Treatment of Hypothyroidism

dr_david_brownstein_130By David Brownstein, M.D.

The treatment of hypothyroidism varies greatly.  I will divide this article into the conventional treatment and the holistic treatment of hypothyroidism. 

Conventional Treatment of Hypothyroidism
The conventional treatment of hypothyroidism relies primarily on using synthetic derivatives of T4, Levothyroxine Sodium, more commonly known as Synthroid®, Levothroid®, Unithroid®, etc.  

As previously mentioned, most conventional physicians will solely monitor TSH levels in order to gauge the functioning of the thyroid gland. TSH is very sensitive to circulating T4 levels.  As T4 levels decline, TSH will increase, trying to stimulate the thyroid gland. As T4 levels increase, TSH levels will decline.

The problem with monitoring TSH levels is that it does not tell you how much T4 is converting to T3, the more active thyroid hormone.  As previously mentioned, there is no lab test that can assess how T3 is functioning inside each of the billions of cells in the body. Relying solely on T4 monitoring and T4 treatment (i.e., Levothyroxine Sodium products - Synthroid®, Levothroid®, Unithroid®, etc.) will miss many of the cases of hypothyroidism and result in sub-optimal treatment for the condition.

Holistic Treatment of Hypothyroidism
The holistic approach to treating hypothyroidism is to look at the underlying cause(s) of hypothyroidism while trying to optimize thyroid function. As previously mentioned, many items interfere with the normal conversion of thyroid hormone from its inactive (T4) to its more active (T3) form. Whether the treatment involves stopping drugs such as birth control pills or synthetic estrogens, correcting vitamin and nutrient deficiencies or using dietary strategies, the focus should be on maximizing the body's own thyroid production and utilization.

When medication is needed to treat hypothyroidism, I believe that desiccated glandular thyroid products (e.g., Armour® Thyroid, Nature-ThroidTM or WesthroidTM) are much more effective treatment options as compared to using T4 derivatives. My clinical experience with using desiccated thyroid has shown that it is a superior product as compared to the synthetic versions of thyroid hormone presently available (such as Synthroid® or Levothroid®).

Desiccated (i.e., heat dried) thyroid glandular products are porcine (pig) derivative.  Although it is not a direct duplicate of our own thyroid production (since it is porcine derived), it is the closest version we presently have available. Desiccated thyroid has T4 (like Synthroid®) but also has the more active thyroid hormone T3 and other factors that allow its conversion to T3 to take place more readily in the body.

Desiccated thyroid contains T4, T3, T2, T1, Calcitonin and Selenium. Desiccated thyroid may also contain an unknown hormone that gives it an additional benefit. This unknown hormone may be a diuretic hormone, which is separate from the other hormones in desiccated thyroid hormone (i.e., T4 and T3). Dr. Barnes was the first to propose this idea when he wrote,  "Evidence suggests that a diuretic fraction [in Armour® Thyroid] may be present." Levothyroxine sodium products (Synthroid®, Levothroid®, Unithroid®, etc.) do not have the diuretic effect that Armour® Thyroid has. This diuretic component of Armour® Thyroid helps to relieve the edema that is commonly found in hypothyroidism.

Thyroid production is very complex in the body.  In addition to the production of T3 and T4 thyroid hormones, there are other thyroid hormones released from the thyroid gland, including T2 and T1 thyroid hormone. T2 hormone has been shown to help increase the metabolic rate, especially for muscles and fat tissue. I believe the added agents in a desiccated preparation such as Nature-ThroidTM make it a much more useful product than the commonly prescribed synthetic versions (i.e., Synthroid®, Levothroid®, Unithroid®, etc). More importantly, I have observed much better clinical results in my patients with using desiccated thyroid (i.e., Nature Throid) versus levothyroxine sodium products. 

Some physicians feel that T3, being the more active thyroid hormone, provides the best results when treating hypothyroidism. Although I have had patients improve their condition with T3, I have not had the sustained success with treating hypothyroidism when using T3 as I have when using desiccated thyroid. Furthermore, T3 can be dangerous if the amounts used are too high or if used in individuals with hypoadrenal or cardiac problems. However, small amounts of T3 added to T4 preparations do provide benefit in many individuals. A study from the New England Journal of Medicine found that adding a small amount of T3 to patients already being treated with T4 preparations (i.e., Synthroid®, Levothroid®, etc.) significantly improved mood and brain function.

I see many patients in my practice that were diagnosed with hypothyroidism by another physician and placed on a levothyroxine sodium product such as Synthroid®. Although their blood tests improved with the use of Synthroid®, many of their symptoms did not improve. Upon changing their thyroid hormone to the desiccated version (i.e., Nature-ThroidTM,  or WesthroidTM), their symptoms dramatically improve. I believe this improvement occurs because the body is able to convert the desiccated thyroid hormone (i.e., Nature-Throid) to the active hormone more efficiently.  

Why Don't Most Doctors Prescribe Desiccated Thyroid?
One of the first things I learned in medical school was to use only levothyroxine sodium products (i.e., Synthroid®, Levothroid®, etc.) for treating thyroid problems.  I was told that these products were the ‘newest' and the ‘best' products on the market. Furthermore, I was told that desiccated thyroid hormone, like Nature-Thyroid, was not consistent from dose to dose.  In other words, each 30mg dose of Nature-Throid® may or may not contain 30mg of Nature-Throid.

I do not know the origin of the complaint that desiccated thyroid is not consistent from dose to dose.  The FDA has been aware of the poor consistency of some levothyroxine products for a number of years however there is no such concern with desiccated thyroid. In 1997, the FDA reported that " currently marketed orally administered levothyroxine sodium product has been shown to demonstrate consistent potency and stability and, thus, no currently marketed orally administered levothyroxine sodium product is generally recognized as safe and effective." The FDA also wrote that Synthroid® has a long history of quality-control problems.  Recently, two levothyroxine sodium drugs have received FDA approval for potency and consistency of their products-Levothroid® and Unithroid®.

I have not found a consistency problem with desiccated thyroid products.  Because of the T4 conversion problem, a thyroid product that enhances the conversion of inactive (T4) to active (T3) thyroid hormone is bound to have a greater efficacy.  In my experience, as compared to levothyroxine sodium products, desiccated thyroid hormone generally works better for the vast majority of patients.

Other versions of desiccated thyroid hormone include WesthroidTM and Nature-ThroidTM.  WesthroidTM, like Armour® Thyroid, is made from porcine thyroid glands.  It also has a cornstarch binder in it.  Nature-ThroidTM is bound by microcrystalline cellulose, which is derived from paper.  I have seen good responses from my patients with these two products.  In fact, these two products are my preferred form of thyroid hormone. 

Final Thoughts

My clinical experience has clearly shown that using a more active form of thyroid hormone is almost always more effective than using T4 derivatives. As the body ages, the conversion of T4 to T3 declines and supporting this conversion process with nutrients and a more active thyroid hormone makes common sense.  More importantly, patients feel better when given the proper thyroid hormone supplement for their condition. 

In evaluating individuals with chronic illnesses, physicians must keep in mind that we are not treating laboratory tests.  We are treating complex individuals who have differing presentations of their illnesses.  We must use the safest, most effective treatment options available. For thyroid patients, I have found that ensuring that the body's conversion of T4 to T3 is optimal will improve the overall health of the patients as well as improve any chronic conditions. 

(This article was excerpted, in part, from Overcoming Thyroid Disorders, 2nd Edition)

 5. Barnes, Broda.  Is There a Third Hormone in the Thyroid Gland?  Which Preparation Should be Used for Treatment?  Journal of IAPM, Nov. 1982
 6. Lanni, A, et al.  Calorigenic effect of di-iodothyroidines in the rat. J. Physiol (Lond) 1996;494:831-37
 7. Horst, C., et al.  Rapid stimulation of hepatic oxygen consumption by 3,5-di-iodo-l-thyrooninne. Biochem J.  1989;261:945-950
 8. Bunevicius, B., et al.  Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.  NEJM. 1999;340:424-429. 
 9. Federal Register, August 14, 1997 (Vol. 62, Num 157)

Dr. David Brownstein, M.D. 
David Brownstein, M.D. is a family physician who utilizes the best of conventional and alternative therapies. 
He is the Medical Director for the Center for Holistic Medicine in West Bloomfield, MI.

December 2010

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