Thyroid UK
87,495 members102,208 posts

On the Clinical Diagnosis and Treatment of Hypothyroidism

I have just read the following Link and it follows along holistic doctors' viewpoints and makes a lot of sense to me: A couple of excerpts:-

Current professional guidelines for the diagnosis and treatment of hypothyroidism abandon clinical medicine for a laboratory exercise:

TSH and free T4 normalization.

This approach is both illogical and ineffective. The TSH level is not a measure of thyroid hormone sufficiency in any given patient, either untreated or treated; reliance on the TSH produces both under-and over-diagnosis and undertreatment.


The diagnosis and treatment hypothyroidism must clinical, guided by

signs and symptoms first and by the free T4 and free T3 levels second.

Every symptomatic patient with relatively low free T4 and/or free T3 levels deserves a trial of T4/T3 combination therapy titrated to obtain the best

clinical response.

The ultimate test of whether a patient is experiencing the effects of too much or too little thyroid hormone is not the measurement of hormone concentration in the blood but the effect of thyroid hormones on the peripheral tissues..........

The active thyroid hormone, T3, is one of the most powerful molecules in the human body, affecting every system, every tissue of the body and every aspect of our well-being and health. It increases the mitochondrial energy

production thereby improving the function of every tissue and organ in the human body. It has other direct and indirect effects that we are only

beginning to understand. The symptoms and signs of hypothyroidism

are many and various.Hypothyroid patients may receive many different


(See Table1.) Even mild hypothyroidism degrades a person’s quality of life and long

- term health; therefore its diagnosis and effective treatment is essential to the practice of medicine. What guidance dophysicians now receive?

14 Replies

Thank you for this, it makes very interesting reading. I was ignored by various GPs with all the symptoms he lists, but an ENT consultant in the US instantly pronounced autoimmune hypothyroid through antibodies (admittedly ow compared to others, but my system is extremely sensitive) and prescribed a low dose of Armour, which was all I needed to be restored. Returning to UK and reliance on TSH/T4, the prescription was denied and the symptoms again ignored, so I have taken blood tests that are identical to those when in the US, and obtained Armour from the US, and am back on one grain, and am gradually starting to feel better. Life's too short, and thank heavens for all the wondrous folk on this forum.


It's a disgrace that they don't listen to those patients who DON'T get well on levo. It's not one size fits all. We shouldn't be given other meds for the remaining clinical symptoms but a decent dose of hormones which suit us.


Thank you :)


Thank you Shaw, fascinating read



1 like

I am one of the many people whose doctor won't listen to my long list of symptoms and I am so desperate to be heard and taken seriously. My freet3 result keep falling and my freet4 is not even optimal but because my TSH is below 2, my doctor is afraid for my heart. She even told me that my freet3 result was irrelevant! What?? Lol. It is not even funny but then again, it is pathetic to hear that from a doctor. She agrees to give me an anti-spychotics and pregabalin and muscle relaxant but no effing ndt! Canada aid as bad as uk!


The fact that we can read and know that the lack of hormones are more likely to cause heart problems than too much. They believe in what I would call 'old wives tales' or rumours actually.

Before blood tests we were given NDT on a trial and prescribed until no symptoms.

The only non-prescriptive NDT I know of was developed by Dr Lowe due to the restrictions. I don't know if you've heard of Thyro-Gold and his wives now deals with that part since Dr L died unexpectedly.

I have read that the 300 are quite strong, so they introduced the 150 capsules.

1 like

Thanks shaws. :) I finally saw my endo two days ago and she agreed to try me on ndt but such a low dose! And on top of my Levo. So am not sure how efficient it might be! However, it is a start. She agreed to a quarter 30 mg tablet on top of my Levo 50 mcg. But I am not allowed to increase until I see her in 8 weeks!


It definitely is a start and gives you some enthusiasm to.

So, do you mean she has agreed a trial of NDT of 30mg (1/2 grain) but you've not to begin until after you see her in 8 weeks?

Or you've to add a 1/4 of 30mg tablet now?

i.e. 1 grain (or 60mg) of NDT is equal approx to 100mcg levo.

1/2 grain (or 30mg) of NDT is equal to approx 50mcg levo

1/3 " (or 15mg) " " " 25mcg levo


She has agreed that I could start adding 1/4 tablet of 30 mg of erfa. (From Canada), on top of my Levo 50 mcg. Does it mean an increase of 25 mcg Levo + t3? I am quite confused in figuring out all of this though it is thanks to this forum that I was able to convince her to give me more than 50 mcg but she would not add t3 and agreed reluctantly on ndt after I just pleaded with her!


Don't worry. It is confusing.

NDT (Natural Dessicated Thyroid) contains, T4, T3, T2, T1 and calitonin (the latter 3 in very small quantities). Yes, 1/4 tablet NDT is approx 25mcg of levo.

I don't understand why she has you on such a low dose of levo i.e. 50mcg because no-one would survive on such a low dose.

So in fact you will be taking the equivalent of 75mcg levo.

The usual doses of NDT before the blood tests were introduced were between 200 and 400mcg. One doctor said that we were put in a 'parlous situation' due to too low a dose.


Trust me I don't either :( but because of my age : 59, she is concerned of heart issues. I come fome a family with a huge history of thyroid disease and my sister, same condition as me as a doctor who has her on 112mcg of Levo so her TSH can stay under 1. She told me we cannot compare because she does not know my sisters case!


They just don't understand and she is erring in caution (and I don't blame her as that's how they've been trained).

1 like

Thank you for educating me. :) I really appreciate the time you took to help me out.


Just bear in mind I'm not medically qualified but have had the same problems as many on this forum. Thankfully I'm fine now and hope everyone is able to do so as well.

1 like

You may also like...