1. Understand the Lab Tests for Thyroid Disease

Some doctors only use the Thyroid Stimulating Hormone (TSH) test to diagnose and manage thyroid disease, and tell patients that their results are "normal" or "abnormal" — nothing more. Integrative physicians take it much further — often including Free T4, Free T3, Thyroid Peroxidase Antibodies (TPO), Thyroid Stimulating Immunoglobulins (TSI), Reverse T3. If you don't know what these tests measure, and what is "normal," "abnormal" — or better yet "optimal" — for each of these tests, it's time to do some homework. You can't ask for tests that you don't know about, and you can't negotiate for optimal treatment if you don't know what your results mean. Need to learn more? Read Challenges in Thyroid Hormone Therapy: Why Is It So Complicated?

2. Start Keeping Copies of All Your Lab Tests

It's your right — and frankly, smart — to ask for a copy of every set of bloodwork test results you get. Don't accept "your tests were fine" as a result. Get a copy, look at the results, look at the reference ranges, and know where you stand. And keep copies of your test results, so you can track results over time. Even better, make notes regarding what dosage you were taking at the time of the test, any other supplements or dietary changes you were making, and any resolved or outstanding symptoms, so you can better understand your response to your treatment approach.

3. Stop Sabotaging Yourself

If you are on thyroid hormone replacement medication — i.e., levothyroxine drugs like Synthroid, Levoxyl or Tirosint; a synthetic T3 like Cytomel; compounded thyroid medications; or natural thyroid drugs like Nature-throid or Armour — make sure you take your drugs correctly! That means:

  • Take iron or calcium supplements at least 3 to 4 hours apart from your thyroid medications. (This goes for calcium-fortified orange juice too.)
  • Take your thyroid drugs on an empty stomach, and wait an hour before you eat
  • Wait an hour after taking your thyroid medication before you drink coffee (including decaf)

If you don't follow these guidelines, you may not properly absorb your thyroid medication and get the benefit of treatment.

4. TAKE Your Prescribed Medication

Many patients, frustrated with slow resolution of symptoms, or new symptoms or possible side effects, simply stop taking their thyroid hormone replacement. Others regularly forget to take their thyroid medication. Yet other patients forget to get a refill, and then have to wait for an doctor's appointment, or wait for a mail order pharmacy delivery, and go weeks without a refill. If you are hypothyroid, your body requires thyroid hormone to survive. It's like insulin for a Type 1 diabetic. Don't stop or forget your medication, and stay on top of refills.

5. Explore Your Options

If you are on a levothyroxine (T4) only treatment like Synthroid, and you don't feel well, you may need a dosage change, or a change to another brand. (Synthroid, for example, has lactose and acacia as fillers, two ingredients that can cause sensitivities and side effects.) Tirosint brand levothyroxine is specially designed for people with absorption problems, and irritable bowel syndrome, and helps with absorption. You may also need to add the T3 hormone, whether in the form of the drug Cytomel, or as a time-released compounded T3. Or, you may benefit from a switch to an all-T3 therapy. Some patients do best with a shift to natural desiccated thyroid drugs, like Nature-throid, Erfa, or Armour Thyroid. The point is, if at first your treatment doesn't succeed, TRY again! Keep working with your doctor on the drugs, dosage, and combination until your treatment is optimal and you have symptom relief.

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