Thyroxine (T4) is a prohormone, and our body converts T4 to T3, the active form of thyroid hormone. Over the last two decades, there is increased awareness of the potential importance of triiodothyronine (T3) levels in patients on LT4 monotherapy. The situation clearly exists, and the normal stress of growth and development can exaggerate signs and symptoms. In pediatrics, there are limited published data on the topic of “persistent signs and symptoms consistent with hypothyroidism despite normal TSH,” but in CHOP’s Pediatric Thyroid Center, we see children with similar symptoms - such as fatigue, brain fog, constipation, dry skin, brittle nails, cold intolerance and others - even when their TSH and T4 levels are normal. Multiple factors of daily life come into play, including increased workload, increased pressures from school and work, poor sleep hygiene (decreased number of hours of sleep per night and late bedtimes), and social stress. For adults, the most common reported signs and symptoms include decreased ability to focus or concentrate (brain fog), fatigue, decreased energy, depressed mood, change in metabolism associated with a decreased ability to lose weight or an increased likelihood of gaining weight, and overall lower quality-of-life scores.Īs all of us are aware, these symptoms are not specific and they are common. Unfortunately, approximately 15% of adult patients who take LT4 only (monotherapy) report persistent hypothyroidism symptoms despite having normal thyroid stimulating hormone (TSH) and thyroxine (T4) levels. This is primarily because of predictable manufacturing that is regulated by the United States Food and Drug Administration (FDA) and one dose a day is enough to normalize thyroid hormone levels for the majority of patients. Since the 1970s, levothyroxine (LT4) has been the mainstay in the treatment of hypothyroidism.
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