Levothyroxine (Synthroid)
Most people diagnosed by a conventional doctor will start on levothyroxine. It is a synthetic form of T4 used as thyroid hormone replacement. While synthetic, levothyroxine is bioidentical, meaning it is the same molecule as that produced by your thyroid. Levothyroxine is the generic tableted form of the medicine that is often also referred to as Synthroid, which is the brand name (the original name when it was patented). Generic drugs are generally cheaper but not necessarily inferior to brand drugs, although some people will respond better to one over the other for a variety of reasons, usually to do with the excipients (fillers, binders, etc.) in each product. There is also an encapsulated form of levothyroxine that is better tolerated by some patients called Tirosint. This also has the advantage of being available in a 13mcg dose. (The lowest dose of levothyroxine is 25mcg, although the pills can – in theory – be broken.)
Liothyronine (Cytomel)
Many patients find they do better with a combination of levothyroxine and some T3, the primary active form of thyroid hormone. This is available as liothyronine (generic) or Cytomel (brand). T3 is rarely given alone.
Armour Thyroid
Others do best with a glandular or dessicated thyroid product – one made from pig thyroid glands. The original of these is Armour Thyroid. NP Thyroid is also available and is sometimes described as a generic and may be cheaper. Previous forms of glandular thyroid, such as NatureThroid and WestThroid, are no longer available.
Compounded Medications
Some patients do not respond well to any of the commercially available thyroid medications and require specially made thyroid medication. These can be immediate release combinations of T4 and T3 in a single capsule or sustained release versions of T4, T3 or a combination of both. Compounded dessicated thyroid is also available if more precise dosing is needed or patients react to excipients in the commercial products.
How Should I Take My Thyroid Medication?
You should take your thyroid medication away from food or supplements containing minerals such as iron or calcium. Coffee can also inhibit thyroid hormone absorption. Taking your thyroid medication one (1) hour before breakfast is ideal. Many patients find it best to keep their thyroid medication on their bedside table. If you forget to take your thyroid medication first thing, you may take it later. It is usually best not to take it in the evening as this may lead to insomnia. If you do not remember until the evening, skip that day’s dose and take it the next morning. Some resources will suggest dissolving pills under your tongue. While this may increase absorption slightly, the taste is generally unpleasant and the difference is not worth it for most patients.
Generally, the doctor will start you on a low dose of your thyroid replacement and increase it incrementally until you feel better. Please do not adjust your dose without consulting your doctor. This can result in unexpected negative consequences.
If you get too high of a dose of thyroid replacement, you may experience adverse symptoms. These symptoms are a bit like drinking too much coffee – racing heart, shakiness, sweating, anxiety, etc. If you experience these symptoms, please back down to your previous dose or stop taking your thyroid medicine and contact our office. The symptoms will subside within a few hours. Occasionally, patients will experience a little of this each time they increase their dose but it then normalizes quickly. This is not usually a concern.
Do you need to find the right thyroid medication for you? Give us a call