Part four of the ongoing hypothyroidism series will address the various forms of treatment for people diagnosed with hypothyroidism. This information is available after the jump, but first, I’ll share what happened at my follow-up appointment with the endocrinologist this week. I think the experience sums up some of the many frustrations other people with hypothyroidism face when seeking out treatment.
Since I was diagnosed with hypothyroidism in my early 20s, I’ve always gone to my family doctor for annual blood tests and prescription refills. My tests all read normal but I’m still highly symptomatic so I saw an endocrinologist in July with hopes that a field specialist would be better able to help me. I prepared a two-page agenda with my questions, concerns and symptoms before my first appointment and discussed all of them with the doctor. She agreed with me that I shouldn’t be having these symptoms and bumped up my Synthroid prescription to from 112mcg to 125mcg. She also promised to consider adding Cytomel to my regiment at my next appointment in six weeks should my symptoms persist (Cytomel works on T3 whereas Synthroid is T4-only).
I met with my doctor again on Tuesday and reported feeling no noticeable difference from the medication increase. I repeated my interest in adding Cytomel and again, my doctor seemed agreeable in adding it, but wanted to do a blood test first to see how the medication increase affected my TSH levels. She said she would have the office call me with the results and the new prescription. They called yesterday and here’s how that conversation went:
Nurse: Hi, we have the results and your thyroid is low, so the doctor wants to reduce your dosage back to 112 mcg.
Me: Oh, okay. We had also discussed adding Cytomel. Did she mention that?
Nurse: Hmmm… no, but I will ask her and call you back.
Several hours later….
Nurse: Hi, the doctor said that since your thyroid was low, she didn’t want to try Cytomel at this time. So, it’s just the prescription for 112 mcg of Synthroid.
Me: Wait… I don’t understand. I thought we had discussed the Cytomel and she agreed to add it. I was on 112 mcg when I first came to see her and yet I was still having hypothyroid symptoms. Obviously, Synthroid alone isn’t working and now I’m right back at square one.
Nurse: And what were those symptoms again?
Me: They’re the same ones I discussed with the doctor at length at both of my appointments [I give her another brief rundown]. I’m really frustrated now. What was the point seeing a specialist if she’s just going to prescribe the same prescription my family doctor — who has a much cheaper copay — already prescribes? I’m still having the same health problems I had on 112mcg and now I’m right back where I started. Why did I even come in?
Nurse: Hmmm… I’ll have to talk to the doctor. I’ll call you back tomorrow.
That was yesterday. I have yet to hear from the office or my doctor. You can see how frustrating this is. Two appointments with an expensive specialist and I’m right back at square one. I’m prescribed the same medication and dosage I was taking initially that left me with recurrent symptoms. I still suffer from a variety of symptoms that affect my quality of life, but because the test reads normal, my doctor dismisses me as fine. Test results are important, sure, but doctors should listen to patients first and foremost when determining health care.
If you are being treated for hypothyroidism and your test results read normal but you still experience symptoms, you aren’t well. Other available treatments and medication are available, but it is often the patient who has to first initiate conversation about them with doctors. More information after the jump.
So, you’ve been diagnosed with hypothyroidism and chances are, you’ve been prescribed Synthroid (levothyroxine). Medication can sometimes take up to a month to kick in, but if you’ve given it a reasonable amount of time and you’re still feeling symptomatic, you’re obviously not well. Yes, even if your TSH levels measure in the normal range. So, what treatment plans are available to you? This section explains exactly that.
Natural Thyroid – Non-synthetic thyroid hormone replacement is made produced from the thyroid glands of pigs slaughtered for food, and therefore work on both T4 and T3 hormones. The top seller in this category is Armour Thyroid, but other brand names include Naturethroid, Westhroid and Biotech. All are legal, regulated, prescription-only drugs. Armour Thyroid has been on the market for more than 100 years and in 2002, saw more than two million prescriptions written for it. Still, many conventional endocrinologists and physicians are generally opposed to prescription natural thyroid, in part, because of ignorance or biasness amongst doctors about natural thyroid replacements, but also because Synthroid drug representatives are quite lavish in proselytizing their product. If you’re taking Synthroid or its generic equivalent and you’re still symptomatic and want to try a natural thyroid drug, be persistent. Some doctors will prescribe it after their patients ask enough times. If your doctor will not budge, see another practitioner who is willing to accommodate you with at least a trial period.
Levothyroxine / Synthetic T4 – Levothyroxine, a synthetic T4 hormone replacement, has been on the market for more than 50 years as an alternative to the existing natural thyroid replacement. Levothyroxine – also known by its brand name Synthroid – is the most popular drug of choice prescribed by doctors for the treatment of hypothyroidism. In fact, it’s not only the top-selling thyroid replacement drug, it’s also one of the top-selling drugs prescribed in America period. My family doctor and my pharmacy both told me to ask specifically for the name brand of Synthroid, which costs about $10 more a month than generic versions Unithroid, Levoid and Levoxyl. According to them, the brand names do not work in the same way as Synthroid, although neither could fully articulate the differences. Author Mary Shomon also recommends not accepting generic versions of levothyroxine, and fortunately, does explain why. According to Shomon, each brand of levothyroxine contains different fillers and binders and some dissolve more quickly than others. Although all brand name levothyroxines are considered to be bio-equivalent, generic levothyroxine may have more ups and downs in potency from batch to batch. As well, some people are allergic to the fillers in one brand versus another, or have other allergic reactions after taking certain brands.
Liothyronine / Synthetic T3 and Liotrix, Synthetic T3/T4 – If the T4 to T3 conversion is working properly in the body, levothyroxine therapy will generally be effective. But if you take levothyroxine and still have persistent symptoms despite normal TSH levels, some doctors may prescribe additional T3. The only brand name drug of T3 is a synthetic version manufactured by King Pharmaceuticals called liothyronine or brand name Cytomel. No generic version is sold in the U.S. The synthetic T3/T4 combination drug Thyrolar (liotrix) is manufactured by Forest Labs. Again, there is no generic version of this drug available on the market. Most conventional doctors balk at prescribing either of these drugs. Osteopaths, naturopaths and holistic M.D.s are more apt to work with these treatments.
Alternative Medicine – Some people may choose to treat their hypothyroidism with alternative treatments like Ayurveda, Chinese medicine, herbalism, mind-body therapy, or naturopathy.
For people who don’t tolerate thyroid replacement medication well, Dr. Stephen Langer recommends working with a reputable compounding pharmacist to produce an aqueous (water-based) solution of thyroid medication. The dosage is then graduated until you reach the right quantity of thyroid using the aqueous solution. Many people can then eventually be transferred over to the tablets. If you’re taking a generic version of Synthroid, ask for a name brand, since each brand of levothyroxines contain different fillers and binders, which may cause an allergic reaction in some people.
Take your medication every day. If you miss a dose, take it as soon as possible. If you’re close to your next scheduled dosage time, skip the missed dose and resume your regular dosing schedule.
Take your medication on an empty stomach. Different brands dissolve at different rates, but a good rule of thumb is to avoid eating for an hour afterward. Food can slow absorption of the drug and slow the process of the drug entering the stomach. Some drugs can also affect the absorption rates of levothyroxine. Do not take a multi-vitamin, supplement or other drugs at the same time you take your thyroid medication.
Be consistent. If you take your pill with food, always take it with food. If you’ve changed from taking it with food to taking it without food or if you take it with food and change to a high-fiber diet, have another TSH test done about 6 – 8 weeks later to ensure you’re receiving the proper amount of hormone.
Be aware. Taking some tricyclic antidepressants (Elavil, Norpamin and Tofranil) with your thyroid hormone can actually accelerate the effects of the antidepressant, while combining thyroid hormone replacement with Zoloft or Prozac may decrease the effectiveness of the thyroid hormone. There are other drugs that interact with thyroid hormone or affect thyroid function, so be sure your doctor know what drugs you are taking and the dosages of those drugs. Women who go on the pill or take estrogen hormone drugs may need additional thyroid replacement hormone. Various forms of the pill or estrogen hormones increase a particular protein that binds thyroid hormone to it, rendering the thyroid hormone partially inactive.
To soy or not to soy? There is debate about the consumption of soy products by people with hypothyroidism. My doctor said that consuming soy products is okay, as along as they are eaten at least four hours after taking my thyroid hormone. Others say soy consumption should be even more limited or avoided altogether. The soy controversy stems from the fact that soy is a rich source of isoflavones. Isoflavones belong to the flavonoid chemical family, which are considered to be endocrine disrupters and antithyroid agents. More research on soy consumption with hypothyroidism is still needed. Vegetarians like me, who rely on soy-based products for protein, will find it difficult to reduce soy consumption. Luckily, Quorn products are not only high in protein, they’re also soy-free (and delicious!).
There is no natural or over-the-counter herb or plant that acts like thyroid hormone and can be taken in lieu of thyroid hormone (Armour is the only natural thyroid hormone replacement drug). There are, however, some alternative approaches that may help your thyroid function better.
Reevaluate your diet – Some doctors recommend a diet that includes whole cooked grains, fresh vegetables and fruit, legumes, nuts and seeds, and fish (if not vegetarian). Consumption of refined sugars and flours, alcohol and coffee should be limited. Excessive alcohol and coffee consumption can lead to impaired liver function, and the liver is the primary organ that converts T4 to T3.
Vitamins, minerals and herbs you may want to consider include:
Vitamin A – A deficiency in vitamin A may limit the body’s ability to produce thyroid hormone.
Vitamin B2 – A shortage of this vitamin can depress endocrine function, especially the thyroid and adrenals.
Vitamin B3 – Helps keep cells working by aiding in respiration and delivery of energy to cells.
Vitamin B6 – Helps convert iodine to thyroid hormone.
Vitamin B12 – People with hypothyroidism may be less able to absorb sufficient vitamin B12.
Vitamin D – Necessary for the pituitary gland to produce thyroid hormone, and may play a role in T3 binding to its receptor and in T4 to T3 conversion.
Selenium – Most important mineral for thyroid function. Selenium activates an enzyme that is responsible for controlling thyroid function by thee conversion of T4 to T3. A selenium deficiency alone is thought to be a trigger of autoimmune thyroid disease in some people. Experts recommend 200mcg of selenium a day. Overdose of selenium can be harmful; intake is recommended to no more than 200 – 400 mcg a day.
Zinc – Needed by the thyroid for both hormone production and T4 to T3 conversion. Also necessary for proper hypothalamic functioning, which is related to the functioning of the thyroid. Zinc should always be balanced out with a small amount of copper.
Iron – Additional iron may be needed by some people with hypothyroidism. If you do take iron, allow at least four hours between taking it and your thyroid hormone.
Magnesium – An essential mineral that is often deficient in thyroid patients. It helps to maintain normal muscle and nerve function, keeps heart rhythm steady and bones strong, and is involved in energy metabolism.
There are also a number of herbal remedies recommended for thyroid treatment. You should select consult an herbalist to determine herbal treatments right for you.
Obviously you should consult your doctor before taking any kind of drug, supplement or vitamin. The above information is informational only and should not be construed as medical advice. Tomorrow’s series will address how to better manage both the depression and weight gain that are characteristic of hypothyroidism.