Currently, synthetic T4 thyroid drugs are standard method of hormone replacement therapy for people with hypothyroidism. The goal of the treatment is to bring the patient into a stable condition where the TSH is in the normal range.
Although the use of T4 thyroid medication has been accepted for many years in conventional medicine, many patients continue to experience symptoms of underactive thyroid even if their lab test results show normal.
Beyond thyroid replacement therapy there are no other treatments for Hashimoto’s and hypothyroidism in the conventional medicine. For those who still have hypothyroid symptoms the only option is to try another brand of the thyroid drug and/or prescribe different types of medication for every symptom the individual may experience. Often a patient receives an antidepressant to treat thyroid related depression and sleeping pills for insomnia.
The answer to the question why the majority of the thyroid patients do not feel well following the thyroid hormone replacement therapy lies in the human physiology and improper diagnosis.
Thyroid Defects Most Doctors Don’t Know About
About 20% of T3 hormone is produced by the thyroid gland and 80% comes from an inactive pro-hormone T4 through conversion in the liver, kidneys, intestines and in cells. The patients who take the T4-only drugs depend on these conversions in the peripheral tissues as the only source of active form of the thyroid hormone T3. The absence or deminished production of T3 by the thyroid gland and impaired hormone conversions could make a significant physiological impact leaving the patient with unresolved hypothyroid symptoms.
Practically the more advanced Hashimoto’s becomes, the more the thyroid gland is destructed and the less the amount of the thyroid hormones is produced. A higher dose of thyroid medication needs to be prescribed to replace the missing hormones. At the same time, the thyroid gland produces less and less T3 and the body becomes more dependent on the T4 to T3 conversions. If the patient has any type of thyroid hormone conversion impairment the person can experience multiple hypothyroid symptoms.
In addition to the diminished thyroid hormone conversion people with Hashimoto’s could have other types of thyroid dysfunctions caused by the inability of thyroid hormone to enter the cell and perform its metabolic action.
In the following video Dr. B. Walsh the author of Fat Is Not Your Fault program talks about the major causes of thyroid hormone underconversion and other thyroid defects that contribute to hypothyroidism and Hashimoto’s and in most cases remain undiagnosed by the conventional medicine physicians:
Proper Thyroid Testing
Another underlying cause of Hashimoto’s and hypothyroidism mismanagement and undertreatment is that many patients are not properly diagnosed. According to the standard medical care, lab guidelines and medical insurance policies, TSH and free T4 thyroid hormone are tested if hypothyroidism is suspected and only a TSH test is required for the follow up visits. Based on the test results most conventional physicians prescribe medication that contains T4 only and seldom check for thyroid antibodies since it does not affect the therapy.
However, free T3 is the metabolically active form of the thyroid hormone. If a patient has normal TSH and free T4 but low free T3 the person still can have hypothyroid symptoms and your doctor won’t be able to find it using the standard testing. A proper thyroid panel includes a measurement of the free T3 and thyroid antibodies test if Hashimoto’s is suspected.
According to a recent study, Hashimoto’s patients with a normal TSH, T3 and T4 lab test results but TPO antibodies over 120 still can experience hypothyroid symptoms. High thyroid antibodies levels indicate an ongoing autoimmune process.
Are You On The Right Type Of Thyroid Medication?
There are several brand names of T4-only thyroid drugs available on the market. All of them contain the same synthetic T4, however they are produced by different manufactures and can have different inert ingredients such as fillers. Some people can be allergic to fillers in one brand but tolerate well with another brand.
Synthroid, L-Thyroxin and Levothyroxin are the most prescribed synthetic T4-only thyroid drugs.
Patients who do not feel well on the T4-only prescription hormone and/or have impaired thyroid hormone conversion could benefit from a combined T4 and T3 type of thyroid drug:
- Combination of synthetic T4-only drug and T3 medication called Cytomel
- Natural desiccated thyroid that already contains T4 and T3 hormones
- Combination of synthetic T4-only thyroid drug and compounding pharmacy slow release T3 medication
Cytomel is a synthetic T3-only type of thyroid drug which releases very fast into the blood stream. The levels of T3 rise for a short time and then rapidly fall down. High boosts of the T3 levels can result in unpleasant hyperthyroid symptoms such as rapid heart beat, insomnia and anxiety and contribute to heart issues and osteoporosis. It can be a very undesirable effect especially for hypothyroid elderly patients and women going through the menopause.
To prevent this boosting effect and support steady levels of T3 a patient is usually advised to take smaller doses of Cytomel spreded throughout the day. However, due to the nature of this type of thyroid drug it is practically impossible to avoid the short lasting periods of high T3 after the Cytomel is taken.
Natural desiccated thyroid can help those who do not feel well on T4-only medication and/or have conversion issues. However, desiccated brands such as Armor thyroid and Naturthyroid or OTC brands such as Thyroid-S have T4 to T3 in a fixed ratio determined by the manufacturer. If a patient has an underconversion of T4 into T3 it is seldom that both hormones are in the same proportion as the patient needs. The amount of T3 in the natural thyroid drugs is usually either too much or most likely not enough and can also differ between brands.and
Desiccated thyroid drug may not be the best option for people who have an autoimmune thyroid condition.
With Hashimoto’s disease, thyroid antibodies attack the thyroid gland and could also develop autoimmune reaction against T4 and T3 hormones. Since desiccated thyroid is a natural compound that includes both T4 and T3 thyroid hormones as well as T1 and T2, the immune system can start to produce its own antibodies against the these hormones and make an existing autoimmune condition worse.
A combination of synthetic T4-only types of thyroid drugs and compounding pharmacy slow release T3 medication is a better choice for hypothyroid Hashimoto’s patients with T3 underconversion due to absence of the boosting effect of Cytomel and fully customizable T3 dose that slowly releases into the blood stream.
However, a common concern with using any type of the T3 medication is that the body cannot regulate the supply of T3 hormone and adjust it to the body’s needs because the portion of T3 comes externally from the thyroid drug.
Why Your Thyroid Drugs Do Not Work
Switching to combined T4 and T3 medication or adding T3 type of thyroid drug can bring relief of some hypothyroid symptoms especially fatigue, hair loss, weight gain and depression in women. However, with time many Hashimoto’s patients do not see much difference compared to being on T4 medication alone because the autoimmune attack and destruction of the thyroid gland remain in progress.
Since the conventional medicine does not make any attempt to modulate the immune system in people with Hashimoto’s any stable and long lasting results are difficult to achieve using practically ANY type of available thyroid drugs alone.
Any type of thyroid medication currently used by conventional medicine does not address the cause of the Hashimoto’s disease which is an overreaction of the immune system due to a combination of certain nutritional deficiencies, genetics and numerous environmental factors.
Patients with Hashimoto’s disease have a latent gene that could remain in an unexpressed state for a long period of time. If some environmental and dietary factors get involved, it could “turn the gene on” and trigger the autoimmune response. Poor blood sugar control, hormonal imbalances, adrenal issues, infections, irregular immune function, gluten intolerance and other food allergies are factors that can also affect thyroid function and trigger the over reaction of the immune system.
Thyroid drugs replace the hormones that cannot be produced and reduces inflammation of the thyroid gland, however it does not stop the autoimmune attack that causes the disease and does not eliminate any environmental factors that trigger Hashimoto’s. The destruction of the gland continues and the patient requires higher and higher doses of ANY type of thyroid drugs with time for treatment of hypothyroidism and symptoms relief.
Many thyroid and Hashimoto’s patients develop low adrenal function or adrenal fatigue when output of stress hormone cortisol is low. This condition can interfere with thyroid function causing many symptoms that similar to hypothyroidism. If increase of dose of thyroid drugs brings only short-term temporarily relief and symptoms appear again it can be also due to adrenal fatigue. Increasing thyroid medication is one of 5 crucial mistakes women with thyroid problems make. In this group of thyroid patients adrenal imbalance should be corrected first because it can provide some improvement of symptoms that were initially attributed to hypothyroidism and a patient often will require lower dose of thyroid medication.
The goal of holistic Hashimoto’s treatment is to identify the contributing factors to the thyroid autoimmunity and balance the immune system using nutrition and natural compounds to stop the destruction of the thyroid gland and potential autoimmune attack on the other organs and/or the body’s systems.
Recent research studies reported that hypothyroidism caused by Hashimoto’s disease is reversible in some cases.
People who experience dramatic improvements are those that start with their diets. By identifying and removing ALL dietary triggers of thyroid autoimmunity and healing leaky gut syndrome all patients improve and many are able to reduce their thyroid medication and reverse thyroid disease.
Gluten and excessive iodine are well-known dietary factors that can trigger Hashimoto’s disease and hypothyroidism. It is also recommended to perform iodine test to find out if iodine deficiency is a contributing factor to hypothyroidism and/or Hashimoto’s disease.
According to a recent studies, patients with Hashimoto’s who went gluten-free and/or decreased their iodine intake were able to reduce their thyroid medication and in some cases even reverse Hashimoto’s. However, many people struggle to to it on their own and need get help of holistic health coach to get results they want.
For many of us it is not enough to just take a thyroid drugs to manage the Hashimoto’s disease and hypothyroid symptoms and to feel well. Finding and addressing the cause of the autoimmune disease and thyroid dysfunction can significantly improve the quality of life and make a true difference for many patients.
P.S. If you got here from Twitter or a link from a friend you can find out more about nutritional approach to Hashimoto’s and hypothyroidism treatment in the FREE Hypothyroidism Diet Guide. Sign up here
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Hope for Hashimoto’s by Dr. A. Haskell, CreateSpace, 2011
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Overcoming Adrenal Fatigue: How to Restore Hormonal Balance and Feel Renewed, Energized, and Stress Free (New Harbinger Self-Help Workbook) by K.R. Simpson, New Harbinger Publications; 1 Workbook edition, 2011
Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state. Thyroid Res. 2010 Dec 20;3(1):11.
The effect of iodine restriction on thyroid function in patients with hypothyroidism due to Hashimoto’s thyroiditis. Yonsei Med J. 2003 Apr 30;44(2):227-35.