For Dr. Robban Sica, optimal treatment for hypothyroidism is when the patient's hypothyroid symptoms -- i.e., fatigue, depression, dry skin, hair loss, etc. -- have totally resolved, without any hyperthyroid symptoms such as palpitations, tachycardia, insomnia, anxiety, tremor, jitteriness, or bone loss. Her goal: for patients to say "I feel like I have my life back" or "I feel like myself again!"
According to Dr. Sica:
Since I believe that hypothyroidism is a clinical diagnosis, the lab values are not the determining factor for me. Many clinically hypothyroid patients have test results within the reference range and yet respond beautifully to treatment. The lab reference range is based on the last 100-200 samples (from symptomatic patients!) submitted to the lab for testing; they are not determined by testing optimally healthy individuals. These tests, therefore, can miss the diagnosis and be misleading.Robban A. Sica, MD is an integrative physician, President of the International College of Integrative Medicine, and a member of the Board of Directors at Alliance for Natural Health. Her practice, the Center for the Healing Arts, is located in Orange, CT.
However, at the point where both the patient and I feel an optimal dose has been achieved, I order thyroxine levels (T4) to make sure that they are within range. Elevated T4 levels have been associated with increased bone loss (not a low TSH, which is what is commonly stated). I also check either an NTx or Pyrilinks urine test to make sure that bone resorption (break down) is not elevated.
Center for the Healing Arts website: www.centerhealingarts.org
Source: Email interview with Robban Sica, MD - December 2010