Treatments for Hypothyroidism
- In This Quick Guide:
- Desiccated Thyroid
- Synthetic T4
- Synthetic T3
While hypothyroidism can cause immense suffering until it’s addressed, there are few other serious diseases as easy to treat and 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.
There are a number of medications on the market, ranging from natural to synthetic, and from brand name to generic. The key is choosing the medication, or combination of medications, that most fully meet your particular needs.
Desiccated Thyroid
This is the most complete choice for thyroid treatment. Desiccated thyroid (also called glandular thyroid, natural thyroid, natural desiccated thyroid, or NDT) is made from the thyroid glands of pigs and is a natural mix of all four thyroid hormones: T4, T3, T2, and T1. Thyroid medications that are synthetic contain T4 and/or T3, but not T2 or T1. Popular brands of desiccated thyroid include Nature-Throid and WesThroid from RLC Labs (RLCLabs.com), and Armour Thyroid from Forest Labs (ArmourThyroid.com and FRX.com).
Benefits
- One desiccated thyroid pill in the morning is likely to keep you going all day, but you’d typically need to take a synthetic thyroid medication twice a day.
- If your thyroid is still partially functioning, desiccated thyroid may actually bolster its chances of becoming healthy again because the parts of the gland 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.
- The price is low; typically a one-month supply is less than $10.
Disadvantages
- The T4:T3 ratio in a pig thyroid is roughly 5:1, while in a human thyroid it’s roughly 10:1. Although 90-95 percent of patients do fine on desiccated thyroid’s higher level of T3, you can take a smaller dosage of desiccated thyroid along with an appropriate amount of synthetic T4.
- Desiccated thyroid is not available in as many sizes as synthetic T4. If you require a dosage that’s not offered by your 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.)
- Many mainstream doctors will either be reluctant or will flat-out refuse to prescribe desiccated thyroid. There actually were issues with desiccated thyroid in the past, but they were solved decades ago. 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.
Synthetic T4
By far the most famous thyroid medication is Synthroid, which is synthetic T4, and is made by Abbott (Abbott.com). Synthroid is affordable and comes in wide range of dosages, and 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.
For roughly one third of patients, the T4 provided by Synthroid 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. 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.
Generics
You can also 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.
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 which you can combine to achieve any dosage. However, it loses its potency after about 10 hours, 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.
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.
Generics
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.
You should never settle for less than optimal treatment for your hypothyroidism. If your symptoms continue while on one type of medication, insist that your doctor let you try another treatment. 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.
From The Complete Idiot’s Guide to Thyroid Disease by Dr. Alan Christianson and Hy Bender
