The Diagnosis and Treatment of Hypothyroidism
I recommend that most patients be started on a T4 preparation, which improves symptoms in the large majority of the patients. I have found that most patients prefer Levoxyl or Unithroid to Synthroid, but this varies with each patient. After initial treatment with T4, I adjust their T4 dose until their TSH is between 0.5 and 2 mU/mL. If they remain symptomatic, despite an optimized TSH, then low doses of T3 given two or three times a day can be added cautiously to T4. If patients start with a low blood free T3 level, then I am more inclined to treat them with T4 plus T3. On T4 plus T3 therapy, I use blood tests to make sure the free T4 and free T3 are in the upper-normal range. The TSH value is usually suppressed on combination treatment.
A percentage of patients will have symptomatic improvement on T4 plus T3 therapy. For those that do not improve, I occasionally recommend treatment with dessicated thyroid preparations, usually Armour, plus synthetic T4. This combination is needed, as desicatted thyroid preparations
have a higher T3/T4 ratio than desirable and need to be supplemented with synthetic T4 to achieve
normal ranges of both hormones. Again, I aim for a free T4 and free T3 in the upper-normal range.
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Thank you for the informative post. I am an RN who was just diagnosed with hypothyroidism as well (TSH 122, T4 0.4, positive antibodies and multiple nodules on thyroid ultrasound). I just started levothyroxine 50mcg last week. I am waiting to feel better, and also to see ENT regarding possible biopsies of nodules.
Any words of advice about nodules?
Heather
http://3underthree.blogspot.com/2009/07/coming-clean.html