The synthetic thyroid hormone, Synthroid (T4) is commonly prescribed by many physicians when thyroid tests are abnormal and in many cases doesn’t seem to work as effectively as expected. Numerous patients who take their Synthroid as prescribed, with T4 levels in the “desirable therapeutic range” do not feel much significant improvement in their condition. Some even discontinue their medication and feel no significant difference.
Increasing the dose of Synthroid sometimes helps, but more often the benefit is greater when either T3 (Cytomel) is added or the patient uses Armour Thyroid (or a similar generic desiccated thyroid), which contains both T3 and T4. Many physicians are unaware of this study.
When conversion of T4 to the more active metabolite T3 is inadequate, it becomes especially important to supplement with T3. Some T3 preparations come in a slow-release formula and are taken twice daily for a more even metabolic effect. This is because T3 does not remain active as long in the body as does T4.
In the past it was thought that osteoporosis may be worsened by excessive thyroid hormones. A study demonstrated that osteoporosis is only seen if TSH is left below 0.1 for a prolonged period of time. The goal is to reach an effective dose of hormone while keeping the TSH above 0.1. Many physicians keep the TSH at 3 – 5, which may not result in much clinical improvement.
For purposes of conversion, levothyroxine sodium (T4) 100µg is usually considered equivalent to desiccated thyroid 64mg (1 grain), thyroglobulin 60mg, or liothyronine sodium (T3) 25mcg. However, these are rough guidelines only and do not remove the need to reevaluate when switching thyroid hormone preparations, including a change from one brand to another. Independent testing of generic T4 preparations have found them to be consistantly equal in potency and absorption to name brands like Synthroid.
On a daily basis, whether you take the hormone on an empty stomach or with food is not too important, but there will be better absorption on an empty stomach. Some even take their dose during the night. If you are trying to take your thyroid medication away from meals, consider a separtion period of at least two hours on either side.
You should not take thyroid medications with iron, calcium, supplemental fiber, calcium or aluminum-based antacids or bile-acid sequestering agents (colestipol, cholestyramine) because they will interfere with absorption. Ingestion of soy products simultaneously with thyroid hormones appears to reduce the absorption of the hormones. Bugleweed (Lycopus virginicus, Lycopus europaeus) and lemon balm (Melissa officinalis) may interfere with the action of thyroid hormones and should not be used during treatment with thyroid hormones.
Some doctors trust symptoms over a borderline TSH when considering thyroid medication dose saying that “If patients are going to have normal tissue metabolism and good metabolic health while using T4, most of them must take a dose that suppresses the TSH level. It’s this fact that mainstream doctors need to come to understand.”
Additional information on T4 and T3 can be found on Dr. Wilson’s web site.
Thyroid Medications can help with the following
Chronic Thyroiditis
Due to the profound effect of thyroid hormones, their use in a hypothyroid and hyperthyroid conditions is well justified. That is, thyroid replacement in hypothyroidism and thyroid medications to reduce thyroid activity in hyperthyroidism.
Hyperthyroidism
Thyroid medications should obviously be avoided with hyperthyroidism. However, there are cases where one would be taking thyroid medication for hypothyroidism, but just be taking too much and would need to reduce the dose – not avoid it entirely.
Hypothyroidism
Thyroid medication should be taken separately from iron and possibly calcium supplements to ensure availability for absorption. It is known that taking iron tablets, or vitamins with iron at the same time as your thyroid hormone can make the thyroid hormone less effective. Many doctors recommend at least 2 hours between taking iron and the thyroid hormone.
A doctor from Johns Hopkins published a letter in JAMA reporting that several patients taking levothyroxine experienced an increase in TSH levels after they started to take calcium supplements. When they changed their pattern and began to take the calcium and thyroid hormone at least four hours apart, TSH returned to the initial level.
One woman ingesting large amounts of calcium carbonate (1250 mg tid) with levothyroxine (T4), continued with symptoms of hypothyroidism until delaying calcium carbonate administration by 4 hours. This separation of supplement times resulted in a return to normal thyroid status. [ Ann Pharmacother 2001;35(12): pp.1578-83]
Once you start on thyroid hormone replacement (especially higher doses of even natural hormones) your thyroid gland can start to atrophy. If you remain on thyroid replacement for more than three years it becomes difficult to stop.
If Wilson’s Syndrome (Wilson’s Metabolic Syndrome) is suspected, one treatment regimen is as follows. Dr. Wilson recommends treatment through a programme of time-release T3 tablets (7.5–15mcg), which are taken every 12 hours until the body temperature reaches an average of 98.2 or until you develop symptoms of hyperthyroidism (such as rapid heart beat). Your Naturopath or MD can work with you to increase the dose until this is achieved. Once you reach a normal temperature, you maintain the dose for 30 days, then taper the dose down slowly before tailing it off completely. With little or no T4 left in the system, rT3 production eventually decreases, and the conversion of T4 can occur normally.
Immune System Imbalance (TH2 Dominance)
Thyroxine (T4) found in Synthroid and desiccated thyroid is a thyroid hormone that increases TH1 cytokines to help balance the immune system.
(Sources: Am J Physiol 1997 Oct;273(4 Pt 1): pp.125-32 and J Immunol 1998 Jul 15;161(2): pp.843-9)
Hives
A study suggests that administration of thyroxine to patients with chronic urticaria associated with elevated thyroid antibodies can result in remission of the hives. [J Allergy Clin Immunol 1995;96: pp.901-905]
Key
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
T4
Thyroxin, thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.
Metabolite
Any product (foodstuff, intermediate, waste product) of metabolism.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Milligram
(mg): 1/1,000 of a gram by weight.
Microgram
(mcg): 1/1,000 of a milligram in weight.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Antacid
Neutralizes acid in the stomach, esophagus, or first part of the duodenum.