Thyroid Thicket - Part Three of Three

How do I get to GOOD?

Or, in other words, if my tests suggest something is amiss, what do I do? Let's just talk about hypothyroidism, which raises the possibility of replacing, by prescription, thyroid hormone. Hypothyroidism, whether overt or subclinical, takes a toll on normal physiology and will generally get worse if treatment is delayed. You have many options for treatment, starting with two special considerations:

1. If any of thyroid’s needed nutrients were low, you might decide to replace those (magnesium, zinc, iodine, selenium) and re-check your thyroid numbers. This is only a viable option for subclinical cases.
2. If you have elevated antibodies, and thus Hashimoto’s Thyroiditis, part of the program should be calming of the autoimmune tendency. Start with gluten avoidance, and consider a full autoimmune response. For more information, see a discussion of Hashimoto’s here. https://drdeborahmd.com/hashimotos-thyroiditis

Treatment of overt hypothyroidism should both enhance personal well-being and normalize blood tests. For those who want to avoid taking a prescription medication, I recommend a well-formulated glandular, containing dessicated preparations of whole thyroid glands. My favorite brand is Dr. Ron’s Thyroid Glandular (with Liver), containing 30 mg of  thyroid from grassfed New Zealand cows. Doses range from 1-3 capsules with each meal. There is a variable amount of thyroid hormone, with the nutrients that comprise a thyroid gland. This option is more “organic”, but more expensive as well as less consistent and predictable. For committed patients, it can work well.

For patients considering prescription forms of thyroid, the choice is essentially between dessicated whole glands – taken from pigs, standardized for predictable dosing, and synthetic hormones, manufactured to mimic our own natural versions of T4 and T3.

Frequently asked questions include:

1. What if I don’t like the feeling? Your experience is more important than your lab tests, in most situations.
2. Is this a permanent issue? Not always, by any means. I follow lab tests at least annually, and more often if people feel their situation changes. Particularly sub-clinical hypothyroidism is unlikely to be a permanent prescription, if other health considerations change.
3. What is the risk of this medication? I always say any side effect is possible with any drug, you tell me. The effect of any of these prescriptions is gone within hours to days, and I have never seen any serious reactions to thyroid, carefully prescribed.

Dessicated Thyroid

Dessicated thyroid in the US is made by three pharmacies, each with a different name, and each contains approximately 80% T4 and 20% T3, with non-specific but perhaps helpful doses of T1 and T2, as well as a small dose of iodine, along with other thyroid gland components. In clinical trials, patients generally feel “better” on dessicated thyroid: perhaps because they contain other thyroid components, or perhaps because the alternate synthetic forms contain so many “inactive” ingredients. I usually start people on dessicated thyroid, unless they clearly have a low Free T4 with an optimal (upper end of normal) Free T3.

1. NP Thyroid has the least inactive ingredients besides the active hormones, triglycerides from coconut and inulin, a fiber which can be difficult for some people to digest without bloating and gas.  No gluten, corn, artificial colors, and no FDA recalls for inconsistency. On average, the most affordable formulation with the use of a pharmacy discount plan such as GoodRx.
2. Natur-Throid boasts the greatest range of dosages over all other forms of prescription thyroid medication. No gluten, corn, artificial colors, and no FDA recalls for inconsistency.  
3. Most widely available, Armour has been taken by far more people and despite a history of FDA recalls for inconsistency, there hasn’t been a problem with dosage consistency or potency for the last ten years.

Synthetic Thyroid

Synthetic thyroid prescriptions were once considered the only safe route, as dessicated thyroid preparations couldn’t be well standardized. That all changed in the mid-1980’s, but you wouldn’t know it to talk with many thyroid prescribers, who favor the “consistency” of synthetics. Most of the synthetics contain artificial dyes.

1. Synthroid was the first and is the most well-known of T4 preparations, otherwise known as Levo-thyroxines. In any Synthroid pill, the amount of the pill that is taken up by T4 is very tiny, so fillers are needed, and they are numerous, ranging from natural sounding carnauba wax to polyethylene glycol, an industrial wax. There are many dosage levels for any of the T4 preparations, one of which is dye-free: Synthroid .05 mg.
2. Cytomel (or liothyronine) was the first and is the most well-known of T3 preparations, which are only rarely added as an additional prescription when someone receives levo-thyroxine. Because they are short-acting and can be stimulating, they might have the good effect of getting your head out of your soup, or – on the worrisome end – over-stimulating your heart. Conventional recommendations advise against T3 preparations in older people for fear of cardiac arrhythmias. I would have a lot of very sleepy and tired older folks if I took that advice.

A final prescribing option is to have your dose compounded at a compounding pharmacy. The potential benefit is an individually tailored dose, considering both symptoms and blood test results. The down side, ironically, is that the quality control of dosage is less precise than that of pharmaceutical thyroid preparations.

However thyroid replacement is prescribed, the goal is that the patient feels better and that the lab tests are normalized.  Some people are “delicate snowflakes” requiring several steps to tweak the prescription until every consideration is optimal. People with Hashimoto’s are most likely to fall into the snowflake category, partly because the magnitude of their inflammation changes, which affects the activity of their own hormones. Others are fairly hardy, and do well with a variety of prescriptions, and with a range of lab tests.

An important consideration, outside of the conventional medical world, in starting thyroid treatment is adrenal health. It is not uncommon for both glands to be suffering at the same time, and addressing one without the other usually creates short-term improvement and long-term confusion. Conventional docs tend to believe adrenal function is either perfect or absent, but most alternative or integrative practitioners have seen fluctuations in adrenal levels that are clearly subnormal and in need of attention. A topic for another day.