Thyroid medication: why less really is more

by Dr. Raquel Espinol

Introduction

The thyroid gland regulates metabolism by releasing hormones called thyroxine (T4) and triiodothyronine (T3). When the thyroid underperforms, it causes everything in your body to work less efficiently. This is known as hypothyroidism. Hypothyroidism affects more than 30 million American adults and is five to eight times more common in females.1 By conservative estimates, one in eight women will develop hypothyroidism.1

The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis. This makes up 75-85% of hypothyroid cases. Oftentimes, people with Hashimoto’s struggle to find a medication or treatment plan that works for them and continue to suffer through symptoms like:

• Fatigue

• Feeling cold

• Losing hair

• Gaining weight

• Depression

While there are many treatment options for hypothyroidism, not all are created equal. Selecting the most appropriate one is vital to managing this disease.

What can interfere with hypothyroid therapy?

Some commonly used prescription drugs that can interfere with thyroid medication absorption and efficacy:

• Antacids

• Lithium

• Amiodarone

• Antibiotics

• Antidepressants

• Dopamine agonists

• Colestipol

• Cholestyramine

• Estrogen, testosterone

Thyroid hormones: T3 and T4

The two hormones to remember are T4 (thyroxine) and T3 (triiodothyronine). T4 circulates throughout your bloodstream and is stored in your tissues until needed. Once your body finds a need, it converts T4 into T3. Establishing the exact levels of T4 and T3, and determining if the conversion process is working normally, are critical to designing the best treatment approach.

While most healthcare providers understand the critical nature of T4 to T3 conversion, many fail to recognize the factors that affect this process. These include:

• Nutritional deficiencies/excesses

• Autoimmune diseases

• Gastrointestinal diseases such as celiac disease, acid reflux, or irritable bowel syndrome

• Use of interfering medications like proton pump inhibitors (Nexium® and Prevacid®, for example) or H2 blockers (Tagamet®, for example), which inhibit the dissolution and absorption of thyroid hormone tablets

• The body’s own obstacles to converting T4 to T3

Some people continue to suffer from hypothyroid symptoms despite being on medication for years. But with some effort, patients can work with their doctor to find an approach that works for them.

Some commonly used nutraceuticals that can interfere with the absorption of thyroid medicines:

• Iron

• Calcium

• Magnesium

• Chromium picolinate

Some foods that can interfere with absorption of medication:

• Soy products

• High-fiber/high-bran foods

• Calcium-enriched foods/beverages

Digestive complications or diseases such as celiac disease, autoimmune gastritis, and irritable bowel syndrome can also complicate thyroid hormone therapy.

Make sure to discuss with your doctor all of your medical conditions, medications (both prescription and nonprescription), and nutritional supplements before starting or switching thyroid hormone therapy.

Dr. Raquel Espinol graduated with honors and received her doctorate in naturopathic medicine from Sonoran University of Health Sciences (formerly Southwest College of Naturopathic Medicine). She struggled with her own thyroid condition, which was not successfully managed until she discovered naturopathic medicine and worked with a naturopathic doctor to control her condition. This firsthand success inspired her to pursue a career in naturopathic medicine specializing in thyroid diseases.

Dr. Espinol works with men and women addressing thyroid conditions, hormone imbalances, and weight loss. She is licensed to practice in Arizona, California, Oregon, Washington, Utah, and Montana.

Common choices for treating hypothyroidism

The most common treatments for hypothyroidism include T4 monotherapy with levothyroxine, natural desiccated thyroid (NDT) aka “glandular thyroid,” and a regimen of T4 and T3 medications taken together. Figuring out the best option for you may take some time. See the accompanying chart for pros/cons of commonly used hypothyroidism therapies.

T4 monotherapy

Pros:

• Current standard of care for hypothyroidism

• Proven safe and effective

• Available at all pharmacies

• Usually low cost

Cons:

• GI conditions, medications, sensitivities to excipients/ inactive ingredients in tablet formulations can interfere with absorption and tolerability

Natural desiccated thyroid (NDT)

Pros:

• Contains both key thyroid hormones: T4 and T3

• An option for people who need supplemental T3

Cons:

• Derived from thyroid glands of pigs – an issue for vegans

• NDT therapies are tablets that contain excipients or “fillers”

• The T4:T3 ratio contained in NDT tablets is 5:1 – different than the normal human ratio of these hormones

• Can lead to cardiac problems like rapid heartbeat, insomnia, and feelings of anxiety

• It comes from pigs and may contain porcine antigens, which may be problematic for some people

• Not all pharmacies carry NDT products. Not all insurance carriers pay for them

Combined T4 and T3 medication therapy

Pros:

• Consistent potency

• Can be an option for those in need of supplemental T3

• Available at most pharmacies

Cons:

• Two separate medicines that need to be taken daily. T4 is taken once a day; T3 may be recommended in multiple daily doses

• Some insurance plans may require two medication copays

• T3 can be risky for some patients with cardiovascular conditions. Some patients can experience heart palpitations and other side effects

Malabsorption and drug underperformance

Most thyroid hormone therapies come in tablet form. These contain inactive ingredients such as wheat starch (gluten), talc, lactose, sugars, and dyes that help hold the tablet together, but also can impede the absorption of their active ingredient, which results in suboptimal or inconsistent levels of thyroid hormones. When this happens, many patients often believe they need to change medication rather than address the factors that contribute to their therapy’s poor performance. They turn to their physician for new therapies in the hope that these can provide long hopedfor relief from their symptoms.2

Nutritional support

Nutrition can play a role in managing hypothyroidism. However, few patients can treat hypothyroidism with nutritional supplements alone. Some examples of helpful nutritional supplements include inositol, nigella, B vitamins, and selenium. However, excess amounts of certain nutritional supplements can also lead to hyperthyroidism or hypothyroidism. Always tell your physician about all drugs and supplements that you are currently taking as well as your soy, fiber, and non-animal product intake.

Thyroid treatment: sometimes less is more Less is often more when it comes to hypothyroid treatment. Tirosint®-SOL (levothyroxine sodium) oral solution is a unique liquid hypothyroid medication made with only three ingredients. It contains no fillers or other ingredients that can irritate your stomach or lead to poor drug absorption. Because it’s a liquid, it doesn’t need to dissolve in your stomach like a tablet or capsule before your body starts to absorb it. It’s not made with any ingredients sourced from animals, and it’s easy to swallow and comes in precise monodose ampules that can be conveniently stored for travel. You can pour it into a glass of water and drink it, or you can squeeze the contents of the ampule directly into your mouth.

Since Tirosint-SOL consists of just water, glycerol, and levothyroxine, it’s a very simple yet effective solution for treating hypothyroidism. This is important to me. Additionally, I want to ensure my patients have consistent access to the thyroid medication that works best for them. That being said, Tirosint-SOL has a generous coupon program and low-cost mail-order option to help patients without insurance or with high insurance copays/ deductibles. These can be found on the product’s website.

So, which treatment is right for you?

Share your answers to the following with your physicians so they can work with you to pick the right option for you:

• Have you been treated for hypothyroidism and are dissatisfied with the results?

• Do you want a simpler approach?

• Do you need a drug that is free of excipients like gluten, dyes, lactose, and preservatives?

• Do you have gastroesophageal reflux disease (GERD) or another GI condition?

• Problems swallowing?

Please see Important Safety Information on the following page or toward the back of this issue, and Full Prescribing Information at TirosintSOL.com.

References: 1. American Thyroid Association Website. https://www.thyroid.org/mediamain/press-room/. Accessed December 8, 2022. 2. McMillan M, et al. Results of the CONTROL Surveillance Project. Drugs in R&D. 2015;16(1):53-68.

PM-01-22-0089

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Meditate Milwaukee – 2:30-3:30pm. A meditation and live music experience for everyone. Free. Sojourner Family Peace Center, 619 W Walnut St, Milwaukee. Register: 414-412-2473 or MeditateMilwaukee.com

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How To Be Happy: A Domo Geshe Rinpoche Event Tibetan Buddhist Tradition – Apr 14-16. Happiness should depend more on the quality of our thoughts than on outer circumstances. How To Find Happiness, April 14, 7-8:30pm. How To Be Happy With Others Half-Day Program, April 15, 1-4:30pm. How To Be Happy With Yourself, April 16, 1-2:30pm. All on Zoom. Register &info: 715-743-6743 or White-Conch.org

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Naturopathic Clinical Assessment Skills Training – 9am-3pm. With Gigi Stafne. Acquire and practice gentle, non-intrusive assessments to help yourself, friends, family and clients. Learn tools and techniques that are ancient yet hold an important place in contemporary clinical CAM practices. Lodging options available. Golden Light Healing Retreat Center, 7102 Sundew Rd, Sobieski. GoldenLightHealing.net

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Whispers On the Wind Shamanic Program – Group 28: Apr 19-23, Jul 12-16, Oct 4-8, Jan 3-7, 2024; Group 29: Aug 2-6, Nov 8-12, Feb 7-11, May 1-5, 2024. With Amy Wilinski. Join us for an intensive training program in shamanism, energy medicine and self-transformation. Learn core energy healing techniques including power animal and soul retrieval, clearing of past-life and ancestral imprints, connecting with the forces of nature, ceremony and more. Lodging options available. Golden Light Healing Retreat Center, 7102 Sundew Rd, Sobieski. GoldenLightHealing.net

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28th Annual Milwaukee Riverkeeper Spring Cleanup – 9am12pm. Volunteer to help clean up trash and restore our rivers. Choose from 85+ locations across the Milwaukee River Basin and be one of our nearly 4,000 volunteers helping our community work towards swimmable, fishable rivers. Celebrate at Rock the Green afterward. Pre-registration required: Tinyurl.com/riverkeeper23

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Plan Ahead

TUESDAY, MAY 2

The Seven Chakras and Restorative Yoga 8-Week Series: Well Being Class – Tuesdays, May 2-Jun 20. 6-7:30pm. Be guided in ways to balance the energy centers with deeper awareness of their impact on one’s life. Restorative yoga offers relaxing poses, allowing the nervous system to reset and experience calm throughout the body. Yoga mats and bolsters provided. Space limited to 5 students. $120. Water’s Edge Therapy Services, 155 E Silver Spring Dr, Ste 211, Whitefish Bay. 262-586-9779. Tinyurl.com/watersedgets

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THURSDAY, MAY 11

Super Salads – 6pm. Whether you already love salads or you’re just trying to eat a little cleaner, join Dr. Axtell for this “Doctor in the Kitchen” workshop where you will learn to build a balanced one-dish wonder and sample super salads. $50 (includes recipes and food tasting), Video Recording: $39 (includes recipes). Lakeside Natural Medicine, 3510 N Oakland Ave, Ste 203, Shorewood. 414-939-8748. LakesideNaturalMedicine.com

SATURDAY, MAY 13

The Phenomenon Bruno Groening: The Sensation of 1949: Still Very Relevant Today – 9:30am-3pm. A deeply impressive film that contains archival footage and eye-witness interviews about the “Miracle Healer,” Bruno Groening, and the countless healings that occurred in 1950s Germany after he simply spoke to crowds of help-seekers. Phenomenal healings, medically verified by physicians, continue to occur today in the Bruno Groening Circle of Friends. Free admission; donations appreciated. Plymouth Church, UCC, 2717 E Hampshire St, Milwaukee. 414-949-2025. Bruno-Groening.Film.org

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Sunday

A.C.I.M. Study Group – A Course in Miracles study group, following Fellowship. Love offering accepted. Fireside Room, Unity Center in Milwaukee, 1717 N 73rd St, Wauwatosa. Joann Baumann: 414-745-7377. UnityCenterInMilwaukee.com

Sunday Celebrations at Unity Center in Milwaukee – 10am. Onsite (observing COVID-19 recommendations for face masks, social distancing and taking temperatures). Unity Center in Milwaukee, 1717 N 73rd St, Wauwatosa. 414-475-0105. Streaming live: UnityCenterInMilwaukee.com

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Monday

Hatha Yoga – 8-9am. We make getting on your yoga mat as easy as possible with multiple ways to practice. Specials for news students and referrals. In-studio or virtually via Livestream. Everyday Bliss, 1930 W Bluemound Rd, Waukesha. 262-781-8102. Everyday-Bliss.com

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Life Journey Group – 6:15-8pm. 2nd & 4th Mon. Come with an open mind and kind heart to support others and self in spiritual growth through daily living. Love offering. Unity Center in Milwaukee, 1717 N 73rd St, Wauwatosa. 414-475-0105. UnityCenterInMilwaukee.com

Tuesday

Cultivating Guts Podcast: New Episode Release – 9am. Tiffany Hinton’s podcast where we discuss gardening, homesteading, gut health, following our intuition, herbalism and functional medicine to create a life of joy and beauty. Listen on Spotify, YouTube and iTunes. Free. Tinyurl.com/CultivatingG

VIBE Fitness: HIIT Class – 6-6:45pm. Class will focus on keeping your heart rate up while still focusing on resistance training. VIBE Yoga Health Fitness, 180 Kossow Rd, Waukesha. 262-788-9147. Register: VibeMKE.com or using the MINDBODY app.

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Wednesday

VIBE Virtual 30-Min Yoga Flow – 12pm. Class is created with the intention to connect with breath, move the body and clear the mind. Great for doing when time is limited, but when a break is needed to flow and breathe. Zoom. Register: VibeMKE.com or using the MINDBODY app.

East Side Pilates: Booty Camp – 6pm. This challenging circuit format utilizes cardio intervals on the jump board with strength and core conditioning segments on the low chair and CoreAlign. A perfect way to build strength, sculpt and tone your body. East Side Pilates, 2445 N Farwell Ave, Milwaukee. 414-915-7100. EastSidePilates.com

Thursday

VIBE Sunrise Yoga Flow-45 – 6-6:45am. Virtual & In-Person Options. Connect with breath, move the body and clear the mind. All levels welcome. For the VIRTUAL class option, the ZOOM link will be emailed to you prior to the start of class. VIBE Yoga Health Fitness, 180 Kossow Rd, Waukesha. 262788-9147. Register: VibeMKE.com or using the MINDBODY app.

East Side Pilates: Mixed Equipment Pilates Class – 9:30am. This open-level class will challenge you in surprising and new ways. Experience the reformer, tower, yoga wall, mat, CoreAlign and/or chair. Increase core and full body strength, balance body/mind/spirit. East Side Pilates, 2445 N Farwell Ave, Milwaukee. 414-915-7100. EastSidePilates.com

Friday

VIBE Fitness-SHRED – 6-6:45am. Class is all about building lean muscle through resistance training. Weight training-based movements that will help boost that metabolism to get you feeling stronger and leaner than ever. VIBE Yoga Health Fitness, 180 Kossow Rd, Waukesha. 262-788-9147. Register: VibeMKE.com or use the MINDBODY app.

East Side Pilates: Reformer/Tower Pilates Class – 7:30am. This open-level class is one of ESP signature classes. Attendees are guided through a dynamic Mat warm up then dive into flowing sequences on the Tower utilizing spring-based exercises. A perfect way to build strength, sculpt and tone your body. East Side Pilates, 2445 N Farwell Ave, Milwaukee. 414-915-7100. EastSidePilates.com

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890 Elm Grove Rd, Ste 1-1 Elm Grove, WI 53122 414-778-1341

SpecializedTherapyServices.com

SATURDAY

Yoga Basics: Free Community Class –11:30am-12:30pm. Come to learn, play, and move in a supportive, welcoming environment. We focus on developing clear and safe alignment in foundational yoga pose. Invivo Wellness, 2060 N Humboldt Ave, Ste 300, Milwaukee. 414-265-5606. InvivoWellness.com