Adverse Reactions And Medication Ineffectiveness Due To Fillers
I have found that some of my clients experience sensitivities and adverse reactions to the many inactive ingredients or fillers found in their T4 medications. These are added as bulking agents used to stabilize the tablets, as coloring agents, as preservatives, or to aid in the manufacturing process in some way. Many have been shown to potentially cause adverse reactions, as well as affect the absorption rate and effectiveness of the very medication meant to help the thyroid.
Most generic levothyroxine products contain lactose and not all are gluten-free .
Can small amounts of these types of fillers really be problematic? Yes! Many people with Hashimotos have sensitivities to these ingredients no matter how small the exposure. In my 2015 survey of 2,232 readers, 57 percent of respondents said they reacted to or avoided all dairy, and over 75 percent avoided gluten due to sensitivities and reactions. Other fillers that are commonly found in T4 medications may include confectioners sugar , sucrose, talc, and dyes. Why would we want these inactive filler ingredients in our thyroid medication?
- You can look up the latest and greatest on medication fillers at glutenfreedrugs.com to ensure that your medications are gluten-free and free of fillers that may be reactive for you.
- Alternately, consider switching to Tirosint and Tirosint SOL these formulations have minimal fillers.
Normal Tsh And Low T4
In some cases, TSH test results are within the normal range but low T4 results can occur. Dr. Louise Newson on Patient.info says that this can often happen in people who are chronically ill. The illness may affect a persons metabolism which affects their thyroid hormone levels. This means that the pituitary gland is secreting TSH within the normal range and the thyroid is working properly. However, thyroid hormones in the body are lacking.22
Also, if you have recently had treatment for hyperthyroidism, you could have normal TSH but low T4.
Where Can I Get T3 Medication
Speak to your primary care physician about where and how to get T3 medication, and then work with your doctors to find the best dose for your personal needs. As medicine generally is moving towards a more tailored approach, it is simply catching up with thyroid treatments which have long been tailored to the individual patients weight, the severity of illness, and needs.
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How To Take Your Medicine
To make sure your hypothyroidism stays under control:
Stick with the same brand. Different types of thyroid hormone medicine may contain slightly different doses. That could mess with your hormone levels.
Follow a schedule. Take your medicine at the same time each day. Aim for about an hour before a meal or at bedtime. Don’t take it when you eat. Food, as well as some supplements, such as calcium, can affect the way your body uses it.
Don’t skip doses. If you miss one, take it as soon as you remember. You can take two pills in one day if you need to.
Follow instructions carefully. Don’t stop taking your medicine without first checking with your doctor.
How Tsh Is Connected With T3 And T4 Levels
Dr. Oliver Starr on Patient.info explains that all your thyroid hormones and TSH need to work in balance. This forms what doctors call a feedback loop where the levels of thyroid hormone in your blood signal to your brain to produce more or less TSH.17
For example, if an overactive thyroid produces too much T4 or T3, the feedback loop to your brain signals to produce less TSH. The same is true if your thyroid isnt working properly and produces too little hormone.
Doctors from the National Health Service explain the basic relationship between TSH and thyroid hormone levels:18
- Hypothyroidism: TSH high, T4 low, and T3 low or normal
- Hyperthyroidism: TSH low, T4 high or normal, and T3 high or normal
- Subclinical thyroid disease: Levels of T4 and T3 are normal but TSH is either too high or too low
- Non-thyroidal illness: TSH low, T4 low or normal, and T3 low or normal
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How Is Hypothyroidism Treated Exactly A Look At Your Treatment Options
Because hypothyroidism involves a lack of sufficient thyroid hormones, treatment focuses on replacing their loss.
Theres no cure for hypothyroidism, so lifelong treatment is required to help you feel better and decrease any related complications, such as heart disease.
But many people are happy to learn that once they and their doctors are able to figure out the best type and dosage of medication for them, many of the most uncomfortable hypothyroidism symptoms such as fatigue, high cholesterol, and weight gain may be reversed.
High Tsh And Normal T4
Lab test results that show TSH levels greater than 4.0 mU/L and T4 within the normal range can indicate subclinical hypothyroidism.
According to the journal American Family Physician, subclinical hypothyroidism could show that person is at greater risk of developing an underactive thyroid disorder. This often happens in older women and there may be no visible symptoms. Doctors treat subclinical hypothyroidism on an individual basis as thyroid hormone replacement can lead to osteoporosis.19
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Finding The Medication And Dose That Work For You
As you can see, there are many different options for thyroid medication, each with their own advantages and disadvantages. Many in the healthcare world like to frame it as a black and white issue, with conventional doctors who prescribe Synthroid® on one side, and alternative practitioners who prescribe desiccated medication on the other. In my experience, its not that clear cut, and what works for one person doesnt necessarily work for another.
Finding the right treatment protocol can often be a case of trial and error, as you learn what medication or combination of medications, and at what doses, work best for you. As you go through this process, its important to work closely with your doctor and check your levels regularly, but its also important to listen to your body. Even if your thyroid levels are within normal range, if youre still experiencing symptoms you might not have found the perfect balance yet, and you should speak with your doctor about continuing to fine-tune your protocol.
Tests For Measuring T4 And T3
The British Thyroid Foundation says that testing for thyroid dysfunction can include one or more of the following tests:6
- Testing to see if free thyroxine is within the range of 0.7 1.8 ng/dL
- Free triiodothyronine tests for the range of 260 480 pg/dL
- TSH and FT4 test
- Testing for thyroid antibodies to diagnose Graves disease or Hashimotos disease
Doctors recommend testing for T4 and T3 as part of a thyroid function test if you have any of the following symptoms:
- Fast or irregular heartbeat
- Thickening around the base of the neck
- High cholesterol
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A Controversy Continues: Combination Treatment For Hypothyroidism
Guidelines are skeptical about adding liothyronine to levothyroxine as a treatment for hypothyroidism, but some patients are convinced that the combination works better for them.
Your hypothyroid patient complains that she still does not feel well despite taking levothyroxine . She has been researching on the Internet, and has read many accounts from patients in her situation who say that they feel much better when their doctors add another thyroid hormone called T3 or something
So, you face a dilemma. You have based her treatment on the American Thyroid Association guideline that says that levothyroxine is the standard treatment. And clinical trials have not found a benefit in adding liothyronine .
LT4 became the treatment of choice following the discovery that the thyroid primarily makes the prohormone thyroxine , which tissues around the body convert into the active hormone, triiodothyronine . T4 has a half-life of a week or so, while T3s half-life is less than a day. It has worked for most patients to take T4 and let the body do the conversionexcept for some 5% to 10% of patients who say it doesnt work for them. Is there a problem in giving them LT3 as well?
Four thyroid experts interviewed by Endocrine News all called this combination therapy controversial but not one of them would refuse to give it a try in an appropriate patient who requested it.
How Hyperthyroidism Is Treated
The treatment of hyperthyroidism can be trickier than that of hypothyroidism. If the problem is too high of a thyroid hormone dose, your doctor will reduce the dose and repeat the thyroid blood tests. However, if your thyroid itself is overactive due to Graves disease, your doctor will likely prescribe medications to reduce the thyroids ability to make new thyroid hormone and to reduce symptoms of a fast heart rate. These are called antithyroid drugs. The two most frequently used in the U.S. are methimazole and propylthiouracil .
Other treatments that may be used for hyperthyroidism include and .
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Armour Thyroid Dosage And Administration
The dosage of thyroid hormones is determined by the indication and must in every case be individualized according to patient response and laboratory findings.
Thyroid hormones are given orally. In acute, emergency conditions, injectable levothyroxine sodium may be given intravenously when oral administration is not feasible or desirable, as in the treatment of myxedema coma, or during total parenteral nutrition. Intramuscular administration is not advisable because of reported poor absorption.
What Does My Thyroid Do
Located at the front of your neck, the thyroid is a butterfly-shaped gland. Glands are organs that can be found all over your body. Some of your glands create and release hormones substances that help your body function and grow. The thyroid gland plays a big part in many of your bodys main functions, including:
- Regulating your body temperature.
- Controlling your heart rate.
- Controlling your metabolism .
When your thyroid gland is working correctly, your body is in balance, and all of your systems function properly. If your thyroid stops working the way its meant to creating too much or too little thyroid hormones it can impact your entire body.
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What Foods Should Be Avoided With Hyperthyroidism
Eating too many iodine-rich or iodine-fortified foods in your diet may cause hyperthyroidism or make it worse in some cases.
If you have hyperthyroidism, your healthcare provider may recommend certain changes to your diet. Always consult your provider or a registered dietician before making drastic changes to your diet. If you take medication for your hyperthyroidism, always take the amount prescribed by your provider.
According to the National Institutes of Health , the recommended daily dose of iodine is about 150 micrograms . The daily dose is higher for pregnant people. A low-iodine diet requires even less.
Seafood has the most iodine. Just 1 gram of seaweed contains 23.2 micrograms , or .02 milligrams .
If your provider or dietician has recommended a low-iodine diet, try to avoid the following seafood and seafood additives:
You Take ‘natural’ Thyroid Medications And Supplements
Many supplements claim to support thyroid health but some are laced with thyroid hormones not listed on the label. Adding them to your thyroid drugs could mean making a thyroid medication mistake of getting too much. In a 2013 study of 10 top-selling thyroid-support products sold on the internet, researchers from Germanys Landstuhl Regional Medical Center and from the Walter Reed Army National Military Medical Center in Bethesda, MD, found that nine were laced with T3, T4, or both in a variety of amounts. Ingredient labels listed animal thyroid tissue for some while others only listed herbs such as ashwagandha, guggul, and Coleus forskohlii.
The researchers concluded that drugs were added to the supplements.¹ Supplements, including types containing a seaweed called kelp, may also contain dangerously high levels of iodine. Some experts also warn about an extremely rare threat that doesnt seem to have ever actually happened, but could. Natural thyroid supplements may contain gland tissue from the thyroid, liver, heart, pancreas and other animal organs of cowsraising a tiny but serious risk for exposure to prionsagents that could transmit the brain disease CreutzfeldtJakob.¹
Iron. National Institutes of Health Office of Dietary Supplements.
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Some Patients Feel T4 Medications Often Result In Inadequate Treatment
While many people do very well on T4-containing medications once they are dosed appropriately and stabilized, a 2019 review of the research found that many people taking T4 medications simply arent happy with their results, and that more than a third of patients remain inadequately treated despite levothyroxine therapy. In particular, 5-10 percent of people taking T4 replacement even if they normalize their TSH level are found to have impaired psychological well-being, anxiety, or depression.
As a pharmacist, I would ask the following questions in this situation.
Foods To Avoid While Taking Levothyroxine
People with hypothyroidism are commonly prescribed the synthetic hormone levothyroxine. There are several foods and drinks that can lower the effectiveness of the drug, although any unfavorable interactions can generally be avoided by timing and method of intake.
Some evidence shows a decrease in absorption of levothyroxine when taken with foods containing calcium, fiber and iron. If taking calcium, iron, or fiber supplements, do so at least four hours after taking levothyroxine, to avoid poor absorption.
It is generally recommended to take levothyroxine tablets on an empty stomach and 30 to 60 minutes before or after drinking coffee or other caffeinated beverages.
The interaction with food or drinks can also be lessened by taking the gel or liquid form of levothyroxine instead of in a tablet.
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What Is Free T4
Similar to free T3, free thyroxine levels are the unbound levels of T4 hormone . You have more free T4 in your blood than FT3. High T4 levels or low T4 levels can help to accurately diagnose hyperthyroidism or hypothyroidism. The book Clinical Methods says that blood tests for both TSH and T4 help to accurately assess thyroid health.7
The amount of free T4 helps doctors see how much thyroid gland hormone is available in your blood to meet your energy requirements.
How Long Does It Take To Treat Hyperthyroidism
The amount of time it takes to treat hyperthyroidism can change depending on what caused it. If your healthcare provider treats your condition with antithyroid medications your hormone levels should drop to a healthy level in about six to 12 weeks.
Your healthcare provider may decide to give you high doses of iodine drops , which would normalize thyroid levels in seven to 10 days. However, this is a short-term solution, and you’ll most likely need a more permanent solution like surgery. Though you may need to wait to be scheduled for thyroid surgery , this is a very effective and definitive way to treat hyperthyroidism. Its considered a permanent solution for hyperthyroidism.
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+ 2 Does Not Always Equal 4 With Thyroid Hormones
Adding some T4 or even T3 medication to your existing dosage may not always increase your FT3 level.
However, knowledge is power! In this case, it helps to set expectations, and helps patients and doctors to understand this response, if it occurs, and know what the next steps might be.
It can be a tricky balancing act, but knowing this at the outset should help greatly to get to a working dosage of thyroid medication that alleviates your symptoms which is what we all want.
As ever, I hope this information may be of some help.
At the end of this blog post are some additional research references for those interested. I also wrote a blog post a long time ago on this same topic that I will reference here for completeness:
Effect of TSH on conversion of T4 to T3 in perfused rat kidneyIkeda, Honda, Murakami, Kuno, Mokuda, Tokumori, Tominaga, Mashiba.See: Metabolism, Volume 34, Issue 11:1057-1060, 1985.URL:
Note: in these last two experiments, T4 medication was added to the rats livers and kidneys. There was a control group of livers/kidneys in which no TSH was added and a group that had TSH added. Upon addition of extra TSH, the level of FT3 in the this group increased, suggesting that TSH was affecting the deiodinase up-regulation. Liver and kidney tissues are not supposed to have TSH receptors within them, so more research in this area is required.
Whats The Difference In Options
To understand the different options, lets start by looking at the thyroid hormones you body produces :
- T1: This is thought to play a role in keeping your thyroid function in check and is also believed to influence heart health.
- T2: This likely plays a role in converting T4 to T3. It also likely has an impact on metabolism and burning fat and is effective in increasing liver metabolism and that of the heart.
- T3: Referred to as the active hormone, T3 has the greatest effect on the bodys energy levels and overall health and well-being. It is more active than T4. T3 is said to be linked to mental health, ability to coping with stress and emotional stability. T4 is referred to as the storage hormone and its main function is to convert to T3, both active T3 and Reverse T3.
- T4: This is a pro-hormone .
- Calcitonin: This is secreted from the thyroid when blood levels are high in Calcium. It acts to lower levels of Calcium in the blood and stops the release of more Calcium from your bones into the blood. Because of this, its said to be effective in the prevention of osteoporosis.
Your body produces all of these hormones itself but some of the T4 produced by the thyroid is also converted into that very important T3 and T3 is the active thyroid hormone the one that gives you energy and removes most hypothyroid symptoms.
An Instagram post I shared in 2021 about my medication experience:
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