The most common complaint I get on a daily basis from my new thyroid patients is this:
“I’ve been treated for my hypothyroidism and have been on my meds for years but I still don’t feel good”. Patients will tell me, sometimes through tears, that despite years of treatment they still feel tired, cold, have aches and pains, have hair falling out and continue to gain weight.
What is happening here? Why are so many Hypothyroid patients still suffering and feeling unwell despite treatment?
The short answer is that many hypothyroid patients are simply under treated by their current thyroid doctor. It may be that the strength of the medication is too low, or the medication itself is not the right one and contains only T4.
Many practitioners are uncomfortable with the idea of optimizing thyroid hormone levels in their patients versus just getting them into the normal range. Why is that? Well, in part it is because they are being cautious and do not want to put you on too much medicine. This is a valid concern, but should not be a reason to keep patients under treated on too low of a dose of thyroid replacement, which unfortunately I see all too often, on a daily basis! Most doctors who treat thyroid are taught to correct the deficiency by simply getting the levels back into the normal range. The fact that being on the low side of that normal range doesn’t seem to resolve the patient’s symptoms is usually not ever addressed when the patient comes back complaining of still not feeling well. This is a sad and extremely frustrating situation for patients who simply will not feel better until they get their thyroid levels into the upper end of normal, or what I like to call optimized versus just normalized. When you are just normalized, many symptoms may linger due to under treatment. The focus must be put on optimizing thyroid levels versus just normalizing, and most times this can only be accomplished by seeing a thyroid doctor who is an expert in thyroid treatment and who will listen and be open to making a change.
So what does optimal look like on thyroid levels? Generally speaking, it would be getting your TSH to 1 or under and the Free T3 into the upper 25% of normal range. If someone feels great and their TSH is at 1.5 or 2 we don’t get hung up on the numbers! Lab values are simply guidelines to achieve optimal dosing and help patients to feel well, and of course to also be sure we are not over medicating.
Remember, these are not hard and fast rules. Each patient’s optimal may be slightly different. This can involve walking the razor’s edge so to speak, and pushing levels up into the upper ranges of normal, and THAT is where most practitioners such as endocrinologists and general practitioners who treat hypothyroidism just do not feel comfortable and don’t want to go there. This is why it is always best to seek out a practitioner who specializes in thyroid treatment and who knows the importance of optimizing. So if your current practitioner will not go there with you, consider a change. You deserve to feel the best you possibly can with thyroid treatment! The best thyroid doctors for this approach would be functional medicine doctors or naturopathic doctors with a focus on treating thyroid patients.
In many patients the issue of still feeling unwell can also involve other hormonal or nutritional imbalances and deficiencies that have not been tested and treated. For example, if the patient is also suffering from perimenopause or menopause, these can have similar symptoms to low thyroid and prevent the patient from ever feeling totally well. Or perhaps cortisol (the adrenal system) may be imbalanced. Vitamin D deficiency and low iron are also extremely common issues. These are just a few of the other areas to consider and address that can cause a thyroid patient to still feel unwell despite treatment.