Thyroid Controversies
In This Chapter
- Avoiding bad practices
- Comparing synthetic and natural medications
- Comparing brand name and generic medications
- Avoiding unsafe remedies
If you research thyroid disease online or skim through other thyroid books, you’ll quickly be struck by the wildly different theories competing for your attention. Some will scream that mainstream doctors can’t be trusted. Others will claim that alternative doctors are quacks. Some will declare that taking synthetic medication is insane. Others will tell you natural medication is unreliable. Further, each side makes an argument that, at first blush, sounds convincing.
These battling schools of thought can be terribly confusing even to experienced doctors, let alone a patient just starting to learn about the thyroid. This chapter will therefore gently guide you through the most common thyroid controversies you’re likely to encounter as you explore potential physicians, talk to friends, and cruise the web.
Why the Thyroid Breeds Controversy
Few other medical problems inspire as much heated debate as thyroid disease. Part of the reason is the ubiquitous nature of the thyroid, which behaves like your body’s thermostat, controlling how much or how little energy you receive. This affects dozens of functions throughout your system, ranging from how quickly you lose weight to how much you want sex to how happy you are. All this can make the thyroid appear to have mysterious and magical powers … and that mystical aura tends to attract eccentrics and quacks.
Further, the wide range and subtlety of thyroid problems can make them difficult to diagnose. There aren’t many disease states whose very existence is debatable, and the frustration this creates for patients naturally leads to strong feelings and passionately expressed opinions.
There are also genuine issues involved. Many mainstream doctors have fallen into bad habits, such as focusing on blood tests to the exclusion of symptoms, relying on health ranges suggested by labs rather than by thyroid experts, and prescribing only high-priced synthetic medications when inexpensive traditional drugs often do a better job.
At the same time, there are alternative doctors who stray from sound scientific practices, or even common sense, championing approaches that pose serious risks to their patients.
Another reason for the heat is an evolution in the doctor-patient relationship. It used to be that your doctor told you what to do and you did it, no questions asked. Many modern patients aren’t satisfied with such a one-sided arrangement; they want to actively participate in their diagnosis and treatment. And when it comes to the often subtle symptoms of thyroid disease, that’s absolutely appropriate.
What’s unfortunate is that the discussion is so frequently framed as an “us against them” battle. There are extremely positive aspects to the strategies of both mainstream and alternative thyroid doctors, to the views of both doctors and patient advocates, and so on. People tend to get in trouble when they cut themselves off from the perspectives of others and become tunnel-visioned.
The key to success for a good thyroid doctor is having a balanced approach. And that’s the attitude you should take with each controversy: a healthy mix of openness and skepticism.
Broda Barnes and Basal Temperature
One of the champions in the history of thyroid disease is Dr. Broda Barnes. Barnes was a prominent voice in correctly declaring hypothyroidism as a vastly underdiagnosed illness. He also pointed out that doctors fail their patients if they focus so much on lab test results that they neglect paying close attention to patient symptoms. And he was an advocate for desiccated thyroid medication at a time when this important option was in danger of being wiped out.
In addition, Barnes and his co-author Lawrence Galton wrote the seminal 1976 book Hypothyroidism: The Unsuspected Illness, an exceptionally readable and compelling description of thyroid disease as Barnes understood it.
Barnes did fine work for his time; and his charismatic advocacy for a more organic approach to thyroid disease has won him followers who continue to use his methods. However, science has progressed since the days when Barnes practiced medicine. Certain techniques that he advocated 50 years ago simply aren’t relevant in the twenty-first century.
Most prominently, Barnes advocated a diagnostic technique called the basal temperature test. This involved a patient placing a thermometer in his armpit for 10 minutes right after waking up. The reasoning was that a slowed metabolism results in a lower body temperature, and so a temperature of 97.8°F or below was evidence of hypothyroidism.
There are problems with this technique, though. Small variations in how a patient performs the test can create substantial differences in the result. There are other factors that can affect body temperature. And some temperatures Barnes considered evidence of a problem are now known to be normal for many patients.
Barnes developed the basal temperature test because the lab tests available in his time were woefully inadequate. Since then, however, medical science had made enormous progress. Labs can now process a small sample of your blood and provide remarkably precise and accurate information about how well or poorly your thyroid is performing.
So if you run across anyone who claims lab tests are useless and the only proper tool for diagnosing your thyroid’s condition is the basal temperature test, that person is living in the past.
Along the same lines, if you learn a doctor you’re considering bases her practice on the techniques of Barnes, seek a different doctor who has the same spirit of caring and attention to symptoms as Barnes did, but is also committed to using modern medical tools.
Wilson’s Syndrome
In the late 1980s, E. Denis Wilson, a Florida doctor, declared he’d discovered a disease that was “the most common of all chronic ailments and probably takes a greater toll on society than any other medical condition.” Rather immodestly, he termed it Wilson’s syndrome. (You may also hear it called Wilson’s temperature syndrome or Wilson’s thyroid syndrome.) The symptoms described by Wilson echo those caused by thyroid disease—fatigue, hair loss, depression, etc. However, Wilson claimed standard thyroid tests often don’t pick up Wilson’s Syndrome because it’s caused by an excess of reverse T3.
More specifically, when your thyroid produces hormones, the bulk of it is T4. The T4 can’t be used by your body as is, however; so when your body is ready for increased energy, it removes an iodine atom, converting the T4 to useable T3. That’s not the whole story, though. Your thyroid will typically produce more T4 than you need, and the T4 will remain in your system until it’s degraded by losing an iodine atom. So what your body does with excess T4 is remove a different iodine atom, turning it into reverse T3. Reverse T3 is inactive and will simply be flushed out of your system.
Doctors don’t normally test for reverse T3 because it’s considered meaningless information, but Wilson based an entire theory of disease on reverse T3. Who’s right? According to most reputable experts, not Wilson.
Thyroid Factoid
Back when Wilson first came out with his theory, I decided to check it out by having my lab run reverse T3 tests on over 100 of my patients along with their standard tests. There was no evidence of elevated reverse T3 for any of my patients; the reverse T3 data proved to be random noise. In fairness, Wilson claims the problem can take place within cells, which wouldn’t show up on blood tests. (In place of lab tests, Wilson relies on the Broda Barnes basal temperature test described in the previous section.) But if there’s no hard evidence of a claim, how seriously can you take it?
Nonetheless, Wilson devised an elaborate treatment for his syndrome that involves escalating and decreasing doses of compounded time-released T3. For example, a dose might start at 5 micrograms and work its way up to 100 mcg in the course of a week, and then work its way back down again. The appeal of the process is that it’s supposed to permanently cure all symptoms.
But aside from there being no reason to believe the treatment does any good, it’s dangerous. In fact, one of Wilson’s own patients died of heart failure after taking large amounts of thyroid hormones. In 1992, the Florida Board of Medicine suspended Wilson’s license to practice. However, Wilson continues to write, lecture, and give seminars, and other doctors have taken up his ideas.
Guy Abraham’s Iodine Project
According to such universally respected organizations as the USDA and the World Health Organization, an adult should consume around 150-300 mcg of iodine per day, and shouldn’t exceed 1,000 mcg—that’s 1 milligram—of iodine daily.
Around two decades ago, however, Dr. Guy Abraham ran across some studies suggesting that megadoses of iodine could stop fibrocystic breast disease. These papers were recommending 5-20 milligrams a day—as much as 20 times what the USDA considers the maximum safe dosage. Abraham extrapolated from this that megadoses of iodine would be good for everyone … and especially patients with thyroid problems.
He blamed recommendations for 150-300 mcg per day on “iodophobia,” a term he made up that refers to an irrational fear of iodine. According to Abraham, the right way to determine your appropriate iodine dosage is by swallowing a 50 milligram tablet of his own product Iodoral and then collecting your urine over the next 24 hours for testing. The rationale is that whatever iodine you don’t pee out in a day is iodine your body must have needed.
After your first Iodoral experience, you’re placed on a daily dose of it, and periodically retested. Your iodine doses keep increasing until you’re peeing out more than you’re taking in. The problem with this process is that your body doesn’t actually eliminate toxins with perfect efficiency (and at such high dosages, the iodine is indeed a toxin). It’s a bit like giving you a high dose of mercury and then saying, “If you didn’t pee it all out after a day, your body must be craving more mercury.”
When your iodine intake abruptly increases, it can actually take months for your body to adjust and learn to expel the excess amounts in your urine. Meanwhile, overloading your thyroid with iodine can cause it to shut down, creating a state of hypothyroidism. Over time, it can also increase the risk of developing goiters, Graves’ disease, Hashimoto’s disease, or even thyroid cancer.
Nonetheless, a significant number of alternative medicine practitioners champion Abraham’s theories.
Desiccated vs. Synthetic Medication
You may hear alternative medicine advocates proclaim that the only thyroid drug anyone should take is desiccated thyroid such as Nature-Throid, WesThroid, or Armour Thyroid.
Definition
Desiccated thyroid is prescription medication made from the cut-up and dried-out thyroid glands of pigs. It’s the only medication available that contains all four thyroid hormones: T4 and T3 (in a 5:1 ratio), plus T2 and T1.
Other names for desiccated thyroid include natural thyroid, glandular thyroid, natural desiccated thyroid, and NDT.
However, most mainstream doctors automatically prescribe Synthroid, which is created from chemicals in a lab and contains only T4. If you request desiccated thyroid instead, many of these doctors will refuse, or at least give you a very hard time before saying yes.
This controversy results from a mix of historical and financial reasons. Synthroid first came on the market in 1955. Its manufacturer created an aggressive marketing campaign that touted it as new and modern, and portrayed desiccated thyroid as old- fashioned and inconsistent from batch to batch.
During this same period, there actually was a problem with a batch of desiccated thyroid that resulted in a patient being severely undertreated for hypothyroidism. This was reported in major medical journals, and it was the final straw that turned mainstream doctors away from natural thyroid to the new synthetic wonder. The problem was that the potency of desiccated thyroid medication at the time was determined by measuring iodine content. We now know this was a blunder, because the amount of iodine in a pill can vary independently of its active hormones—most notably, its T4 and T3 content. As a result, these medications truly were inconsistent.
Since the mid-1980s, though, desiccated thyroid manufacturers have switched to measuring the exact amounts of T4 and T3 in their pills. They follow the guidelines of the United States Pharmacopeia (USP), which is a highly respected authority that sets public standards for medication. Synthetic drug companies follow these same USP guidelines.
Therefore, while their ingredients come from different sources—pigs for natural thyroid and chemicals for synthetic—both types of pills are formulated in labs following strict quality control procedures, and you can expect to consistently get the stated amounts of T4 and/or T3 in a pill regardless of its origins.
However, Synthroid generates much more revenue. It costs up to four times as much as desiccated thyroid, and its manufacturer holds a patent on it, while pig thyroid isn’t something anyone can patent. Some have observed that the greater financial clout of Synthroid’s manufacturer has been used to influence medical organizations to tout it above all other thyroid solutions. In fact, Synthroid is one of the most-prescribed drugs in the United States.
Which isn’t to say Synthroid isn’t an excellent medication. It is. And for a large percentage of patients, the T4 it provides does the job. Their bodies convert the T4 into T3, and the latter supplies all the energy they need. Plus there are some clear advantages to Synthroid. Since it’s made from lab-based ingredients that are never likely to run out, it’s always readily available, while there have been periodic shortages of desiccated thyroid. Synthroid poses no problems for anyone who’s uncomfortable consuming pig-based products, such as Orthodox Jews and vegetarians. And Synthroid is available in the widest range of dosages of all thyroid drugs, which makes it easy to fine-tune how much medication you’re taking daily.
Thyroid Factoid
Synthroid is available in the following microgram (mcg) dosages and pill color codings to meet any need for T4: 25 mcg (orange), 50 mcg (white), 75 mcg (violet), 88 mcg (olive), 100 mcg (yellow), 112 mcg (rose), 125 mcg (brown), 137 mcg (turquoise), 150 mcg (blue), 175 mcg (lilac), 200 mcg (pink), and 300 mcg (green). And in case you can’t remember what a color represents, the pertinent dosage number is etched into each pill.
However, a healthy thyroid produces not only T4, but also T3 (in a roughly 10:1 ratio). No one knows why, but it turns out that a large number of people really do need direct T3 as well as the T3 converted from T4. (This is especially the case for patients whose symptoms include depression, as direct T3 often has an enormous beneficial impact on emotions.) The solution for these patients is to take medication that provides direct T3 in addition to T4.
If you are one of these patients and your doctor won’t budge from prescribing synthetics, you can request that your Synthroid be supplemented with Cytomel, which is synthetic T3. Cytomel’s strength starts to fade after about 10 hours, so it should ideally be taken twice a day (once in the morning and once in the late afternoon). For many patients, a Synthroid-Cytomel mix is a great solution.
That said, a healthy thyroid also produces a certain amount of T2. There haven’t been any major studies of T2 yet, but what’s out there so far indicates that it plays a significant role in metabolism and weight loss. Studies also show that, all things being equal, patients taking synthetic medication have less than half the T2 of patients on desiccated thyroid. In other words, even if your body is converting T4 to T3 efficiently, it’s probably not also converting enough of that T3 to T2. The only medication on the market that provides T2 is desiccated thyroid.
(Desiccated thyroid also contains T1, which doesn’t appear to do anything useful, but it might serve some function no one’s discovered yet.)
Therefore, if you’re not feeling satisfied with the results of purely synthetic medication, you shouldn’t hesitate to switch to desiccated thyroid—or, if you need to fine-tune your dosage, to a combination of Synthroid and desiccated thyroid. (There’s no problem with mixing these medications; it’s analogous to getting your daily vitamin C from eating two oranges, or by eating one orange and taking a vitamin pill.)
Alternatively, if you’re seeing an open-minded doctor, you can simply start out with desiccated thyroid. It’s much less expensive, just as reliable as Synthroid, and is the only medication that provides a mix of all four thyroid hormones.
There’s no right or wrong answer to this controversy. People have different body chemistries, and also diverse relationships with their doctors. The way to find the best medication for you is to simply try out various options until all your symptoms disappear and you feel 100 percent well again.
Brand Name vs. Generic Medication
If you’re using desiccated thyroid, you don’t have to make brand name versus generic decisions. The brand names are already so inexpensive that no generics even exist.
If you’re considering synthetic medication, though, such brands as Synthroid (T4) and Cytomel (T3) can be three times as expensive as their generic versions of levothyroxine (T4) and liothyronine (T3). Many patients swear they do significantly better on a particular brand name medication. Sometimes this is just their imagination. A perfect example are those who passionately declare WesThroid superior to Nature-Throid, or vice versa. The truth is that both medications come from the same manufacturer, RLC Labs, and are identical.
They didn’t start out that way. WesThroid (on the market since 1934) originally had filler ingredients that caused some patients allergic reactions, so in the 1960s RLC came out with a hypoallergenic version named Nature-Throid. Eventually RLC decided to do away with WesThroid’s allergic filler, and use the exact same active and inactive ingredients for both medications.
That doesn’t mean patients who champion WesThroid over Nature-Throid are lying, though; the strength of their belief that one brand is superior to the other actually gives them a better experience with that brand.
Then again, sometimes patients really are better off with a particular brand.
The active ingredients in thyroid pills are minute—a fraction of the size of a grain of salt. Most of a thyroid pill therefore consists of inactive ingredients that serve as filler. While the active ingredients are the same in both brand name and generic versions, the fillers will vary … and will have different effects on how well or poorly the active ingredients are absorbed by your body.
Further, the same pill might be absorbed efficiently by you but badly by someone else, because each person’s body chemistry is unique. (In fact, this is why you’re told to take your thyroid medication 30-60 minutes before eating. Anything you consume might unexpectedly bond with the medication and prevent it from being absorbed.)
Therefore, the main advantage of buying a brand name is that you know what to expect. Unless the manufacturer changes the formulation, your pills will contain the same inactive ingredients every month; so even if you aren’t absorbing a pill with maximum efficiency, it won’t matter because your doctor will simply raise your dosage until you’re always getting the amount of medication you need.
If you buy generic, though, there’s a chance your pharmacy will obtain your pills from a different source in any given month. That means you could absorb the active ingredients efficiently one month and poorly the next—effectively changing your dosage without your knowledge.
That said, if you give generics a chance, you may find your body isn’t very sensitive to changes to inactive ingredients. Or you may discover that your local pharmacy uses the same generic source month after month, in which case it’ll provide you with the same consistency as the brand name version.
If you want to save $10-$30 a month, you’re not at great risk by giving generics a try. But if you go this route, pay extra attention to how you’re feeling; and don’t hesitate to see your doctor for another blood test if you believe your symptoms might be returning.
Thyroid Factoid
There are occasional manufacturing snafus that cause a thyroid medication to be recalled, or to be temporarily taken off the market. This happens regardless of whether a thyroid medication is natural or synthetic, or a brand name or generic. The issue isn’t the source of the hormones, but the extreme precision required to make any thyroid pill that meets or exceeds USP specifications.
Standard vs. Compounded Medication
Some doctors aren’t satisfied with thyroid drugs as they come from their manufacturers, and instead have a local compounding pharmacy create a version customized to their specifications—typically, by putting the medication into a time-released form so it’s more effective throughout the day. The reasoning is that while T4 is long-lasting, T3 loses its optimal strength relatively quickly.
However, if you’re on desiccated thyroid medication such as Nature-Throid, the T3 will typically last most of the day; and since you’re taking it daily, that’s good enough.
Alternatively, if you’re on Cytomel, its T3 will stop being optimal in your system after around 10 hours. If you find yourself fading out in the middle of the day, though, you can address this by taking half your Cytomel dosage in the morning and the other half in the late afternoon.
It’s true that a compounded thyroid medication that’s time-released provides extra convenience. But the risk isn’t worth it. For example, a patient of mine we’ll call Stella was doing well on standard thyroid medication. She then became convinced by another doctor that he had better ideas and switched to him. A few months later I received a call from Stella over the weekend, and it quickly become obvious to me that she was suffering from severe hyperthyroid symptoms. I urged Stella to go straight to the ER. When she was admitted, the hospital found her T3 levels were hundreds of times above normal. Stella ended up spending several months in a coma and on a respirator, and for a while it didn’t seem as if she’d survive.
What happened is that the other doctor prescribed Stella a compounded mixture of T3 in a time-released form. The dosage was supposed to be 7.5 micrograms. How-ever, the pharmacist made a mistake and instead created a dosage of 7.5 milligrams, or one thousand times as much. You may wonder how such a blunder could happen, but both a milligram and a microgram are smaller than a grain of salt. When dealing with such minute quantities, errors can and do occur. In fact, Stella was lucky. Other patients have died from similar accidents with compounded thyroid medication.
It’s possible you’ll end up taking thyroid medication every day for the rest of your life. If so, using compounded medication means you’d be allowing 365 chances a year for a pharmacist to make a serious mistake. Considering that the convenience factor is small and there’s a risk of a fatal outcome, I recommend staying away from compounded thyroid medication.
To be clear, there’s nothing wrong with compounding pharmacies. Most other medications aren’t in quantities as minute as thyroid hormones and so don’t involve the same degree of danger. Also, not every doctor who prescribes compounded thyroid is a quack. Some just haven’t thought through the ramifications. Still, if you’re considering a doctor who follows this practice, take an extra careful look at what else that doctor is doing.
Thyroid Medication Substitutes
As you cruise the web or visit health food stores, you may find people touting over-the-counter substitutes for thyroid medication. These products are desiccated thyroid derived from pigs or cows, but with the fat extracted. Hormones are concentrated in the fatty acid of the glands, so removing the fat eliminates most of these products’ active hormones. Obviously, that makes these products much less effective. If the bulk of the active hormones were allowed to remain, however, the USDA would consider these products drugs—which means you wouldn’t be able buy them over the counter.
The ingredient lists of these substitutes imply that if you consumed about a dozen tablets, you’d be getting the rough equivalent of 1 grain (65 mg) of Nature-Throid. Even if that’s true, it’s a pretty inelegant way of taking thyroid medication. More importantly, these products aren’t regulated remotely close to the standard of thyroid medication, so the dosing is likely to be inconsistent.
Also, because cow thyroid is sometimes used, and that thyroid is exposed to the brain during the slaughtering process, there’s a small but real risk of contracting bovine spongiform encephalopathy (commonly known as mad cow disease). In other words, desiccated thyroid is a great product … but only via prescription.
Finally, as a general rule of thumb, it’s not a good idea to self-medicate. You should work with a doctor who can regularly check your blood’s thyroid levels and provide an objective view of your symptoms.
Other Over-the-Counter Remedies
There are also a number of over-the-counter products that claim to enhance thyroid function. The most popular are focused around iodine, which truly is a key component for thyroid hormone production. The only problem is these products often provide way too much iodine.
Specifically, you should consume between 150 and 300 mcg of iodine per day. You’ll typically get at least 50-100 mcg automatically from the foods you eat, so you shouldn’t even think about taking an iodine supplement that provides more than 200 mcg. However, many of these products provide doses of 1,000-50,000 mcg, which is utterly dangerous to your health.
If you want to supplement your iodine intake, some safe and tasty alternatives to consider are:
- Nori: Green seafood popular in Japan that’s used to wrap sushi. It’s also a fine snack.
- Wakame: Green seaweed with a subtly sweet flavor that’s been farmed for centuries in Japan and Korea. You can use it in soups and salads.
- Dulse: Red algae that grows along the shorelines of the Atlantic and Pacific oceans, and tastes a little like beef jerky. It’s an especially popular snack in Ireland and Iceland.
- Iodized salt: Table salt mixed with a tiny amount of iodine. You can sprinkle this on food as a quick and painless way to meet your iodine requirements.
Another safe way to add iodine is via a quality multivitamin pill, which will typically supply 50-100 mcg.
Also be aware that if you’re taking Nature-Throid or WesThroid, 130 mcg of iodine is included in each 1 grain pill, which is as much supplemental iodine as you need.
The Least You Need to Know
- Steer clear of basal temperature testing, T3 overdoses, and iodine overdoses.
- To get all four thyroid hormones, take desiccated thyroid, either by itself or combined with synthetic thyroid.
- Avoid compounded thyroid medication.
- Don’t buy poorly regulated over-the-counter thyroid remedies; stick to prescription thyroid medication.