My Thyroid Relief

MY THYROID RELIEF

Traditional Vs Natural Medicines for Hypothyroidism

Liliana Sierra T.
Hypothyroidism is a condition in which the body does not produce enough thyroid hormones. Thyroid drugs are used to supplement low thyroid levels in people with hypothyroidism. Thyroid hormone medications vary from patient to patient and what works for one person may not work for another.

Constant feelings of fatigue, anxiety, brain fog, and weight gain can be the result of delayed treatment. The right thyroid hormone medication can reduce thyroid antibodies and slow down progressive thyroid destruction, while also providing energy.

What is Hypothyroidism?

Hypothyroidism is a condition in which the body does not produce enough thyroid hormones. Thyroid drugs are used to supplement low thyroid levels in people with hypothyroidism. Thyroid hormone medications vary from patient to patient and what works for one person may not work for another.

Constant feelings of fatigue, anxiety, brain fog, and weight gain can be the result of delayed treatment. The right thyroid hormone medication can reduce thyroid antibodies and slow down progressive thyroid destruction, while also providing energy.

If you think you may have hypothyroidism, it is important that you get a blood test as it can be difficult to diagnose hypothyroidism without a lab exam.

Existing Medicines for Hypothyroidism

Levothyroxine is the most used medication for treating hypothyroidism. It is the synthetic version of the T4 hormone. T4 is a prodrug, and it’s not active in the body. It requires a process called “deiodination”, which converts T4 into T3 hormone, the biologically active compound. This is important, because taking a T4-only medication may not guarantee that you are going to normalize your thyroid hormones completely. The conversion of T4 to T3 doesn’t happen in the exact same way in every person, so this can result in unresolved symptoms. Some conditions that may impact this process are:
  • Age
  • Smoking and alcohol consumption
  • Fasting
  • Diabetes and obesity
  • Kidney and liver disease
  • Nutrient deficiencies
  • Pesticides and heavy metals
  • Other hormones imbalances
  • Surgery
Since the standard treatment is based on LT4 only, people may have high expectations that it would resolve all of their symptoms. But if it does not happen, it may lead to frustration and a negative experience [1]. This can be added to the fact that conventional doctors may not be familiar with other forms of treatment. In general, LT4 is a safe and well-tolerated option, and it’s low cost. It can be taken orally in the form of tablets, gel capsules, liquid, and can also be compounded by a pharmacist.

Traditional Medicines for Hypothyroidism T4 Medications: Levothyroxine (LT4)

The treatment for an underactive thyroid gland is usually hormone replacement therapy in addition to addressing the underlying cause. The most common options in the market are:
  • T4-only medications (levothyroxine): Generic levothyroxine tablets, Euthyrox tablets, Synthroid tablets, Levoxyl tablets, Tirosint gel caps, Tirosint liquid (Tirosint-SOL), and compounded T4 medications.
  • T3-only medications (liothyronine): Triostat, Cytomel, compounded T3 medications.
  • T4 T3 combination medications: these can be found in synthetic and natural vers A combination of synthetic versions of T3 and T4 are usually the compounded medications. The other option is the natural desiccated thyroid (NDT) extract obtained from pigs or bovines. Some brands of NDT medications are Nature-Throid, Armour Thyroid, NP Thyroid, and WP Thyroid.
Let’s get into how thyroid medications work and their differences, so you know which one is the best for you!

T3 Medications

LT4 monotherapy may not be able to restore normal thyroid function in all tissues of hypothyroid patients. And normalization of TSH levels, the lab test of thyroid function during treatment, might not ensure normal T3 in the body [2]. Also, for patients who have already tried T4-only medications in the optimal dose and have persisted with symptoms, T3 therapy should be considered as combined therapy with LT4.
This can make T3 levels fluctuate after oral administration [3], so they must be dosed by a practitioner with experience using them. Because of this, some studies show that taking liothyronine three times a day may be more beneficial than only once, but long-term studies are needed to support this use [4]. Another solution for this is having your doctor prescribe a sustained-release T3 medication from a compounding pharmacy. This way you can avoid having hyperthyroidism symptoms due to the rapid changes of the T3 hormone in your body.
Another option is Cytomel, the branded version of synthetic T3. It doesn’t contain gluten, but it also has corn starch as a filler, so consider this if you are sensitive to this food.

Combination Medicines: LT3 and LT4

For a group of patients who feel suboptimal on LT4 medication, combination therapy is beneficial and safe. It can better control the hypothyroidism symptoms and improve the quality of life [5]. In this situation, patients tend to prefer the combinations [2]. The British thyroid foundation found in an online survey made to 969 patients under treatment for hypothyroidism, that 77.6% of them were unsatisfied, and had the overall quality of life scores very low.
The survey showed that treatment with a combination of levothyroxine and liothyronine, or treatment with desiccated thyroid extract was associated with better-reported quality of life than LT4 or LT3 only therapies [1].
Some patients complain of palpitations and anxiety when first they change their treatment from LT4 only medication to combination therapy [5], since T4 and T3 levels may increase because of dosage adjustments.
It is important to know that prior to commencing combined therapy, other autoimmune conditions like type 1 diabetes, adrenal insufficiency, and celiac disease are ruled out [7]. Let’s talk more about that now!

Safety of Hypothyroidism Medications

Thyroid medications are generally well-tolerated and safe, but they should only be used by those with hypothyroidism under medical prescription. Here are situations in which taking these medications can be dangerous, so please, talk to your doctor if that is your case:
  • People who already have normal thyroid function and are looking to lose weight.
  • People that have adrenal insufficiency or Addison’s disease that is not well controlled.
  • People with Hyperthyroidism.
  • People with several underlying health conditions, or older individuals that already take too many medications.
  • Women during pregnancy and breastfeeding. Thyroid medications are generally safe, but it might be necessary to adjust the dosage or formulations, so don’t make any decisions on your own.
Clinical evidence suggests that a TSH level within the reference range is not a sufficiently optimal marker of adequate thyroid hormone replacement therapy in hypothyroid patients [8]. This can be explained for several reasons, and we will check the two most important now.

Absorption Problems

For optimal and consistent absorption, the American Thyroid Association recommends levothyroxine intake either 60 minutes before breakfast or at bedtime, at least 3 hours after the evening meal. ements for at least 4 hours [4].
This is because an acidic environment in the stomach, such as during fasting time, is important for intestinal absorption of an orally administered LT4, which is about 70-80%. Levothyroxine should also be separately taken from medications, and calcium or iron suppl
If you want more flexibility around meals, consider Tirosint gel caps and Tirosint-SOL since these formulations can be taken with food, tea, or coffee without compromising the absorption. When the dosage and the ingestion time are correct but there are still symptoms, an underlying malabsorption condition should be ruled out. You should be tested for Helicobacter pylori-related gastritis, atrophic gastritis, and celiac disease [6]. Talk to your doctor to get some tests and maybe change the formulation of your medicines mmended.
In some studies, also an association between thyroid autoimmunity and persisting symptoms has been found, even with normal thyroid function [9]. In these situations, a complete reevaluation of thyroid function is reco

Nutrient Deficiencies

Thyroid hormones do not work by themselves. They need vitamins and minerals in optimal levels to be normally produced and converted.
Unfortunately, too many people are undiagnosed from nutrient deficiencies, and it may perpetuate hypothyroidism symptoms leading to frustration and low quality of life.
The recommendation here is: talk to your physician and get a lab test, adopt a balanced and healthy diet, and take supplements as needed. Just remember not to mix them with your thyroid medications. And If you have gut issues, consider adding a probiotic.

Natural Medicines for Hypothyroidism

Natural desiccated thyroid (NDT) is a combination of T3 and T4 hormones in a T4:T3 ratio of 4:1. As many tissues are bioidentical, they are normally isolated from the thyroid gland of pigs and bovines. Some examples of these medications are Armour Thyroid, Nature Throid, and WP Thyroid.

Like all medications, desiccated thyroid may produce side effects when the dose is wrong or incorrect. Some side effects to look for are brain fog, tiredness, and lack of energy [2]. 

Further, some experts say there are safety concerns related to the use of natural thyroid extracts, such as excess T3 in the body [6], compared to the normal T4:T3 ratio that is about 15 to 20 -yes, 15 to 20 times more T4 than T3-. Excess of T3 hormone may trigger hyperthyroidism symptoms, and a rare, but severe reaction with alteration of mental status and fever [10]. 

However, other researchers have found better results from patients who switched from traditional medication to NDT, saying that they feel significant improvement in symptoms, have higher overall wellbeing, and perceive NDT as more effective than previous therapies [11][12]. 

Compounded Medicines for Hypothyroidism

Compounded thyroid medicines offer a tailored approach. For many patients, thyroid compounds are prepared in the same ratio found in NDT products, however, compounding pharmacists can change the amounts of T3 and T4 separately as needed since they must make them from scratch. 

The main benefit of compounded medicines is that they allow your physician to prescribe a specific formulation that is perfect for you, considering the dose, strength, and ratio of the thyroid hormones T4 and T3. 

For example, commercial T3 only exists as a fast-acting preparation, but may cause undesirable side effects such as pounding heartbeats, sweating more than usual, anxiety, and the highest. 

Compounding allows the pharmacist to make a sustained release preparation or lower doses of the immediate acting form, avoiding those side effects from adjustments. 

The pharmacist may also be able to change the formulation of the medication, so that it’s easier for you to take, such as turning a pill into a liquid or adding flavors. 

But the benefits do not end there. Food sensitivity and allergy problems due to fillers in the traditional and natural commercial forms can also be addressed by compounding T3 and T4. 

Hypoallergenic excipients such as cellulose-derived molecules can meet these criteria and are well tolerated. This could help avoid the use of dyes, sugar, gluten, grains, or soy as inactive ingredients that may alter the absorption process or cause inflammation. 

The downside of using compounding medicines is the fact that there are some concerns about safety and potency due to the lack of data proving superiority to standard preparations. The American Thyroid Association does not recommend its use, except for those with suspected allergy to an excipient that cannot be avoided with a change of brand or dose formulation [4]. 

Another disadvantage is that compounded T4/T3 prescription drugs need to be made by specially trained pharmacists, which may not be as easy to find as regular pharmacists. In terms of the medication itself, it often costs more.

With all that being said, compounded medicines are a great option that can provide an alternate solution for people who haven’t had good results with traditional or natural medicines.

Conclusions

In summary, hypothyroid medication should be based on your symptoms and needs. For some hypothyroid patients, synthetic levothyroxine will work well to control hypothyroidism and its symptoms. But for many, it will not be enough.
If you find that you still have hypothyroid-related issues after being treated with levothyroxine alone, such as fatigue, brain fog, depression, and difficulty losing weight, then it may be time to consider alternatives.
You can talk to your doctor to ask for a change of brands, or start a combination therapy with synthetic or natural medications.
Compounded medications are a great option for those hypothyroid patients who experience poor adherence to some hypothyroid treatment, intolerance to excipients in hypothyroid medicines, or allergy to fillers.
They may be more expensive, but they can offer you >personalized treatment for better results, and a better life!

References

1. Mitchell, A. L., Hegedüs, L., Žarković, M., Hickey, J. L., & Perros, P. (2021). Patient satisfaction and quality of life in hypothyroidism: An online survey by the British thyroid foundation. Clinical endocrinology, 94(3), 513–520. https://doi.org/10.1111/cen.14340

2. Escobar-Morreale, H. F., Botella-Carretero, J. I., Escobar del Rey, F., & Morreale de Escobar, G. (2005). REVIEW: Treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. The Journal of clinical endocrinology and metabolism, 90(8), 4946–4954. https://doi.org/10.1210/jc.2005-0184

3. Idrees, T., Palmer, S., Maciel, R., & Bianco, A. C. (2020). Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism. Thyroid: official journal of the American Thyroid Association, 30(10), 1399–1413. https://doi.org/10.1089/thy.2020.0153>

4. Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., Sawka, A. M., & American Thyroid Association Task Force on Thyroid Hormone Replacement (2014). Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid : official journal of the American Thyroid Association, 24(12), 1670–1751. https://doi.org/10.1089/thy.2014.0028

5. Tariq, A., Wert, Y., Cheriyath, P., & Joshi, R. (2018). Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life. Southern medical journal, 111(6), 363–369. https://doi.org/10.14423/SMJ.0000000000000823

6. Wiersinga W. M. (2019). T4 + T3 combination therapy: any progress? Endocrine, 66(1), 70–78. https://doi.org/10.1007/s12020-019-02052-2

7. Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in therapy, 36(Suppl 2), 47–58. https://doi.org/10.1007/s12325-019-01080-8

8. Biondi, B., & Wartofsky, L. (2012). Combination treatment with T4 and T3: toward personalized replacement therapy in hypothyroidism?. The Journal of clinical endocrinology and metabolism, 97(7), 2256–2271. https://doi.org/10.1210/jc.2011-3399

9. Groenewegen, K. L., Mooij, C. F., & van Trotsenburg, A. (2021). Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review. Journal of translational autoimmunity, 4, 100101. https://doi.org/10.1016/j.jtauto.2021.100101

10. Jha, S., Waghdhare, S., Reddi, R., & Bhattacharya, P. (2012). Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis. Thyroid: official journal of the American Thyroid Association, 22(12), 1283–1286. https://doi.org/10.1089/thy.2011.0353

11. Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. The Journal of clinical endocrinology and metabolism, 98(5), 1982–1990. https://doi.org/10.1210/jc.2012-4107

12. Toloza, F., Espinoza Suarez, N. R., El Kawkgi, O., Golembiewski, E. H., Ponce, O. J., Yao, L., Maraka, S., Singh Ospina, N. M., & Brito, J. P. (2020). Patient Experiences and Perceptions Associated with the Use of Desiccated Thyroid Extract. Medicine (Kaunas, Lithuania), 56(4), 161. https://doi.org/10.3390/medicina56040161

The content on mythyroidrelief.com, such as text, videos, graphics or images, and other materials, are for educational and informational purposes only. It is not intended to be a substitute for professional medical and nutritional advice, diagnosis or treatment. It should not be used as a substitute for medical consultation. The knowledge provided in this blog comes from the author's own experiences and research. Consult your doctor before making any decisions about your medical care.

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By Liliana Sierra T.

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