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My TSH Test Results Are Normal, But I Still Have Symptoms


Updated June 02, 2014

3. Some HMOs and insurance companies are automatically filling prescriptions for levothyoxine with generic versions of the drug. There is a problem with generic levothyroxine.

The key challenge with generics, and a valid complaint by doctors, is that when you have a prescription for generic levothyroxine, every time you get a refill, you may get a levothyroxine made by a different company. This means that every time you get a refill, you may have a product that has slightly different potency, which could have an impact on your TSH levels. This is particularly a concern for thyroid cancer survivors, who require careful dosing in order to suppress TSH as a way to prevent cancer recurrence.

If your HMO or insurance is trying to force a generic on you, you can ask your doctor to write a prescription for you that says "no generic substitution" and DAW (dispense as written). the doctor may even write a letter to help defend a brand name prescription.

If you are absolutely forced to take a generic, one way to protect yourself against fluctuation from brand to brand is to get a supply that will last for some time. Consider getting your doctor to write you a prescription for a six-month supply, for example. But when you get this prescription filled, make sure you get a fresh batch, one that will not expire until long after you will have used up the six-months' worth of drugs.


4. 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 functionally hypothyroid, due to the body's inability to move convert circulating T4 thyroid hormone into the active T3 hormone at the cellular level, inadequate T3 hormone levels in general, 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. For these patients, supplemental T3 may help them to feel well.

Some patients find that adding T3 in the form of Cytomel or via compounded, time-released T3, to their levothyroxine, resolves symptoms. Others have had success with the another approach: synthetic T4/T3 drug Thyrolar, and a subset of patients seem to feel best on the natural desiccated T4/T3 drug Armour Thyroid, which has been available by prescription for more than 100 years.

I am one those people who feels far better taking T3. Since my diagnosis in 1995, I have taken various brands of levothyroxine, levothyroxine plus Cytomel, Thyrolar, and Armour, and I have always felt better on a regimen that included T3, versus levothyroxine drugs alone.

Surprisingly, It's still considered controversial to use T3 for people with hypothyroidism by the less innovative or accepting members of the medical world. The controversy still rages, and some of the old school doctors have crafted various flawed studies in attempts to discredit the use of T3.


5. If you've optimized your thyroid treatment, the next step is to consider complementing your conventional thyroid treatment with additional approaches. These may include dietary changes, herbs/vitamins/supplements to help alleviate specific symptoms, adrenal support, metabolism-boosting techniques, stress reduction approaches, and other integrative efforts. To help develop your own integrated thyroid plan, there are various books that provide in-depth information. See information on thyroid-related books for ideas.


6. If your doctor won't discuss options, then you'll need to find a doctor, one who is familiar with thyroid conditions, who will 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 Top Docs Directory. The Directory features US and international doctors by state or country.


Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," "Living Well With Chronic Fatigue Syndrome and Fibromyalgia," and the "Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success." Click here for more information on Mary Shomon.

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