Doc: Should thyroiditis treatment pass hormone level?
Dear Dr. Roach: My wife, age 67, has been under treatment for Hashimoto’s thyroiditis for 18 years now. The diagnosis was confirmed by antibody tests, and she has been taking some form of thyroid medication ever since. She has been treated by four different doctors, including two endocrinologists. She has tried both synthetic and natural hormones, as well as generic and brand-name products. What we have found is that it is not hard to maintain acceptable serum levels of these substances as measured by lab tests, but elimination of physical symptoms, such as fatigue, sensitivity to cold, etc., has been elusive. The doctors seem to be satisfied with good lab results, and give only lip service to symptoms. Recently she was told that the goal was to maintain proper hormone levels, and she would just have to learn to adjust to the symptoms.
We would like to know if she has to settle for this, or if she should push for a more nuanced level of treatment? It doesn’t take much internet research to discover that there is a lot more to thyroid metabolism than getting the right balance of TSH and T4, not to mention all of the other conditions that might mimic or aggravate hypothyroid symptoms. But it is hard to confront a practitioner, who has years of practice, with something we found on “Dr. Google.” A quick check of thyroid forums online shows that this is a very common complaint.
Dear G.C.: Persistent symptoms of low thyroid despite lab tests that are normal is indeed a common problem. Knowing that some people’s normal is slightly out of the “normal” range, many experienced endocrinologists will adjust the dose of the replacement hormone somewhat, increasing the amount of thyroid hormone in order to improve symptoms while still being cautious not to cause hyperthyroidism, with its attendant risks, including atrial fibrillation.
One issue I see occasionally is that some people cannot convert T4, the usual replacement form of the hormone, to T3, the active form. A very small dose of supplemental T3 sometimes can dramatically improve symptoms.
Finally, even people with thyroid problems might have other reasons for fatigue and cold sensitivity, and a comprehensive look for other issues (such as anemia) should be done.
Email questions to ToYourGoodHealth@med.cornell.edu.