Is Your Hypothyroidism Being Undertreated?

TSH Level of 1-5? What's the Right TSH Level for You?

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If you're on thyroid hormone replacement, have a TSH level that's in the normal range, and are still having a range of thyroid-related symptoms, you may be one of the millions of thyroid patients suffering from undertreated hypothyroidism and can benefit from a discussion with your doctor about optimum TSH levels and thyroid drug options.

What is undertreated hypothyroidism? It's hypothyroidism at the cellular level that means you still have hypothyroidism symptoms such as fatigue, weight gain, depression, fibromyalgia/muscle and joint aches and pains, hair loss or coarse/dry hair, infertility and more—despite taking thyroid replacement and having a "normal" TSH level.

There are two reasons this can occur. First, some doctors believe that providing only enough thyroid hormone to get a patient to mid to high-normal TSH levels is sufficient. And second, the current standard treatment, levothyroxine (brand names include Synthroid, Levoxyl, Levothyroid, Eltroxin, Euthyrox) may not be enough for the majority of people to actually feel well, because the body also needs a small amount of the hormone T3 in addition to the levothyroxine in order to truly feel well.

TSH Levels

The endocrinologist I saw periodically in the past, as well as my regular physician, both believe that a TSH of less than 2 is optimal for most people to feel well and avoid having hypothyroid or hyperthyroid symptoms. There is also research that suggests that values above TSH of 2 may actually even represent abnormal levels. See the British Medical Journal for more information on that research.

(NOTE: TSH levels are usually kept lower than 1 to 2 for thyroid cancer survivors—a process known as thyroid suppression—to help prevent cancer recurrence.)

TSH Less than .3 - This is considered potentially hyperthyroid (too much thyroid hormone) at most labs in the U.S. You may be anxious, find it hard to sleep, hair falling out, diarrhea, and other symptoms.

TSH 1 to 2 - The optimal normal level for most people. This is theTSH range where the majority of people feel best. It is sometimes considered "too low" by less-informed doctors.

TSH .3 to 4.5 - The "reference range" according to some lab standards. Some people feel well in this range, but many suffer low-grade hypothyroidism symptoms when the TSH is above 2.0. 

TSH 4.5 to 10 - Considered "subclinical hypothyroidism" levels, but amazingly, some doctors won't even treat these levels, and do not attribute hypothyroidism symptoms felt by patients at this level to the hypothyroidism itself. Many people have symptoms at these levels.

TSH Above 10 - Considered hypothyroid that merits treatment by most doctors

The Need for T3

Some people do not feel well on a levothyroxine/T4 only drug (like Synthroid). I am one those people who feels far better taking T3. I take the drug Thyrolar, and it has worked far better for me than Synthroid. Others have had success adding T3, such as in the form of Cytomel or via compounded, time-released T3, to their levothyroxine. Finally, yet others have had success with Armour, the natural thyroid hormone replacement. For more information on the various thyroid drugs, see A Quick Look at Thyroid Hormone Replacement, and Armour Thyroid and Thyrolar: Alternatives to Synthroid and the Other T4-Only Drugs.

Surprisingly, It's still considered controversial to use T3 for people with hypothyroidism by the less innovative or accepting members of the medical world, despite research that clearly demonstrates the need for T3 in many thyroid patients. Many people have a normal or even LOW-normal TSH level, yet still suffer continuing hypothyroidism symptoms. In these cases, the addition of T3 helped relieve depression, brain fog, fatigue and other symptoms. This information about T3 is quite revolutionary and has major implications for people who don't feel well on their current thyroid therapies! For more info, see my full report on this research.

Your Next Steps

If you're still suffering hypothyroidism symptoms despite treatment, your first step is to document this in a way that you can review easily with your doctor. A good tool to help is the Hypothyroidism Symptoms Checklist, which offers a checklist of risk factors and symptoms you can take to your doctor to help get a diagnosis, or make the argument that your hypothyroid symptoms are not resolved by your current treatment.

Before you have your discussion with the doctor, I'd also suggest you read two key articles: Six Questions You Ought to Ask Your Doctor...And How to Interpret the Answers, covers the six critical questions you really should ask your doctor about your hypothyroidism. Diagnosis: Hypothyroidism --Answers to Some Common Questions, answers the main questions a newly diagnosed person with hypothyroidism often asks, such as how long it takes to feel better after starting treatment, long-term health risks, whether or not you'll get a goiter, fatigue and weight gain and how to combat them, and more.

Armed with information and your checklist, you should sit down and have a discussion with your doctor about your optimal TSH level, and whether or not you should be considering the addition of T3 to your thyroid hormone replacement therapy.

You may also need some ammunition in getting your doctor to listen and understand. To help, there's are various books that I recommend for all thyroid patients. See The Thyroid Bookstore for ideas.

If your doctor won't discuss options, or refuses to consider the T3 therapy without providing clear, valid, and substantiated reasons particular to your own medical situation, then you'll need to find a doctor who wants to 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 Too Docs Directory. The Directory features US and international doctors by state or country.

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