For a much fuller explanation of my approaches to all forms and grades of hypothyroidism, see:

          (1) Dommisse, John MD:  Best Kept Secret: A Successful Approach to  Underactive Thyroid Hormone Function.  'Wise Traditions', Journal of the Weston A Price Foundation, Washington, DC, Summer (June) 2009.  http://www.WestonAPrice.org

1.           (2) My definitive paper on the most sensitive diagnosis and optimal treatment of all types and grades of hypothyroidism.  For the full version of this ground-breaking paper, go to the "Order" section at the end of my home page and download or arrange shipping of The Natural Medicine Letter #8 (Vol. 4, No. 2, March, 2000), after paying $10 if downloaded, $15 if shipped.
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3.           (3) Illustrative case reports and commentaries on hypothyroidism in several other Natural Medicine Letters - see titles of these Letters for those that contain info on hypothyroidism.
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5.           (4) The long interview that Mary Shomon (author of "Living Well with Hypothyroidism", Avon WholeCare Paperback, New York, March 2000) did with me, under "Practitioner Perspectives" on the Thyroid.About.Com website.
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     Physicians should not be restricted to the brand name T4 hormone Synthroid, nor should they be restricted to only T4 products.  The former manufacturers of Synthroid (Boots Pharmaceuticals) were, a few years ago, reported by The Wall Street Journal to have commissioned an endocrinologist at a prominent SanFrancisco Bay area medical school to conduct clinical/ pharmaceutical research, which they hoped would show that Synthroid is the only stable and consistent brand of T4.  They also put up $250,000 to fund the research.  The article was accepted for publication by the Journal of the American Medical Association but was withdrawn when Boots pulled the article, as their legal contract with the medical school entitled them to do, when they discovered that all the T4 products tested, including Levoxyl (Jones Medical Industries) and Levothroid (Forest), had been found to be of at least equal, if not superior, quality!

     A large part of my practice consists of the optimal correction of underactive thyroid hormone - see Hypothyroidism Treatment.  I am not an endocrinologist, nor even an internist, but I have made an extensive study of the subject and now have 20 years of clinical experience in treating about 5,000 patients with this condition.  I would probably never have become so fascinated by it if, after having all my patients' nutrient and hormone levels measured for a full 10 years, I had not finally measured the same levels in myself and discovered an elevated TSH (thyroid stimulating hormone) level, indicating Primary Hypothyroidism, among other deficiencies and imbalances!  I was born with a thyroglossal cyst, which was removed when I was 12 years old;  in retrospect, it seems that my Hypothyroidism dates back to the surgery at age 12, which means that it went undiscovered for 36 years.  The physical and mental effects during those 36 years, compared to the first 12, and the past 22, years of my life, are clear to me now. But their origin was hidden from me, my physician father, and every physician I ever saw, for all that time.  I hope to not miss this condition, nor fail to treat it optimally, in any future patient.

     Armour Thyroid and Thyrolar (both by Forest Pharmaceuticals) are perfectly good T4/ T3 combination products, in my opinion.  The latter is synthetic (but bioidentical to your own T4 and T3 hormones), the former natural desiccated hog thyroid.  Actually, my favorite T4/T3 combination product now is Naturethroid (Western Research Labs), another natural desiccated hog thyroid product that has less additives - to which people can be allergic - than Armour Thyroid has in it.  Also, I must say that even the generics, Thyroid USP, are all good now, and are, of course, cheaper.  I believe the reason why all of them have been suspected, to a greater or lesser extent, of 'instability' is not because they are poor-quality products but because they are prescribed incorrectly, both in the sense of the wrong patients being chosen for this therapy (whose Free T3 levels are no lower than their Free T4 levels);  or because the Free T3 level is not done as part of the diagnostic work-up, nor in monitoring the Treatment for Hypothyroidism;  and because the necessary after-meals and twice-daily prescribing are not done.  The FDA even banned the use of Thyrolar temporarily, a few years ago.  The other important aspect of monitoring any T3-containing treatment for hypothyroidism is that NO DOSAGE SHOULD BE MISSED IN THE 24 HRS BEFORE THE BLOOD IS DRAWN.  This is because T3 is short-acting and can be very low within 8-12 hours of the last dose - not because it is the wrong dose but because it was not taken to maintain a stable 24-hr blood level.

     In someone on T4 whose Free T3 level is lagging, it is not only acceptable but desirable to add small to large doses of Cytomel or, possibly, the sustained release T3 (5-25 mcg), after brkfst and supper daily, as long as the patient does not have an acute life threatening illness.

     A concept that I find strange is that of 'subclinical hypothyroidism'.  This term used to refer to those cases which had TSH levels above its normal range but under 10 mIU.  Nowadays, the physicians who treat patients with TSH levels at all above its normal range, still sometimes refer to this degree of Hypothyroidism as either grade 2 (fair enough) or 'subclinical':  I have never seen a case that exhibited a TSH level above its normal range (with low-normal Free T4 and Free T3 levels) that did not have clear Symptoms of Hypothyroidism.  I can only conclude that physicians are not eliciting all the Symptoms of Hypothyroidism when making this assessment.  It can be debated that patients with a TSH level in the upper half of its normal range don't always have clear Symptoms of Hypothyroidism, yet, in my experience, they do.