Doctors Should Be Willing To "Optimize" Treatment for Hypothyroid Patients

What is really important when a thyroid patients is being treated for hypothyroidism, is that they are on optimal dose of "thyroid hormone replacement therapy medication" (HRT). When a patient is placed on a dose of HRT, most will need 1, 2 or 3 dose changes (usually increases) before they reach the adequate/optimal level. Strangely, some Doctors place a patient on thyroid hormone and if that first dose gets their thyroid blood lab levels, anywhere into the normal range, they simply stop there. They do not afterward try to "optimize" the patient's HRT. This is unfortunate because some patients need more of a targeted treatment goal, for example, many patients do not see symptoms resolve significantly, unless their dose gets thier "TSH" level (most common thyroid lab test Dr.s use to monitor HRT), at about "1.0" and some may even need their TSH level at lowest normal, which is about "0.3 to 0.5". A Doctor has to be willing to work with a patient in getting their HRT optimized, by going by their symptoms as well as their lab levels.

In regard to emotional symptoms caused by thyroid disease, anxiety and depression are commonly listed and patients not being treated optimally, may see these symptoms linger. Some do also need the addition of antidepressant and anti-anxiety medications but some patients see their emotional symptoms resolve with thyroid HRT alone. In my case as a hypothyroid patient, once I was treated on the correct dose of thyroid HRT, my emotional symptoms of anxiety and depression resolved within a couple of months. Previous to this however, I was treated by a different Dr. who did not optimize my HRT and I struggled with anxiety and depressive symptoms for nearly two years. That Dr. kept my TSH between 3.0 and 5.0 and I'm the type patients that needs a very low TSH (lowest normal). Not all patients need a lowest-normal TSH to see symptom relief but a good target range to start with, is the "1.0" I mention above.

Many Dr.s will claim that depression and anxiety are not caused by hypothyroidism but it certainly is, especially the autoimmune type-Hashimoto's (type I have) and many research studies have concluded this. Almost all reputable medical sources list "depression" as a symptom of hypothyroidism and many have added "anxiety" to the list as well. Below are examples:

"In a study of patients with Hashimoto's thyroiditis, anxiety was a prominent initial symptom at the time that the condition was diagnosed."

Link> www.drrichardhall.com/anxiety.htm < (MD/Psychiatrist, researching for John Hopkins University)

"A case control study on psychiatric disorders in Hashimoto disease and euthyroid goitre: not only depressive but also anxiety disorders are associated with thyroid autoimmunity"

Link>

www.pubmedcentral.nih.gov/ articlerender.fcgi?artid=1308833 <(National Institutes of Health)

"CONCLUSIONS: Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone. Therefore, inclusion of T3 in the treatment regimen may be warranted after adequate trial with T4 alone."

Link> www.biopsychiatry.com/hypothyroidism.htm <(Department of Behavioral Medicine and Psychiatry)

Patients should be pro-active in discussing optimal HRT with their Doctors because it is afterall a person's health at stake, which affects every aspect of their lives. It is only right that hypothyroid patients be treated, so that they can pursue their livelihood, family needs and enjoyment and all around quality of life. There are sensational Doctors out there but the ones who don't understand the need to optimally treat hypothyroid patients, in my opinion, should refer their hypothyroid patients, to the Doctors who do.