What do you do if you have been diagnosed with hypothyroid and started medication, but still are not feeling much better? One simple step is to try a T4/T3 combination hormone (Armor, Nature-Throid) if you have been using a T4-only medication like Synthroid or levothyroxine. Let’s review a study that showed that the majority of patients preferred a T4/T3 combination over T4 alone. Then let’s discuss why you should save your money on expanded thyroid panels if neither of these has helped, and what you should do.
Dr. Michael Ruscio: Hi, this is Dr. Ruscio. And let’s discuss what the best form of thyroid hormone might be.
You’ve likely heard about different forms of thyroid hormone. There’s your standard levothyroxine or Synthroid, which is just a T4 fraction of the hormone. And then there are other types of hormones that have a combination of T4 and T3. These are things like Westhroid, Nature-Throid, Armour Thyroid.
And there’s a little bit of—I guess you could say debate as to which one is the best. But generally speaking, these are your two classes or two of the main classes of thyroid hormones—ones that only contain the T4 hormone and ones that contain T4 plus T3.
Now, a recent study was done that helps give us an appreciation for what type of response you may have to one of these compared to the other. This study was a placebo controlled, crossover trial.
And the crossover part of this is very important. We’ve probably all heard of placebo controlled, meaning you don’t know what you’re getting, nor does the doctor. So the placebo effect has been guarded against.
In a crossover trial, what’s interesting is they take one group, and then they are later given the other end of the treatment. So what this looked like in this study, to help clarify this—one group of hypothyroid patients was divided into two separate groups.
One group was given just a T4 hormone. The other group was given a dessicated thyroid hormone, which contains T4 and T3, for 16 weeks. Then the groups were switched. And they went forward for another 16 weeks.
Now, what this gives us is a very accurate assessment of the effect of each treatment, because it could’ve been that one group just happened to respond better or worse. So one group has the treatment for a little while, and then they switch it over to the other treatment. So we isolate for the impact of potentially one group being comprised of a base of people that are more or less prone to respond.
Now, here’s what’s interesting. At the end of the study, 48% preferred the dessicated T4/T3 combination hormone, whereas only 18% preferred the T4 hormone, and 32% had no preference.
So what we see here—32% having no preference, 48% having a preference—shows us that there’s a slightly better chance, at least according to this study, that one may feel better on a T4/T3 combination.
Now, what was it that made the group that preferred the T4/T3 combination prefer the actual T4/T3 medication? Well, there were a couple things that were found. One, the group on the T4/T3 combination dessicated thyroid lost 4 pounds compared to the other group. That’s not a ton of weight, but it’s something.
And they also noticed that their subjective symptom assessments were improved compared to the other group. So their general symptom assessment and their weight were a little bit improved compared to the T4 only group.
Now, what does this mean? Well, it means that if you’ve started on a T4 medication and you’re not feeling well, you should simply try a T4/T3 combination medication and see if you feel better. You may want to try one or two different formulas.
And you want to work with your doctor to adjust the dose to see if you can find the optimum formula and the optimum dose, because there are a couple different formulas. And some people sometimes react to some of the fillers in some of these. But generally speaking, it’s a pretty simple endeavor.
If you start on T4 and you don’t feel better, speak with your doctor about trying a T4/T3 combination and see if you feel better on it. Don’t have the expectation that it’s going to change your life necessarily. It may help you feel better, but approach it with a reasonable expectation. And simply assess after a number of months if you feel better.
If you don’t—and here is the important piece—I would not get overly wrapped into doing much more robust thyroid testing, where you look at other fractions of thyroid hormone like reverse T3, T3, and you look at the free and total fractions, because the problem is probably not your thyroid.
If you’ve tried a different type of medication and you’ve tried a couple dose adjustments—and by “a different type of medication” I mean this T4/T3 combination—and you’re not feeling noticeably better, the problem is probably not your thyroid.
So don’t continue to bark up the thyroid tree. I’d recommend looking at another system of the body that’s potentially causing the symptoms that you think are thyroid symptoms but actually aren’t.
And as you’ve probably heard me say before, in many cases, it can come down to a problem in the gut. So I would start with your gut. Start with a gut evaluation and see if it might be a problem in the gut that’s contributing to this.
And it can contribute in a number of ways. One, the inflammation produced in the gut can cause symptoms that look like hypothyroidism.
Two, problems in the gut can cause malabsorption of your thyroid hormone, which can lead you not to adequately get that hormone into your system and have a hard time stabilizing your dose or stabilizing your symptoms.
And then thirdly and finally, problems in the gut can fuel autoimmunity, which can be one of the underlying causes of hypothyroidism.
So in quick recap, this study shows us that more patients tend to prefer a T4/T3 combination than do just a T4 hormone. So if you’ve been on T4 and you’re not feeling well, you may want to try a T4/T3 combination. Try one or two formulas. Allow for a reasonable amount of time to work with your doctor to adjust the dose and try to find the optimum dose.
And if that doesn’t work for you, move on to looking into another system of the body that might be the underlying cause of the symptoms that you’re experiencing.
So this is Dr. Ruscio. And hopefully this information helps you get healthy and get back to your life. Thanks!
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