Health knowledge made personal
   
Now, flip that same scenario around. Let's say that your TSH used to hover around 1-1.5mIU/L when you felt "normal" although you might not have known that unless you checked. Then let's say you develop symptoms of hypothyroidism confirmed by TSH >10mIU/L. In response, we start you on levothyroxine and give you just enough to get your TSH below 4.5mIU/L and then tell you that you're normal. But you still don't feel right, not like you did before you developed hypothyroidism. Just like Oliver Twist asking for more gruel, you plead for more levothyroxine. Unfortunately, most of my colleagues just sneer back and ignore you because "your results are normal."
If the above scenario didn't quite hit home, imagine yourself back in school. You're aiming to be your class valedictorian w/straight A's. But there's a fly in the ointment. You just can't understand some class, let's say statistics. So you fail. Luckily, your teacher is willing to tutor you, but then you find out, s/he will only teach you just enough to pass, but no more. S/he won't spend the energy/effort to help you truly understand the importance of statistics and to help you get an A. After all, a D grade is passing, right? No argument there! But it's just not the same for you, the budding valedictorian.
And so it is w/treatment of hypothyroidism . That's why this clinical review, as extensive as it is, really & truly represents a change in direction, at least for two leaders in the specialty of endocrinology. Luckily for you & me, many of my other colleagues are ahead of the ball and treating their patients to clinical goals rather than just numerical ones. These same colleagues have also been willing to consider the addition of triiodothyronine if necessary, as suggested in the text. So if you have hypothyroidism and you just don't feel like yourself on your current regimen, show your family physician or endocrinologist this clinical review. And do your best Oliver Twist imitation.Follow @alvinblin 
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