JAMA 2/20/08, PAGE 769-777
It is well known that there is a distinct group of people who become hypothyroid and don’t return to normal feels of health even with fully normal serum T-4 free levels. Often the addition of T-3 replacement helps for a time but often energy flags after a few months.
This is an excellent scientific approach to the problem but in my mind will not have me do anything different.
I still don’t know the answer but I do know the way to approach this problem. In the main, patients usually will better by pushing T-4 free near the top, the TSH down near the bottom and use a healthy amount of Vitamin D3 (50,000) IU daily for a month or two.