I received an e-mail from a lady being treated for hypothyroidism and she was complaining of not experiencing satisfactory symptom relief from the thyroid hormone therapy her Doctor is administering. She asked if I thought her changing from the brand of hormone she is taking "Synthroid" (T-4 only), to a different brand like "Armour" (combo T-4 and T-3), might help her to experience better symptom relief and below, was my e-mail response to her question.

MY E-MAIL RESPONSE:

Your repeat blood retests, to check your thyroid hormone levels, let your Doctor know how well your thyroid hormone replacement for thyroid is working. He has so far given you two dose adjustments, so looks like he is trying to get you to the best level for you.

Now I wish to comment on how some Doctors are more targeted with hormone therapy for hypothyroidism but I am in no way applying this to your Doctor, just making you aware of this, so that you can ask for copies of your lab results that were done to monitor your thyroid hormone therapy and see if it looks like he is optimizing your therapy. If it appears that he is not and he also is not willing to do so, I would suggest finding a Doctor who is willing to better optimize your thyroid hormone therapy.

The fact is, not all Doctors are equal when it comes to treating hypothyroidism. Some are less targeted and simply dose patients on thyroid hormone, to get their TSH and thyroid hormones (Free T-4 & Free T-3), anywhere into the normal range. Doctors, who have more targeted therapy goals, will have a TSH level they want to reach for the patient, at about "1.0". Those who don't do this will believe that a "3.0" or even higher is sufficient treatment and the patient will only reach a break-even point. In other words they don't have a worsening hypothyroidism but don't feel better either. Symptom relief happens for some patients at a TSH from 1.0 to 2.0, while others may need a TSH between; 0.3 to 1.0 and it's those Doctors willing to optimize patients according to their symptoms, in addition to lab results, that get the best results in treating hypothyroidism. I've heard patients relate that their Doctors will stubbornly claim they don't believe anything beyond getting the TSH level anywhere within the normal reference range is necessary but I've seen the testimonies of hundreds of patients who simply do not feel well unless their TSH is at a low-normal reading. I've also read the testimonies of Thyroid Specialists and Endocrinologists who stated that they began resorting to a 1.0 TSH hormone therapy goal because they had seen so many patients experience symptom relief at that level, rather than at a higher TSH level. In my opinion, this is something to consider first before considering a change to a different brand of thyroid hormone therapy.

The question of how well optimized your hormones are, is as important as the question of whether a different brand of hormone will work better because the same Doctor can potentially under-treat you on the brand "Armour Thyroid", as he can on "Synthroid". Once a patient has been optimized on their current brand of hormone and they still feel unsatisfied with results, in my opinion, a Doctor should be willing to give them a trial of another brand, such as one that has a combination of T-4 and T-3, rather than a brand that contains T-4 only.

If you live in the US, you can request your lab results from your Doctor's Office and they are obliged by the "HIPPA Law" to provide them. If you feel you have not been well treated on thyroid hormone therapy, you can discuss this with your Doctor and if he is not willing to work with you on getting better optimized (but within normal lab values), you can take those lab results to a new Doctor who believes in better optimizing your hormone therapy. Some Doctors might be outraged at the suggestion that a patient change Doctors when they are not satisfied with their treatment but this is where the concept of "second opinions" comes from and patients have resorted to second opinions, since the beginning of modern medicine. Commitment and faithfulness to a Doctor is very nice and something we all hope to see happen but it is after all our health and lives we are talking about and common sense tells us that some Doctors are better than others when it comes to treating different health disorders.

Here's a link to the National Institutes of Health/National Library of Medicine website page about TSH and the treatment therapy goal. Note under the heading "Normal Results", that it states if you're being treated for hypothyroidism, your TSH should be "between 0.5 and 2.0". This therapy range includes readings such as 0.5, 0.6, 0.7, on up to 2.0, in fact "1.0" would be close to the middle of that suggested treatment range. I point this out because it would be difficult to believe that a Doctor would argue with a reference from the U.S. Gov. Health Institute that sets guidelines for licensed Doctors. Here's that link:

click here>> www.nlm.nih.gov/medlineplus/ency/article/003684.htm