Nowadays, a great number of people are wondering if they have an underperforming thyroid gland. They may suffer from fatigue, hair loss, weight gain, feeling cold, dry skin, mental fogginess, menstrual dysfunction, depression, or other symptoms. So they go to their doctor and get a thyroid test, and are told it’s “normal”, and that “it’s not your thyroid. Here, take this antidepressant.” But it turns out that there is a normal level, and an “optimal” level. And when optimal levels are achieved, patients often feel a positive difference. There’s a book called, “What Your Doctor May Not Tell You About Hypothyroidism” by an endocrinologist, Ken Blanchard, MD. It’s a good book to read if you’re having thyroid issues, and I subscribe to its philosophy of trying to achieve a 98:2 ratio of T4:T3. A patient may have normal serum levels of TSH, free T3, and freeT4 but have positive thyroid antibodies. Those patients can sometimes benefit from thyroid hormone replacement. As a person’s thyroid hormone levels increase, the TSH (thyroid stimulating hormone) goes DOWN. Most doctors do not yet realize that the normal range of TSH has been lowered and that most lab reports do not yet fully reflect the changed reference ranges. Personally, I like the TSH to be around 1 most of the time, when we are working on getting people fine-tuned. And occasionally, we will push the thyroid dose even higher to where the TSH is <.3 as long as there are no signs or symptoms of hyperthyroidism starting to develop. Also, many endocrinologists do not like to prescribe Armour Thyroid or other desiccated thyroid products, because they don’t have faith in the consistency of the product. But I use Armour and generic thyroid extract quite regularly and have not seen a problem. In truth, some patients seem to do better on just L-thyroxine (T4) and others on a T4/T3 mix like Armour or Thyrolar. I have put some patients on BOTH L-thyroxine AND a little Armour in order to try and achieve the 98:2 ratio. I also use regular liothyronine (generic Cytomel) or compounded timed-release Liothyronine in small doses. My philosophy is to use whatever works the best for each individual patient. Recently, most of the desiccated thyroid products that have both T4 and T3 in them have been quite hard to find, and usually requires using a compounding pharmacy. I also often choose to use nutriceuticals to support the thyroid function as well as the conversion of T4 into T3. Using supplements can sometimes obviate the need for actual thyroid hormone supplementation. Some people subscribe to checking axillary temperatures in the mornings with a glass thermometer for ten minutes before arising and seeing if their temps are < 97.4 (Broda Barnes method). Low body temperature may or may not be a sign of low thyroid function, but may provide some useful data Low adrenal function and low estrogen are also possibilities as well as other causes.