PART II
In part one of this Thyroid Dysfunction series, I explained the physiology of thyroid function, signs and symptoms of thyroid dysfunction, and the diagnostic labs to search for the root cause of that dysfunction. Now, in part two, I will explain treatment of hypothyroidism, as well as some of the most common causes of thyroid dysfunction.
The current gold standard treatment for hypothyroidism is levothyroxine (brand name Synthroid). Levothyroxine is a T4-only medication. It is synthetic, however it is also bio-identical.
Synthroid is an incomplete option for treating hypothyroidism
Levothyroxine is by no means a bad choice of hypothyroidism treatment. However, it is incomplete as our thyroid glands produce T4 and T3 (as well as T1 and T2, but those are not available as current treatment options.)
How and when you take Synthroid/levothyroxine is important, too
It is important that levothyroxine is taken the correct way for proper absorption. It must be taken on an empty stomach, first thing in the morning, at least one hour prior to any coffee or food. Also, it cannot be taken with other vitamins including calcium, iron or biotin. Finally, medications like proton pump inhibitors (Prilosec, Protonix, Nexium), or antacids (Tums, Pepcid) can limit the body’s absorption of Synthroid/levothyroxine. Foods to be avoided to ensure proper absorption include grapefruit, walnuts, and high-fiber diets.
Levothyroxine is an important option for many women if the thyroid gland is not producing T4 efficiently. However, if a patient’s thyroid disorder lies in a T4 conversion or absorption problem, it’s important to note that no amount of levothyroxine will ever be enough to eliminate hypothyroidism symptoms or consequences.
When T3 and T4 are both needed to treat hypothyroidism
If a woman has low T3 production from her thyroid, poor conversion in the liver due to liver dysfunction (caused by alcohol, toxins, or fatty liver, among many other causes), poor absorption by the gut (caused by Irritable Bowel Syndrome, excessive yeast, or leaky gut syndrome), or poor uptake by the organs (caused by nutrient deficiencies or toxins), then T3 replacement is also necessary.
T4 and T3 options: Armour Thyroid
T3 can be compounded and added to T4 (if needed) or can be found in desiccated porcine thyroid or Armour Thyroid. (Unfortunately, I cannot currently recommend desiccated thyroid due to multiple recalls because of poor production and lack of dosage reliability; Armour seems to be safe, though).
Armour combines both T4 and T3 in a 5:1 ratio. Our bodies produce these hormones in a 20:1 ratio. So, Armour could be a good or bad option for a woman, depending on the hormones her body is able to produce. A doctor can help determine the right fit for her.
T3 options: Cytomel
A prescription brand of T3 is called Cytomel and it comes in several doses. The best option is to get the thyroid hormones compounded in the individualized dosages and combinations needed. However, this can be an expensive option.
T3 should be taken in the immediate release form, at least in the beginning of treatment. This means that it should be taken up to three to four times a day (unlike T4, which can be taken only once a day). T3 should be taken in the morning and afternoon, but not before bedtime.
It’s important to start low and move up in dose slowly every 2-4 weeks until symptoms improve AND the Free T3 lab levels are in the upper range of normal. Side effects to look out for are racing heart and an increased temperature / feeling hot. But, these same symptoms could also signify adrenal dysfunction, which is the most common cause of hypothyroid symptoms.
Investigating the role of cortisol and adrenal dysfunction in hypothyroidism
If the thyroid labs look good, but there are ongoing hypothyroid symptoms, it will be important to investigate cortisol, which is produced by the adrenal glands. Low cortisol will make T3 “pool,” thus resulting in high T3 levels in the blood, but it won’t be absorbed into the organs. Symptoms of low cortisol can be similar to thyroid dysfunction, as well as feeling tired upon waking, feeling hot, palpitations, low blood pressure, dizziness, allergies, anxiety, low blood sugar, weakness, arthritis, and fatigue after exercise.
Adrenal dysfunction can also cause autoimmune disorders, chronic fatigue, infertility, and chronic viral infections. Testing for adrenal dysfunction should include a four-point salivary cortisol level and serum DHEA-S. Treatment for adrenal dysfunction should be focused on stress reduction, both emotional and physical. Physical stress can include inadequate nutrition or hydration, chronic illness, inadequate sleep or sleep apnea, and excessive exercise.
Supporting your adrenals, supporting your thyroid
The adrenals can also be supported with an anti-inflammatory supplement like Vitamin C or N-Acetylcysteine. Bovine Adrenal Cortisol is an over-the-counter replacement that many find helpful for adrenal support. There are a couple herbal supplements that can help as well: Ashwagandha Root and Maca Root are known to support the adrenals and help healthy cortisol production. (As with any supplement or over-the-counter remedy, please check with your health care provider prior to starting).
Other causes of thyroid dysfunction
Other causes of thyroid dysfunction can include the following:
- Hashimoto’s Thyroiditis (an auto-immune disorder in which the body attacks its own thyroid)
- heavy metal toxicity (bromide, mercury, or fluoride)
- iodine, magnesium, or selenium insufficiency
- pituitary dysfunction
- drug-induced hypothyroidism, which can be caused by Lithium (a psychiatric medication), some seizure medications, Amiodorone (a heart arrhythmia medication), Nitroprusside (a blood pressure medication), and sulfonylureas (antibiotic often used for bladder infections)
- overconsumption of goitrogens (raw cruciferous vegetables like cauliflower, brussels sprouts, cabbage, kale, turnips, radishes, rutabagas)
- overconsumption of soy
- estrogen dominance (often found in peri-menopause, post-partum, PCOS, and endometriosis)
- Candida (yeast) overgrowth in the gut, or low stomach acidity
- cigarette smoking
- mold exposure
Each of these root causes has their own symptoms, diagnostics, and treatments, which are beyond the scope of this article. However, there are multiple resources I highly recommend by which to investigate further:
- Stop the Thyroid Madness by Janie Bowthorpe. Written more for patients than physicians. Excellent and detailed information on diagnosis and treatment, including supplements.
- Hypothyroidism Type 2: The Epidemic by Dr. Mark Starr. Medically oriented with lots of great info beyond just hormones. This is my highest recommendation for medical professionals (in addition to Janie’s books, not instead of).
- Hypothyroidism: The Unsuspected Illness by Dr. Broda Barnes. An oldie but goodie.
- Dr. Izabella Wentz, PharmD: On-line resources including a nutrition guide and sample thyroid diet. I highly recommend signing up for her emails at https://thyroidpharmacist.com
My goal in writing these articles on Thyroid Dysfunction is that they will provide you with the information needed to better know your body, to be able to interpret the signs of thyroid dysfunction in your FAM chart, and to have confidence in speaking with your medical provider in order to get the necessary testing and treatment to heal thyroid dysfunction. Further, recent evidence also suggests that the thyroid health of a pregnant mother can have an impact on the future health outcomes of her children, so working to correct thyroid dysfunction is not only important to your own health, but an investment in your future children’s health, too.
In part 3 of our Thyroid Dysfunction series, we will take a deeper dive into Hashimoto’s thyroiditis, which is an autoimmune disease, and the most common culprit behind thyroid dysfunction in young women. Stay tuned!
Click here to read Part III of our series on thyroid dysfunction, “Hashimoto’s Thyroiditis.”
