DEAR THYROID^TM

I always tell my patients that choosing a thyroid medication is similar to shopping for shoes – it’s not one-size-fits-all; it takes a long time to settle fully into a choice that works for you on multiple levels; and it takes commitment to consistent tracking of the criteria that matter, from hair loss to energy to weight to libido to heart palpitations. And, very importantly: intuition. In other words, as with most adult decisions, a robust combo of trial-and-error together with gestalt.

After years of “big pharma” influence and advertizing with physicians, many patients get started on Synthroid (a form of synthetic T4) and stay with it forever, or until a more enlightened clinician perhaps mentions that the Synthroid might be causing their increased hair loss.

Many folks on synthetic T4 (beyond Synthroid, there’s also levo-thyroxine, levothroid, levothyroxyl, unithroid, etc), end up adding T3 such as cytomel or long-acting T3 (my favorite is available from Medhaus Pharmaceuticals). My patients with high reverse T3, which blocks thyroid receptor, do particularly well on long-acting or slow-release T3.

What works best for many of my patients is natural, desiccated thyroid such as Armour, or its hypoallergenic cousin, Naturethroid. I find this is probably the best fit for most people, but I also have a growing number of vegetarians and patients who keep kosher, and pig thyroid, even if bioidentical, is not an acceptable choice.

When to consider switching? I have a few criteria in mind when I partner with patients in thyroid optimization.

1. If you don’t feel at least 80% improved on the hypothyroid symptoms you are tracking (I suggest a tracker, based on the thyroid questionnaire on my blog, http://drgottfried.blogspot.com/)
2. If you have hair loss on Synthroid, consider particularly a switch to Thyrolar or Desiccated thyroid.
3. If you have autoimmune thyroiditis and your antibodies are not decreasing appropriately on your thyroid treatment.

Enter Thyrolar. Thyrolar tables (Liotrix) contain both triiodothyronine (T3) and tetraiodothyronine (T4). As you probably know, T3 is four times more potent than T4 on a microgram by microgram basis. Thyrolar has been intermittently available and continues to make the FDA’s “Shortage” list (last check: 11/30/10), and upon my regular query of my pharmacist friends, the backorder is to resolve by January 2011. That means the manufacturer (Forest Pharmaceuticals, same as Armour) expects to meet demand next month (fingers crossed). For more details, call their hotline at 866-927-3261. Prepare, my friends. Dosage is a little higher than Armour. Here’s a short list:

Thyrolar-1/4    3.1 mcg/ 12.5 mcg

Thyrolar-1/2    6.25 mcg/ 25 mcg

Thyrolar-1       12.5 mcg/ 50 mcg

One final thought before I close on decision-making – it is the prevailing model in our Western healthcare system to make decisions with our brains, but I often find that what serves us best is a more Eastern approach, not gut-level, but also not purely driven by our minds. Somewhere in between, where we decide the next course of action with our heart, a balance of gut and mind, but informed by intuition, leads us to our best healing.

Tags: Best Thyroid Drugs, Best Thyroid Medications, choosing thyroid medications, finding balance, how to find a thyroid medication and dosage that is right for you, thyroid medications, working with hormones and the endocrine system, working with thyroid patients, written by Dr. Sara Gottfried

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