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Have you been looking for the perfect underactive thyroid medication? There are so many options, it can often be difficult to figure out which one is best for your health. Whether you are looking or you are currently on medication, you need to know which is best. Today, let me walk you through the different kinds and how they can help get your health back in order.
If you are on medications for thyroid issues, the first thing you need to know is that medications do not make up the whole answer. You want to make sure that you are addressing the root causes, getting deep into your diet and healing the big factors that influence thyroid issues. At the same time, medications are going to remain a big part of this entire equation.
There have been so many cases where having the correct medication can have a huge influence on someone’s well being. The difference between a good medication and an ineffective medication is feeling great versus a selection of symptoms, like:
- Dry skin
- Weight gain
- Memory loss
- Chronic pain
If you are suffering from any of these symptoms, switching on to the right medication can basically change your entire quality of life.
Case Study: Samantha
I want to talk about one of my patients: “Samantha” (not really her name, as I am sure you know). Samantha was a 39-year-old woman who had been dealing with Hashimoto’s disease. She had put on about 23 pounds when her thyroid slowed down and simply could not find a way to lose it. Her hair had also thinned pretty badly – altogether, she was definitely showcasing some of the worst symptoms of improper thyroid medication.
She had been on one medication, Synthroid, for quite some time, and she was not progressing. After visiting with Dr. Beardsley, she changed from Synthroid (at 100 mg) to 0.75 grains of WP thyroid. Over a few weeks, with no other changes, she had already dropped 12 pounds. After three months, her hair growth also returned – her energy started coming back, and she even started needing less and less WP thyroid. This reduction in her dose came from the fact that her thyroid was making more, so she needed less.
Samantha’s case is all too common, and one that we see many times. Today, I want to dive deep into the different kinds of medications and what they can do for you.
Types of Thyroid Medications
Let’s start by talking about the various types of thyroid medications that we have available to us. There are two big types:
The problem that I have with talking about synthetic thyroid medications is that they too often come off as sounding foreign, unnatural or weird. There’s just something about the term “synthetic” that gives these medications an undeserved bout of criticism right off the bat. They are actually bio-identical, which means that they are chemically the same as what your body would naturally produce.
I don’t use them much but for other reasons than the term ‘synthetic.’
There are 3 categories of synthetic thyroid meds, T4 only, T3 only, and T4 + T3 combos.
T4 Only Synthetic Medications
I’ll start with the T4 only meds because they are by far the most commonly used.
- Levothyroxine (generic)
T3 Only Synthetic Medications
We also have T3 only medications, like:
- Cytomel, and
- Liothyronine (generic)
T4 and T3 Combo Synthetic Medications
There is also a combination of both which you can find in synthetic form. These are not commonly found in pharmacies, or even stocked, but they are worth knowing about. They are:
Compounded Synthetic Medications
Then, there are compounded versions of those previously mentioned combinations. You can find compounded T4 or T3 by themselves, or together. The thing about compounded is that they can be made into any potency you like. The drawback is that they are not standardized, and there have been fatal and near-fatal incidents involving compounding errors.
Key Insight: When it comes to compounded thyroid medications, you should definitely be on the lookout for PCCA pharmacies – these are the places which can provide these medications in their proper format. You can find one HERE.
Now we can focus on the natural versions of thyroid, which is where we want to focus on natural desiccated thyroid (NDT). Of these, there are many brands, which include (in tablet form):
- NP Thyroid
- Armour Thyroid
- WP Thyroid
- Thyroid desiccated (generic)
I’ll talk more about details, but overall I’m a fan of desiccated thyroid and I am particular about which brand I use. They do vary in terms of which and how many binders and fillers they have, they also vary in how well standardized they are.
Along with brand names, there is compounded desiccated thyroid. This is going to bring up the same positives and negatives of synthetic thyroid medications, where you can have them in any potency but they are not regulated. (Read: Top 10 myths about Natural Desiccated Thyroid)
Finally, there are over-the-counter (OTC), non-prescribed thyroid medications. These ones are simply best to avoid because while they may have active thyroids, the amounts are completely unpredictable1. The main brand from these is called Thyrogold. Across the board, this is the kind of option you are going to want to avoid.
What are the differences between the medications?
Recent data is showing that T4 is important in its own right and that it is not just being used for your body to turn into T3. We actually need T4 to help repair our brain cells, it also turns out that we need it for bone growth and to repair our blood vessels. These are all super important tasks, which is why it is important that we have T4 in our system – and why we might need it from medications.
T4 also helps us lower our TSH score2 and we can get it from NDT and all T4 medicines.
Bottom Line: Your body needs T4, and only having T3 (and no T4) can lead to cardiovascular and other issues down the road.
We just finished talking about T4, but T3 is also very important in its own right. T3 is going to play a big role in:
- Boosting metabolic rate and helping us lose weight
- Energy production to keep us going while stimulating the heart
- Just like T4, it also lowers TSH
We can find T3 in NDT, Cytomel and Thyrol.
This is one that often gets forgotten along the way. This one can only be found in NDT, and it plays a powerful role in helping the body burn fats more effectively. It helps both mitochondrial and ovarian function, it also helps fertility – we can only see T2 in NDT, though.
The thing about T2 is that it does not lower your TSH score. This means that you might be hypothyroid, and not know it, due to a lack of T2. Getting more T2, from my personal experience, is one of the big advantages of NDT.
Binders and Fillers
This is another consideration we want to make when we are thinking about thyroid medications. Binders and fillers can be just plain icky. We want to be able to keep our chemical burden as low as possible. Binders and fillers are used to make the solid tablet and this can make things hard to digest. It might even be reactive to those who are sensitive to it.
Key Insight: If binders and fillers make it hard to digest your thyroid medication, you might be missing out on super important hormones from micrograms of thyroid hormone.
Binders and fillers can include a collection of any of the following:
- Sodium glycolate
- Calcium stearate
- Confectioner’s sugar
- Magnesium stearate
It’s important to know that all raw powder for all NDT raw materials come from one manufacturer: American Laboratories, Inc. They first make freeze dried NDT powder which the tableting companies buy to make into tablets. American Laboratories Inc uses about 5 mg of lactose for the amount of powder that goes into a 1 grain tablet.
For comparison, a glass of milk contains about 20,000 mg of lactose. WP Thyroid, Nature-Throid, and Westhroid all disclose this lactose even though they do not add it. NP Thyroid and Armour still have lactose since they start with the same raw materials from American Laboratories Inc. The difference is they do not disclose the presence of lactose. If there was a brand that had no lactose at all I’d use it. Meanwhile, I don’t consider the quantities of it present to be a deterrent from NDT.
Brands that do disclose:
- WP Thyroid
Brands that don’t disclose:
Bottom Line: There is no way to get away from the lactose present in thyroid hormones, but it is important to know that it exists.
There are two distinct brands that are premade, and free from binders, fillers and preservatives. These ones are:
- WP Thyroid (raw NDT powder), and
- Tirosint (T4 only)
It is important to know that binders and fillers actually vary from manufacturer to manufacturer. This is actually the danger of being on generic meds, that you may get different medicine each time you fill up your prescription. Even if you have the right levels with one, things could change when you refill.
The Importance of Standardization
One of the big issues, when we talk about thyroid medications, is going to be the topic of standardization. The two types of thyroid medications that avoid any sort of standardization are:
- Compounded thyroid medications, and
- OTC NDT
When it comes to all synthetic medications, though, there is 10% variation allowed (by the industry). This means, especially when it comes to medications with two hormones, that you could be missing up to 20% of the hormone you need.
The good part is that some manufacturers can voluntarily have a narrower threshold when it comes to their medications. The brands that have voluntarily decided to have less than 2% variation are:
- WP Thyroid
The perk about this is that they end up being better standardized, with less variation, for more reliability.
Anytime we have to deal with an ongoing medication, we do need to consider cost. Thyroid medications, just like anything else, cost money. Generally, NDT is not a super expensive substance – so, the various brands will feature prices like these:
- Armour – 1 grain dosage – $30/mo
- WP Thyroid – 1 grain dosage – $20/mo
- Westhroid / Naturethroid – 1 grain dosage – $30/mo
- NP Thyroid – 1 grain dosage – $25/mo
Synthetic brands are going to be a bit more expensive:
- Brand name
- Synthroid 100 mcg – $45 – $75/mo
- Cytomel 5 mcg – $20 – $35/mo
- Levothyroxine – $15 – $30/mo
And, as for compounds, they can vary wildly. The typical range for compounded thyroid medication is going to be between $40 – $75 per month.
Here are some other thoughts I have about thyroid medications and some things you might want to consider for yourself when it comes to choosing a medication.
NDT is going to be derived from porcine, which is a fancy way of saying pig! So, if you are Kosher, Halal or vegan, this might not be an ethical fit. We definitely do not want this to be a surprise for anyone, so make sure you know about your medications before you put them in your body – which is always a good rule to follow.
Glandular Thyroid Supplements
There are plenty of these types of supplements that you can find over the counter, or even on Amazon. If you look online, you might even find people suggesting that these supplements can be used instead of thyroid medications.
That is because these glandular thyroid supplements come from the same raw material as those other thyroid medications: natural desiccated thyroid. There are two things that you often hear about these kinds of supplements:
- That there is no active hormone
- There might be active hormone, but you can change it by taking a certain amount of supplement
The problem here is that the first is simply not true, and the second is somewhat true but not always consistent (which is also not good). The idea of “removing” the hormone is actually impossible, first and foremost, so that is a problem whenever you see that claim made.
The second is that a study was done by a group of scientists which shows how these supplements varied in their range of having T3 and T43. The range, for both, was actually huge. Based on this, if you were to take these supplements in greater quantities you might risk overdosing without even knowing it. That is because each supplement is like playing the lottery, you might get a little, or you might get a lot!
The other dangerous aspect of these supplements is that they are bovine-derived, and therefore are subject to what are known as prions. Prions are like a more basic version of a virus, which has led to the outbreak of what you might know as mad cow disease. The problem here is that you might be subjecting yourself to this problem, which also takes almost 15 years to manifest itself when you take bovine-derived supplements4.
Bottom Line: False claims, inconsistent amounts and the dangers of bovine-derived, glandular thyroid supplements might work for a minute, but they are not worth the long-term risks you might suffer if you keep using them.
When you are changing medications, make sure you understand the equivalences (otherwise known as how much you need when you are switching). Pay attention to charts like these, and make sure you are not getting too much or too little of the medications you need.
When you are changing medications, keep some of these helpful tips in mind:
- Go down by 1-2 steps at first – this is because sometimes one type of medicine will feel more powerful than another (even at an equivalent dose). So, it is safer to err on the low side than to step it up and get too much./span>
- Retest every 2 weeks until your levels are right/span>
- You will rarely need more than 2-3 tests/span>
- Make sure to note that TSH scores take several months to level out. In 2 weeks, you just want to be sure that it is moving in the right direction./span>
How do I take my thyroid medications?
The best way to take your thyroid medications is first thing in the morning, a half hour before eating or drinking anything (besides water). Just follow these simple steps:
- Put the tablet and a glass of water out at bedtime
- Take it the moment your feet hit the floor
- Use the restroom, shower, brush your teeth
- Usually the above will take 1/2 hour, then you can eat, have tea, coffee, whatever!
This is less common, but some people prefer taking their thyroid medication once daily at bedtime rather than in the morning. It has been studied and appears to be equally effective.
A drawback is that it takes longer for food to leave your stomach and make room for the thyroid tablet than it does for the thyroid tablet to leave your stomach and make room for food. That’s why in the morning you can eat as soon as 1/2 hour after taking your tablet. At night, you’d need to wait a minimum of 2 hours after anything besides water. You’d also want to be sure not to be taking any other pills during this timeframe.
Key Insight: It is not recommended to take your medications twice daily, it’s because of the circadian nature of thyroid hormones. Most are made late in the evening and early in the morning, so taking them at different times can disrupt your body’s important schedule.
How do I re-test my thyroid if I am on medications?
That’s an easy one and you can refer to my handy thyroid testing guide if you need the extra information5. All you need to do is test sometime in between 7 – 9 AM, and then take your medication immediately after having been tested.
What’s the best option for thyroid medication?
In my opinion, it has to be WP Thyroid, because:
- It’s clean
- It’s standardized
- It has all of the hormones (T4, T3 and T2)
The drawbacks of going with WP Thyroid are that they are not vegan, kosher or halal, and that your pharmacy might not readily stock it. All pharmacies can stock it, though!
Most of the time, pharmacies will give generics when they see WP Thyroid on a prescription slip. That is why it is so important to check the tablets. When you look, you will need to see that the “P” is present. If you see a “050” that means that you have a half grain potency.
If WP Thyroid is unavailable, my next favorite option is Naturethroid. It is, along with being well-standardized, it also has the advantage of containing all three active hormones. The disadvantage is that it does contain binders and fillers, but it is the second best option available.
What if I can’t tolerate NDT?
This is a rare case, but it can happen. If your body is incapable of tolerating NDT, consider:
- Tirosint + Cytomel
- Compounded T4/T3
Know Your Thyroid, Love Your Thyroid
Do you know the state of your thyroid? Please stay on top of your health, it is so important. Take the thyroid quiz today, and do what is best for your body.
1 – https://www.ncbi.nlm.nih.gov/pubmed/?term=Thyroxine+and+Triiodothyronine+Content+in+Commercially+Available+Thyroid+Health+Supplements
2 – http://drchristianson.com/how-to-test-your-thyroid-the-definitive-guide/
3 – https://www.ncbi.nlm.nih.gov/pubmed/?term=Thyroxine+and+Triiodothyronine+Content+in+Commercially+Available+Thyroid+Health+Supplements
4 – https://www.livestrong.com/article/485514-what-are-the-dangers-of-taking-bovine-pituitary-extract/
5 – http://drchristianson.com/how-to-test-your-thyroid-the-definitive-guide/
P.S. Whenever you are ready, here is how I can help you now:
1. Download and use my Favorite Recipes Cookbook Here
2. Check out my podcast Medical Myths, Legends, and Fairytales Here
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet and The Metabolism Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.