In order to discuss the different options for hypothyroid treatment, it is important to fully understand what hypothyroidism is and what causes it.
The thyroid is a very important gland in our bodies that releases hormones to help control metabolism. The hormones that the thyroid releases help in regulating most of our bodily functions - including our breathing, heart rate, body weight, muscle strength, body temperature, menstrual cycles in women, nervous system, and more. Hypothyroidism occurs when the thyroid is not producing enough thyroid hormone, which our bodies need to survive, causing a host of symptoms.
Common symptoms include cold intolerance, weight gain despite decreased appetite, dry skin, fatigue, sluggishness, depression, constipation, slowed heart rate, increased bleeding during menstrual cycles, low blood sugar, among others.
The most common cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis, which is an autoimmune disorder where the body produces antibodies that attack the thyroid, causing it to slow down and decrease production of the essential hormones your body needs for energy and metabolism.
Along with Hashimoto’s, there are other causes of hypothyroidism. Some patients make enough T4, but have trouble converting it into the active form, T3. low iodine intake (much more common outside the US), major hormonal shifts like giving birth, problems with the pituitary and hypothalamus, and a radiation to the thyroid gland. No matter the cause of the slowed thyroid, the signs and symptoms will be similar. Figuring out the cause is important, as it will help you and your doctor tailor your treatment.
As stated above, it is important to know the cause of your hypothyroidism. If it is due to iron deficiency, taking iron supplements should correct the disease. If it is due to the high stress of pregnancy, it may correct itself postpartum. If it is due to the hypothalamus or pituitary gland, surgical correction may be needed.
A complete analysis of your thyroid function will help with determining treatment. There are medications that mimic the body’s naturally producing hormones, T4, T3, and some medications offer a combination of the two.
A medication that mimics your body’s naturally producing thyroid hormone, T4 is the most common hypothyroid treatment and is also one of the most widely prescribed medications in the US and the whole world. That is why you have likely heard of Synthroid or Levoxyl, which are brands of levothyroxine.
Levothyroxine is a synthetic form of the T4 hormone, which is called the storage thyroid hormone. It comes in many doses and can even be taken on alternating days to fit a person’s hormonal replacement needs. Your body takes the T4 hormone and converts it to T3, which is the active hormone, helping your body’s metabolic processes. If you are someone who has conversion issues from taking T4 to T3, a standard T4 medication may not be sufficient for you.
T3 medications come in preformed, synthetic, and compounded forms and are beneficial for those who do not convert T4 to T3 well. The synthetic form of T3 most commonly prescribed is Cytomel. The downside to prescribing the active form of the hormone is that it only stays active in the body for 10 hours, so patients must take two doses a day. They are also seen to provide a sudden burst of metabolic processes when the active thyroid hormone is taken, followed by feelings of sluggishness when they wear off.
There are two main types of combination thyroid medications, desiccated and compounded. The desiccated thyroid brands most commonly known are Amour, WP Thyroid, NP Thyroid. These medications come from the dried thyroid glands of pigs, therefore containing the full range of thyroid hormones. The main difference seen is that pigs produce their T4 to T3 at a lower ratio than humans do, so patients often have to supplement with additional T4 hormone.
Like compounded T3, compounded T4 and T3 is custom-prepared in specialized compounding pharmacies to provide the strength and T4 to T3 ratio that the patient needs. It gives the most flexibility for those who need very specific doses.
As you can see, there are various medication options that should be tailored particularly to how your thyroid functions and needs to be supported. It is important to have a specialized thyroid doctor to look in detail at your thyroid function and symptoms to help you consider the best course of treatment.
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