Here is a question from our member nBarnard in Texas, about the failure to achieve an adequate clinical response to t4 treatment, and what to do about it. My response follows.

Hello Dr. Pepper,
I just found your blog and decided to join. I admire you for helping so many people this way. As with many people on this board, I have hypothyroidism. They removed my thyroid due to Hashimoto’s Thyroiditis a few years ago. It took a very long time before I started to feel better after taking the generic T4 meds. I was much heavier than I am now, since having started a special diet program where I lost 100+lbs. During my weight loss experience, I felt my best ever when I was down 60-80lbs. At that time, I was taking 250mcg Levothyroxine daily, with 25mcg every other day. (also taking maxzide 25mg, levonorgestre, and calcitriol – due to the parathyroid glands malfunctioning). Now I am down 100lbs and feel like I did before they removed my thyroid and I cannot lose any more weight. I am on a program where I should be losing everyday and nothing. My current dose is 200mcg per day. The doctor did blood work and they stated the levels were too high, so she lowered my thyroid medication. At the same time, I had to lower my blood pressure meds. My concern is that as the days go by, I feel worse and worse. My hypothyroid symptoms are so bad, that I cannot function. I am tired, cannot concentrate, dizzy, depressed, and on and on. I live in Texas and need a heater by my desk because I am so cold. I talked to the doctor about this and we did another blood test. She said the level dropped from 20 to 16 and that is an indication the med change is working. In the past when my numbers were too high, the doctor raised my medication. I am very concerned that this might be wrong dosage direction. I have appointments to see her, but cannot get in for a few months. In the mean, time, I am researching what can be done to help my situation. Any help would be appreciated.

Dear nBarnard:

As you know I can’t provide medical care or advice over the internet. I can make some general comments I hope you find useful.

First, congrats on losing all that weight! That is never an easy job. You mention your “levels” dropped from 20 to 16. Which levels: T4, or TSH ? That is a crucial piece of information.

At we have extensively reviewed the pro’s and con’s of using Armour Thyroid. In my medical practice I have found that hypothyroid symptoms that fail to respond to traditional t4 treatment often respond to Armour. It is my thought, shared by many, that the combination of thyroid hormones in Armour, particularly the presence of t3, is the reason Armour is superior to t4 only. Perhaps you can approach your physician about trying Armour, or alternatively adding some t3 (liothyronine) to t4.

Keep us posted and good luck.

Dr. G. Pepper

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