by Dr. Will Cole
Your thyroid gland is hugely influential in your health and every cell of your body depends on the thyroid hormone, yet as many as 20 million Americans have some form of a thyroid problem and as many as 60% of those with thyroid disease are unaware of why they are not feeling well.
Hypothyroidism, or low thyroid function, is the most common form of thyroid dysfunction and can lead to many health problems, including weight gain, fatigue, and digestive issues.
In certain cases, it’s more severe: Some research shows up to 50% of depression is caused by undiagnosed thyroid problems. Another study found that people with underlying low thyroid problems were twice as likely to have heart attacks.
But treatment of thyroid disorders in conventional medicine is, in my opinion, inadequate. Patients with hypothyroidism are typically given a thyroid replacement hormone as medication and care stops there. Because of this, some people still experience low thyroid symptoms despite medication and “normal” labs. The reason is that many thyroid problems are not actually problems of inadequate thyroid hormone. My patients often ask me which thyroid medication is right for them or whether they even need to be on one in the first place. Here is my functional medicine perspective.
What are my options for thyroid medicines?
Thyroid replacement hormones are one of the most commonly prescribed medications. Here is a rundown of the most common prescriptions:
Levothyroxine: This is the most common thyroid hormone. This synthetic T4 hormone comes in over 30 different brand names such as Synthroid and Levothroid.
Liothyronine: This is the generic name for synthetic T3, the active form of the thyroid hormone. The most common brand name is Cytomel.
- compounded thyroid hormones
These naturally sourced supplements come from pig thyroid tissue. Because they are natural, they contain both T4 (the less active hormone that has to be converted in the liver and gut) and T3 (the more biologically active form) hormone.
Many primary care physicians and endocrinologists are only comfortable prescribing the synthetic replacement hormones because decades ago, there was less standardization with natural options. Today, this is not as much of a concern and when thyroid hormone replacement is necessary, I prefer natural options (these are obviously not vegan friendly, if that is a concern for you).
However, these drugs aren’t right for everyone, synthetic or natural, since everyone is different and there is no “one size fits all” or magic pill for thyroid dysfunction. This brings me to the next question I am frequently asked:
I’m on a thyroid medication but it isn’t working for me. Why not?
If you’re still having low thyroid symptoms despite medication, it’s probably not that “you’re just depressed” or “just getting older.” Here are some other factors you should consider:
1. Thyroid drugs contain fillers
Thyroid drugs are pretty comparable as far as their active ingredients, with the biggest variable being the inactive ingredients. Because everyone is different, and many thyroid problems are autoimmune in nature, the fillers used in these pills may be causing a negative response. Drug formulas can change, so it’s important to check your individual medication. If you think you might be having a reaction, immunological labs can uncover certain intolerances you may be having.
Some common inactive ingredients found in thyroid medications that you may react to include:
- other sugars
- extra iodine (excess iodine can trigger autoimmune thyroid problems)
- corn starch
- modified food starch (may contain gluten, which can trigger autoimmune thyroid problems)
2. “Normal” lab ranges may not be normal
On your lab, you’ll see a “Reference Range.” This range is what’s considered normal in mainstream medicine. That range is based on a bell curve – a statistical average of the population of that particular lab you went to. People who go to labs are typically sick people, so if your result comes back within that reference range, it doesn’t automatically mean it’s at the optimal level for you.
In functional medicine, we look at a narrower and more personalized range of “normal,” so you may find that while a conventional doctor says you are “normal,” a functional medicine doctor will disagree. In addition to tweaking this reference range, your functional medicine doctor may also want to run more expansive thyroid tests to help uncover your exact issues. To get a full list of thyroid labs and their optimal ranges, check out my previous article.
3. You might have underlying thyroid dysfunctions
Sometimes there are other thyroid problems that won’t be solved by a pill alone. Thyroid conversion problems and Hashimoto’s disease (autoimmune thyroiditis) are two often overlooked underlying thyroid issues that should be ruled out before defaulting to a pill as the only treatment.
4. You might have inflammation
Inflammation can significantly inhibit thyroid hormone function. Addressing this means dealing with the underlying causes of inflammation, including a poor diet, stress, and toxins. Thyroid hormone resistance, similar to insulin resistance, is one reason why your thyroid medication may not be working for you. I recommend working with a qualified functional medicine practitioner to uncover and address chronic inflammation.
5. You might be experiencing decreased absorption
There are several medications that alter the absorption of activity of T4, a hormone produced by the thyroid. These might include commonly prescribed drugs like antacids, antibiotics, and antifungals, antiarrhythmia medications, cholesterol-lowering medications, diabetic medications, diuretics, hormone replacements, and pain medications.
Some foods may decrease the absorption of thyroid hormones, such as soy-based and high-fiber foods. Iron and calcium supplements can also inhibit thyroid hormone function.
According to the drug manufacturers, it’s best to take your medications four hours before or after you ingest foods, drugs, or supplements that can affect its effectiveness.
6. You might have other health problems
There are other underlying health problems that can both mimic low-thyroid symptoms and also complicate healthy thyroid function. Candida overgrowth, leaky gut syndrome, adrenal fatigue, and other underlying metabolic problems should all be investigated along with thyroid dysfunction, as they are common co-issues.
How to start healing
There are many variables to consider, and it’s important to remember that everyone is different. I encourage you to talk to your doctor about your options. You can also consider a free webcam or phone evaluation to answer your questions from a functional medicine perspective.
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