Hypothyroidism: Are You Sure Your Treatment Is Working?

"Thyroid Clinic" by Ingrid Iwanow

Hypothyroidism is defined as a medical condition in which the thyroid is under-active. The thyroid struggles to produce enough hormones called T3 and T4. An under-active thyroid can be the cause of a slow metabolism, myopathy, anemia, and other health complications. Hypothyroid can be diagnosed through blood work, as T4 levels will be low and TSH (thyroid stimulating hormone) levels will be high. TSH is produced and released into the bloodstream by the pituitary gland; the purpose of TSH is to signal the thyroid to produce more T3 and T4.

Symptoms of Hypothyroid are vast. They include weight gain, depression, constipation, fatigue, sensitivity to cold, and decreased appetite. The condition is 5 to 8 times more common in women than in men; it is especially common for it to arise in pregnant women.

There are a few causes of Hypothyroidism; however, the most common cause is an autoimmune disease called Hashimoto’s Thyroiditis. When someone has Hashimoto’s, their immune system attacks the thyroid; this causes inflammation and could disrupt thyroid function.

I Have Hypothyroidism and Hashimoto’s Disease

When I was just eight years old, I was taken to the gastroenterologist for indigestion and stomach pain. The doctor ordered blood work and without giving it too much thought, he opted to have my thyroid levels checked. My thyroid levels ended up being the only issue.

Hypothyroidism is the last thing the doctors expected in a child like me. I was underweight, anxious, irritable, full of energy, and frail. If anything, the doctors would have suspected I had Hyperthyroidism, which is when the thyroid is overactive and produces too much thyroxine (thyroid hormone). A Hypothyroid diagnosis could come as a surprise; in fact, millions of people have Hypothyroid and don’t even know it.

Every month for about a year, I was getting my blood work monitored. At one point, my endocrinologist decided to wait 3 months before retesting, and my levels drastically changed. I then needed to get blood work every two weeks until I was stable again.

With children who have Hypothyroidism, it is important for endocrinologists to frequently check their levels. Prior to and during the stages of puberty, the thyroid levels will change the most. Thyroid levels will also fluctuate the most during pregnancy. It was not until I had the disease for at least 8 years that my doctor agreed to perform blood work every 6 months.

Mainstream Treatment

Most doctors will immediately prescribe Synthroid (levothyroxine) to patients who have high TSH levels; this is what my doctor did for me. Synthroid is a pill that is taken at least 30 minutes to an hour before breakfast. For the 12 years that I was taking Synthroid, I took it at night. It does not matter if you choose to take it at night or in the morning, as long as it is taken on an empty stomach (2 hours after eating).

Endocrinologists may have different suggestions for what to do in the case that you miss a pill. My pediatric endocrinologist bounced back and forth with his ideas about what to do. One time, he told me to double up the following night. Another time, he told me NOT to take both at the same time; a double dose could put the metabolism into overdrive. Thankfully in my years of taking medication, I have only forgotten to take my pill less than a handful of times.

How Does Synthroid Work?

Synthroid is a synthetic, man-made T4. It is not the T4 hormone in its exact form; however, it is the closest thing to it. When T4 is administered to patients, their TSH levels will go down, and their T4 levels will go up. This is the most common treatment for Hypothyroid; however, most patients will unfortunately need to take Synthroid for rest of their lives.

When the body is given T4 on a regular basis, it forms a dependency that is irreversible in most cases. Most people that have Hypothyroidism become dependent on Synthroid because it is their only option; it is considered by many to be the best solution, and Synthroid hasn’t proven to have any significant negative long-term effects.

Issues With Synthroid

The main issue with Synthroid is that it does not contain T3. You might be asking yourself, what is T3? I mentioned it at the beginning of this article; however, T3 is often overlooked. T4 is actually useless to the body because it is inactive; T3 is the active thyroid hormone. When T4 is produced, it is converted into T3. Many people that have thyroid issues struggle with converting T4 to T3.

Blood work often only checks the T4 levels. This means you could be receiving treatment for Hypothyroidism and your blood work will show that your TSH and T4 are both within normal range; however, you may not be receiving optimal treatment because your T3 levels may be low. To make sure that you do not have this issue, request a screening of your Free T3 and Reverse T3 (inactive T3) levels.

Although it is not a major problem, another potential issue with Synthroid is that it is not an exact form of T4. Since it has generally been proven to work the same as the real hormone, this issue is much less concerning; however, this is a bummer for those who don't like taking synthetic hormones.

My final concern with Synthroid is that in almost all cases, it is a life sentence. While Hypothyroid is a lifelong condition for most people, there are potential ways of treating it if the underlying cause could be identified and treated. It is in my belief that many people who may have had a chance of outgrowing Hypothyroidism do not because they quickly grow dependent on the medication.

I have Hashimoto’s Disease. As mentioned before, this is when the immune system produces an excessive amount of antibodies that attack the thyroid. This causes inflammation, which is what often triggers Hypothyroid. Diets containing gluten worsen inflammation; it is encouraged for anyone with an autoimmune disorder to avoid gluten, even if gluten doesn’t make them sick. Could a gluten-free diet potentially resolve Hypothyroidism caused by Hashimoto’s when it is first diagnosed? Most doctors never explore this possibility.

Synthroid also has several side effects that may be overlooked or diagnosed as separate issues. Particularly fatigue, excessive sweating, anxiety, and nervousness is very common.

Alternative Medication

Armour Thyroid tablets

The great news is that Synthroid is not the only option for treating Hypothyroid. There are other prescription medications that are more natural. Nature-Throid and Armour Thyroid are the two most common alternatives to Synthroid.

Armour Thyroid and Nature-Throid both contain a non-synthetic T4 hormone. The T4 is obtained from pigs; unfortunately, this medication is not vegetarian-friendly. Although the hormones are not obtained from humans, they are the same and they work the same way.

Both of these alternative medications also contain the natural T3 hormone. This ensures that patients are receiving both hormones.

Once I switched to alternative medication, I noticed changes in my mood and energy levels. I was no longer feeling unexplained fatigue, and I noticed a decrease in my anxiety levels. I believe that these symptoms I once had were either side effects of the Synthroid, or they could have been from of a lack of T3.

A study has shown that Armour Thyroid produced better clinical results than Synthroid. When taking the equivalent dosage of Armour Thyroid after switching from Synthroid, my TSH levels dropped; they were lower than they have been in a very long time.

Fortunately, there are no common side effects to Armour Thyroid; but serious side effects are possible and include fast heartbeat, excessive sweating, nervousness, and fainting. The only common side effect of Nature-Throid is temporary hair-loss. Other potential side effects are similar to those of Armour Thyroid.

The Issues With Alternative Medication

When I switched to Nature-Throid, I also had to switch doctors. My pediatric endocrinologist, along with many other doctors do not want to prescribe these medications. For many, it could be because Synthroid is far more popular; however, some doctors are partnered with Synthroid and make money by promoting it to their patients.

As soon as I switched to Nature-Throid, the pharmacy informed me of their issues with the supply. Nature-Throid stopped making medication, so I started taking their generic brand called Westhroid. After about 2 months of taking Westhroid, the pharmacy ran out; they had no more medication to supply me with. I then made the switch to Armour Thyroid. Armour Thyroid is the most popular of the three; however, the pharmacy did warn me that a shortage is still possible. It has not happened yet, but it's something I worry about.

Even with alternative medication, people with chronic Hypothyroidism are likely to need treatment for the rest of their lives. This downside is inevitable; but at least with more a natural medication, patients may be better off.

Can Supplements Help?

Supplements should be considered for anyone with a thyroid condition. Because Hypothyroidism is a medical issue and involves monitoring levels, talking to your doctor beforehand is a MUST. Your doctor must know exactly what you are taking and how much. Iodine could be great for you, but it could also be horrible for you depending on your condition. This cannot be generalized.

Stay tuned for an article coming soon about different supplements that support thyroid health!