Updated December 16, 2014.

A reader writes:

I just had my thyroid tested by my doctor, and I was again told it was in the "normal" range. My doctor didn't recommend any other treatment. I have gained weight over the last two years. I have dry hair, and my biggest problem is that I'm tired all the time and I can't stay focused The TSH (thyroid stimulating hormone) test results for me were 0.91 and the normal range is 0.35 - 5.00. I know I haven't felt like myself the last couple of years. I am 45 so the doctor blames it on menopause and getting older. I've always been active (walking, or riding my stationary bike) - I have two teenagers I run around with and keep up with. So I'm not a couch potato by any means....
Any suggestions? I feel like I have to be my own doctor on this all the time now. Unfortunately, I switched jobs and so did the insurance, so the endocrinologist I had been working with (who was wonderful) is no longer available to me!!!! Also, I used to take "Synthroid" for my medication and I the last couple years I have been switched to the generic "levothyroxine," Could that have anything to do with it?

I get many emails like this from readers who have been diagnosed with hypothyroidism, and are receiving treatment, have test results that are firmly in the so--called "normal" range of TSH, and yet still don't feel well.
Thre reality is that despite treatment for hypothyroidism, many patients -- some even say the majority of you receiving thyroid treatment-- continue to have symptoms that may be related to your thyroid. Even after you've been diagnosed and are on thyroid hormone replacement drugs, you may have persistent symptoms such as continued weight gain or difficulty losing weight, depression, brain fog or difficulty concentrating, hair loss, hand/feet/facial swelling, intolerance to heat and cold, muscle aches and joint pains, constipation, carpal tunnel or tendonitis, high cholesterol levels, low sex drive, and difficulty getting pregnancy, among others.

What are some steps to take to move toward feeling better?

1. The first step for you is knowing your exact TSH level, and other key thyroid levels such as T4 and T3.

These levels allow you to help gauge where your doctor is in terms of treatment, and give you a common point of discussion.

Knowledgeable doctors know that a TSH of around 1 - 2 --- in the low end of the normal range -- is the normal level for people without thyroid disease, and they aim for this range in treating thyroid patients. Keep in mind that a doctor telling you your TSH is "fine" is not enough, because if your doctor is using the standard normal range of .5 to 5 , you could have a TSH of 4 and be told that you are "normal." (Note, some doctors are following a new, recommended TSH range of 0.3 to 3.0). In my own situation, I know I feel terrible at a TSH of 3.0 or above, and I get hyperthyroid symptoms at .1, but I feel well at around 1.5 or so. (NOTE: this TSH is usually kept even lower than 1-2 for thyroid cancer survivors to help prevent recurrence.)

ASK THE DOCTOR IF A NEW TARGET TSH MIGHT BE APPROPRIATE FOR YOU.

2. Another important step is to determine if you are on the right drug for you. The majority of thyroid patients are started out on levothyroxine, synthetic T4 drug, usually the Synthroid brand. But if you are not feeling well on Synthroid, or whichever brand you are on, you may want to ask your doctor about trying a different brand. The brands all have different fillers and binding ingredients, and some are more easily dissolved/absored than others, so some people find they do better on one brand versus another. The most available brands include Synthroid, Levoxyl, Levothroid, and Unithroid.

ASK THE DOCTOR IF A SWITCH TO ANOTHER BRAND OF LEVOTHYOXINE MIGHT BE APPROPRIATE FOR YOU.

If you still don't feel well, find out about the problems with generics, the need for T3, integrative approaches, and good doctors.