Chapter
8

Treating Hypothyroidism

In This Chapter

• Choosing the right medication for you
• Mixing medications
• Supplemental non-drug treatments

If you’ve been successfully diagnosed and your doctor has determined that you’re hypothyroid, then you’re ready for treatment.

Happily, while hypothyroidism can cause immense suffering until it’s addressed, there are few other serious diseases as easy to manage. All you need is thyroid medication, which is inexpensive, relatively harmless, and low maintenance—taking a pill or two when you wake up each morning will typically do the trick.

Further, you have a number of medications to choose from, ranging from natural to synthetic, and from brand name to generic. The key challenge is choosing the medication, or combination of medications, that most fully meet your particular needs.

Desiccated Thyroid

As explained in Chapter 3, the most complete choice for thyroid treatment is desiccated thyroid (also called glandular thyroid, natural thyroid, natural desiccated thyroid, or NDT). Desiccated thyroid is made from the thyroid glands of pigs. It’s a natural mix of all four thyroid hormones: T4, T3, T2, and T1. Thyroid medications that are synthetic—that is, made entirely from chemicals in labs—contain T4 and/or T3, but not T2 or T1. No one knows if T1 provides any benefits, but T2 has been found to play a role in metabolism and fat burning.

Throat Quote

It should be the function of medicine to help people die young as late in life as possible.

—Ernst Wynder

Another advantage of desiccated thyroid is that it includes significant amounts of thyroglobulin protein, which slows the dissolution of T3. This means one desiccated thyroid pill in the morning is likely to keep you going all day. In contrast, a synthetic version of T3 such as Cytomel will lose its potency after 10 hours, so you’d typically need to take half your dosage in the morning and the other half in the late afternoon—and having to remember to do the latter without fail day after day can become burdensome.

Thyroidian Tip

Thyroid medication shouldn’t be taken with anything but water. That’s because there are numerous foods (ranging from dairy to soy to cabbage to calcium-enriched juice) and other substances (including iron and calcium) that will bind with the thyroid hormones while they’re in your stomach, keeping the hormones from moving on to your small intestine and then your bloodstream. You should therefore take your thyroid pill(s) as soon as you wake up in the morning, and wait 30-60 minutes to allow the hormones time to move out of your stomach and into your blood. You can then eat breakfast, and take your vitamins and any other medication.

If you also need a pill during the day (e.g., because you’re on twice-a-day synthetic T3), wait three hours after your last meal or snack to take your second dose of thyroid medication.

Another benefit is that if your thyroid is still partially functioning, desiccated thyroid may actually bolster its chances of becoming healthy again. That’s because when you consume an animal’s gland, the parts of it that aren’t digested will be transported by your immune system to the corresponding gland in your body to strengthen it and help rebuild it.

One other positive aspect of desiccated thyroid is its low price. Pigs are raised for their meat—until this medication was developed, pig thyroids were just thrown away—so the cost of the prime ingredient is small. Further, the market is wide open, because no one can patent the gland of an animal that’s been on earth for thousands of years. You can typically buy a one-month supply of desiccated thyroid for under $10. In fact, there’s no such thing as a generic version of desiccated thyroid because the brand names are already at generic-level prices.

A potential disadvantage of desiccated thyroid is that the T4:T3 ratio in a pig thyroid is roughly 5:1, while in a human thyroid it’s roughly 10:1. In my experience, 90-95 percent of patients do fine on desiccated thyroid’s higher level of T3—after all, it’s the hormone that does the actual work of powering up your cells, and T4 exists merely to be converted into T3. Further, your body has ways of balancing things out, ranging from breaking down excess T3 into T2 and T1, to converting less of your T4 into T3 and more into reverse T3 (see Chapter 1).

If you prefer to adjust your medication’s T4 to T3 ratio, though, you can easily do so by asking your doctor to prescribe a smaller dosage of desiccated thyroid along with an appropriate amount of synthetic T4 such as Synthroid. Your body makes no distinction between the T4 from desiccated thyroid and synthetic T4, so you can freely combine these medications as long as you end up with the right overall dosage.

Along the same lines, desiccated thyroid can be a bit less convenient than Synthroid in that it’s not available in as many sizes. If you require a dosage that’s not offered by your desiccated thyroid brand, however, you can take a mix of desiccated thyroid and Synthroid to achieve the dosage you need. (Alternatively, you can opt to cut your desiccated thyroid pills in half, as the hormones are evenly distributed throughout each pill.)

A more significant issue for desiccated thyroid is that it’s not always available. While synthetic medication can be made in a lab at any time, desiccated thyroid depends on pig thyroids, and occasionally there are shortages of the latter. When this occurs, you may have to call around to different pharmacies to find one with a supply of your medication—or, as a last resort, briefly switch to a synthetic T4/T3 combination such as Synthroid and Cytomel.

Another potential downside is that you may object to the prime ingredient. For example, if your religion forbids you from consuming anything from a pig, or if you’re a vegan opposed to ingesting parts of any animal, or if you simply find the idea of getting your medication from a pig yucky, then synthetics may be a better choice for you.

Perhaps the biggest disadvantage of desiccated thyroid is that many mainstream doctors will either be reluctant or will flat-out refuse to prescribe it. There actually were issues with desiccated thyroid in the past, but they were solved decades ago (as explained in Chapter 3). In the twenty-first century, desiccated thyroid is the most complete solution to hypothyroidism, and a number of doctors will accept your choice of it if you clearly and tactfully explain why it’s your top preference.

Popular brands of desiccated thyroid include Nature-Throid and WesThroid from RLC Labs (RLCLabs.com). These two medications are actually identical, and they’re marketed under different names only for historical reasons (see Chapter 3 for details).

Another highly popular brand is Armour Thyroid from Forest Labs (ArmourThyroid.com and FRX.com). This book doesn’t mention Armour Thyroid very often simply because its manufacturer had stopped making it, for unknown reasons, while we were writing most of the chapters. Armour is now back on the market, however, and is as excellent as any other natural thyroid medication.

Throat Quote

The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.

—William Osler

Synthetic T4

By far the most famous thyroid medication is Synthroid, which is synthetic T4, and is made by Abbott (Abbott.com). Synthroid is what most doctors prescribe across the board to manage hypothyroidism. In fact, over the years it’s been one of the top 10 most prescribed medications in America.

Synthroid is excellent at what it does—which is provide T4 in a readily available and affordable way, and in a wide range of dosages. The key question you have to consider is whether T4 alone is sufficient for your needs.

As explained in Chapter 1, T4 is a “storage” hormone designed to circulate in your bloodstream and be stored in your tissues. T4 gives your body stability because the hormone is long-lasting, remaining potent for around eight days.

When energy is called for, your body converts T4 to T3. And it’s T3 that actually does the work of powering up your cells.

Doctors prescribe Synthroid based on two beliefs:

• Synthroid’s T4 will be converted into all the T3 you need.
• T4 and T3 are all you need from your thyroid medication.

These beliefs are often validated. In my experience, roughly two thirds of patients whose thyroids are still functioning—that is, still make a certain amount of T3 and T2—do well on Synthroid alone. (Whether they’d do subtly better on desiccated thyroid is anyone’s guess ….)

For roughly one third of patients, however, the T4 provided by Synthroid definitely isn’t enough. No one is sure whether it’s because these patients have problems fully converting the T4 to T3, or if they simply require direct T3 in addition to direct T4 (which is what a healthy thyroid produces—again, in a roughly 1:10 ratio).

Whatever the reason, if you happen to fall into the latter category, you’ll continue experiencing hypothyroid symptoms despite being on Synthroid. In this case you should switch to either desiccated thyroid, or to a mix of Synthroid and Cytomel (to be described shortly).

Synthroid is the best-known T4 medication, but it’s not the only one available. Others include:

• Levothroid from Forest Laboratories (FRX.com)
• Levoxyl from King Pharmaceuticals (KingPharm.com)
• Unithroid from Jerome Stevens Pharmaceuticals (Unithroid.com)

There isn’t much difference between these brand name versions of T4. The main advantages of Synthroid are that it’s readily available from any pharmacy, and sold in a wide range of dosages to fit any need (as detailed in Chapter 3).

Alternatively, you can buy a generic version of T4, called levothyroxine, which is produced by multiple manufacturers. A generic version has the same thyroid hormone as any brand name. However, because T4 is minute—much smaller than a grain of salt—it takes up less than 1 percent of a pill. The rest of the pill consists of “filler” material, and your body may absorb one type of filler material better or worse than another, which influences how effectively the T4 will enter your bloodstream.

It doesn’t matter if one brand is a little more or less effective at delivering T4 to your body, since your doctor will be tailoring your dosage based on the ultimate effect your medication is having. As long as you keep taking the same brand, and the manufacturer makes no changes to its medication (and your thyroid’s status isn’t changing), you should do fine at the same dosage month after month.

The issue with generics is that your pharmacy might get in pills from manufacturer X one month and manufacturer Y the next month; and because each manufacturer uses different filler material, one pill might deliver less T4 to your bloodstream than another. If you notice your generic T4 looking different from month to month (meaning the pills are coming from different manufacturers), pay close attention for any signs of your hypothyroidism symptoms returning. If they do, consider switching to a pharmacy that consistently uses the same manufacturer for its generic T4, or switching to a brand name so you always know what you’re getting.

That said, as long as you’re keeping an eye out for hypothyroidism symptoms, the risk of trying generics is low … and can save you $10-$30 a month.

Thyroidian Tip

If you’ve been taking the same generic medication month after month, and notice your pharmacy has suddenly given you pills that are a different size and shape, you can perform a quick test to compare them to what you’ve been used to. Fill two glasses with cold water, and place one of your old pills in the first glass and one of the new pills in the second. After half an hour, check the glasses. If both pills have become equally mushy, you’ll probably absorb the new medication just as well as the old one. If you see a lot more hard chunks in the second glass, however, you may need to either switch to a different pharmacy for your generic medication or switch to buying a brand name.

Synthetic T3

If you’re taking synthetic T4 such as Synthroid and want to supplement it with T3, but for some reason don’t want to take desiccated thyroid, you can instead choose Cytomel from King Pharmaceuticals (www.KingPharm.com).

Cytomel is synthetic T3. It comes in three sizes: 5, 25, and 50 micrograms. You can combine these to achieve any dosage (e.g., if you needed 35 mcg, you’d take one 25 mcg and two 5 mcg pills).

Cytomel should be taken first thing in the morning, along with any other thyroid medication, to avoid mixing it with food. Cytomel loses its potency after about 10 hours, though, so you should ideally split your daily dosage, taking half in the morning and the other half in the late afternoon (waiting at least three hours after eating before taking the second dose).

For reasons that aren’t yet fully understood, taking direct T3 such as Cytomel is especially helpful in eliminating depression. That’s the case even for patients who don’t appear to be hypothyroid—which is why doctors are increasingly prescribing Cytomel as a supplement to antidepressants.

Therefore, if you’re exclusively on T4 and still experiencing hypothyroid symptoms, don’t hesitate to ask your doctor to add Cytomel to your prescription. Even doctors who are hardcore Synthroid advocates will generally be willing to supplement it with Cytomel.

Alternatively, you can purchase a generic version named liothyronine, which is up to three times less expensive. In most cases, the generic will be just as effective as the brand name version. However, as discussed in the previous section, beware of your pharmacy using generics from different manufacturers from month to month, which can create variable results.

On the other side of the expense spectrum, you can purchase a time-released version of synthetic T3 from a compounding pharmacy. This spares you from having to take the medication more than once a day. However, there are serious risks involved (see Chapter 3).

Another downside to compounding pharmacies is that most of them aren’t equipped to perform post-production analysis. That’s significant, because brand name manufacturers end up rejecting as much as 20 percent of their thyroid pills due to the medication not passing quality control standards. That means as much as one out of five thyroid pills from a compounding pharmacy might have too little or too much thyroid hormone.

For example, Forest Labs could’ve made Thyrolar’s T4:T3 mix similar to the 10:1 ratio of a human thyroid. Instead, it chose a ratio of 4:1 (which is close to the 5:1 ratio of its natural product Armour Thyroid).

In addition, one of the main advantages of a synthetic product is that it can be created from chemicals that are always available. But Thyrolar has had a spotty record of availability, and at the time this book is being written isn’t even on the market.

Meanwhile, Synthroid and Cytomel—as well as their generic versions—are readily available; and you can combine them in any T4 to T3 ratio that suits your needs. So the only clear advantage of Thyrolar is that it provides a synthetic combination of T4 and T3 in a single pill.

Arguably, an ideal synthetic thyroid medication would mix T4 and T3 in a 10:1 ratio, include small amounts of T2 and T1, and always be available for purchase. But no such product currently exists; and considering the costs for a new drug seeking FDA approval is $300-$500 million, such a product is unlikely to appear anytime soon.

Meanwhile, the medication closest to this ideal is a mix of desiccated thyroid and synthetic T4.

For example, a 55-year-old patient of mine named Marti had been stable for several years on a 90 milligram (mg) dose of Nature-Throid. While going through a divorce, Marti came to see me about persistent anxiety. Her anxiousness wasn’t unusual under the circumstances, so we mostly focused on lifestyle changes to reduce stress. For safety’s sake, though, I took some of Marti’s blood for testing.

The results showed Marti’s cortisol levels had gone up, which is something that can happen in response to acute stress. Cortisol can initially speed the conversion of T4 into T3 (though over time it’ll block T3 from accessing cells, leading to hypothyroidism—see Chapter 14). Since Marti was getting too much T3, but I didn’t want to lower her T4, I adjusted her medication from 90 mg of Nature-Throid to a mix of 30 mg of Nature-Throid and 88 micrograms (mcg) of levothyroxine (generic T4). After a couple of months, Marti’s anxiety faded away.

According to a 2003 survey by thyroid health advocate Mary Shomon, over half of thyroid patients are unsatisfied with their treatment. Some are never given the best medication for them. Others start out well, but grow worse as their medication fails to keep up with their changing conditions. Yet others are on the right medication but the wrong dosage (see Chapter 9).

You should never settle for less than optimal treatment. If your symptoms continue while on one type of medication, insist that your doctor let you try something else. And if your symptoms go away but then recur, or you experience new symptoms, don’t hesitate to return to your doctor for retesting.

With all the options available for treating hypothyroidism, you should be able to lead a life just as rich and symptom free as that of anyone with a perfectly healthy thyroid.

Beyond Medication

Thyroid medication is the primary remedy for hypothyroidism, but it’s not the only one. For example, if your diet is low on iodine, you’re depriving your thyroid of the fundamental chemical it needs to make its hormones. This is especially common during pregnancy, when the body’s need for iodine abruptly increases. If you suspect you’re iodine deficient, try gently increasing your iodine intake and see if that helps.

Alternatively, if you’ve been consuming too much iodine—for example, by eating a lot of seafood, or via products with iodine megadoses—your thyroid can respond by shutting down to prevent severe hyperthyroidism. In this case, cut way back on iodine and give your body a couple of weeks to flush out the excess.

Thyroidian Tip

If you aren’t sure whether you have the right amount of iodine, you can check by collecting your urine for 24 hours and having your doctor’s office submit it to a lab. (This is not to be confused with the dangerous 50 milligram Iodoral process warned against in Chapter 3; you don’t take any iodine for this test other than what you normally consume.) The typical cost is $60-$130; ask your doctor for details.

Then again, you may be low on selenium, which is a key chemical your body uses to convert T4 to T3 (see Chapter 1).

The simple solution is to eat a single Brazil nut daily, as this nut is the richest food source of selenium. (Don’t eat more than one a day regularly, though, or you’ll end up overdosing.)

Thyroidian Tip

If you aren’t sure whether you have enough selenium, you can check via a red blood cell element test. This is a highly informative blood test that measures your 3-month average levels of essential chemicals boron, chromium, calcium, copper, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, vanadium, and zinc; and in addition detects the presence of the toxins arsenic, cadmium, lead, mercury, and thallium. (For more on toxins, see Chapters 18 and 22.) The test costs around $250.

Something else worth exploring is the traditional Ayurvedic herb ashwagandha (Latin name withania somnifera), which can help heal and strengthen glands. Ashwagandha is Sanskrit for “smells like a horse,” but in its commercial form its odor is typically neither strong nor unpleasant. Ashwagandha has virtually no side effects, so there’s little harm in giving it a try.

It’s also important to eat foods that foster both your thyroid’s health and your overall health. Much more about this appears in Chapter 18.

One other approach that involves zero medicine is a yoga posture called the shoulder stand. It involves lying flat on your back, letting your body rest on your shoulders and the back of your neck, and raising your legs together until they’re pointing straight up. It’s a little like doing a headstand, but instead of the top of your head you’re using the back of your neck, with your chin pressed hard against your chest. This places substantial compression on your thyroid and can increase the blood supply to it.

If any of these remedies help you, then you may end up with a healthier thyroid that’s less dependent on medication.

The Least You Need to Know

• If you want a medication that includes all four thyroid hormones, choose desiccated thyroid such as Nature-Throid.
• If you want the bestselling thyroid medication on the market, choose Synthroid, which is synthetic T4.
• If you pick Synthroid, seriously consider supplementing it with Cytomel, which is synthetic T3.
• You can freely mix T4 and T3 medications to achieve the treatment that’s ideal for your needs.
• Additional ways to treat hypothyroidism include adjusting your iodine and selenium levels, using the herb ashwagandha, and yoga.