When scientists monitored the levels of TSH, free T3, and free T4 in people with hypothyroidism who were taking combination thyroid medications over a 24 hour period, they found that TSH levels may be falsely suppressed for 5 hours after taking a T3 containing medication. Right after taking a T3 containing medication, the TSH level begins to drop and stays suppressed for 5 hours. The TSH level then begins to increase again 5 hours after the dose and continues to rise until 13 hours after the last dose, after which point it stays stable.
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Conventional medicine today grossly underestimates the importance of optimal hormone levels. It remains disease-oriented, stuck in the mid-20th century. Endocrinologists are taught only to recognize and treat severe hormonal deficiencies caused by some identifiable disease, and to provide only enough hormone replacement to "normalize" certain tests. They claim to practice clinical endocrinology, but instead they ignore the patient's signs and symptoms and the complexities of the endocrine system.
The practice "Reference Range Endocrinology"; accepting any hormone level anywhere within the laboratory's reference range as "normal", meaning "no disease". They fail to understand the persons have various degrees of hormone resistance. They fail to understand the interactions among hormones. They fail to understand that the laboratory ranges include 95% of a group of "apparently healthy" adults who were not screened for symptoms. The reference range includes almost everyone! Worse, they ignore a person's actual thyroid levels and symptoms and rely almost entirely on the TSH test to deterimine their thyroid hormone status.
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