I have seen patients who were doing well on thyroid pills -- Armour, Naturethroid, synthetic -- who have their symptoms and signs under control, but then reduced their thyroid dose on the basis of limited thyroid blood testing which can result in getting the wrong advice leading to a worsening of their symptoms and overall condition, sometime dramatically. This happens because the thyroid testing is usually not as complete as possible (due to financial/insurance restrictions). To be accurate, testing should look carefully at Free T4 and Free T3 levels, Total T4 and Total 3 levels, and TSH and the two common thyroid antibodies. Top university laboratory experts cannot agree as to which of these types of tests is the most accurate; therefore, in difficult cases it is helpful to check all of them.
Without the proper appropriate lab data it is hard to adjust the thyroid dose correctly. The lab tests themselves have a wide normal range so the interpretation of the labs by the doctor should optimally include some clinical judgment as to how the patient is doing on thyroid in terms of signs and symptoms. The interpretation can vary from doctor to doctor depending on how the doctor feels about achieving optimal functioning for the patient as opposed to merely maintaining the normal range.
I remember one gentleman who said he always felt his life was like pushing slowly through jello. Although he had normal test results -- they were at the low end of normal -- and his symptoms fit the presentation of a person with an underactive thyroid. Once we adjusted his thyroid through natural prescription medication, he felt that life was no longer a struggle – astoundingly better.
We have often found an underactive thyroid to be the issue when women have trouble becoming pregnant and/or maintaining a healthy pregnancy. Once treated with the appropriate type and dosage of thyroid, pregnancy often results.
We have had countless patients who have been told clearly that there is nothing wrong with their thyroid at all based on basic lab testing but when correct, thorough testing is done including the all important anti thyroid antibodies, low and behold, they come back positive, meaning there is definitive evidence of Hashimoto’s Thyroiditis which does need to be treated.
This is not meant to criticize other physicians. All doctors do their best to try to help patients. Every doctor has different areas of special interest and experience. It is up to the patient to seek advice from a doctor who is well versed in the clinical and sub clinical aspects of thyroid function.
I have not seen a thyroid test -- via blood, urine, or saliva -- that is really able to measure how much thyroid hormone actually gets into the cells of the body. Due to genetic factors, toxic factors from the environment, and nutritional factors, there can be a degree of tissue hypothyroidism or peripheral hypothyroidism, as it is called, even in thyroid tests that look fairly normal. Since thyroid hormone is so vital to the functioning of the metabolism of the whole body, it is therefore important to check testing thoroughly, evaluate the patient clinically, and work to find a method of fixing it that works.
Please refer to Dr. Ross’ 2006 book , Depression and Your Thyroid (New Harbinger Publications).