Thyroid Hormone Dosing Dilemnas. Part 1


Several members of metabolism.com have posted their opinions on methods to determine the best dose of thyroid medication for treating hypothyroidism (sluggish thyroid). Many physicians work on the assumption when giving thyroid hormone replacement, that the achievement of thyroid function tests in the normal range, particularly TSH , is the sole indication of an appropriate replacement dose. This is a fair assumption but not every treatment is successful using such rough guidelines. (for more on using TSH levels in the treatment of hypothyroidism see my article here at metabolism.com, “Major Revisions Possible in Guidelines for Diagnosing and Treating Hypothyroidism” ).

To answer the question of when the ideal thyroid hormone replacement dose has been reached, I look at nature’s own experiments. I have treated countless people with diseases of the thyroid resulting in both hyperthyroidism (over-active thyroid) and hypothyroidism (under-active thyroid). Standing out prominently for me is how differently people respond to the presence of either too much or too little thyroid hormone.

Many people visiting metabolism.com express dissatisfaction with their replacement dose for hypothyroidism because they continue to experience symptoms typical of thyroid hormone deficiency (hypothyroidism) on thyroid medication. Their physician is reluctant to increase their dose because the TSH levels are in a normal range. It therefore may come as a surprise to know that in a few office consultations I have encountered people actually preferring to operate with deficient thyroid hormone levels as judged by TSH being elevated in the range 4 to 15. In these instances, increasing thyroid levels by giving thyroid hormone results in symptoms we typically associate with hyperthyroidism such as being excessively hot, shaky, nervous, fatigued and increase in palpitations.

Much more commonly, are those on the other end of the spectrum experiencing symptoms compatible with deficient thyroid levels when thyroid functions tests are in the low end of normal with TSH between 2 and 4. Symptoms in this group may include fatigue, puffiness, lack of concentration, weight gain, cold, muscle cramps and achiness, and constipation.

The diversity in symptomatic response to hyperthyroidism (thyroid hormone excess) can be equally broad. I can think of numerous individuals who are not the least bit troubled by extremely elevated thyroid level never experiencing typical symptoms such as feeling hot, shaky,sweaty etc. One might suspect that these people are just a tough breed of non-complainers. But checking for typical signs of hyperthyroidism which are independent of personality such as tremor, or rapid heart rate yields totally negative results. Others however, with just the slightest excess of thyroid hormone are plagued by feeling worn out, anxious, sweaty, hot with markedly elevated heart rates and tremors.

What could explain the wide variation between individuals, in response to thyroid hormone levels? In Part 2 of this article I will explore some of my thoughts and theories, while, as always, I invite members to join in with their own experiences.

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