In this article:
- What is compounded medication?
- What is a compounding pharmacy?
- Can thyroid medications be compounded?
- Are compounded thyroid medications safe?
- What to do if your FDA-approved thyroid medication is not working
People with hypothyroidism need lifelong thyroid replacement medication. Typically, levothyroxine, a synthetic T4 hormone, is the medication used to treat hypothyroidism. Levothyroxine (also known by brand names) is one of the most commonly prescribed drugs in the United States. However, thyroid medication is not a one-size-fits-all treatment option. Between fillers, additives, and difficulty resolving symptoms in the presence of autoimmune thyroiditis, many people turn to compound medication to find a unique treatment approach for their thyroid disease.
What is compounded medication?
According to the U.S. Food and Drug Administration, drug compounding is where ingredients are combined, mixed, or altered to create a unique drug for an individual patient. Generally, compounded medications contain at least two or more drugs.
Drug compounding can be beneficial for patients who cannot do not find success with an FDA-approved medication. There are various reasons why a person may not be able to take a specific drug. For example, people with allergies to dyes or fillers may not be able to take certain medications. Likewise, children and adults who cannot swallow tablets or capsules may require medication prepared in an oral suspension.
What is a compounding pharmacy?
Some health care facilities like hospitals offer to compound when a drug does not meet a patient's need — for example, an elderly adult who cannot safely swallow a pill without aspirating. However, some pharmacies specifically make compounded drugs.
Compounding pharmacies typically invest in the right equipment and preparation mediums (ointments, creams, capsules, etc.). All pharmacists have the training to do basic compounding to meet the needs of their patients.
In a compound pharmacy, a licensed pharmacist creates a customized medication according to a doctor's prescription. For example, a doctor may prescribe a personalized dose or strength of a medicine, or request a specific flavor. Similarly, compounding pharmacies can also remove undesirable or problematic ingredients for a patient, like gluten, lactose, or dyes.
Can thyroid medications be compounded?
People with thyroid conditions sometimes turn to compound pharmacies because they have sensitivities to manufactured thyroid medication or wish to avoid additives and fillers. For example, people with Hashimoto's (an autoimmune condition afflicting the thyroid) may be sensitive to corn or lactose in their medication.
Compounding pharmacies sometimes use bioidentical thyroid hormones that are not from an animal source. In these preparations, T4 and T3 are synthesized in a laboratory to mimic the body's natural thyroid hormones. These preparations can be made in lactose-free powders or suspended in oil inside a gelatin capsule. Some compounding pharmacies also use desiccated thyroid hormones from the thyroid glands in pigs.
Here is a short list of what may be in compounded thyroid medication.
Active ingredients may include:
- Desiccated porcine thyroid
- Pure liothyronine (T3)
- Pure levothyroxine (T4)
Inactive ingredients or medium (also called excipients) may include:
- Ginger root powder
- Olive oil
Are compounded thyroid medications safe?
Compounded medications are not regulated or approved by the FDA. Thus, the safety and efficacy of compounded thyroid medications cannot be verified. Similarly, manufacturing quality cannot always be determined, leading to unease for both providers and their patients. Because there is no safety verification in compounded drugs, there may be a higher risk of serious complications if a drug contains excess amounts of the active ingredient.
Compounding pharmacies are also not regulated by the FDA. However, each state should have a board of pharmacy that regulates compounding pharmacies.
What to do if your FDA-approved thyroid medication is not working
Finding the right thyroid medication and dose can be challenging. Usually, hypothyroidism treatment starts at a specific dose of thyroid medication, which then titrates over several weeks. The right dose is determined when thyroid labs indicate a return to a euthyroid state and achieved symptom control.
If you have been taking thyroid medication for some time and still struggle with hypothyroid symptoms like fatigue, weight gain, sluggishness, and moodiness, you may need adjustments to your prescription. Before meeting with your doctor, make sure you optimize your current dose of thyroid medication in the following ways:
- Take your medication on an empty stomach (usually, people take it first thing in the morning).
- Do not combine your thyroid medication with other medications, including supplements with calcium.
- Avoid adding "thyroid support supplements" without talking to your doctor first.
- Monitor your weight for significant fluctuations.
- Stick with the same medication and avoid switching between generic and brand medication.
- Assess for any changes in your diet. For example, a diet high in fiber may interfere with thyroid hormone absorption.
After you confirm that you are taking your thyroid medication correctly, meet with your endocrinologist to re-check your thyroid labs. Generally, it is best to stick with the same thyroid medication you were started on unless it is not working. In that case, your doctor may switch you to a different medication. For example, your doctor may add T3 into your treatment plan, but keep in mind T3 may not always improve your symptoms.
A note from Paloma Health
Paloma Health thyroid doctors work with you to determine the best treatment option based on your symptoms, history, lifestyle, and lab results. If you're interested in learning more or trying compounded thyroid medication, talk with your Paloma Health doctor.