrenal dysregulation, and don't feel better on thyroid augmentation unless their adrenals are optimized simultaneously.
In our patient/physician partnership, we optimize most readily when a patient is primed for focus on all-things-thyroid: she is reading Rich Shames' or Mary Shomon's books; she is taking her supplements; she is addressing her adrenal issues; and eating whole grains that don't act goitrogenic. Optimization often is hardest in women with autoimmune thyroiditis – there we have to work not only on the endocrine system but on quieting the immune system as well.
The Gottfried Center website: www.gottfriedcenter.com Source: Email interview with Sara Gottfried, MD - December 2010