Good news! A recent analysis showed that Synthroid does not contain gluten. But, what do you do if you are taking Synthroid and still not feeling well? Let’s discuss the practical and effective steps you can take if this is you.
Dr. Michael Ruscio: Hi, this is Dr. Ruscio. And let’s discuss if Synthroid contains gluten. If you have hypothyroid, or you’re on thyroid medication, and you’ve been doing some reading on the Internet, you’ve likely heard some connection between gluten and hypothyroidism. And because of this, there is concern, rightfully so, that’s been voiced potentially about different medications, thyroid medications like Synthroid, and if they contain gluten or not.
I wanted to present to you the study that recently looked at this issue to help dispel any misconceptions out there and to help you know that if you have gluten intolerance or if you have celiac and you’re trying to avoid gluten, if Synthroid does or does not contain gluten.
And I’ll put the study abstract up here on the screen entitled, Gluten and Aluminum Content in Synthroid. “These data demonstrate that Synthroid tablets are not a source for dietary gluten and are a minimal source of aluminum.”
They assessed multiple batches and essentially found that there was no detectable gluten in any of the batches assessed. So this is comforting. And this may run counter to what you’ve heard before. And this may be because, according to my knowledge, there was gluten in Synthroid or levothyroxine tablets before, but this is no longer the case. So this can be comforting if you are someone who is gluten insensitive or gluten intolerant or have celiac and you’re trying to make sure you avoid gluten.
Now, what if you’re listening to this and you’re saying, “I’ve been on Synthroid, or levothyroxine, or a thyroid hormone, and I’m not feeling any better,” because it’s important that you understand some of the effective treatments or interventions that can be done to help you feel better if you’re not feeling well, and not to get pulled in to an elaborate sea of testing in the hopes that that is going to actually tell you what to do to improve your health, because a little bit of testing can be helpful, but sometimes excessive testing does nothing more than waste money.
So I wanted to offer a few guidelines. So, first of all, it is possible that you may be on Synthroid or levothyroxine, and not feeling better. And sometimes people may feel like their doctor’s telling them that that shouldn’t be happening, yet their personal experience clearly indicates that they’re on thyroid hormone. And they’re not feeling better. That can happen.
So let’s look at a few things that you can do if that does happen. First, you want to establish if your dose is correct. The initial thing to look at may be a very simple one, which is you may be underdosed. You may be overdosed. And a simple dose adjustment that you can do under the supervision of your doctor, by looking at your lab work, can be very easy to do. So that’s number one.
Now, if it’s been challenging to find a stable dose, then malabsorption might be the problem. And what this means is you’re taking the pill, but you’re not consistently absorbing the pill. And so you’re getting inconsistent amounts into your bloodstream. And therefore, your hormone levels are inconsistent and your testing is inconsistent. And, oftentimes, when this happens, it can be an underlying gut issue.
Now, if you’re eating foods around the same time of your medication,that may be interfering with the absorption, also. So that’s important to mention. But I’m assuming most people understand that you should not be eating with your thyroid medication. And so if you’re not eating with your thyroid medication, but you’re still inconsistent in your dose or your dosage level, but your levels are inconsistent, and so your doctor keeps trying to adjust it, then you may not be absorbing the medication effectively or consistently. And this may be caused by malabsorption in the gut.
And the answer or the solution to that problem is to fix any underlying problem in the gut. If there is IBS, treat the IBS. If there is SIBO, treat the SIBO. If there are ulcers or GERD, see those through to resolution.
Now, moving on, you may want to also try a liquid form of thyroid hormone. Let’s say you do have a case of mild or severe IBS, or maybe inflammatory bowel disease, or maybe SIBO, small intestinal bacterial overgrowth, is very hard to resolve. And you have this ongoing inflammation. Or maybe you have ulcers that are chronic. Then, you may want to try a form of thyroid hormone that is liquid that is much more easily absorbed.
And there have been trials done in patients with various gastrointestinal conditions that were struggling on normal Synthroid or levothyroxine. And then, when switching to the liquid form, their dose became more stable and their symptoms improved, also. And there’s one under the trade name of Tirosint, which is a liquid gel cap that can be helpful in these cases.
Okay, so moving through our list. If your hormones are generally in the normal range, then what do you do then? Well, in that case, you may want to consider a trial of a T4 or T3 medication. What ends up happening with some patients is about 20% of the patients prefer a T4-only medication like levothyroxine, according to one study. And about 43% of patients actually prefer a T4 or T3 combination. So you may have your levothyroxine, and you add Cytomel. Or you may switch from levothyroxine to something like Westhroid or Nature-Throid that has a combination of T4 and T3.
And in some of the studies that have been done, there’s a clear documented benefit. And this is not based upon people’s lab work. It was simply a trial. A trial of a different form or a balance of the medication, meaning instead of just giving a T4, a balance of T4 and T3 was administered. So that can be a simple thing to do with your doctor on an experimental basis to see if that aids.
Now, what also maybe happening is the problem is no longer your thyroid. And this is very important to understand, because unfortunately on the Internet, there is so much information about thyroid. And the thyroid symptoms are so non-specific that people oftentimes are chasing after the thyroid as the root cause of their problem and overlooking the fact that it’s actually a problem in the gut that’s driving their symptoms. So this is very important.
So if you’ve gone through some of these basic, simple steps for your thyroid, and you’re still not feeling better, the thyroid symptoms that you are concerned about may actually not be thyroid symptoms, but may be symptoms that are being driven by a problem in your gut. And it’s manifesting as what looks like thyroid symptoms, because remember, many of the thyroid symptoms are non-specific. Weight gain, fatigue, constipation, depression, dry hair, skin, and nails, those can all be caused by a problem in the gut. Or they can all be caused by a problem in the thyroid.
So if you’ve gone through some of these thyroid basics, or I should really say fundamentals, and not responded, then I would caution you about not going too far down the thyroid rabbit hole, but rather have a thorough gut evaluation and optimize the health of your gut and see if that improves the symptoms that may have been falsely attributed to being caused by your thyroid.
So here are some things that can be helpful to help you feel better if you have a thyroid condition or a suspected thyroid condition, and you haven’t. Also, remember that if you are gluten sensitive or a celiac, that Synthroid or levothyroxine has been shown not to contain gluten. So that may be comforting and make your life a little bit easier.
This is Dr. Ruscio. And I hope this information helps you get healthy and get back to your life. Thanks.
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