Do We Need New Thyroid Medication Treatments?
When are we going to get new treatments and new thyroid medications to treat thyroid disease?
I have seen this question several times over the last few years in some form or another.
From their perspective, it makes sense that the problem is most likely related to their medication.
After all, shouldn’t they feel better if they are taking their medication each and every day?
You would think so but this way of thinking is actually incorrect!
Would it surprise you to know that you already have plenty of options in terms of thyroid medications to use?
All prescription thyroid medications are exact replicas of the same hormone that your thyroid gland would produce if it was healthy.
This applies to Synthroid and levothyroxine!
The problem isn’t in the medications that you are taking but in how you are taking them.
And this is the entire point of this article.
Today I want to explain what type of changes you can make to your thyroid medication to optimize your dose so you can feel better.
Let’s jump in…
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4 Tweaks You Can Make To Optimize Your Thyroid Medication
If you are faithfully taking your thyroid medication every day but still experiencing low thyroid symptoms then this information is for you.
Between all of the tweaks that I’m about to list, there is some combination that will work for your body.
This is true even if…
- You’ve tried other thyroid medications in the past unsuccessfully
- You’ve tried T3 only thyroid medications and experienced negative side effects
- You’ve tried several different types of T4 thyroid medication without success
I’ve found that as long as you are willing to continue to try new things and tweak how you are taking your medication, you will eventually find what works for you.
Yes, this may take some time and yes, it may require a doctor but we are talking about your quality of life here.
No amount of work is more important than being able to function day to day at an optimal level, to experience better relationships in life, to have energy to enjoy your life, to experience a normal weight, to have normal hair growth, and so on.
Do not let your thyroid take the best years of your life!
With that in mind, let’s talk about these tweaks:
#1. Tweak the Type of Thyroid Medication You are Taking
When it comes to managing your thyroid symptoms you simply won’t feel better unless your thyroid medication is optimized for your body.
For most people, that means using a combination of T4 and T3.
Unfortunately, most thyroid patients are given thyroid medications like levothyroxine or Synthroid and that’s it.
In other words, you are probably receiving 100% T4 thyroid hormone.
But that’s not how your thyroid gland works.
If we were to line up 100 thyroid patients (or even healthy patients) we would find that each person would do better on a different ratio of T4 to T3.
One person might do well with 99% T4 and 1% T3, another might do better on 80% T4 and 20% T3, and another might do better on 50% T3 and 50% T4.
It’s very difficult to find where you fit on this T4 to T3 ratio spectrum unless you play around with your dose.
Right away you can see that there are many variables at play when optimizing your thyroid medication but it doesn’t stop with the T4 to T3 ratio.
In addition to the T4 to T3 ratio, some people will react better to certain types of thyroid medications.
As an example, think about levothyroxine and Synthroid.
Even though these are technically both the same thyroid medication (one is generic and the other is brand-name), one person may do better on one and not the other.
This logic applies to all brand-name thyroid medications and generic thyroid medications.
Between finding your T4 and T3 ratio, as well as finding the right type of thyroid medication, you have tons of options and ways to optimize your dose in this section alone.
With this in mind, let’s talk more about prescription thyroid medications and stratify them even further based on additional factors.
Generally speaking, we have 4 subcategories of thyroid medications:
- T4 only thyroid medications – These are medications that contain only T4 thyroid hormone. Included in this group would be levothyroxine, Synthroid, Unithroid, Levoxyl, Tirosint, and Tirosint-sol. And each of these medications has its own set of pros and cons and can be stratified even further.
- Regular T4 thyroid medications – Regular T4 only thyroid medications are those medications that don’t have anything special to offer and this is the group that levothyroxine and Synthroid would fit into.
- Cleaner and more absorbable forms of T4 – Among T4 thyroid medications, some are formulated in such a way as to improve absorption in the intestinal tract. Those medications that fit here include Tirosint and Tirosint-Sol.
- T3 only thyroid medications – T3 thyroid medications are medications that contain only T3 thyroid hormone. These are the most powerful thyroid medications available and are the least prescribed as most doctors are not familiar with them. Among T3 thyroid medications we have two additional groups:
- Immediate release T3 – These are medications that are absorbed quickly into your body. Liothyronine and Cytomel fit into this category.
- Sustained release T3 – Sustained release T3 thyroid medications are compounded by a compounding pharmacy and have a delayed-release to prevent a flush of T3 into the system (thereby helping to reduce symptoms of using T3 thyroid hormone).
- NDT (Natural Desiccated Thyroid) – Natural Desiccated Thyroid is a class of medications that come from the thyroid gland of animals (usually porcine). They are considered both natural in that they are not produced synthetically and bio-identical because they look identical to the thyroid hormone that your own body produces. Natural Desiccated Thyroid medications contain both T4 and T3 in a specific ratio as well as some additional ingredients such as T1, T2, calcitonin, and some iodine. Medications in this class include Armour Thyroid, NP Thyroid, WP Thyroid, and Nature-Throid.
- Combination T4 & T3 Thyroid Medications – You can get both T4 and T3 thyroid medications by combining two medications together or by compounding T4 and T3 together via a compounding pharmacy. The ratio of T4 to T3 in each case may differ and can be adjusted to your needs.
- Using a compounding pharmacy for T4 and T3 – If you use a compounding pharmacy then your doctor can write a prescription for any amount of T4 and any amount of T3. Your prescription may be 55mcg of T4 and 15mcg of T3 or virtually any other ratio.
- Using individual T4 and individual T3 to get your desired dose – Alternatively, you can take two prescription thyroid medications to get both T4 and T3. If you used both levothyroxine and Cytomel, for instance, you would be getting T4 from the levothyroxine and T3 from the Cytomel. You could then adjust your dose of each medication to find out what works best for you.
So what does this information mean for you?
Let’s use an example to really help this hit home.
Imagine you are someone using 100mcg of levothyroxine and you are not feeling well even though you’re taking your thyroid medication faithfully.
Knowing you are not feeling well is a great starting point but from here you have many potential options:
- First, you could simply try switching to another more absorbable form of T4 thyroid medication such as Tirosint or Tirosint-Sol. This change might be enough to help you feel a lot better all on its own.
- Second, you might consider adding T3 in the form of liothyronine or Cytomel to your medication. If you did this, you would then be taking a combination of both T4 and T3 in various doses. You could start slow by adding 5mcg of T3 to your 100mcg dose of levothyroxine.
- Third, if the other options failed then you could try switching to Armour thyroid (a type of Natural Desiccated Thyroid) to see if that helps.
This is just the beginning in terms of options available to you but hopefully, it opens your eyes to the possibilities.
If your doctor isn’t actively working with you to figure out what works best for your body then you may want to start looking for a second opinion!
You can use this resource to help you find additional doctors.
#2. Tweak How You Take Your Thyroid Medication
The next tweak that you can make to your thyroid medication is to adjust how you are taking it.
Most thyroid patients, when they are given thyroid medication, assume that they just take it by mouth with some water, swallow their pill or capsule, and call it a day.
It turns out that there are other ways to take your thyroid medication!
Here are 3 different methods you can use to get thyroid medication into your body:
- Orally – This is the way that most thyroid patients take their thyroid medication. They swallow their capsule whole and hope that it gets absorbed into their bloodstream via the intestinal tract.
- Sublingually – Another method you can use to get thyroid medication into your body is to allow it time to be absorbed under your tongue. This method is known as sublingual absorption. This doesn’t work for all types of thyroid medications and absorption isn’t consistent from person to person but it is definitely still another option. You can learn more about taking your medication sublingually (including how to do it) here.
- Via injection – Lastly, some thyroid medications can be taken via injection. This route of taking your thyroid medication allows you to bypass the gut which is the place of a lot of problems as far as absorption is concerned. This route isn’t used very frequently, and often as a last resort, but can still be considered in rare cases.
Doing something simple like mashing up your thyroid medication and allowing it time to get absorbed under your tongue may be all you need to see a significant improvement in your symptoms.
#3. Tweak The Time of Day That You Take Your Thyroid Medication
You can also consider adjusting the time of day that you take your thyroid medication.
You were probably told that you need to take your thyroid medication first thing in the morning, right when you wake up, and away from food.
If you are like most thyroid patients then you probably followed directions and you’ve been taking your medication this way ever since.
It will probably come as no surprise when I say this but this isn’t the only time of day that you can take your medication and it isn’t even necessarily the best time of day to take it.
Let’s talk about some additional patterns and times of the day that you can take your thyroid medication which may help your thyroid medication work more effectively:
- Taking your thyroid medication in the morning – This is probably what you are doing right now. The standard advice (1) is to take your thyroid medication as early as you can away from food, drink, coffee, supplements, etc. If this isn’t working for you then you may want to try some of the other options listed below.
- Taking your thyroid medication in the evening – If you were only going to take your thyroid medication once per day then taking it in the evening is probably better than in the morning. This is confirmed by some clinical studies which show that thyroid patients who take their medication in the evening see higher free thyroid hormone levels (2) compared to those who take it in the morning. Taking your thyroid medication in the evening may be better because the intestinal tract is naturally slower in the evening versus the morning. You may think that taking your thyroid medication in the evening will interfere with your sleep but this doesn’t seem to be the case for most thyroid patients! Yes, it can occur but it’s actually quite uncommon.
- Splitting your dose and taking it multiple times throughout the day – The next strategy to consider would be to take your total dose of thyroid medication and split it up throughout the day. Why would you want to try this? Because this more closely mimics the actions of a healthy thyroid gland! In a healthy person, the thyroid gland produces thyroid hormone continuously throughout the day. Thyroid patients who take thyroid medication by mouth are getting one massive dose that is supposed to last for the entire day. Multi-dosing or splitting your dose allows for more sustained thyroid hormone levels throughout the day and this may have an impact on how you are feeling.
- Multi-dosing throughout the day – Multi-dosing is commonly used with T3-only thyroid medications like Cytomel and liothyronine because they can cause symptoms if taken all at once. But you can also use this strategy with any type of thyroid medication including levothyroxine. If you want to do this you just need to take your total dose of thyroid medication and split it up into either halves, thirds, or quarters and take your medication at intervals throughout the day. If you use halves then every 12 hours, if you use thirds then every 8 hours, and if you use quarters then every 6 hours.
- Alternate daily total doses of your thyroid medication – Some patients are so sensitive to small changes in thyroid medication that it can be hard to pinpoint exactly how much they need. In addition, the dosing of some thyroid medications like levothyroxine is more like a blunt instrument than a fine scalpel. They are limited in their dosing options which means it’s hard to find a dose if your body wants something in between the standard doses. If you fit into this category then alternating total daily doses may make the best sense. Here’s how it works: Imagine you are taking 100mcg of levothyroxine daily but it’s not quite enough. When you increase your dose to 112mcg of levothyroxine you find that it’s too much. To get a dose in between these levels you can alternate days of taking 100mcg of levothyroxine and 112 mcg of levothyroxine throughout the week. This will give you a total daily dose average of somewhere around 106mcg of levothyroxine if you are taking it every other day. You can also alternate higher doses every third day, taking higher doses only on the weekend, and so on. The options are endless! It’s just a matter of figuring out what works for you.
As a rule of thumb, when you think about how you are taking your thyroid medication try to mimic how the healthy thyroid gland functions in nature.
Despite the best efforts of your doctor, taking one massive dose of thyroid medication by mouth to try and replace a complicated system like the thyroid will never approximate the function of a healthy thyroid gland.
But that shouldn’t stop us from trying!
When you multi-dose throughout the day you are getting closer to how that healthy thyroid gland functions (3).
Until we develop a low-dose continuous pump of thyroid medication that is streamed into your blood as needed, we won’t ever be as good as the thyroid gland.
But we can get close and multi-dosing can help get us there.
The awesome part about multi-dosing your medication is that it doesn’t require any convincing on the part of your doctor.
For the most part, your doctor shouldn’t care that you are taking the same amount of thyroid medication just at different intervals throughout the day.
It’s much easier to multi-dose your current thyroid medication dose than it is to try and convince your doctor to use a medication they are not familiar with.
For this reason, multi-dosing should be at the top of your list of things to try if you are working with a doctor that isn’t open to new thyroid medications.
The biggest downside to multi-dosing is that it can get complicated really quickly and if it isn’t done correctly then you may suffer from decreased absorption.
If you multi-dose your thyroid medication you still need to avoid taking your smaller doses around food, drink, supplements, and so on.
If you don’t think you can do this or if you think you’re more likely to miss doses because of the new schedule then it’s probably not a good idea to try it out.
#4. Tweak Your Dose of Thyroid Medication
Lastly, we have the dose of thyroid medication that you are taking.
This is the one that most people put their attention on and for good reason.
If your dose of thyroid medication is not optimized then it doesn’t matter what other changes you make! You simply won’t feel better.
Despite how important this one is, it’s hard to give specific advice because the dose of thyroid medication that each person needs is highly variable.
As a result, we have to keep the information here general.
The first thing you should know is that most thyroid patients are not getting enough thyroid medication.
In other words, they are being underdosed.
That means for most of you reading this, the chances are high that you need to be taking more thyroid medication (not less).
Having said that, there are still some people who are taking too much thyroid medication and should have their dose reduced.
To make things even more confusing, what needs to happen to your dose can change many times throughout your life.
Your requirement for thyroid medication can change based on many factors including age, comorbidities, recent illness or infection, how much stress you are under, how much you are sleeping, hormones levels, and more.
Even if you find a dose that works for you right now there’s no guarantee that it will stay that way over the next few years.
For this reason, you need to always pay attention to both your symptoms and your thyroid lab tests.
You can use the combination of these two things to help guide your dose.
Never just use one without the other, though!
This is the strategy that most doctors employ (dosing based only on the TSH), which is why so many thyroid patients remain underdosed.
The second thing to remember is that you can’t determine if a dose is working for you or not unless you give it enough time.
Thyroid medication changes take at least 6 weeks to take effect in the body.
For this reason, you must have patience when making changes!
You won’t know for sure if a dose change is working unless you give it a solid 6 weeks.
Making changes before this will lead to inconsistent and/or confusing results.
Wrapping It Up
Believe me when I say, I know it can be hard to be a thyroid patient.
Just because it’s difficult to be in your shoes, though, doesn’t mean you can’t do things to help yourself feel better!
One of those things should be taking the time and energy required to optimize your thyroid medication.
With the 4 categories listed above, you should have literally hundreds of different options and ways to adjust and tweak your thyroid medication.
As you make changes to your thyroid medication you will eventually find a combination that just works.
I can tell you that this is exactly what I used to do when I saw patients.
And it is this strategy that helped me to get thyroid patients back to 100% (or close to it).
Now I want to hear from you:
Do you feel that your thyroid medication is optimized?
If not, are you thinking about making any changes or tweaks?
Did you know that you could make all of these changes to how you take your thyroid medication?
Have you already tried some of these tweaks? Did they work for you?
Leave your questions or comments below!