THEODORE C. FRIEDMAN, MD, Ph.D. OPTIMIZING THYROID HORMONE REPLACEMENT Dr.

Friedman optimizes thyroid hormone replacement in all his patients. He bases this on 3 factors: how the patient is feeling, the patient's thyroid function tests, and side effect profile. The first issue is what thyroid medicine is the patient on Dr. Friedman gi!es !arious combinations of thyroid hormone replacement to patients depending on their circumstances and conditions. "ost of the time, he starts with T# replacement that could be $ynthroid, %e!o&yl, generic le!othyro&ine, or a new product called Tirosint which is a li'uid form of thyroid hormone in a gel that has no additi!es, preser!ati!es, or dyes. (f the patient is on T# treatment, Dr. Friedman primarily loo)s at the T$H and aims for a T$H between *.+ and ,.*. -ithin this range, Dr. Friedman may ad.ust the thyroid hormone dose slightly based on the patient's symptoms. (f the patient is ha!ing some hypothyroid symptoms, he might increase it so the T$H is near the bottom of the range and if the patient is ha!ing some hyperthyroid symptoms, Dr. Friedman may decrease the thyroid hormone so the T$H is near the top of this range between *.+ and ,.*. /t times, Dr. Friedman fine tunes the thyroid dosage by ha!ing the patient ta)e one dose + days a wee) and another dose on wee)ends. For e&ample, he may ha!e a patient ta)e 0** mcg of le!o&yl on wee)days and 00, mcg on wee)ends. Dr. Friedman puts some patients, especially those that are euthyroid on T# replacemenr and still ha!ing hypothyroid symptoms, on either an /rmour1T# combination or a T#1T3 combination. /lthough T# is long2lasting and most patients do fine on T#, there are many patients who do not con!ert T# to T3 properly and for this reason, Dr. Friedman uses some T3 preparations. /rmour has T# and T3 in it in a fairly good mi&ture and also contains other thyroid factors that may be beneficial. 3ecause the T# and T3 in /rmour is mi&ed in with other proteins, /rmour4s half2life is a little longer than if the patient is .ust ta)ing T3 which would ha!e a !ery short half2life. Howe!er, /rmour should be gi!en twice a day because of the T3 in it that has a short half2life. Dr Friedman adds T# to /rmour because /rmour has too much T3 in it by itself and therefore, Dr. Friedman would gi!e a little lower dose of /rmour and supplement with T#. (f Dr. Friedman gi!es T3 plus T#, he gi!es the T# once a day and the T3 dose two or three times a day, or he gi!es slow2release T3 compounded for daily use. (f a patient is on an /rmour1T# combination or T#1T3 combination, Dr. Friedman will often see a low T$H. Dr. Friedman does not li)e the T$H to be completely zero, but is comfortable with it being slightly below the normal range. Dr. Friedman would then aim for a free T# and free T3 in the mid2to2upper normal range with the T$H slightly below the lower range. The suppressed T$H occurs because the T3 in either /rmour or T3 'uic)ly suppresses the T$H after its administered and often leads to a lower T$H e!en though the free T# and free T3 are normal. (t is unli)ely the patient will ha!e side effects from ha!ing this suppressed T$H, but Dr. Friedman would watch carefully for any heart problems or osteoporosis.

5age , Dr. Friedman then e!aluates the patient's symptoms and is loo)ing for an impro!ement in the patient's hypothyroid symptoms. "ost of the time, the patient sees a fairly rapid impro!ement in his1her symptoms if he1she was truly hypothyroid. $ometimes, the patient needs a little bit longer

5age 3 time or a little ad.ustment of either the dose or type of thyroid medicine before an impro!ement is seen. (f there is no impro!ement seen, Dr. Friedman reassess the diagnosis of hypothyroidism and would loo) for other causes of some of the symptoms that may be o!erlapping with the symptoms due to hypothyroidism. Dr. Friedman also carefully monitors patients for side effect. For e&ample, too much thyroid hormone can gi!e palpitations, .ittery feeling, wired, trouble sleeping, and other symptoms of hyperthyroidism. (f this is the case, Dr. Friedman would bac) down on the thyroid hormone replacement. Dr. Friedman is aiming for optimal thyroid health and monitoring a patient on thyroid hormone replacement is crucial. For more information about Dr. Friedman's practice, please go to www.goodhormonehealth.com.