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Michael M. Kaplan, David H. Sarne, Arthur B. Schneider, In Search of the Impossible Dream? Thyroid Hormone Replacement Therapy That Treats All Symptoms in All Hypothyroid Patients, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 10, 1 October 2003, Pages 4540–4542, https://doi.org/10.1210/jc.2003-031436
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We tell our patients, “It’s really quite simple, your thyroid is not working (or has been removed or destroyed by our treatment). The tablet contains the natural hormone that your body cannot make. Don’t worry, you’ll be fine.” For many of our patients, T4 therapy resolves their symptoms and they are fine. For some, however, this therapy remains unsatisfactory, with the persistence of specific symptoms or a failure to regain a normal sense of well-being.
It is unclear how many patients fail to achieve satisfactory results, because dissatisfied patients are more likely to be referred or to seek advice from other physicians. A survey conducted in Bristol, United Kingdom, attempted to determine the degree of dissatisfaction with T4 therapy (1). Records obtained from general practitioners’ offices were used to create a roster of patients taking T4 and an equal number of controls. Two survey instruments, a well-established one related to feelings of general well-being and a second one containing questions related to the symptoms associated with hypothyroidism, were administered. Patients on T4 scored worse on both surveys. For the thyroid-specific survey, 48.6% of the 397 responding patients with a recent normal TSH and 35.0% of the 551 responding controls had scores indicating dissatisfaction with their health status. In other words, an excess of about 13 in every 100 patients had symptoms that might, in some way, be related to their T4 therapy.
