Treatment of hypothyroidism typically consists of levothyroxine. What is levothyroxine? It is a synthetic form of thyroxin. What is thyroxine? It is one of the two hormones – T4 and T3 – that your thyroid gland produces every day. T4 is the other name for thyroxine. It is called T4 because each molecule of thyroxine contains 4 atoms of iodine. The other names for Levothyroxine are brand names such as Synthroid, Levoxyl, Unithroid, Levothroid.
Levothyroxine Is NOT The Best Treatment Of Hypothyroidism
The best treatment of hypothyroidism is the one that is scientific, effective, and aim to cure hypothyroidism permanently. Unfortunately, the usual treatment of hypothyroidism – levothyroxine – does not meet these criteria as explained below. Hence, levothyroxine is NOT the best treatment of hypothyroidism.
1. Levothyroxine Treatment Of Hypothyroidism Is NOT Scientific
Why? Because levothyroxine is only one of the two thyroid hormones: T4 and T3. In fact, it is T3 – not T4 – that is the active thyroid hormone. T4 is simply a prohormone. Therefore, we need to focus on T3. In the body, T3 comes from two sources:
- Thyroid gland produces 6 – 8 micrograms of T3 per day.
- There is a conversion of T4 into T3 in almost all organs of the body.
Daily total production of T3 is about 32 micrograms (mcg.) About 75-80% (24-26 mcg) comes from T4 to T3 conversion. However, about 20-25% (6-8 micrograms) comes directly from the thyroid gland.
Therefore, if you are taking only levothyroxine (T4), you will still miss out on 20-25% of T3 that comes directly from the thyroid gland. In addition, conversion of T4 to T3 is not optimal in many patients, especially those with Hashimoto’s Thyroiditis.
Hence, treatment of hypothyroidism with levothyroxine alone is NOT scientific.
2. Levothyroxine Treatment Of Hypothyroidism Is NOT Effective
In a vast majority of patients, levothyroxine treatment of hypothyroidism is NOT effective. This is my observation after treating thousands of patients with hypothyroidism. Even though patients continue to complain to their physicians about their ongoing hypothyroid symptoms.
Unfortunately, most physicians ignore hypothyroid symptoms in their patients. Instead, physicians simply focus on treating a blood test called TSH. The main problem is that TSH itself is another unscientific approach to monitor the treatment of hypothyroidism.
3. Levothyroxine Treatment Of Hypothyroidism does NOT Cure Hypothyroidism
Levothyroxine treatment approach to hypothyroidism is like a band-aid approach. Because it simply tries to replace your thyroid hormone. And that too in a suboptimal way, as elaborated above. Levothyroxine does not cure your hypothyroidism, a misconception many patients have.
In order to cure hypothyroidism, first you have to find out what is the cause of it, right? Hashimoto’s thyroiditis is the root cause of hypothyroidism in the vast majority of patients.
What Is The Best Treatment Of Hypothyroidism
The best treatment of hypothyroidism should:
- Aim at replacing both T4 and T3.
- Treat patient’s symptoms and not just the blood test. Hence a careful, clinical but scientific monitoring is important.
- Try to cure hypothyroidism.
Replacing T4 and T3 for Hypothyroidism Treament
There are three different ways to give T4 and T3 to treat hypothyroidism.
Armour Thyroid or Nature-Throid or NP Thyroid
These are various names of the same basic preparation: desiccated thyroid. These are generally inexpensive pills and work very well for the treatment of hypothyroidism.
Desiccated thyroid has been around since the late 19th century. It was the standard treatment of hypothyroidism until the 1960’s when synthetic T4 hit the market as Synthroid. Gradually, synthetic T4 took over- thanks to aggressive marketing by the pharmaceutical industry. Finally, Synthroid became synonymous with “treatment of hypothyroidism.”
In the last couple of decades, some out-of-the-box physicians started to realize the flaws withT4-only therapy. Hence, they started to prescribe desiccated thyroid preparations.
These pills contain both T4 and T3 in the proportions present normally in pig and human thyroids: A ratio of 4:1. Each one grain is equal to 60 or 65 mg (milligram). It contains about 38 mcg (microgram) of T4 and 9 mcg (microgram) of T3.
Currently, some doses of Nature-throid, and NP thyroid are not available in the US. Find out about the alternatives to Nature-Throid and NP Thyroid
Desiccated thyroid is available as Thyroid in Canada, Thyroid-S in Thailand, Thyroid Extract in Australia, Thyreogland in Germany, and Whole Thyroid in New Zealand.
The process of making desiccated thyroid
Pork (and sometimes beef) is the usual source of Dessicated Thyroid preparations. The thyroid glands are dried (desiccated), ground to powder, combined with chemicals known as fillers, and pressed into pills.
Levothyroxine Plus Liothyronine
Some people do not like the idea of getting pills from animals. Or they may be allergic to pig or beef or one of the Dessicated Thyroid pills. In these patients, I prescribe both T4 (Levothyroxine, brand Synthroid, Levoxyl, Unithroid, Levothroid) and T3 (Liothyronine, brand Cytomel). I give T4 and T3 in a ratio of about 4:1 to mimic the normal daily production of these hormones.
For example, I may give a patient a daily dose of T4 (Levothyroxine) as 100 mcg and T3 (Liothyronine) as 25 mcg. Sometimes, I use a ratio of T4 to T3 as 3:1, especially in my obese individuals in whom T4 to T3 conversion is often impaired.
Customized T4 and T3 Combination Preparation from a Compounding Pharmacy:
Sometimes, using T4 (Levothyroxine) and T3 (Liothyronine) in the correct ratio can be tricky. Why? Because T3 (Liothyronine) comes only in three strengths: 5, 25 and 50 microgram tablets. T4 (Levothyroxine) is available in many strengths, but still the precise amount for an individual may fall in between the two strengths. Then, it becomes difficult to precisely titrate the dose.
Some individuals are very sensitive to slight changes in T3 or T4. In these patients, I sometimes resort to compounding pharmacies, which can compound T4/T3 combination according to the formula I write down.
Why T4 and T3 Combination Does Not Work?
Due to pressure from patients, some physicians may reluctantly prescribe T3. However, many are afraid to use T3, as they do not have in-depth knowledge about the intricacies of T3, T4 and TSH. Therefore, they will use only a small dose of T3 such as 5 mcg of Cytomel. Consequently, you will continue to suffer from hypothyroidism. Then, you may think that even T3 did not work for you.
You need to find a physician well-versed with T4 and T3 combination for the treatment of hypothyroidism.
Allergy To Dessicated Thyroid
If you develop allergy to any drug, you may be allergic to the drug (active ingredient) or the filler (inactive ingredient). In the case of Dessicated Thyroid, you may be allergic to pig, beef, or the fillers. For example, Armour thyroid was reformulated in 2009, and corn-starch was added as a filler. Since then, a lot of individuals have reported allergic reactions to Armour Thyroid.
If you develop an allergic reaction to one of the Dessicated Thyroid pills, and you are not allergic to pig or beef, then it is likely that you may be allergic to one of the fillers. Various Dessicated Thyroid preparations have various fillers in them. Therefore, it is worthwhile to switch to a different Dessicated Thyroid preparation.
Sometimes, you may need to switch from Dessicated Thyroid to synthetic T4 (Levothyroxine) and T3 (Liothyronine, brand Cytomel) for the treatment of hypothyroidism. Alternatively, you may decide to go to a compounding pharmacy.
When To Take Thyroid Hormone?
All thyroid hormone pills should be taken on an empty stomach, in the morning. Don’t eat for about one hour. Wyh? Because it enhances the absorption of the thyroid hormone. However, if T3 is a large dose, such as more than 15 mcg (microgram), it should be split into two doses: One dose in the morning and a second dose before lunch.
Do not take calcium or iron pills at the same time when you take thyroid pills. Why? Because these vitamin supplements may interfere with the absorption of thyroid hormone.
Which Drugs May Interact With Thyroid Pills?
There is drug-to-drug interaction between Thyroid hormones and several commonly prescribed drugs. This may be one of the reasons why some patients face difficulty in the treatment of hypothyroidism.
Many women take Estrogen such as Oral Contraceptive, and Oral estrogen pills (PREMARIN, ESTRACE etc.)
Estrogen increases TGB (Thyroid-Binding-Globulin). Consequently, your blood level of total T4 and total T3 gets elevated, but Free T4 and Free T3 levels are usually normal.
2. Warfarin (COUMADIN):
The addition of thyroid hormone makes you more sensitive to warfarin, the dose of which needs to be decreased. Test for clotting, such as INR, should be done more frequently until you have achieved a stable dose of warfarin.
3. Drugs That can decrease the absorption of thyroid hormone.
Therefore, these agents should be taken at least four hours after thyroid hormone:
- Grapefruit juice
- Ciprofloxacin and similar antibiotics
4. Drugs that can decrease the level of thyroid hormone in the blood.
Consequently, your physician may titrate dose of thyroid hormone upwards if you are on any of the following drugs.
Clinical Monitoring of the Hypothyroid Patient
A careful, clinical but scientific monitoring is an important aspect of treatment of hypothyroidism. A good thyroid physician listens to her patients carefully. She takes into account patients’ symptoms of hypothyroidism while interpreting the results of Free T3, Free T4 and TSH. Sometimes, a physician needs to tweak the doses of T4 and T3 to get rid of patient’s symptoms of hypothyroidism.
Curing Hypothyroidism When Possible
A good thyroid physician get to the root cause of hypothyroidism. Among others, Hashimoto’s thyroiditis is the leading cause of hypothyroidism. The good news is that it can be cured.
Treatment of hypothyroidism is complex. Only a physician who has an in-depth knowledge of T4 and T3 is able to adequately treat hypothyroidism scientifically. In addition, physician must try to find out the root cause of hypothyroidism and cure it if possible.