A Pharmacists Review Of Medications For Hashimotos And Hypothyroidism
Medically reviewed and written by Izabella Wentz, PharmD, FASCP
2020 has been a crazy year. I know many of us have had some health set-backs .
Some of us may be struggling with more symptoms due to our thyroid hormones. Stressful times and infections can increase our need for thyroid hormones, as well as the co-factors we need to make those hormones work properly.
Furthermore, some of us have been affected by a recent recall of natural desiccated thyroid medications. This may have resulted in having unstable thyroid hormones and needing to switch to a different medication.
Due to the various thyroid medication recalls, I wanted to provide a comprehensive overview of the available medication options, and how you can be sure to get the best outcomes from using each of the medications.
For those with Hashimotos, optimizing thyroid hormones is one of the keys to feeling our best, while we work to remove the underlying triggers that caused and/or are worsening the autoimmune component of the condition.
The right thyroid hormone medication can reduce thyroid antibodies and slow down the progressive thyroid destruction, as well as provide the energy needed to continue to work towards ones health. Thyroid hormone medications can also reduce the size of thyroid goiters and nodules, as well as reduce the likelihood of thyroid cancer.
Read on to learn more about:
What Is Thyroid Eye Disorder
Thyroid eye disease is a rare disease characterized by progressive inflammation and damage to tissues around the eyes, especially extraocular muscle, connective, and fatty tissue. Thyroid eye disease is characterized by an active disease phase in which progressive inflammation, swelling, and tissue changes occur.
Why Wont Some Doctors Support Thyroid Treatment With Ndt
The T4/T3 Issue
Your body needs two primary thyroid hormones made by your thyroid gland: T4 and T3 . T4 is a storage hormone whose only role is to convert into T3ÃÂ¢the active hormone used by cells and tissues in your body.
The typical daily T3 requirement in a 150-pound healthy adult is around 30 mcg. A healthy thyroid gland itself produces about 5 mcg of that T3. The remaining 25 mcg of T3 needs to be made by T4 to T3 conversion. Mainstream endocrinology believes that if you take adequate dosage of only synthetic T4 , enough of that T4 will convert into T3 to meet your daily needs. ÃÂ¢
Since the introduction of levothyroxine, some patients have anecdotally reported much better symptom relief and management of their hypothyroidism by taking NDT vs. levothyroxine. The likely reason? NDT contains natural forms of both T4 and T3 hormones.
Experts are beginning to understand thatÃÂ¢for reasons that include nutritional status, stress, and other hormonal imbalancesÃÂ¢some patients donÃ¢t convert T4 to T3 as well as thought. More recently, research has shown that a subset of the population has a genetic defect that impairs the ability to convert T4 into T3. Many of these patients report far better symptom relief and quality of life taking NDT because it includes T3 and doesnÃ¢t rely solely on conversion.
Still, some doctors believe that measuring T3 levels and treating low-normal or low T3 is unnecessary or unbeneficial. They prefer not to treat patients with NDT drugs.
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Westminister Thyroid By Westminster Pharmaceuticals
Westminister Thyroid was a new producer of NDT. It was only introduced to USthe market in 2000s. As of now , it is no longer being manufactured. The producer has even removed it from itsits website.
Benefits of Westminister Thyroid:
- It was cheaper than Armour Thyroid.
- It used to work quite well.
Drawbacks of Westminister Thyroid:
- According to the FDA, it was recalled that the factory that produced the active pharmaceutical ingredient allegedly didnt follow GMP guidelines.
- It is no longer available.
Overall rating: 6/10
The American Thyroid Associations Opposition To Natural Desiccated Thyroid
Most endocrinologists take their direction from the ATA, which maintains that the guidelines and recommendation for levothyroxine and against NDT and combination T4/T3 therapy are evidence-based. There are, however, some disputable or questionable elements in their claims about NDT. On the ATAâs information page on thyroid hormone treatment, they make the following statements , to which Iâve offered my rebuttal:
While the unquestioned âsuperiorityâ of levothyroxine compared to âold-fashionedâ NDT drugs has become accepted dogma in the endocrinology community, itâs clear that the research does not support it. This raises a question: Are the ATAâs âevidence-basedâ guidelines being unfairly influenced? Given what we know about the influence of drug companies, itâs a valid question.
The ATA panels that create guidelines are supposed to operate without bias. At the same time, the ATA itself, as well as panel members, are frequent recipients of grants, funding, and financial support from drug companies whose products they are in a position to recommend. In fact, according to the 2016 ATA annual report, pharmaceutical company Abbvie, â manufacturer of the Synthroid brand of levothyroxine â is one of the ATAâs top corporate donors. No manufacturers of NDT are major donors to the ATA or funding sources for its guidelines panel members.
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Where To Buy Nature Throid In The Us Or Where To Purchase Nature
Nature-Throid is a medication that has been used to treat thyroid conditions for over 80 years. Unfortunately, it is currently unavailable in the United States. However, there is hope that it will be back on the market in 2023. In the meantime, patients can continue to purchase Nature-Throid alternatives such as:
Conversion Of T4 To T3
The conversion of T4 to T3 takes place under the direction of an enzyme called Deiodinase. There are two types of this enzyme one inside the brain which is called Type 2 Deiodinase and the one inside the rest of the body is called Type 1 Deiodinase.
The conversion to T3 gets easily disrupted due to a variety of conditions, such as Hashimotos thyroiditis, stress, obesity, aging, diabetes, nutritional deficiencies and certain medications including beta-blockers and steroids.
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What Are The Possible Side Effects Of Desiccated Thyroid
Get emergency medical help if you have signs of an allergic reaction: hives difficult breathing swelling of your face, lips, tongue, or throat.
Common side effects may include temporary hair loss .
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Indications Of Nature Throid
According to the package insert for Nature Throid, the tablets are to be used:
1. As replacement of supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis. This category includes cretinism, myxedema, and ordinary hypothyroidism in patients of any age , or state primary hypothyroidism resulting from functional deficiency, primary atrophy, partial or total absence of thyroid gland, or the effects of surgery, radiation, or drugs, with or without the presence of goiter and secondary , or tertiary hypothyroidism.
2. As pituitary TSH suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute, or chronic lymphocytic thyroiditis , multinodular goiter, and in the management of thyroid cancer.
3. As diagnostic agents in suppression tests to differentiate suspected mild hyperthyroidism or thyroid gland anatomy.
These indications apply to the use of compounded thyroid as well as it is the same medication.
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Generic Of Armour Thyroid:
Armour Thyroid is still one of the best choices for thyroid hormone replacement. There are several generic brands of natural thyroid hormones, and they all contain the same active ingredient: porcine desiccated thyroid extract. Generic Armour is made by various manufacturers, so its essential to do your research before choosing a particular brand. We will rate and review Armour Thyroid first, the original thyroid hormone, so you can have a good benchmark.
Having Difficulties Filling Your Prescription Thyroid Therapy For Nature
RLC Labs, the manufacturer of Nature-Throid® and WP Thyroid® products, announced that it is voluntarily recalling all unexpired lots of Nature-Throid® and WP Thyroid® to the consumer level. See RLC Labs September 2, 2020 statement below:
RLC Labs, Inc. is voluntarily recalling a total of 483 lots of Nature-Throid® and WP Thyroid® in all strengths, all counts of product within current expiry to the consumer level. The products are being recalled because testing of samples from six lots by the U.S. Food and Drug Administration found the samples to be sub potent. The product may have as low as 87% of the labeled amount of Liothyronine or Levothyroxine.
Risk Statement: Patients being treated for hypothyroidism , who receive sub potent Nature-Throid® or WP Thyroid®, may experience signs and symptoms of hypothyroidism which may include, fatigue, increased sensitivity to cold, constipation, dry skin, puffy face, hair loss, slow heart rate, depression, swelling of the thyroid gland and/or unexplained weight gain or difficulty losing weight. There is reasonable risk of serious injury in newborn infants or pregnant women with hypothyroidism including early miscarriage, fetal hyperthyroidism, and/or impairments to fetal neural and skeletal development. In elderly patients and patients with underlying cardiac disease toxic cardiac manifestations of hyperthyroidism may occur, such as cardiac pain, palpitations or cardiac arrhythmia.
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How Should I Take Desiccated Thyroid
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.
While using desiccated thyroid, you may need frequent blood tests.
Keep using this medicine as directed, even if you feel well. You may need to take thyroid medication for the rest of your life.
Call your doctor if you notice any signs of thyroid toxicity, such as chest pain, fast or pounding heartbeats, feeling hot or nervous, or sweating more than usual.
If you need surgery, tell the surgeon ahead of time that you are using desiccated thyroid. You may need to stop using the medicine for a short time.
Store at room temperature away from moisture and heat.
What Is This Medication
THYROID hormone treats low thyroid levels in your body. It works by replacing a thyroid hormone normally made by the body. Thyroid hormones play an important role in your overall health. They help support metabolism and energy levels.
This medicine may be used for other purposes ask your health care provider or pharmacist if you have questions.
COMMON BRAND NAME: Armour Thyroid, Bio-Throid, Nature Throid NT, Nature Thyroid, Nature-Throid, NatureThyroid NT, NP Thyroid, Westhroid, Westhroid TH-1, Westhroid TH-1.5, Westhroid TH-1/2, Westhroid TH-1/4, Westhroid TH-2, Westhroid TH-2.5, Westhroid TH-3, Westhroid TH-3/4, Westhroid TH-4, Westhroid TH-5, Westhroid-P, WP Thyroid
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Which Thyroid Medication Is Best For You
For some patients, levothyroxine works well to resolve hypothyroidism. In other cases, you may feel best with the addition of T3, whether by adding synthetic T3 to your levothyroxine treatment or taking NDT.
Suppose you take levothyroxine and need a better resolution of your symptoms. In that case, you may want to discuss with your thyroid doctor if natural desiccated thyroid might be a good option for you.
As a thyroid patient, youâre probably asking the operative question: âWhich thyroid medication is best for me?â Thereâs no definitive answer. Ultimately, the best thyroid hormone replacement regimen for you is the medication, brand, and dosage that best and safely manages your hypothyroidism and relieves your symptoms. Finding out which medication and dosage will work best for you is often a trial-and-error process. Itâs essential to be informed about all of your options and work with a thyroid doctor who is open to all treatment options to determine if NDT drugs are right for you.
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Is Np Thyroid And Nature
Both NP Thyroid and Nature-Throid are natural medications since they are made from a desiccated gland rather than synthetic resources. This reason is why Desiccated Thyroid medications can be used for T4 and T3 hormone replacement.
Importantly, as the FDA report, natural and synthetic components may produce a difference , which mainly depends on the individual.
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Diet And Lifestyle Changes
Sugar and processed foods, both of which can lead to increased inflammation in the body, can interfere with normal thyroid hormone activity. This may make symptoms of thyroid disease worsen. Reducing the amount of sugar and processed foods may be beneficial to thyroid health and may help with weight loss since weight gain is often a symptom of hypothyroidism.
Physical and mental stress can be a trigger for upsetting thyroid function. Stress can also cause flare-ups in symptoms of hypothyroidism. Control stress by engaging in self-care every day such as by exercising, meditation, aromatherapy with essential oils, or any other activity that is relaxing.
Understanding Synthetic Versus Natural Thyroid Medications
What is the difference between synthetic versus natural thyroid medications? Natural Thyroid formulations such as Nature-Throid, Armour, and WP Thyroid are derived from desiccated porcine thyroid glands which contain not only T4 like in synthetics but also T3. Natural thyroid from desiccated thyroid have been used to treat thyroid problems for more than 100 years as reported in medical journals and books. Natural thyroid formulations also target T2, T1 and Calcitonin which can be beneficial. Synthetic thyroid medications such as Synthroid and Levothyroxine contain Thyroxine , which is the identical hormone produced by the thyroid gland.
In our practice most patients feel much better, with more energy, and relief of symptoms when switching from synthetic to a natural thyroid. In addition, natural thyroid seems to address other medical problems by improving immune system, aiding in in depression, lowering cholesterol, lowering blood pressure, and stabilizing cortisol levels.
Some people have concerns with the stability of natural thyroid formulations. Therefore to ensure that natural thyroid formulations are consistent analytical tests are performed on the raw material and on the actual tablets to measure actual T4 and T3 activity.
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Choice No : Switch To A Compounding Pharmacy
You can also switch to a compounding pharmacy to substitute for Nature-Throid or NP Thyroid.
Thyroid USP from a compounding pharmacy is an excellent alternative to Nature-Throid. It has the same high quality active pharmaceutical ingredient found in Nature-Throid, according to RLC The manufacturer of Nature Throid. Also, it is made in the USA.
Click here to find out Thyroid Compounding Pharmacy in your area
You can ask your physician to write you a prescription of T4+T3 per capsule.
The conversion from Dessicated Thyroid to Compounding pharmacy requires in-depth thyroid knowledge on the part of the physician. One grain of Nature-Throid, WP Thyroid andNP Thyroid contains approximately 38 mcg of T4 and 9 mcg of T3 .
Over the years, I have prescribed T4, T3 combination through compounding pharmacies. In general, it works out well.
The good side is that it gives your physician a lot of room to tailor the amount of T4 and T3 to your individual needs.
The downside is that compounding pharmacies are expensive. In addition, you need to find a reputable compounding pharmacy in your area.
Why Did Rlc Labs Issue A Recall
Nature Throid and WP Thyroid are natural desiccated thyroid products with two main active ingredients: liothyronine and levothyroxine. These products also include naturally occurring thyroid cofactors T1, T2, calcitonin and iodine . The recall that occurred in August 2020 was initiated because testing found that certain lots of the two thyroid products may have been sub-potent, which means that they contained less than 90% of the labeled amount of liothyronine or levothyroxine. This was determined from an FDA inspection that occurred February 2020 to March 5, 2020. When RLC Labs learned of the sub-potent thyroid products, they issued the nationwide voluntary recall of all unexpired lot numbers.
Although at the time of the recall there were no adverse events reported to RLC Labs, there was the potential for adverse reactions from patients receiving sub potent doses of the medications. Patients who receive sub potent thyroid products may experience signs and symptoms of hypothyroidism which may include, fatigue, increased sensitivity to cold, constipation, dry skin, puffy face, hair loss, slow heart rate, depression, swelling of the thyroid gland and/or unexplained weight gain or difficulty losing weight.
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What Is Wp Thyroid
WP Thyroid is a prescription drug used to treat hypothyroidism by providing supplementing natural thyroid hormone. It is produced by RLC Labs and comes in 13 different strengths. WP Thyroid is a sister brand of Nature-Throid, one of the oldest brands of natural desiccated thyroid , and many people trust it to treat their condition effectively. The medication works by replacing the missing hormones that are typically produced by the thyroid gland.
As a result, it can help to improve symptoms such as fatigue, weight gain, and hair loss. Nature-Throid is generally well-tolerated, but some people may experience side effects such as headache, diarrhea, or joint pain. If you are considering taking WP Thyroid, be sure to speak with your doctor first to ensure that it is the proper natural desiccated thyroid hormone treatment for you.
NDT medications are considered to be more bioidentical active than synthetic thyroid medications, and some people prefer them because they feel they work better. Nature-Throid is manufactured by RLC Labs, and it comes in 8 strengths:
- ¼ Grain 9.5 mcg T4, 2.25 mcg T3
- ½ Grain 19 mcg T4, 4.5 mcg T3
- ¾ Grain 28.5 mcg T4, 6.75 mcg T3
- 1 Grain 38 mcg T4, 9 mcg T3
- 1 ¼ Grain 47.5 mcg T4, 11.25 mcg T3
- 1 ½ Grain 57 mcg T4, 13.5 mcg T3
- 1 ¾ Grain 66.5 mcg T4, 15.75 mcg T3
- 2 Grain 76 mcg T4, 18 mcg T3