When it comes to thyroid medications, there are a couple of absolutes: one size does not fit all; and you will likely be taking thyroid medication for the rest of your life. Understanding what medications are available and how they respond to various thyroid issues is extremely important.

Questions regarding thyroid medications are extremely common among thyroid patients. If you are happy with the medication you are taking – that is excellent! If you are still not feeling well, despite taking the medication your doctor has prescribed, you are not alone. The most important thing to remember is that you know when you feel right - if your medication is working - then that is great! If you are not feeling well, it may be important to discuss trying a different type of treatment with your physician.

Prior to starting thyroid medications, it is also important to address adrenal fatigue, iodine deficiency, and environmental toxicity. If these issues are not addressed prior to taking thyroid medication, the medications may actually worsen symptoms of hypothyroidism.

Thyroid medications need to be taken in increasing amounts. When first starting, it is recommended that patients start on a small dose, which is gradually increased over a period of up to six months before the appropriate level is achieved. It is very important that the patient stay in touch with their doctor during this period and report any unusual symptoms to their doctor immediately, especially rapid heart beat, heart palpitations, chest pain, tremors or shortness of breath.

In general, thyroid medication should be taken at the same time each day, usually first thing in the morning, with a full glass of water. Waiting at least ½ hour before eating is recommended – eating too soon after taking your medication can affect how much hormone is absorbed in your body. If you miss a dose in the morning, it is suggested that you take it as soon as you can, but do not double up on a dose if you don’t remember until the next day. It is also recommended that you wait at least one to two hours after taking thyroid hormones before taking any vitamins or nutritional supplements.

There are three basic protocols doctors use for treating thyroid disorders today. Sadly, some doctors are influenced by the pharmaceutical companies and/or have not taken the time to thoroughly research how and why one medication may be appropriate for one patient, but not for another. If is very frustrating for some patients who know they do not feel well, but their physician will not vary the type or dose of medication he/she prescribes. In this case, it is extremely important for the patient to investigate their options, and even provide information to their physician about additional medication options.

Synthetic T4 – Levothyroxine (aka l-thyroxine)

Synthetic T4 supplementation is the most common form of medication prescribed today. The four brands of synthetic T4 are Levothroid, Levoxyl, Unithroid, and the most common brand, Synthroid. These medications provide synthetic T4 hormones, which the body must then convert to the active thyroid hormone – T3. Many patients do well on l-thyroxine. However, if your body has difficulty converting T4 to T3, it is possible that l-thyroxine alone will not effectively relieve hypothyroid symptoms. Adding liothyronine (synthetic T3), known as the brand Cytomel, may be beneficial.

Natural Desiccated Thyroid

Today, natural desiccated thyroid products are derived from pig, or porcine, thyroid. The most common brands of desiccated porcine thyroid are Armour Thyroid, Nature-Thyroid, Thyroid USP and Westyroid. These medications provide T4 and trace amounts of T3, T2 and other hormones naturally found in the thyroid. Patients, who do not respond well to l-thyroxine, often feel better when they switch to porcine thyroid because of the addition of the trace amounts of T3. However, for patients who have religious or vegetarian issues, natural desiccated thyroid is not a good option. If Hashimoto's patients do not feel well with natural desiccated thyroid, trying other medications may work more effectively. Some Hashimoto's patients find that increasing the dosage of desiccated thyroid medication may be the key to eliminating symptoms.

Combination T4-T3 Supplements

T4-T3 combination supplements are gaining in popularity. The synthetic forms of this medication are called T4 – Levothyroxine and T3 – Liothyronine. In the United States, the brand used is Thyrolar. The drawback to this product is that the amounts of T4 and T3 included in the pill may not be the exact amounts best recommended for the patient. Ideally, a compounding pharmacy can tailor make capsules with the exact dose of T4 and T3 that the doctor prescribes. This choice is also optimal for patients with Hashimoto’s and may be a great option for patients who have not responded well to other thyroid medications. However, finding a physician who will work with you and a compounding pharmacy can be difficult.

Please note that the information provided on the Thyroid Health site on Bella Online is for information and educational purposes only and may not be interpreted as medical advice.

Sources: THYROID BALANCE, Glenn S. Rothfeld, M.D., M.Ac. & Deborah S. Romaine; HYPOTHRYOIDISM TYPE 2, Mark Starr, M.D.; OVERCOMING THYROID DISORDERS, David Brownstein, M.D.
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