Doctors write millions of prescriptions annually for thyroid hormones as a treatment for hypothyroidism. Judging from this, a surprisingly large number of Americans suffers with an underactive thyroid gland.
Many others have symptoms that might suggest a problem with thyroid hormones: fatigue, constipation, dry skin, depression, brittle fingernails, mental fogginess, high cholesterol, weakness, hair loss and more. No one of these symptoms is unique to hypothyroidism, however, so doctors may need time to put all the puzzle pieces together. Unfortunately, some people feel less than well for years before diagnosis.
The Best Treatment for Hypothyroidism:
The standard treatment of hypothyroidism has long been Synthroid, a synthetic form of the thyroid hormone levothyroxine. It is also available as a generic drug. While many, perhaps even most, thyroid patients do very well on levothyroxine alone, not everyone thrives.
Q. I have been on levothyroxine (75 mcg) for many years to treat a hypothyroid condition. I still feel exhausted every day. My skin is incredibly dry, I am losing far too much hair and gain weight even though I am on a strict diet. I can never get warm enough, even with extra layers.
My thyroid panel has values within the normal range, so my doctor says I am fine and won’t change my prescription. I have asked him about switching me to natural thyroid (Armour) or adding T3 in the form of Cytomel. He seems to believe my symptoms are psychological. How can I convince him otherwise?
A. You are not the only person with hypothyroidism who is not feeling great on levothyroxine (T4) treatment alone. Researchers have found that as many as 10 or 15 percent of people on this medication still have some symptoms of inadequate thyroid hormone (Annals of Internal Medicine, Jan. 5, 2016). This may be due to genes that make the body less efficient in converting T4 to the active form of the hormone, T3.
Could Combination Therapy Help?
Leading researchers suggest that some of these individuals will feel better on combination therapy (Frontiers in Endocrinology, July 9, 2019). They urge endocrinologists to personalize thyroid treatment so that patients end up feeling well. Physicians may need to give this particular consideration for patients with persistent symptoms or abnormal laboratory values even though their TSH (thyrotropin) level is in the normal range (Journal of Clinical Endocrinology and Metabolism, Sep. 1, 2020).
Do You Really Need Treatment for Hypothyroidism?
Sometime people have the opposite problem. The TSH may be outside the normal range, but the patient may not have troubling symptoms.
Q. My doctor says my blood tests indicate I have hypothyroidism. I’m skeptical because I have none of the symptoms on her list. I’d rather not take medicine I don’t need.
Is there another way to determine for sure if I have it or not?
A. Laboratory tests may sometimes give misleading data. In addition, some medicines and dietary supplements may alter some results on a thyroid panel. Ask your doctor if you could be tested again before starting treatment.
It is possible that you have “subclinical hypothyroidism.” In this condition, people don’t have bothersome symptoms even though their thyroid glands are not functioning properly. Sometimes, thyroid hormone levels normalize over time. However, some people later develop symptoms such as weight gain, fatigue, brain fog, dry skin, brittle fingernails, constipation, puffy eyes and sensitivity to cold.
Treatment of subclinical hypothyroidism is controversial. An endocrinologist will enable you to review your test results and assess the need for hormone supplementation. To help with that conversation, we have created an eGuide to Thyroid Hormones. It provides insights on interpreting test results and analyzing various treatment options if necessary.
Is Armour the Answer?
Q. I was on Synthroid for more than 20 years, from my early 40s to my mid-60s. As I got into my late 50s, I assumed the constant pain in my joints was from old athletic injuries or arthritis.
A naturopathic doctor from my church suggested switching to natural Armour Thyroid as a treatment for hypothyroidism. Within six weeks the joint pain was gone and my energy level went up. I had a constant struggle convincing my primary care doctor to prescribe the natural treatment, though.
A. Synthroid is the synthetic thyroid hormone levothyroxine (T4). It contains 4 iodine atoms and is inactive until the body converts it to a compound with three iodine atoms (T3).
Combining T3 and T4 as a Treatment for Hypothyroidism:
Most physicians have been taught that T4 is all patients need to achieve normal thyroid function. Evidence is building, however, that people vary in their ability to convert T4 to T3 (Clinical Endocrinology, Nov., 2014). As a result, people with less efficient enzymes may be uncomfortable even while taking levothyroxine. In a randomized, controlled trial, patients with lingering symptoms while on T4 preferred a regimen combining T3 and T4 (Journal of Clinical Endocrinology and Metabolism, Oct. 21, 2021).
Armour desiccated thyroid is powdered thyroid gland from pigs; it contains T3 as well as T4. Some people find that such a combination makes them feel better than levothyroxine alone.
To Learn More:
There is more information about this new research, diagnostic tests and treatment with both T3 and T4 in our online Guide to Thyroid Hormones. You may also be interested in our interview with Antonio Bianco, MD, the scientist who did the research on genetic variability in the enzyme that converts T4 to T3. Perhaps you will also wish to listen to our hour-long radio show on this topic.
