The biggest human temptation is to settle for too little.
Many Hypothyroid Mom readers ask which thyroid drug is best. My answer is always the same, “I wish there was one thyroid drug that worked for all of us but the reality is that we each react differently to the different medications. We must work closely with our doctor to investigate which treatment is ideal for us and what dosage is optimal.” The key is that you must know all the treatment options to ensure your doctor is exploring the options to find what’s right for you. If you are being treated with thyroid hormone replacement medication but you still don’t feel well, insist on further exploration. If you are still not feeling well, get a second opinion, a third opinion, even ten medical opinions until you find a doctor that explores the options to find what’s right for YOU.
Thyroid Drug Options
Mary Shomon included the following information at About.com Thyroid Disease.
Levothyroxine is the generic name for the synthetic form of thyroxine, a thyroid hormone replacement drug. This drug contains the synthetic form of one thyroid hormone, T4. Levothyroxine is the most commonly prescribed thyroid hormone replacement drug.
Brand names in the U.S: Synthroid, Levothroid, Levoxyl, Unithroid
Brand names in Canada: Synthroid, Eltroxin, and PMS-Levothyroxine
Brand names outside U.S.: Euthyrox, Thyroxine, Berlthyrox, Droxine, Eferox, Elthyrone, Eltroxin, Eutirox, Letrox, Levaxin, Levotirox, Levothyrox, Levotiroxina, Oroxine, T4KP, Thevier, Throxinique, Thyradin, Thyradin S, Thyrax, Thyrax Duotab, Thyrex, Thyro-4, Thyrosit, Thyroxin, Thyroxin-Natrium, Tiroidine
Mary also included an article on a thyroid medication called Tirosint. The levothyroxine in Tirosint is in a liquid form inside a capsule.
There are synthetic T3 drugs like Cytomel. Through a compounding pharmacy, there are also prescription compounded T3 drugs including time-released T3.
Natural Desiccated Thyroid
Brands include Forest Lab’s Armour, and Nature-throid and Westhroid by RLC Labs. There is a generic version of NDT made by Acella Pharmaceuticals. Canada’s desiccated thyroid made by Erfa is called Thyroid. There are also compounding pharmacies worldwide that produce compounded versions using the raw natural desiccated thyroid powder.
Find The Right Thyroid Treatment For YOU
We are each unique with individual sensitivities. Our bodies will NOT all react the same to these different medications. The dosages that are ideal for each of us will also vary. Our uniqueness is what makes finding the right thyroid treatment tricky.
Thyroid hormone replacement drugs are powerful, so powerful they can kill you if not taken properly. This is why it is critical to be under careful medical supervision when on these drugs, especially careful when starting a new brand or increasing dosage level. Call your doctor immediately if you experience adverse reactions.
1. Sensitivities to the fillers used in the medications
Chris Kresser at Medicine For The 21st Century wrote a great post 3 Steps To Choosing The Right Thyroid Hormone:
Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in a previous post, most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose).
Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.
Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.
Compounded T4/T3 products offer another alternative. These medications also offer the advantage of being made without fillers such as lactose or gluten, which are present in some thyroid medications and can be problematic for thyroid patients.
However compounded T4/T3 products need to be prepared by a specially trained compounding pharmacist. These compounds are usually much more expensive and may need to be refrigerated to preserve activity.
Thyroid compounds are usually prepared in the same physiological ratio that is found in Armour®, however, physicians can elect to change the amount of T3/T4, as the compounding pharmacists are literally making the medications from scratch. This can be a huge advantage for those patients that did not feel well on conventional treatments or natural desiccated treatments.
2. A gentle start to dosing
My doctor increased my thyroid drug dosage gradually in an incremental fashion until she found the dose that was optimal for me. She adjusted my dosages by regularly monitoring my Free T4, Free T3, Reverse T3 and thyroid antibodies and most importantly by listening to my symptoms. I contrast that with the stories I hear from readers of their adverse reactions to their doctor’s prescription for sudden large dosage increases and medication brand switches at high doses. T3 drugs such as Cytomel and natural desiccated thyroid have active T3 in them which for some people can be stimulating for the heart and cause heart palpitations. It is critical to have a gentle start.
In the book Thyroid Power, Richard Shames and Karilee Halo Shames wrote:
Some people do not want to take the time to start with a mild dose, adjusting to their medication gradually. However, we have found that the slow, step-by-step method of reaching your optimal dose is more easily tolerated by the body than the “sock it to me” approach so characteristic of our fast-paced culture.
3. The need for T3 treatment
In mainstream medicine, T4 drugs like Synthroid are the gold standard for treatment of hypothyroidism. While these drugs work for some, for many of us these drugs fail to relieve our symptoms. Our bodies need to convert the T4 in these drugs to the active useable thyroid hormone T3. However for many hypothyroidism sufferers, our bodies don’t convert the T4 to T3 and we are left suffering symptoms. If you are on T4 only drugs and you are still not feeling well, speak with your doctor about testing your Free T3 levels to determine if you would benefit from T3 medication.
Many of us report feeling our best on natural desiccated thyroid. However others report not reacting well to NDTs and responding better to synthetic T4 and T3 drugs. Even with natural desiccated thyroid, many of us feel great on one brand but terrible on another. Again we are each unique and it’s about finding what works best for you.
4. Finding your optimal thyroid levels
Many hypothyroidism sufferers are not feeling well despite treatment because their lab results are in the “normal” range but not at the optimal level for them.
Mary Shomon included this great article at About.com Thyroid Disease.
More innovative doctors are beginning to believe that a TSH of around 1 -2 —in the low end of the normal range — is optimal for most people to feel well and avoid having hypothyroid or hyperthyroid symptoms. Similarly, some practitioners feel that optimal hypothyroidism treatment includes Free T4 in the top half of the normal range, and Free T3 in the top 25th percentile of the normal range.
If you are being treated with thyroid hormone replacement medication but you still don’t feel well, insist on further exploration. If you are still not feeling well, get a second opinion, a third opinion, even ten medical opinions until you find a doctor that explores the options to find what’s right for YOU.
Thank you Sarah Downing for including Hypothyroid Mom in your guest post at ThyroidChange How To Be A Good Doctor – 10 Patient Tips. Sarah also has her own blog Butterflies and Phoenixes (sarahjdowning.com) where she writes about thyroid and chronic illness.