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Posted in: Hypothyroidism.

Treatment of Hypothyroidism

From: gimel - 1 year 38 weeks ago

Why is it that you say treatment of hypothyroidism should be based on TSH levels. Each person may have a different equilibrium among TSH, and the actual thyroid hormones, Free T4 and Free T3, at which they feel normal.
Due to the degree of inter-individuality plus intra-individuality, there is extensive data showing that TSH has only a weak correlation with FT4 or FT3. In addition, hypothyroidism is not just "insufficient thyroid hormone", but instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone". Suboptimal TISSUE T3 EFFECT causes hypothyroid symptoms. Since there are no direct measures of TISSUE T3 EFFECT, indirect measures must be used instead. The most important among those indirect measures are signs/symptoms related to hypothyroidism, supported by tests for Free T4 and Free T3, sometimes Reverse T3, cortisol, Vitamin D, B12 and ferritin. TSH is useful for diagnosis only when at extreme levels.

During treatment, when medication is adequate to relieve hypo symptoms, TSH is usually suppressed. That does not indicate hyperthyroidism, unless there are hyper symptoms due to excessive levels of FT4 and FT3. In the untreated state our bodies receive a continuous low flow of thyroid hormone from the gland. Several studies have confirmed that it is not the dosage amount, but instead it is the dosing procedure (taking it in only one or two doses), that causes the TSH to be suppressed for most of a day. So TSH should not be used to titrate thyroid medication.

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