The T4 vs. T4/T3 Thyroid Treatment Controversy Continues

Interestingly, some research published during the summer of 2011, and the recently published summary for patients published by the American Thyroid Association (ATA), point up the confusion — and some would say, deliberate obfuscation — of the issue that is still going on in the endocrinology world.

The study was titled: “Levothyroxine Monotherapy Cannot Guarantee Euthyroidism in All Athyreotic Patients.”In plain English — levothyroxine-only treatment (i.e., Synthroid, Unithroid, Levoxyl, Eltroxin, Tirosint, etc.) cannot guarantee normal range thyroid lab results in patients who do not have a thyroid.

Sounds interesting, right?

And what did the researchers find?

Well, simply put, they found that the Free T4 levels were much higher — and Free T3 levels much lower — in the patients treated with levothyroxine, as compared to a control group of people with thyroids who were not on thyroid medication.

The wide range of Free T3/Free T4 ratios showed that individuals have a wide variety in their ability to produce T3, and the fact that TSH levels remained in the so-called normal range, the researches said that this demonstrated “an abnormal feedback mechanism in levothyroxine-treated patients.”

And, more than 20% of the patients, despite having TSH levels in the normal range, did not have Free T3 or Free T4 values in the reference range. The researchers concluded that “A more physiological treatment than levothyroxine monotherapy may be required in some hypothyroid patients.” Again, in plain English — some patients may need a medication that includes T3 in addition to T4.

The authors also stated: “These observations do not allow to take for granted the conclusions, drawn from short-term studies, that levothyroxine monotherapy is adequate for all hypothyroid patients, considering that even subtle abnormalities might have important consequences when lasting for many years or decades.”

Sounds interesting, and promising, especially to the millions of thyroid patients who have to struggle to get doctors to test more than just TSH and evaluate the actual circulating thyroid levels, much less get T3 treatment from mainstream physicians.

But here’s the kicker: The American Thyroid Association — which has a pretty tight relationship with the big pharma levothyroxine drug manufacturers — publishes “Clinical Thyroidology for Patients,” where they find selected research studies, and then summarize them for patients.

And how does the ATA take the above study and “explain” it to patients?

First, they change the implications of the original title. Their summary is called Should patients with no functional thyroid gland be treated with both thyroxine (T4) and triiodothyronine (T3)?

They summarize the general research, and along the way, make this interesting statement: “Recent studies have generally found that there is no clinical advantage in adding T3 to the usual T4 replacement regimen.”

It appears that the writers at Clinical Thyroidology for Patients missed the late 2009 study published in the prestigious European Journal of Endocrinologythat found that where TSH levels were kept consistent, the T4/T3 combination therapy that included 20 mcg of T3 daily was superior to levothyroxine-only treatment, when evaluating for a number of quality of life measurements, depression and anxiety scales, and patient preference. In the study, half the patients preferred the T4/T3 combination — 15% preferred levothyroxine-only — AND, quality of life and other factors were improved.

Back to our friends at ATA’s Clinical Thyroidology for Patients, who summarized the research findings in their own words. (And remember, the original study is saying that T4 alone is not able to maintain normal circulating thyroid hormone levels in some patients, and some may need a medication that includes T3 in addition to T4.) So here’s how they summarize the findings:

“A number of studies have demonstrated that T4 alone is sufficient for the majority of hypothyroid patients. The present study identifies a subgroup of hypothyroid patients, namely those whose thyroid was surgically removed who do not have normal FT4 and FT3 levels despite normal TSH levels on T4 alone. What is not shown by this study is whether or not combination therapy (T4 plus T3) is beneficial in these patients.”

So they have taken a study that says levothyroxine (T4) only treatment cannot guarantee normal Free T4 and Free T3 levels in a subset of patients, and turned it around into a vague statement of what is notshown by the study about the benefits of T4 plus T3 combination therapy, and end up with a question: should patients with no functional thyroid gland be treated with both T4 and T3?

The Bottom Line? When research directly shows the benefit of adding T3 to T4 for hypothyroid patients, as it did in the European Journal of Endocrinology, the mainstream thyroid organizations are not going to tell you about it. Or if they mention it, they’ll dismiss even a top medical journal, and say “Oh, it was a bad study.” If they find a study that suggests something they don’t like, they write a summary that changes around what the study actually says.

Is it any surprise then, that, the work of the National Academy of Hypothyroidism is so desperately needed, educating patients and practitioners about the real science behind hypothyroidism.

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66 Responses to The T4 vs. T4/T3 Thyroid Treatment Controversy Continues

  1. Marge says:

    I am one of the people who had radioactive iodine and for over 20 yrs struggled with thyroid issues, once my doctor tried cytomel I regained a feeling of health, my cholesterol dropped, my blood pressure became regular and I re-enteered the human race.I now have my meds compounded and at times need adjustments but when I was on Synthyroid I never had normal levels of T3 but the Dr. at the time just tested and looked at my TSH, we the patient suffers because the medical field do not want to change and they are influenced too much by the pharmaceutical companies. Remember you oath “I will do no harm”

  2. Laura N, San Jose, CA says:

    I’m 56 and my thyroid was removed at age 10. For years I existed on Armour Thyroid successfully, that is until the pharmaceutical industry decided they wanted everyone moved to synthetic thyroid. For 15 years I suffered and no one even seemed to care!!! Not until I read “The Thyroid Factor” did I understand what I needed and that’s when I found Holtorf Medical Group, and believe me not all endochronologist are the same!! What a difference the last two years have made.

    • Laura I’m 56 and I’ve suffered with this Hypothyroidism for 20years now and I found out my great grandmother from my Moms side had the same, my Mom had Hyper, I got so fat in one month I gain 50 pounds I almost didn’t even know who I was… I’m still taking Levothyroxin up and down it goes, and I’m a singer so it’s really a drag, if I don’t take the meds, I get very hoarse and I’m cold a lot which is so weird because the Hot Flashes, Wow, and my hair is falling out at the top of my head my skin dries out, I fight this depression constantly, now I just happened to read this info about T3 and T4 it was never suggested to me, my Thyroid just stop working one day. I went to many doctors and finally one told me what was’s better now I’ve lost weight over the years and was 10-12 now still at size 14, so I walk a lot and eat healthy lots of smoothies and fruit and veges, thinking of going vegetarian just want to say Thanks for sharing, I will read the Thyroid Factor.. I truly do my best to stay in a Positive Mood, I create better. will talk to my doc about T3 and T4..

    • Rhonda Pratsch says:

      I am 56 years old as well and I still have my thyroid and I also am going threw the change of life as well. I am on Armour Thyroid and my thyroid levels are normal and I still have issues. What else should I do during the change in life to help my system threw this. I can not sleep and my emotions are up and down.

      • joanne says:

        I got to this website researching the treatment for low t3 and higher reverse t3. I wanted to ask if you are taking the brand Armour. Many people do much better on the generic of Armour which is NP Thyroid by Acella.

        • Gail says:

          My internist put me on Amour Thyroid and my endocrinologist threw me out of her practice because I would not stop taking it! It has helped me to have more energy and lose 40 lbs. so far! No way was I going to stop taking Amour Thyroid. Two endocrinologists told me that Amour Thyroid is unsafe, can cause heart problems and death. The doctor who I saw for over 10 years said that it is malpractice to prescribe Amour Thyroid. Well, the government has over sight of all drugs and has not pulled it from the market!

          • Dotti says:

            I can not understand why some doctors and hospitals are against Armour! I now see two doctors – one in the IU network for one medication I need (and although he was the one who dx’d the hypo, he refuses to talk about it except to hand me more and more prescriptions for the symptoms!!) and I see an MD in the St Francis network because they will prescribe the Armour. In fact, he also prescribed several natural remedies I was already taking and in fact, he insists that I do take them. But I guess the real point is these are doctors less than 15 miles apart, yet one won’t prescribe the Armour and the other will! It more on the Board of Directors than it is on the doctors maybe… Either way, it’s Stupid, just stupid!

      • Kathy Reid says:

        Rhonda, have all your hormones tested. When I was diagnosed, I was 53 was tired of taking depression medicine. I was referred by a business associate to a nurse practitioner that specialized in thyroid and hormones. Not only did I have Hashimotos but almost no hormones period. I also did a saliva test for adrenal function. It has been 14 months and I am a new person.

  3. tom cottrell says:

    I am 70 years old and have been using levoxyl for 20 some years. I have noticed recent energy loss that can occur any time of the day. For example at 10 am I feel like I could lay down and go to sleep and this can occur at any time of the day. My doctor always says that my TSH test are in a normal range. What ever that is. I should also add that I am a carpenter and while I move a little slower things have been pretty good except for this recent malaise .

    Any thoughts?

    • Bob Monty says:

      Tom, it’s called being 70. I will be 69 soon and get the same thing. I’ve been using levothyroxine for about 12 years or so. I was also a carpenter/remodeler for over 35 years. Maybe it’s from sucking up all the dirt and grime – or maybe – at our ages, we need naps, more often. I usually get tired after having a carb-loaded snack or meal, so taht might be the real reason. Who knows? Live long and prosper as Spock used to say.

      • Bob Monty says:

        so “that” might be the real reason”

        • Mighty_Kameleon says:

          Really there? Sucks for you Bob. I know many 70 year olds who dont feel like Tom or you describe. As a matter of fact they will say that they are having the time of their lives. Read an article here thats called something like “is it your thyroid or your age” good stuff.

          Tom, you may also consider checking your testosterone and growth hormone levels. Bringing those levels to more optimal levels will do wonders for you. Also levoxyl is a t4 product. Problem is t4 is inactive, it needs to convert to t3. Your body is not doing that naturally (apparently) so why give it more t4 if it does nothing?? You need to find a better doctor.

    • Jeny says:

      Hi Tom,
      You need T3 to feel better. Read Dr. Holtorf’s TSH proves to be an unreliable test for hypothyroidism. It’s on the home page of this site. It talks about how the TSH drops as you age. Check your Free T3. Taking that will increase your metabolism and make you have the energy you need to get through the day.

    • Mona Hatch says:

      I had my thyroid radiated and have not changed dosages in 19 years. Just got a phone call saying my TSH was .9. That is not good. I feel the same way as the carpenter. At 10:00 AM I have to lie down. The office that called me asked the usual questions ( do you wait 30 minutes after taking the Synthroid before eating and etc. I have been a RN for 35 years so I know all the answers. This low level explains a lot of questions. Help! The doctor wants to wait a couple of weeks to change the dosage. That is not going to happen.

  4. Lynda says:

    I, too, am 69, and I’ve been on thyroid medication since I was 26. I have probably taken nearly every thyroid med. on the market! When the generics came out, my mail-order pharmacy would send me whichever one they had in stock at the time. Now, my doctor insists on Synthroid, but I must pay for that myself; the insurance won’t cover the brand name. Since I also was diagnosed with MS about 20 years ago, you know I’ve been tired for years! My doctor was willing to prescribe Armour, but the company no longer has the dosage I need. By far the best med. I’ve ever been given was Euthroid (it had both T3 and T4 in varying combinations), but they stopped making it years ago, so I’m back to having all the symptoms of hypothyroidism, but at the last testing my TSH and fre T3/T4 were “perfect”. I see my doctor on June 4, and I’m taking with me certain pages from the NAH website! I am fortunate to have a doctor who allows me to be part of my health care.

  5. Libby A says:

    In my mid 70s I was taking 180mg Amour thyroid just to get by, but I was increasingly fatigued. I checked out my hypothalamus, pituitary, thyroid, adrenal balance with a doc. Tests led him to give me compounded cortisol (called ‘cortisone’ by other docs, but regular pharmaceutical cortisone didn’t help me.) I was just barely making it through the day, still.

    One day I asked for T3–got 25 mcg in addition to my Armour. I instantly became energized! I cut my Armour down to 90mg on my own, since it wasn’t being converted to an active hormone in the body, anyway. The thyroid issue then became unimportant when I found out the greater cause of my health issues.

    I told the doc I needed more help. We did a urine test for Lyme. (Blood tests previously indicated 1 out of 8 tests showed Lyme, so we thought it was a false positive.) I was very blessed that finally, the Lyme urine test showed spirochetes!

    Turns out Lyme usually doesn’t show up in blood and it can hide out for years in ANY part of the body, so tests are frequently not able to report it. Lyme affected all my glands and the whole neurological system. Unfortunately, taking that cortisone was very bad for my Lyme.

    I started the antibiotic treatment. The pills create terrible gastrointestinal problems but I took herbal remedies for a damaged esophagus/stomach—bad reflux. Having found an experienced Lyme doctor, I was able to navigate treatment with supplements. Five months later I am still in bed for several hours for part of most days, highly dependent on my sauna treatment daily. (Lyme bacteria don’t like heat and the sweating detoxes the body, reducing the GI detox symptoms.) I can read again, cook a meal several times a week, making improvements as the bacteria is being fought. By the time I was diagnosed, I was a CHRONIC Lyme patient of 3 years duration, with no treatment. NOW treatment will likely be for years, costly and I likely will never totally get rid of the spirochete.

    Turns out that Lyme OFTEN doesn’t have the typical rash, fever, tick bite, etc. symptoms. My only bite resulting in a rash was from a mosquito and my only symptom a gradual arthritic condition in my knees (just aging? –NO!) then extreme fatigue, fibromyalgia and sleepiness. My docs offered pills for the edema, high blood pressure, urinary infections, hormone changes, insomnia (common,) fibromyalgia and chronic fatigue that looked like depression. Lyme causes different symptoms in different parts of the body—so difficult to identify unless the doc is experienced –that experts think most cases aren’t diagnosed.

    A course in antibiotics is better than a lab test to diagnose Lyme. (If you get better—bacteria is the cause.) However, I would never start Lyme treatment without a very experienced doc, though. Good docs without experience make it worse. Do research on the internet, look up ILADS. Get referrals from holistic docs and chiropracters to help find the best doc.

    This is not to blame doctors who don’t know Lyme—Lyme knowledge is silenced by the Infectious Diseases Society of America and the CDC. Go to ILADS associated doctors for help!

  6. glenda bonta says:

    I am 78 years old. Do I really need to take the meds for hypothyroidism at my age. What will happen if I go untreated? I don’t want to take meds. I am afraid of the side effects.

    • Mighty_Kameleon says:

      You will be miserable if you don’t. I’m sure you’re not having the best quality of life right now. Why not give it a shot??? If you go to the right doctor and he/she knows what they’re doing, your side effects could be minimal.

      Think about it. Thanks to modern medicine, we are living much, much longer – feeling like crap. No thanks, “modern medicine”! Why not live long and enjoy it???

  7. ericas says:

    I had RAI for Graves’ 2 1/2 years ago. I was on Synthroid for over a year and worked my way up to 150mcg. I was still suffering with many hypo symptoms, extreme fatigue, swelling of eyes and face, constipation, hot flashes, anxiety attacks and weight gain. I started researching online and found that many people need to add a T3 med. My dr agreed to add cytomel to my synthroid, but would not prescribe Armour. We reduced my synthroid to 137 and added 5mcg. After my body had sometime to adjust, many of my hypo symptoms improved. Over time we tweaked my dose to 125mcg synthroid & 15mcg Cytomel.

    I continued to feel better and my FT3 levels were coming up. I noticed the higher my FT3 got the better I felt. My FT4 did not change much at all and TSH stayed suppressed. I pointed this out to the dr, but because of my suppressed TSH, she wanted me to reduce my dose. She said the symptoms were not from my thyroid.

    I started searching for new doctor. I saw several more drs who kept telling me that TSH is the most important test. I decided to see a holistic MD who is out of my insurance network. I have to pay out of pocket, but has been worth every penny. She agreed that many of my symptoms were being caused from low thyroid. She switched me to Armour 4 weeks ago and I’m already feeling a bit better. I am so thankful that there are still great doctors out there, who are listening to their patients. I hope some of these other docs will wake up and start to help their patients in the healing process!

    • Bobbie Ingersoll says:

      Is it possible to sue a physician for being incompetent to treat due to not keeping up with what works for many thyroid patients? This seems to border on criminal if you ask me. I have been dealing with this bullshit for a decade after having my thyroid ablated. I’ve simply come the the conclusion that they WANT to keep people hypothyroid so they can make more profit off the multi-systemic derangement that ensues from this condition.

  8. Gabe says:

    I’m 21 and had graves disease back when I was 15 and had radiation treatment, I have gone the last 2 years with out treatment due to no insurance ,, I recentlyy went to the dr after doing some bloodwork an got prescribed 150 mcg of synthroid, I still feel tired, unmotivated, and find it hard to control certain emotions….what are my long term effects an what should I do??

    • siccatum says:

      Keep reading.
      As the above quoted study says: “Levothyroxine Monotherapy Cannot Guarantee Euthyroidism in All Athyreotic Patients.”
      Did you see that? For at least 20% …T4 monotherapy is NOT working.
      The answers are here, just look for it, it has been repeated several times:
      Check my other posts on this site.

  9. karen says:

    I also am having trouble getting my doctor to listen to me. I am medicated with only t4 and feel tired, have trouble regulating my temperature, have low motivation, feel like I am not metabolizing, and my doctor keeps telling me it is not my thyroid. She is going to send me to an endocrinologist, that was a week ago and I haven’t heard from her since. VERY FRUSTRATING WHEN YOU FEEL LIKE CRAP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! How do you get someone to listen to you, when they think they know everthing?

    • Lisa says:

      Hi Karen:

      I find myself on this page because I’m tired of not being listen to as well. So what I am doing is printing as much information off here I can and taking it to my next appointment with my Endrio. I am 45 years old and should not feel like I’m 80. I have been on synthroid for 3 months and couldn’t figure out why I wasn’t feeling better. Now I know why. At age 37 I felt like I was having a heart attach it really started at 32 put it took five years and six doctors (that all told me I was just getting older) before I met a nurse practioner “Vicky” that said to me, “let’s run some blood test”. Within 24 hours of her calling that test I found out I had Graves Disease. After fighting that battle I have now moved into the opposite direction and begin a whole other fight since I have now moved to a new state and need to find new doctors that will listen to me. My suggetion to you is print out as much information you can. Remember knowledge is power. If the doctor doesn’t want to listen get up thank them for their time and just leave. On to the next. One thing is true not all doctors are bad. You just have to go through some bad eggs in my case, before you find a good one. Also Nurse Practioners are awesome and “Vicky” truely saved my life. I will be forever greatful to her and wish she could be hear to help me with this new struggle.

  10. Tiffany says:

    Hey everyone! I am 25 (almost 26) and I have never had a thyroid. I was born without it and I have always just taken my levothyroxine because I was told I was supposed to. I had a thyroid specialist while I was still in Pediatrics but since I turned 13 I have just been seeing a regular pcp. I never looked into or asked what exactly thyroids do. And recently I started researching because I am having fertility issues. And its scary what I have found. I thought all my tiredness and depression and so on just stemmed from different things in my life. I actually stopped taking my meds about a month ago to kinda see “the difference” but there really isnt one. And after reading these articles and what not I am afraid I havent been treated properly for all these years. What does T3 and T4 and all that mean? And does anyone know if infertility is a huge thing with my hypothyroid issue or if I still may have a chance. Like having possibly not had the best treatment all these years. Could it have created permanent damage? My specialist as a child had my on synthroid, It was changed to levoxyl and for the last like 10 years levothyroxine….are these all the same. I feel horrible that I have had such a condition for so long and am only just now seeking information. Please help and thank you.

    • siccatum says:

      Asking a question is a good thing, otherwise the brain is not receptive for an answer. Start with reading all that fine print that comes with you Synthroid\Levoxyl\L-thyroxine\T-4 pills. Your life depends on it.
      A healthy thyroid produces both T4 and T3 in about a 4:1 ratio, and why? Because you need it.
      Only Levothyroxine is dispensed in “standard” care because profits are controlling manufacturing and marketing, and not science.
      You need to read more. There is a wealth of information on this website.
      99.4% of medical doctors don’t know enough about this subject.

    • Tiffany,I’m a real live practicing Endo who treats patients, not bl tests. You need trial on T3. #1 Thyroid hormone works in side of cell & only T3(not T4) can access & attach to nuclear receptor site(have used inpatients for 40yrs). The best test is put a patient on & see response & 95% + the response is 4+ & you’ve hit a home run. Worst case no good response (~ unheard of w. your history) but a therapeutic trial is the best test!!. I see folks like you all the time. At least 90+% of my pts are on some T3. It works the best & you don’t need bld tests necesssarily!

  11. karen says:

    Thanks for your response Lisa.
    I have tried to talk to my doctor on occasion about my thyroid and the comment she gave me was…thyroid is cookbook medicine, we check your levels, we give you medicine according to these levels. Talk about frustrating! I work in the medical field and feel very powerless right now. Today my blood pressure was 156/129 and my pulse was 48 with an irregular heart symbol on the monitor and my pressure is usually 105/75 with a pulse of 60. I have been waiting 2 1/2 weeks for my doctor to book me a holter monitor and get me an appointment with an edocrinologist, and when I called her office last week the secretary said she knew nothing of my tests and the doctor was on holidays till Monday. I give up!

  12. Lori says:

    I have hypothyroidism and have been on 75mg of synthroid for a few yrs now… Thankfully I have never had cancer of the thyroid (had biopsy) but did find out thyroid not to be “working” I have been gaining weight and stilllll very sluggish. Does anyone know if the cytomel would help something like this… I sleep at night and by 10am I am ready to go back to sleep and if I do … I can sleep easily til 12:00.. Does that sound like anyone else out there…. Advice ????

    • siccatum says:

      You have found one of the best sources for information on the web. Why don’t you start reading some of it? Your question is answered on this very page. You belong to the 20%+ that is not important to the profits of some pharmaceutical companies and generate a lot of office visits for a multitude of related subsequent ailments. Read like your life depended on it, it does.
      Then ask the question again.

    • cherie says:

      I used cytomel which is t3 /t4 and did well according to what I have read it is what we need.

  13. siccatum says:

    The comments from the carefully worded piece from ATA states:
    “Recent studies have generally found that there is no clinical advantage in adding T3 to the usual T4 replacement regimen.” and …
    “A number of studies have demonstrated that T4 alone is sufficient for the majority of hypothyroid patients. …”
    Take note the weasel words “generally” and “majority”. The Study by Dr. Damiano Gullo points to T4 monotherapy being insufficient in 20% or more of the people.
    If cancer survival by Chemotherapy was successful in 80% of the cases that would be great huh?
    80% is definitely a “majority”, so these rats can crawl back to their holes and absolve themselves of any guilt for obviously mistreating 20% of a very large group of people and give them blank stares of innocence.

  14. siccatum says:

    …Treatment Controversy Continues.

    Is it really a “controversy” or is it that the dominant parties (ATA) et cetera, are continuing unabated with their dissemination of their DOGMA and opinions, and that Science publishes discovered FACTS that the high priests of medicine tries to sweep under the rug?

    One new finding can potentially unravel a whole century of dogma, it has happened before.

    Defending status quo and Financial Interests which otherwise could upset the applecart of an continuing stream not so hard earned dollars, seems to be a priority of the medical associations, ATA is no exception. People are rightly expecting these organizations to be trustworthy and neutral and work in the patients best interest, however there is evidence to the contrary. As has been seen in some bribery cases, it may take surprisingly little incentive for someone to sell his integrity, and the medical field is very money oriented to begin with.

    As a patient you are not left with any other choice than to do you own homework, (made much easier due to the inter-webs), and select medical practitioners that agree with your findings. Ultimately the responsibility for your life and health rests with you.

  15. Lynn says:

    I am one of those people whose thyroid because of papillary cancer was removed six years ago and my FT4 levels have always been high without my TSH being suppressed. I have been to about ten endocrinologists, none of whom have suggested adding T3. Thus I have suffered with hyperthyroid symptoms, looking fervently for someone to help me. I have a racing heart and insomnia, and severe bone loss, if related. The doctors have said that they have never had a patient with this problem before (the high FT4 while TSH remains normal). I should add that I also had hyperparathyroidism and one parathyroid was removed and replaced and although my calcium levels are high normal, the issue is considered resolved. What do you suggest?

  16. Char says:

    I have been on Levothyroxin for 36 years Dx. with Hashimotos, large goiter. Currently my TSH is under 1.0, but I continue to gain weight, lack of energy, depressed, hair loss and dry skin. My Doc feels there is no palpable goiter. All other labs WNL, no anemia, etc. Would T3/T4 provide any further info. Also what is the normal range for TSH. I hate it when they tell you “it’s OK.”

  17. Craig says:

    I was recently diagnosed hypothyroid with a TSH level of 5.22. I am an active 65 jogged most of adult life, ran 4 marathons, etc. and otherwise healthy. Over the last 6 months I have noticed the symptoms, tiredness, tired legs when running, low energy. Now I know why. My doctor said they don’t usually do any thing until TSH levels are above 10.0. There seems to be alot of mixed opinions about what medication to take and when. I am looking for a thyroid specialist but they also seem to have mixed opinions. Any feedback when to start medication and specialists in Massachusetts.

  18. adrienne says:

    I was diagnosed with Hashimoto’s disease in 2007 and had a partial thyroidectomy in Aug., ’07. Since then I’ve been on Levothyroine back and forth from 75mg to 137mg and now at 100mg for the past 6 months. I’ve complained to my pcp about heavy pressure in the chest, muscle weakness, high LDL, hot flashes, ridges in my fingernails, severe headaches, blurred vision, constipation and now food I’m swallowing doesn’t seem to digest properly, I tend to burp ofter and acidic foody taste comes up easily, my joints ache so bad and insomnia is tireing! I’m 55, in otherwise good health, I weigh around 158lbs seems ok for a 5’5″ female, so my pcp contributes all to anxiety and normal aging. I beg to differ, I have to always request for all my T’s to be checked, I experience no more anxiety than most americans living in a downsized economy with pcp who don’t care to listen. I’ve just rec’d my labs and it shows that my liver enzymes are elevated (ALT/SGPT=90 & AST=40) My T3 is 0.9, T4 is 6.8, TSH is 1.62, and Free T4 is 1.2 I’m scheduled for a sonogram to check out the liver, my PCP says maybe it’s stones?? I’ve read about the side effects of too much Levothyroine and one source stated that Liver damage was one, along with the severe headaches, etc. My doctor doesn’t seem to agree! After this lab report I’ve removed myself off the Levothyroxine, it’s been about 1 week and my bowels have ret’d. to norma1 and no more joint pain or headaches. I’ve been limiting myself to a vegetable and fruit diet for now to give my liver a chance to recover. I know that I need my health monitored by a good endo, but what’s a body to do? I’m researching now on substitutes. It’s a shame that we have to do so much legwork and monitoring ourselves, I wish we all could have a “Dr. Oz” in our neighborhoods!

    • Jordan says:

      Hi all,

      I came across this website, and felt I needed to reach out to everyone who seems to be suffering with thyroid issues, specifically hypothyroidism. I myself have suffered from being hypothyroid since I was 17, also diagnosed with Hashimoto’s.
      I am now 39 and have never felt better! I was on Syntheoid (T4) from age 17-30, then, after suffering from multiple symptoms, and feeling so out of control and helpless from seeing multiple highly acreddited doctors, including Endocrinologists, I finally came across Dr. Holtorf, and he switched me to Thyronine (slow release T3). Every symptom I had been suffering from, including weight gain, fatigue, foggy memory, sluggishness, depression, carpal tunnel syndrome, sleeplessness, feeling cold all the time, dry skin, and even anemia all dissipated. I have been seeing the doctors there for the past 9 years, and as I get older, they adjust my mess and even add natural supplements to my regimen as needed. I just feel so awful when I hear people suffering from what I used to suffer from, not knowing where to turn or who to trust. Please be voracious with your health and don’t give up! I hope this has helped some of you :)

  19. Jordan says:

    Correction on 2 words on my former comment: ‘Synthroid’ instead of Synthoid, and ‘meds’ instead of mess ;)

  20. Eve Meyer says:

    Hello, I have been taking Armour Thyroid for two years now. I keep feeling worse by the month. I’m 44 and consider myself pretty healthy until this point of my life. I could sleep and sleep and sleep and never feeling refreshed. Always in a fog, legs ache, strange taste in my mouth, vision problems and so out of it. Could it be the Armour? PLEASE help. I want to enjoy life again.

  21. Jordan says:

    Sounds like symptoms I once suffered from while on Synthroid, not the same medicine as Armour, but can induce similar effects that you are mentioning if your complete thyroid blood panel is not being assessed correctly. I cannot stress enough that you should make an appointment at the Holtorf Medical Group. Start by going to their website online and review what they do and where they can help. Then make an appointment! I promise if you go through with the treatment they specifically prescribe for YOU (because everyone has different needs with thyroid issues), you will feel like a new person again, without a doubt. Best of luck to you :)

  22. Martine says:

    This past summer I went through a phase of extreme fatigue and lethargy and heart palpitation. I had my levels tested and my MD said that they were fine. However I pressed the issue and explained that maybe a slight change for me meant a very noticeable shift in my energy, mood and heart palpitation…Though it did not warrant any change in prescription, he told me to reduce my i take by 1/2 pill per week and have the levels checked agaib 6 to 8 weeks later. I had them checked 10 weeks or so later and I am back to normal. However I am now seriously considering switching to a mix of T3 and T4.

  23. Martine says:

    Addendum: i have been on synthetic hormones for over 25 years either synthroid or levothyroxine. Since I had a complete thyrodectomy, I cannot be without. It is interesting to read consistantly how T3 seems to really improve people’s overall quality of life…

    • Armour is better than Synthroid/Levoxyl but only has 8-9mcg per grain & my guess would be you need 50-75mcg daily of T3. If getting a bld test get a freeT3 & today most should have levels in the upper 25% of test range ,ie.,~ 3.8pg/ml. If you have auto immune thyroid disease may need more because of “blocking antibodies” (not measureable) inhibiting T3 from biding to nuclear receptor site(s).

  24. Nadia says:

    I was first diagnosed with hypothyroidism after the birth of my daughter at the age of 41. I met with a endocronolist who put me on synthroid (.100mg). It took several months to find the right level. I seemed to feel alright after that and remained on that same dosage. Then in 2005 I kept complaining that I was not feeling good. Blood work was done, thyroid levels normal, etc. Still not feeling better. Finally I went to my family doctor and she became proactive. She scheduled an ultrasound, results showing nodules. Six months later another ultrasound, nodules growing bigger. She suggested I see my endo and he had a fine needle bioposy done and it came back benign. But since the nodules continued to grow he suggested I have my right lobe removed so not to have complications with the nodules down the road. May of 2006 scheduled surgery and it was on the operating table that it was found to be malignant. I understand fine needle biopsies are not 100% accurate. Long story short, I had the right removed and met with an oncologist who treated me with 6 rounds of chemo and 15 days straight of radiation. Back on synthroid and still felt awful. In 2007 I found this wonderal homeopathic doctor who said I was feeling tired and sluggish all the time because my T4 was converting to T3. She put me on T3/T4 (it has been 5 years now) and I have never felt better. In fact, I started feeling better right away. Now my family doctor says that eventuall the T3/T4 will catch up with me. It will affect my blood (which I do not understand), something like eventually would need to be on blood thinners. She scared me and now I do not know what to do. I read that Armour would be just as good but how do I find a doctor that will prescribe this for me. Most doctors read the levels as being normal when in fact, it may be normal for one person but not for another. Too confused……..

  25. Lou says:

    Add me to list of people who has been misdiagnosed and poorly treated by the “best” endocrinologists in Dallas and Houston. I’m 46 years old and was diagnosed with Hashis at 15 (diagnosed by my dentist, by the way). For 35 years I was treated only with Synthroid. None of my doctors..NOT ONE…ever mentioned or tested my T3 levels, or talked with me about how to control the Hashis through my diet. Even after I had roughly 20 FNSs and a total thyroidectomy, NDT and T3 were never discussed. I learned about T3 supplementation from a preventive cardiologist’s blog. Since then, I’ve discussed NDT with 1 endo and 2 GPs and none would prescribe it. I ordered Armour online without a prescription and the difference in the way I feel is night and day. I’m weaning off the anti-depressant I was put on 8 years ago, given up the statin that was destroying my liver, and have given up the foods that aggravate my condition. I feel wonderful. I’m still trying to figure out the correct dosage of Armour/Cytomel but I don’t know if I’ll ever go back to endo or GP for help with my thyroid. They know nothing and they either don’t care, or don’t have time to care. There are groups on Facebook and thousands of people who have experienced the same lack of support from the medical industry. I’m so happy to have found this site and look forward to doing my part to spread the word.

  26. Lou says:

    FNAs, not FNS. Fine needle aspirations. Sorry.

  27. My long time endocrinologist was ill for about 5 years. I was on Thyrolar, 30mg, 4 x per day. The Pharma companies stopped making Thyrolar and the pharmacy gave me a prescription for generic levothyroxin and Liothyroxine. I was told the two combined would equal the thyrolar with no problems. 4 years later, I had gained 15lbs and gradually had became bedridden. After experiencing total exhaustion and lethargy, I contacted my old endocrinologist and I was in luck as he was back in practice. 6 weeks ago I started a compounded T3/T4 and I am now up and around daily. I should be swimming again and working out and back to optimal health within another 6-8 weeks. My doctor said that I was about 2 months away from entering M. shock. My vitamin D levels dropped to 11, I was extremely ill.

    • I need to mention that I have been told that the generic brands of thyroid meds do not work on some patients. I experienced this as I was not absorbing the medication and getting what I needed. This may be the case for other patients, if so, it may be prudent to switch to Brand instead of generic.

  28. Tiff, you need a trial on T3 it’s the active hormone! Only T3 (not T4) can attach to nuclear receptor (inside cell) & produce the hormones axn. Thyroid hormone DOES NOT WORK IN BLD STREAM! I’m an Endo. who has used T3 for 40 yrs because in my experience it works the best alone or in combo w. some T4 in spite of what you’ve heard ~ the glories etc of synthroid/levoxyl(T4) alone. It’s not for everyone! There’s no harm in therapeutic trial espec. w. your history.

    • Bobbie Ingersoll says:

      When you say “some” T4, what ratio are you talking here? I got the impression that you meant to say more T3 with a little T4. Yes? Could you elaborate a little?


  29. cathy mary says:

    Hi I wonder if anyone could help on this. Ten years ago I was treated for thyroid cancer. I had a total thyroidectomy and further treatment with radioactive iodine to remove any remaining thyroid tissue. As is normal for thryoid cancer treatments I was put on a standard dose of T3 which leaves the system easily if further treatment is required. After that I believe many patients are moved to T4 but I seemed to have been overlooked and for the last ten years have remained on 60mg of T3. I have just been discharged by my oncologist as being ten years clear of cancer and he’s stated that my gp would like me to go onto T4, stating there was no reason not too. When pushed he admitted the main reasons were financial, T4 being cheaper. Does anyone have any advice? I’ve felt fine on T3 and am reluctant to undergo months of messing and trying to get my levels right. Is it ok to stay on T3 forever, are there any pitfalls to be treated with just T4? Thanks.

  30. Mary E. says:

    You all should try the natural thyroid supplement called Thyroid Porcine-combines T-4 and T3. Been on it for years and I’m over 60. But my medical doc will not prescribe it for me from Apothecure Pharmacy. Frustrated as my Naturopath is no longer working. Need to quickly get a new naturopath here to prescribe it for me at Apothecure. But its the best. Go natural! See websites for more info-

  31. Gail T. says:

    i’m so tired of being so exhausted. for way too many years. and i’m getting worse. i’m losing hope of ever feeling well again. i’m too exhausted to keep myself fed properly. which adds to the downward spiral. i feel like i am dying a slow miserable death. i’ve lost 30 pounds in less than 6 months (not trying to). i quit all anti-depressants in october after one doc almost killed me with a different combo. they haven’t worked for years anyway, probably because depression was never the issue, only a symptom. i basically hate doctors now, but i must always take thyroid med because i was convinced by doctors that i needed my thyroid removed. i was naive and trusted them. never again! so now i HAVE to see a doc to get thyroid meds. which aren’t working, not stabilizing. so i’m still losing weight since being off the anti-depressants; and i changed my diet to exclude all the toxic stuff. that doesn’t leave much. organic, whole foods, no wheat, no dairy, no processed, etc. and no meat because coming out of the numbing effects of anti-depressants (on them for 25 years) i realize i can’t support the HORRORS of how those animals are treated and killed – (by doing research on line about healthy food i came across a video of the HORRORS of how the pretty packaged meat on the grocery shelves came to be). it costs more and takes more work to prepare and keep food stocked to eat healthy. and since i’m too weak and live alone i’m basically starving to death. i see no way out. my hope is just about extinguished. i’m not strong enough for this suffering. and no one but you all seems to get how terrible it feels. i’m also dealing with peri-menopause. and weaning off klonopin. i’m doing my best but i’m losing the fight. it’s also discouraging to realize that the treatments for thyroid issues are, well, not very successful for many of us. i ended up on this site because i read that levoxyl is not going to be available for a while. that’s what i’ve been on. it may be a blessing in disguise for me – maybe another drug will work. but like i said i really am basically hopeless. anyway, glad i found this site, and that i got a chance to vent to people that “get it.” hope i made sense, because my brain pretty much feels like a wasteland.

    • Tanya Stoia says:

      I’m sorry that you feel that way always tired always sick depressed I feel the same way I have since I had my the total thyroidectomy I usually don’t even get out of bed it’s hard for me to make food for myself also I’m chronically depressed, I had stage 3 thyroid cancer, I thought maybe we could talk if you wanted to talk I’ll give you my email address it’s it would be great to talk to someone who feels like I do everyday.

      • Dotti says:

        Gail, I can relate to your story and your frustrations – same thing is going on with me… I have lost at least 20 pounds and am starving but too weak or too sleepy to cook a decent meal. I need someone to come and stay with me for a week or two to make sure I eat and start to get my strength back! Good luck Gail – my thoughts are with you. You are not alone.

  32. Becky says:

    what does TSH 1.321 and T4 .91 mean?

  33. Marilyn Caputo says:

    I had my thyroid removed 7 years ago because it was growing big and into my chest. The doc said it was the size of a grapefruit. He started me on levothyroxine and it seemed to work ok for the past 7 years. I tried the name brand and could not take it. Every 6months I have the levels checked and it was not good the last time. The T3 were all high, but the T 4 were ok. Doc increased the amount from 112 to 125 and said to have it checked in 8 weeks again. I am seeing a psychologist for depression. One of the things I’m depressed about is my weight – which I can’t seem to loose no matter what I do. I retired 2 years ago, lost my house due to housing market, moved into an apartment – which I don’t like, but still don’t think I should not be this depressed. I am now living near my kids and grand kids. Taking naps in the afternoon and falling asleep watching the news – never did that before. How long should I wait to see if the increase works before going back to the surgeon to see if he can help. These are all Cleveland Clinic doctors. Right now I’m going through having cataracts removed on both eyes. I guess I should wait until this is all over.

  34. cris2009 says:

    Hello, I have been on the thyroid medication rollercoaster ride since 2007 when I had a partial thyroidectomy due to thyroid cancer. I am also very sensitive to the thyroid medications (I cannot take more than 75 mcg). Although labs have been “normal” and from what I can remember, I don’t have a problem with free or reverse T3. It’s is just that I never got relief from hypothyroid symptoms on just 75 mcg of T4 Levoxyl – fatigue, brain fog, weight gain, coarse, dry hair, hair loss, constipation, depression, increased cholesterol, and constant sweating.
    Tried the Nature-throid for a while (1/4 grain 3 times per day) saw some improvements but not much and my T4 was a bit low. Not being able to “control” the amount of T4 & T3 hormones, my doctor switched me back to T4 Syntroid (50 mcg) and finally agreed to let me add some Cytomel (5 mcg) which I take in ½ doses a day (½ Syntroid ½ Cytomel 6am, other halves at noon). I have been on that for the last 7 weeks my labs were:
    TSH 1.57 (range 0.450-4.500)
    Free T4 0.92 (range 0.82-1.77)
    Free T3 2.5 (range 2.0-4.4)
    I did notice some improvements. Fatigue was better, still sweating and hair is falling out even more.
    Past 4 days I tried to add more T4 and decrease T3 and am now trying 62.5 mcg T4 and 2.25 mcg T3. Past two days have a headache and feel prickly waves in my arms and legs.
    Should I stay with these doses? Go back to 50 mcg T4 and 5 mcg T3?
    Any suggestions, advice would be appreciated.

  35. Serena says:

    Diagnosed with Hashimotos x 2 years now. Not exactly sure if I have that or just Hypo. Have had the routine TSH tests over and over. Took Synthroid, generic, and Tirosint (more expensive but not preservatives, added colors, etc). Never felt good. Very tired all the time, slept over 10 hours a day, very droopy and just depressed and unhappy. Up the dose and better for a few weeks, then bad, etc, etc.

    Trying a new doctor now. Cash only, but specializes in fatigue and thyroidism. Was tested for everything you can think of and found out some interesting things. I’m 43 y/o female with only a triglyceride issue (hereditary) besides the thyroid issue. anyway, found out that my lab numbers for different hormones are out of whack for my age. Low iron, high cortisol, low growth hormone, and also further tests indicated slow absorption. So, I was prescribed a number of different supplements and vitamins as well as T3 and Tirosint. Taking 75 mcg Tirosint and 25 mcg T3 and just upped the T3 to 35mcg due to hair loss and achy joints, and dry skin.

    Not saying that this is the best way, but was desperate to try ANYTHING to improve my life. So far after 2 months, I am feeling better. Still have low days, but overall I only sleep 8 hours, have lost 5 pounds, have energy to work and socialize. I still get tired often, but not the kind that drags you down completely. I can hold off until bed time.

    Hoping to see after adjustment and maybe at six months to know if this is a good program for me. It’s not mainstream treatment, but my old doctor wouldn’t even discuss any other labs or possibilities for treatment.

    Am hopeful to get my full life back.

  36. maria says:

    i took some blood investigation and one of them is thyroid .now they come and my throid is 7 .iget to alarmed my selve cos they told me its to high.i have several bloods to wait for the result one of it is the cholesterole.the question is can i have cholesterole because i have hyperthyroid?

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