Choosing the Best Thyroid medication can be tricky. Many people with thyroid disease at some point are either overmedicated, under medicated or given the WRONG kind of thyroid medication for their thyroid pattern.
I get a lot of emails from people all over the world and One of the questions I often get is “What is the BEST thyroid medication to take.” Unfortunately, there is no simple straight forward answer here. There are many things to consider and in today’s article/video will touch on these considerations.
The most important thing worth remembering is that we are all very different and its these differences and subtleties need consideration when it comes to taking the best thyroid medication for you.
Watch the Video
Having TSH and Free T4 Measured- Just Doesn’t Cut it!
Many patients are simply taking T4 thyroid hormone replacement (Synthroid or Levothyroxine) without the proper thyroid testing. Having your TSH and Free T4 just doesn’t cut it and if you are still feeling lousy while taking thyroid medication, its clear that these may not be the best thyroid medication for your situation.
There Is No one Size or One Brand of Thyroid Replacement That Fits ALL.
Now let me start off by saying that if you need to take thyroid medication, it’s important that you are on the best one, but more importantly I want you to understand that the Bigger picture of this lies not only in giving the body the thyroid hormone that is best for it, but addressing the reason Why it needs the thyroid replacement in the first place.
No amount of Thyroid Replacement will fix your thyroid problem in the long run. With that being said, One of the problems I continue to see is that most doctors only look at the quantity of hormones not the factors that affect the quantity.
What I mean by this is that while most doctors run a TSH and Free T4, nothing is being tested to determine why the TSH and Free T4 levels are abnormal and out of range. A good doctor always tries to find the cause.
This is so important and I would say after 20 years of working with thyroid patients this is the most overlooked area in a patients recovery. Correcting the Thyroid often requires thinking outside the box.
Download my free E guide titled “The 6 patterns of thyroid disease“ that wont show up on standard blood tests”.
Determining the Best Thyroid Medication
What are the events and mechanisms that led up to the need for medication in the first place? If you had your thyroid removed because it was filled with cancerous nodules or you were having trouble breathing and your were autoimmune you are going to need a different kind of thyroid hormone medication than someone who has low T3.
The next issue is, is this really a problem with the Thyroid itself or is the problem related to delivery of the hormone to the target cell or does the problem lie in how the body is transporting the hormone.
Each of these scenarios can be rooted in problems such as Inflammation, Leaky gut, low iron levels, Sex hormone imbalances, nutritional deficiencies, hyper or hypo adrenal states, food sensitivities, infection, heavy metal, or autoimmunity any of these scenarios could be the reason the thyroid is shutting down and unless you address these metabolic issues, the thyroid hormone replacement will not be as effective.
What Kind of Thyroid Medication Are You Taking?
Another possible scenario has to do with the Kind of Thyroid Medication You Are Taking. In other words, is there a sensitivity to any of the binders and fillers used in the medications? it’s no surprise that people who have thyroid disease suffer from a number of food allergies, intolerances and chemical sensitivities. In some cases, food sensitivity or food allergy testing for these issue can help determine which thyroid medication will cause the least amount of problems.
If you haven’t seen my video titled Why Do I feel worse when I take my thyroid medication, after watching today’s video this might be a good place to start. While pharmaceutical drug reps who visit your doctor with a handful of free samples of Synthroid would like us believe, there is simply no “one size fits all” approach to thyroid hormone replacement. Statements like “I prefer to use synthetic T4 with my patients” or “I only use T4/T3 combination with my patients” demonstrate a lack of understanding of thyroid pathology.
Synthroid or Levothyroxine May Not Be The Best Thyroid Medication For You.
Giving all patients the same thyroid medication without understanding the mechanisms involved, is the reason millions of men and woman have become prisoners within their own body. Many of my patients have spent the last 10-15 years of their life half dead, walking around like a zombie. Why?
You Can’t Fix Something If You Don’t Know What Is Causing It.
So, now that we have laid the ground work, let’s get into the really important stuff and lets unpack each of these possible mechanisms so you can determine if you need to talk to your doctor about changing medications.
Ask Yourself These Questions Before Taking Thyroid Medication….
How you answer these questions ultimately determines, if you need thyroid hormones, or which kind is the best for you. (not everybody needs thyroid hormones) but this is another video.
So let’s jump into these
#1- Do you have an Autoimmune disease (Hashimoto’s) causing destruction of your thyroid gland?
#2 Do you have Estrogen dominance? (Are you menopausal, Perimenopausal or are you taking birth control pills or HRT… All of these have the potential to cause High levels of estrogen, low levels or progesterone, and disrupted testosterone levels? Often changes in libido, vaginal dryness, loss of stamina, unwanted hair growth, etc These imbalances can all cause symptoms of hypothyroidism. So like I said earlier, you may be producing sufficient quantity of Thyroid hormones, but the hormones are not getting delivered to the target tissues correctly.
#3 Do you have a systemic inflammatory condition. Inflammation will affect the thyroid in a number of ways, Inflammation affecting your ability to convert T4 to T3, and inflammation decreasing the sensitivity of the cells in your body to thyroid hormone?
Let me give you a real time scenario, Something I see in practice every day. Lets say you go to Good old Dr Jones, because you are experiencing terrible fatigue, depression, weight gain, your cold all the time, and you are walking around like a zombie- total brain fog- Let’s say the only tests your doctor runs is a TSH and T4.
Your test results come back and your TSH is elevated and your T4 levels are low and so your doctor say Mary, you have hypothyroidism, we need to start you out on some Synthroid thyroid medication.
You start taking the Synthroid and several months go by and you don’t notice any improvement and so you go back to his office and good old Dr Jones just ups your dosage.
Is this T4 medication hormone going to help you?… The answer is probably not! This is why its important for your doctor to investigate the reasons behind your High TSH. Another problem I see over an over again is testing only TSH and free T4. When your doctor doesn’t run a complete thyroid panel then you will never know if your Free T3, total T3 levels and T3/RT3 levels are also low.
If these other markers are low, you could take T4 all day long, and it won’t do a thing unless your body can convert it to the active T3.
If You Have Low T3 or High TSH
#1- Again, you need to figure out What’s causing Low T3 and What’s causing my High TSH
#2- You might benefit from a T4/T3 combo. This would not only give your body the T4 hormone, but also the T3. In this scenario Armour or a compounded T4/T3 combo made by the pharmacist (who knows your sensitivities) might be a good fit for you.
Scenario #2- My Thyroid Medication Stopped Working.
Does this sound familiar? You start taking a T4 and T3 combo thyroid hormone Replacement and like so many people out there you went through what I have coined the “Thyroid honeymoon phase.” You felt amazing and then after 6 months it feels like your thyroid medication has just stopped working. So you go back to your doctor because you are noticing, weight gain, fatigue, coldness is starting back up and So Dr Jones want to increase your medication because your back to feeling lousy?now what do you do?… Again… There are several reasons for this.
First, inflammation (which is characteristic of all autoimmune diseases, and Hashimoto’s is no exception) causes a decrease in thyroid receptor site sensitivity. This means that even though you may be taking a substantial dose of replacement hormone, your cells aren’t able to utilize it properly.
Second, elevations in either testosterone or estrogen are affecting the levels of circulating free thyroid hormone causing low thyroid symptoms.
Third, there are several classes of medications that alter the absorption or activity of T4. These include commonly prescribed drugs like antibiotics & antifungals, anti-diabetics, diuretics, stimulants, cholesterol lowering medications, anti-arrhythmia medications, hormone replacement
pain medication, and Certain psychiatric medications, All of these factors must be considered if a particular medication isn’t having the desired effect.
Here is another article I wrote, 10 Reasons Your Thyroid Medication has stopped working
Another important consideration in choosing the right thyroid hormone comes down to some of the fillers and binders contained in each medication.
Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in so many past videos and in my free thyroid guide, most hypothyroid patients have sensitivities to gluten, and many of these patients also react to corn and dairy (which contains lactose).
These are all things I test on my patients so that in the event they do need thyroid replacement, we can get them on the one that will be the most effective.
So right about now you might be watching this and wondering if the thyroid medication your taking contains cornstarch, dairy and lactose as a filler.
So… let me touch on the Three most commonly prescribed Thyroid replacements out there, Synthroid, Cytomel and Armour.
Synthroid, hands down is one of the most popular T4 replacements… and guess what?… has both Cornstarch and Dairy (lactose) as a filler.
Cytomel, again a very popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler. So you might be thinking… whew… I’m in the clear I don’t take either one of those, My doctor has me on natural thyroid hormone replacement, I’m on Armour.
Some of you who were taking Armour before 2008 may have done well on armour 2008 and then all of a sudden you felt worse? well in In 2008, the manufacturers of Armour reformulated the product, what they did was they reduced the amount of dextrose & increasing the amount of methylcellulose in the filler.
Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.
What do you do in this situation? My best advice is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to.
The last thing I want to cover with you on today’s video is about the Natural or Synthetic Thyroid hormone replacement Debate.
This is an emotionally and heavily debated area, you will find doctors, patients and thyroid advocates who have their feelings about one or the other. and once again I think there is no one size fits all.
In general if a patient is autoimmune- meaning they have Hashimotos disease, I think Tirosent is the best option. Tirosint is a brand-name for levothyroxine sodium (like Synthroid, Levoxyl, Levothroid, Unithroid, and Eltroxin). Tirosint is different from other brand names of levothyroxine in that The levothyroxine found in Tirosint is in a liquid form, inside a soft gelatin capsule.
As of 2014 it is the first and only liquid levothyroxine capsule that I am aware of. The manufacturer of Tirosint capsules states it contains no dyes, gluten, alcohol, lactose, or sugar.
For those of you who have problems with T4 to T3 conversion, I think bio-identical hormones are the best choice. For you, Armour might be the best option. A frequently perpetuated myth (in Synthroid marketing, for example) is that the dosages and ratio of T4:T3 in Armour aren’t consistent. Studies have shown this to be false. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3.
What if you tried natural thyroid hormones Replacement and you felt worse- this can happen in some patients and one of the reasons for this is that some people with Hashimoto’s produce antibodies not only against thyroid peroxidase and thyroglobulin but also to their own thyroid hormones (T4 and T3).
When this happens essential what happened is that you just gave their immune system a reason to get fired up and further attack the thyroid gland.
The last scenario to consider is those of you who not only have Hashimotos but are also poor T4 to T3 converters also known as low T3
These are the people who have normal T4 levels but low T3 and Low Free T3 levels, Low T3/Rt3 ratio. If you remember your thyroid makes T4 inactive and T3 active form. The downside for some of you who are autoimmune and are poor converters is that if you go into a hyperthyroid state while you are taking T3 Thyroid replacement (lets say Cytomel or dare I say Armour) you could be over medicated with T3.
If this happens you will feel anxiety, heart palpitations, Insomnia, inward trembling, sweats and you might experience weight loss. So again if this is you, you might find that T4 synthetic replacement is best.
In bringing this video to a close, (I know we covered a ton of information), and I hope you made it to the end, the best thyroid hormone for each patient can only be determined by a full thyroid work-up, followed by trial and error of different types of replacement medications.
The Most Important Video You Will ever watch on thyroid Function and How Functional Medicine Helps Those suffering with Thyroid Disease.
I encourage you to watch my video titled “10 steps to supporting your thyroid naturally”, watch my video titled “Why do I feel worse when I take my Thyroid medications” and watch my video titled “10 reasons your thyroid medication stopped working”
I hope this video clears up some information for you, please feel free to share it with your friends, loved ones and workers. Until next time take care.
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Other Articles Recommended By Readers
- If I Have to Take Thyroid Medication, Which one Is the Best For Me
- 10 Reasons It Feels Like Your Thyroid Medication Has Stopped Working.
- Ingredients Binders and Fillers in Thyroid Medication
- Thyroid Symptoms Despite Medication? You Might Be Suffering From A More Serious Condition.
- How High Reverse T3 will Cause Thyroid Symptoms
- IBS SIBO and Its Connection to Hypothyroidism