Symptoms of Hypothyroidism

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). For example, T4 preparations are often ineffective for patients with Chronic Fatigue and Immuno-Deficiency Syndrome (CFIDS) and Fibromyalgia(FM). The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all CFIDS/FM patients.

A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable to T4 alone. However, the only commercially available form of T3 is synthetic liothyronine sodium (Cytomel®) in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects. Ultimately, it is the expertise of the prescriber, use and interpretation of appropriate tests, dosing of the T3 or T4/T3 combinations, and the formulation of the medications that determines the success of treatment.
N Engl J Med 1999 Feb 11;340(6):424-9

Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.
J Endocrinol Invest 2002 Feb;25(2):106-9