Which type of thyroid medication is best for Hashimoto’s? This is something I am asked all the time by my patients, in my support community, and in my Facebook community.
I first want to clarify that thyroid medications are not in the same family as harsh drugs and immunosuppressants used to treat other autoimmune conditions. Thyroid medications are a supplemental dose or replacement for a hormone that is necessary for you to live.
If your thyroid is too damaged from Hashimoto’s, you may need supplemental thyroid medication for the rest of your life. My thyroid was ablated, so I certainly do. This does not mean you have failed or that your condition cannot be reversed. Reversing Hashimoto’s means that your immune system is no longer attacking your thyroid, your antibodies have disappeared, and you are symptom-free. Now I’ll address the million-dollar question.
There is no “one size fits all” when it comes to thyroid medications and I don’t believe that there is one right choice for everyone.
What I have learned over the last fifteen years, as both a thyroid patient and a thyroid-prescribing physician, is that when it comes to thyroid medication, it can be just as much an art as it is a science. You, the patient, need to listen to your body and share your experience with your doctor. And we, physicians, need to listen to our patients as well as look at their labs. I have found over the years that how the patient feels can often tell more than the labs.
That said, the first step in finding the right thyroid medication for you is to make sure your doctor checks all your thyroid levels.
Most doctors only check your thyroid-stimulating hormone (TSH) levels. If you are lucky, they will test your Free T4 levels to see if you are low on the storage form of thyroid hormones. What those two tests will not tell you is if you have difficulty converting T4 (the storage form of your thyroid hormones) to T3 (the active form), if you’re converting too much T4 to Reverse T3 (the hormone that “puts the brakes” on your metabolic processes), or if you have autoimmune thyroid disease. In short, TSH and T4 tests only tell you a small part of the story. If your treatment is based solely on those two numbers, there is a good chance your lab results will return to “normal,” but your symptoms will not go away.
To get a complete picture of a patient’s thyroid health and medication needs, I would order all of the thyroid tests listed below. I've also included the ranges for each marker that I’ve found to be optimal for both my patients and me. You can find all of this information and more in my book, The Thyroid Connection.
TSH 1-2 UIU/ML or lower
Free T4 >1.1 NG/DL
Free T3 > 3.2 PG/ML
Reverse T3 > 10:1 ratio RT3:FT3
Thyroid Peroxidase Antibodies < 4 IU/ML or negative
Thyroglobulin Antibodies < 4 IU/ML or negative
Now that you’re armed with the insights from your lab results, you’re ready to look at all of your thyroid medication options to find the solution that best matches your needs. There are four main types of thyroid medications available for Hashimoto’s patients.
T4 Thyroid Medication
The most common Hashimoto’s treatment is synthetic T4 hormone medication, usually prescribed as the drug Synthroid® or Levoxyl®. Synthroid® is actually the most commonly prescribed drug in America, with 21.6 million prescriptions a month.1
Synthroid® and Levoxyl® provide a steady dose of T4 (the storage form of thyroid hormones) for your body to convert into T3 (the active form), and come in a wide range of doses, making them very convenient. The downside of T4 medications is that, unlike your real thyroid, they don’t provide any T3. As we’ve discussed previously, many patients have difficulty converting T4 to T3 because of adrenal fatigue or nutritional deficiencies, meaning no matter how much T4 they take, their T3 levels will remain low, and they’ll continue to experience symptoms. This is why it is so important for doctors to check not just TSH and T4 levels, but also T3. A patient’s lab results can look “fine”, yet they’ll still be low in the hormones that actually power all of their metabolic processes.
Another downside of synthetic medications is the inactive ingredients used. Thyroid hormones are prescribed in micrograms, so the amount of T4 in each pill is incredibly small. The rest of the pill is composed of inactive ingredients, synthetic colors, and fillers that vary by brand. Synthroid®, for example, contains lactose and cornstarch.2 Tirosint is a T4 medication that includes only three inactive ingredients (gelatin, glycerin, and water). It is also produced in a dedicated facility to eliminate the risk of cross-exposure. This makes it a good alternative for those who are sensitive to foods and fillers.
There are also generic versions of Synthroid®, labeled levothyroxine. Their fillers vary by manufacturer and can sometimes contain allergens. Pharmacies can change manufacturers of generic medications without warning, so the inactive ingredients in your generic medications might vary month to month. What’s more, studies on levothyroxine show that T4 doses vary across manufacturers and pharmacies. In a number of patients, I saw improvements in lab results and decreases in symptoms after switching from generic T4 to a brand-name T4 medication. For this reason, I never recommend that anyone take generic T4 medications.
T3 Thyroid Medication
If you are not converting T4 to T3 well, T3 can be prescribed to supplement your T4 medication. There are several types of T3 medication, including preformed, synthetic T3 (frequently prescribed as Cytomel®), and compounded T3, which is custom-prepared to the exact strength and dose requirements of the patient, as specified by their doctor.
As we covered in Part I of the series, T3 doesn’t remain active in your body for very long. Preformed T3 medications, such as Cytomel®, are only effective for about 10 hours, and must be taken twice a day. They provide a sudden burst, then a decline, in active thyroid hormone levels. I’ve found that many patients feel jittery shortly after taking them, as if they took a shot of espresso. They can then feel sluggish or tired as the effectiveness wears away.
Compounded T3 medication can be prepared in a time-release formula to avoid the hormone rollercoaster patients often experience on Cytomel® and similar preformed drugs. The downside of compounded medications is that some insurance companies won’t cover them, and compound pharmacies are not as common as regular pharmacies, so it might be difficult to find one near you. Fortunately, compounded medications are far less expensive than standard medications, so they are typically still affordable even without insurance, and most compounding pharmacies can ship your medications to you.
T4 and T3 Thyroid Medication
There are also a few thyroid medication options that include both T4 and T3, namely desiccated thyroid medication (derived from dried pig thyroid glands) and compounded T4 and T3 medication.
Desiccated thyroid medications, such as Amour®, WP Thyroid®, and Nature-Throid®, provide the full range of thyroid hormones, including T4, T3, T2, and T1. This is particularly beneficial for those patients who have difficulty converting T4 to T3. It may also be helpful for hypothyroid patients trying to lose weight. According to some scientists, T2 is important for weight loss.
Desiccated thyroid medication also includes thyroglobulin (the binding protein that carries thyroid hormones through your bloodstream). Thyroglobulin slows the distribution of T3 throughout the body, so a single dose lasts all day.
In theory, the thyroglobulin could cause problems for those with Hashimoto’s as it could elevate your thyroglobulin antibodies. I say ‘in theory’ because I was taught this in my functional medicine training. However, I prescribed thyroid medication to over a thousand patients, yet I only actually saw this happen in four patients. So, while it is possible, clinically I would say it is very rare.
Desiccated thyroid medication is the most complete treatment option, and the most similar to your body’s natural thyroid process. I found it to be the right fit for many of my patients. Beyond my own clinical experience, multiple studies show that some patients prefer desiccated medication to T4-only treatment.
In a double-blind study in which patients received either desiccated thyroid extract or generic synthetic T4 for 12 weeks, then switched to the other, 49% preferred desiccated thyroid extract, 19% preferred synthetic T4, and 23% had no preference.3 The patients also lost an average of 2.84 pounds while on desiccated thyroid hormone compared to the synthetic T4 drugs. Another study found that 78% of patients who switched from synthetic T4 to desiccated medication preferred the desiccated formulation.4
Like synthetic medications, desiccated thyroid medications also contain inactive ingredients that vary by brand. Armour® and Nature-Throid® each contain five or more inactive ingredients, including cellulose, and Armour® contains cornstarch. WP Thyroid®, which is the hypoallergenic version of Nature-Throid®, contains only two inactive ingredients—inulin and medium-chain triglycerides.
Each brand also differs in the variety of strengths it offers. WP Thyroid® and Armour® are available in eight strengths (WP Thyroid® offers more options for smaller doses, while Armour® offers more options for higher doses), whereas Nature-Throid is available in 13 strengths, ranging from low to high concentrations.
Many conventional doctors are reluctant to prescribe desiccated thyroid medication. They claim that their thyroid hormone levels are inconsistent and unregulated. Although this was true decades ago, since the 1980’s, the exact amounts of each thyroid hormone in desiccated thyroid medications have been regulated using the same standards as synthetic medications.
It is important to note that, while consistent and regulated, the T4 to T3 ratio in desiccated medications is lower than your natural T4 to T3 ratio (4.22:1 compared to 11:1). This is because pigs produce thyroid hormones at different ratios than humans do. Some patients taking desiccated thyroid medication who want to increase their T4 dose without increasing their T3 will need to supplement with a T4 medication. Personally, this is what I have to do.
For those who need extremely specific doses, compounded combination T4 and T3 medications offer the most flexibility. They are custom-formulated for each patient to provide the exact strength and T4-to-T3 ratio they need. The drawback of compounded medications is that they do not contain other components of the thyroid. The desiccated porcine gland does—with T2, T1, and thyroglobulin.
Finding the Medication and Dose that Work for You
As you can see, there are many different options for thyroid medication, each with its own advantages and disadvantages. Many in the healthcare world like to frame it as a black and white issue, with conventional doctors who prescribe Synthroid® on one side, and alternative practitioners who prescribe desiccated medication on the other. In my experience, it’s not that clear-cut, and what works for one person doesn’t necessarily work for another.
Finding the right treatment protocol often requires trial and error. You’ll learn what medication or combination of medications, and at what doses, works best for you. As you go through this process, it’s important to work closely with your doctor and check your levels regularly. It’s also important to listen to your body. If thyroid levels are within “normal” range, yet you still experience symptoms, you might not have found the perfect balance. You should speak with your doctor about continuing to fine-tune your protocol.
Going Beyond Medication: Treating the Root Cause of Thyroid Disease
Finding the right thyroid medication that works for you is very important. It will go a long way in helping you feel better. Still, remember that managing your thyroid levels through medication is only part of the process. The real work comes in identifying the underlying factors that caused your thyroid disease and making healthy lifestyle changes to remove them.
If you’re ready to tackle the underlying health issues that triggered your thyroid disease, you can read my book, The Thyroid Connection.
Remember that achieving optimal health is a journey, and each person’s path is unique. This is particularly true for Hashimoto’s, which can involve many different interconnected factors. Whether you’re just starting out or well on your way, know that resources and support are available. With enough knowledge and commitment, you can find the solution that works for you.
Beat Hashimoto’s Symptoms for Good!
Find out why conventional medicine gets Hashimoto’s wrong and what’s really causing your symptoms.
You’re about to discover:
- What diet is best for Hashimoto’s
- Why you can still feel like crap, even if your doctor says your labs are fine
- What thyroid medication is best for Hashimoto’s
- And how to finally drop those stubborn pounds!
Click here to get the secrets!
Article Resources
Leave a Comment