This is Part 1 of a 3-part series on the Ultimate Guide to Thyroid Medication:
- Part 1 – [You Are Here] – The Ultimate Guide to Thyroid Medication (the Good, the Bad, and the Ugly)
- Part 2 – 3 Simple Rules to Supplementing Thyroid Hormone the Right Way
There’s a lot more to your thyroid medication than you might realize.
Sure, as with most medications and drugs today we are led to believe that all we have to do is pop a pill and somehow it just magically works as expected and everything will be OK.
But what happens when it doesn’t?
Well, the reality is that in the case of thyroid medications, it almost never does…
…which is why today we’re NOT going to be talking about useless medical theory that sounds great on paper.
Instead, we ARE going to be covering the practical experience… the good, the bad, and the ugly of thyroid medications and how they actually work in the “real world”.
Finding What Works Best For YOU
When working with clients, we sometimes spend a good amount of time discussing what options might work best for them.
And in most cases, I find they are using the wrong medication… or using the right medication in the wrong way.
I’ve personally had dozens of clients who have seen drastic improvements just by changing to a source of thyroid hormone more appropriate for them.
In case you missed that, let me repeat “a source of thyroid hormone more appropriate for them.”
When it comes to thyroid medications and supplements, there’s no one best option that works for everyone.
I wish there was, but there’s not.
The type of medication or supplement that would work best for you can be quite individualized depending on the underlying problems that are driving your thyroid condition.
(Note: If you haven’t seen it, I discuss many of these underlying problems and how we address them in this article here.)
And oftentimes determining what works best for you requires a little experimentation to see what your body responds to best.
In other areas of medicine we see this all the time.
In cancer treatment, it’s not uncommon for doctors to try multiple anti-cancer drugs or even combinations of drugs until they find what works the best for a specific type of cancer.
But when it comes to hypothyroidism… I guess the medical system doesn’t think your quality of life is quite as important.
While this is not designed to be a comprehensive list of every available thyroid medication option…
…let’s cover the most commonly used thyroid medications you might be using or might want to work with your doctor to take for a test drive.
If you’re unsure of which category your supplement or medication falls under, you should ask your doctor or do a little research and look at the manufacturer’s website.
1. T4-Only Medications
Here’s quick list of some commonly prescribed T4-Only medications:
T4-only medications like Synthroid and Levothyroxine are by far the most commonly prescribed thyroid medications used today.
In fact, Synthroid is the most prescribed drug of all drugs today.
Unfortunately, these are pretty much the worst options too, which means that they are doing millions of people a great disservice.
We’ll have to dig deep here, because by themselves, T4-only medications tend to cause more problems than they solve.
However, there are cases when T4-only medications can provide some benefit.
For example, when your thyroid gland becomes blocked resulting in a significant drop in your T4 level.
However, this rarely if ever is the only thyroid issue at hand. And in almost every case the addition of T3 is warranted.
Or if you have a goiter or enlarged thyroid and we need to slow the production of thyroid hormone produced by your gland in order to allow your gland to unload its stored thyroid hormone slowly.
In this event, the addition of T3 is almost always warranted as well.
Yet, in some cases, T4-only medications can be better than nothing at all.
T4 is the inactive form of thyroid hormone that must first be converted into the active T3 version of thyroid hormone before your body can actually use it.
This T4 to T3 conversion takes place in your liver.
Unfortunately, almost all hypothyroidism sufferers quickly develop liver dysfunction, which impairs your ability to convert your T4 medication into usable T3 thyroid hormone efficiently.
I talk about this in detail along with simple ways to fix this in this post on How to Heal Your Thyroid By Healing Your Liver.
In other words, for most hypothyroidism sufferers, T4-only medications are more often than not useless, and oftentimes dangerous.
I’ll explain what I mean by dangerous in just a second.
Yet, this is the most common reason why you may still be experiencing all of the same thyroid symptoms even after long term use of your T4 thyroid medication… and even when your thyroid labs are within the “normal” range.
There are now plenty of studies showing just how ineffective T4-only medications are.
For example… the following study showed that the test subjects using T4-only medications experienced worse thyroid symptoms than test subjects that received no treatment whatsoever.
Journal of Nutritional & Environmental Medicine (2001), 11, 159–166
Yet, the medical system still continues to push T4-only medications as the best available option.
But, what about when T4-only medications become dangerous and cause more harm than good?
When your liver can’t convert T4 into useable T3, then what happens to all that T4 you’re medicating with?
It tends to build up in your system and shuts down your thyroid gland.
Keep in mind that your thyroid gland produces both T4 and T3… so this can result in a further drop in your useable T3.
This is oftentimes the main reason why many feel worse after using T4-only medications or fail to improve no matter how much T4 they use.
2. Desiccated Thyroid
- Natural Desiccated Thyroid (NDT)
Desiccated thyroid has been used for well over 100 years and was the thyroid medication of choice long before synthetic T4-only medications were designed in a lab.
It is derived directly from the thyroid glands of pigs and/or cattle depending on the brand of the medication or supplement.
One of the biggest benefits of desiccated thyroid is that the thyroid hormone it contains is far better matched to what your thyroid gland naturally produces.
Your thyroid gland produces both T3 and T4, making T4-only medications quite unnatural from a physiological perspective.
For many of my clients who come to me using T4-only medications and have not tried desiccated thyroid, I generally recommend that they start there.
And it’s typically easier to get a prescription for desiccated thyroid than some other options.
But unless you are working with someone qualified to understand your lab results and help you in more depth, desiccated thyroid is generally a safer option.
And research studies continue to show that compared to T4-only medications patients prefer desiccated thyroid.
However, there are also problems with desiccated thyroid as well which is why some people don’t respond well.
But it’s important to understand that if you don’t respond well to desiccated thyroid, it’s not “typically” an issue with the medication itself.
It’s typically an underlying issue with you that needs to be fixed, which I’ll explain in a second.
Many doctors are not open to the idea of using desiccated thyroid with their patients. If your doctor is one of them, then it might be time to start looking for a new doctor…
…one that will listen to you and truly has your best interests at heart.
As I mentioned, some people don’t respond well to desiccated thyroid for a couple of reasons.
Many hypothyroidism sufferers respond negatively to desiccated thyroid because they are very sensitive to the active T3 thyroid hormone it contains.
(Note: I talk about how to use thyroid hormone in this post on the “3 Simple Rules to Supplementing Thyroid Hormone the Right Way”)
For many, using a thyroid medication or supplement containing T3 can cause elevated heart rate, heavy breathing, and feelings of stress and anxiety.
If you’ve ever experienced this then you know exactly what I’m talking about.
But the important thing to understand is that just because you can’t tolerate T3 (right now)…
…it doesn’t mean that you don’t need T3 (quite the opposite).
Elevated stress hormones are by far the most common cause when it comes to not being able to tolerate T3.
Because when you become hypothyroid your body compensates by over-activating your stress response.
For many, this means very high levels of adrenaline.
And T3 tends to make you much more sensitive to the effects of adrenaline.
In other words, too much T3 will amplify the effects of adrenaline causing those symptoms of increased heart rate, anxiety, and other high stress symptoms.
This is one reason why you might want to be careful when using thyroid medication containing active T3 when you’re already in a stressed state.
But as I mentioned, this is not a problem with the medication, it’s a problem with you that needs to be corrected by properly de-activating your stress response.
Do that and your tolerance for thyroid hormone will improve dramatically.
Another problem with desiccated thyroid medications is that some people can’t digest and absorb them properly.
And when you can’t digest and absorb the thyroid hormone from your medication, you tend to experience little to no positive benefits.
Oftentimes this is due to various fillers and binders used in the production of the tablets.
For example, with Armour Thyroid, some people cannot break down the cellulose (fiber) component within their digestive tract, so it just passes through and is excreted without being absorbed.
The bottom line is… if you can’t absorb the thyroid hormone, it’s not going to do you much good.
3. Compounded Thyroid
Compounded thyroid is thyroid hormone containing T3 and/or T4 that is specially formulated or customized through what is called a compounding pharmacy.
Oftentimes it is very similar to standard desiccated thyroid medications but with certain tradeoffs.
One of the biggest benefits of using a compounded pharmacy is that they have the ability to customize or adjust the strengths or ratios of T3 and T4 outside of what is commercially available with desiccated thyroid medications.
So, in a perfect world where you knew the perfect ratio of T3 and T4 that works best for you, it could be made to order.
Another benefit of compounded thyroid is that compounding pharmacies can also control the additional inactive ingredients that are added to the formula which you might be sensitive to as well.
This can be a benefit to people with severe allergies to certain ingredients commonly used in many types of thyroid medications.
Like desiccated thyroid, compounded thyroid also oftentimes contains fillers, binders, and time release components that can negatively affect your ability to digest and absorb the hormones.
And even though compounded thyroid can be customized to your needs, it is rarely if ever done properly.
And in reality, the amount of thyroid hormone you may need at any given time can change depending on a number of variables from seasonal climate changes to changes in your stress levels.
For example, I had a client who over the course of three months made a miraculous recovery.
Then after her father passed away unexpectedly, the amount of stress she was under set her back significantly.
While we can’t always control stress, we can learn how to compensate for it through proper diet and supplementation.
And after making some adjustments to her diet and thyroid hormone, this particular client was able to stabilize her thyroid function and prevent further regression.
The inability to adjust the dosage is really a problem with most types of thyroid medications including desiccated thyroid.
Unless your doctor is willing to work with you and take the time to properly monitor how you’re responding to your thyroid medication, it can be difficult to find a single dosage of thyroid that works best year round.
There is a common problem among compounding pharmacies in that they typically do not do a good job producing a standardized product.
In other words, there tends to be variations in the actual amount of thyroid hormone from batch to batch.
In my experience in working with clients using compounded thyroid, it’s not the most reliable option.
In many cases, my clients have had to switch from a compounded thyroid medication to something more reliable and the results in some cases have been remarkable.
4. T3-only Medications
T3 as mentioned above is the active or useable form of thyroid hormone on which you and your cells thrive.
Because T3 is the useable form of thyroid hormone and doesn’t need to be converted by your liver it has a much better chance of being used by your cells.
Or in other words, T3 generally works better, makes you feel better, and is much more effective at improving your thyroid function and health.
(Note: Simply taking T3 does not mean that your body will be able to use it. There are still places along your Thyroid Hormone Pathway that can block your cells from using T3 as covered in this article on How We Overcome Hypothyroidism When All Else Fails.)
T3 is also found in both desiccated thyroid and almost always in compounded thyroid, so this applies to those types of thyroid medications as well.
But I also want to cover some important points specific to T3-only medications.
Similarly to compounded thyroid, using T3 alone provides a much greater degree of flexibility with adjusting your dosage.
But since it’s T3-only, you can also adjust the amount on an as needed basis.
It can also very effectively be paired with T4-only medications, desiccated thyroid, or any other T3/T4 combination medications.
This really allows you to completely fine tune your dosage to meet your specific individual needs… including the timing of when you take it and how often you need to take it during the day.
Many of my clients have favored this approach among all others.
There’s a general fear of T3 in the medical community making it more difficult for patients to get it prescribed.
This goes for desiccated thyroid as well, but even more so for T3-only medications.
Working with my own clients, I’ve found that most doctors are completely opposed to the idea of giving T3 to their patients.
Some of my clients’ doctors are open to the idea but simply don’t know how to because they are entirely uneducated on how to use and prescribe it.
And based on the dozen or so of my clients who have been prescribed a T3-only medication by their doctor, only two were using it properly.
It is this general unawareness and uneducated use of T3 that accounts for the vast majority of negative responses that patients experience when using it.
As mentioned with desiccated thyroid, some people with poor diet and who compensate with a large over-production of adrenaline can’t tolerate much T3.
Too much T3 at one given time can make you very sensitive to adrenaline resulting in almost hyper-thyroid like symptoms… elevated heart rate, sometimes heart palpitation, anxiety, feel extremely stressed, etc.
Yet, this doesn’t mean that you can’t use T3 or even that you shouldn’t.
You may simply need to adjust the dosage properly while you address your over-active stress response through proper diet.
It’s also important to note that with certain heart conditions, T3 should be used with extreme caution and generally in very small amounts while being closely monitored by your doctor.
Keep in mind that your heart does depend largely on T3 to remain healthy and function properly.
But when the heart is in a weakened state, stimulating it too much with too much thyroid hormone can sometimes over-stress the heart.
So, there you have it.
That’s a fairly comprehensive overview of thyroid meds.
Now the question is…
…if your thyroid medication isn’t working for you, are you going to take what you’ve learned and push your doctor to try a medication or supplement that might be more appropriate?
Or is it going to take something as serious as cancer before finding the right medication or supplement for you becomes a priority?