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Doctors write millions of prescriptions annually for thyroid hormones as a treatment for hypothyroidism. Judging from this, a surprisingly large number of Americans suffers with an underactive thyroid gland.
Many others have symptoms that might suggest a problem with thyroid hormones: fatigue, constipation, dry skin, depression, brittle fingernails, mental fogginess, high cholesterol, weakness, hair loss and more. No one of these symptoms is unique to hypothyroidism, however, so doctors may need time to put all the puzzle pieces together. Unfortunately, some people feel less than well for years before diagnosis.
The Best Treatment for Hypothyroidism:
The standard treatment of hypothyroidism has long been Synthroid, a synthetic form of the thyroid hormone levothyroxine. It is also available as a generic drug. While many, perhaps even most, thyroid patients do very well on levothyroxine alone, not everyone thrives.
Q. I have been on levothyroxine (75 mcg) for many years to treat a hypothyroid condition. I still feel exhausted every day. My skin is incredibly dry, I am losing far too much hair and gain weight even though I am on a strict diet. I can never get warm enough, even with extra layers.
My thyroid panel has values within the normal range, so my doctor says I am fine and won’t change my prescription. I have asked him about switching me to natural thyroid (Armour) or adding T3 in the form of Cytomel. He seems to believe my symptoms are psychological. How can I convince him otherwise?
A. You are not the only person with hypothyroidism who is not feeling great on levothyroxine (T4) treatment alone. Researchers have found that as many as 10 or 15 percent of people on this medication still have some symptoms of inadequate thyroid hormone (Annals of Internal Medicine, Jan. 5, 2016). This may be due to genes that make the body less efficient in converting T4 to the active form of the hormone, T3.
Could Combination Therapy Help?
Leading researchers suggest that some of these individuals will feel better on combination therapy (Frontiers in Endocrinology, July 9, 2019). They urge endocrinologists to personalize thyroid treatment so that patients end up feeling well. Physicians may need to give this particular consideration for patients with persistent symptoms or abnormal laboratory values even though their TSH (thyrotropin) level is in the normal range (Journal of Clinical Endocrinology and Metabolism, Sep. 1, 2020).
Do You Really Need Treatment for Hypothyroidism?
Sometime people have the opposite problem. The TSH may be outside the normal range, but the patient may not have troubling symptoms.
Q. My doctor says my blood tests indicate I have hypothyroidism. I’m skeptical because I have none of the symptoms on her list. I’d rather not take medicine I don’t need.
Is there another way to determine for sure if I have it or not?
A. Laboratory tests may sometimes give misleading data. In addition, some medicines and dietary supplements may alter some results on a thyroid panel. Ask your doctor if you could be tested again before starting treatment.
It is possible that you have “subclinical hypothyroidism.” In this condition, people don’t have bothersome symptoms even though their thyroid glands are not functioning properly. Sometimes, thyroid hormone levels normalize over time. However, some people later develop symptoms such as weight gain, fatigue, brain fog, dry skin, brittle fingernails, constipation, puffy eyes and sensitivity to cold.
Treatment of subclinical hypothyroidism is controversial. An endocrinologist will enable you to review your test results and assess the need for hormone supplementation. To help with that conversation, we have created an eGuide to Thyroid Hormones. It provides insights on interpreting test results and analyzing various treatment options if necessary.
Is Armour the Answer?
Q. I was on Synthroid for more than 20 years, from my early 40s to my mid-60s. As I got into my late 50s, I assumed the constant pain in my joints was from old athletic injuries or arthritis.
A naturopathic doctor from my church suggested switching to natural Armour Thyroid as a treatment for hypothyroidism. Within six weeks the joint pain was gone and my energy level went up. I had a constant struggle convincing my primary care doctor to prescribe the natural treatment, though.
A. Synthroid is the synthetic thyroid hormone levothyroxine (T4). It contains 4 iodine atoms and is inactive until the body converts it to a compound with three iodine atoms (T3).
Combining T3 and T4 as a Treatment for Hypothyroidism:
Most physicians have been taught that T4 is all patients need to achieve normal thyroid function. Evidence is building, however, that people vary in their ability to convert T4 to T3 (Clinical Endocrinology, Nov., 2014). As a result, people with less efficient enzymes may be uncomfortable even while taking levothyroxine. In a randomized, controlled trial, patients with lingering symptoms while on T4 preferred a regimen combining T3 and T4 (Journal of Clinical Endocrinology and Metabolism, Oct. 21, 2021).
Armour desiccated thyroid is powdered thyroid gland from pigs; it contains T3 as well as T4. Some people find that such a combination makes them feel better than levothyroxine alone.
To Learn More:
There is more information about this new research, diagnostic tests and treatment with both T3 and T4 in our online Guide to Thyroid Hormones. You may also be interested in our interview with Antonio Bianco, MD, the scientist who did the research on genetic variability in the enzyme that converts T4 to T3. Perhaps you will also wish to listen to our hour-long radio show on this topic.
Terry
For years my dr was reluctant to prescribe Armour Thyroid, as she felt it was inconsistent. Then a patient of hers, who was seeing some sort of homeopathic person as well, went on it with no issues, so she asked me if I was still interested.
It didn’t affect the symptoms I was hoping it would help. However, I had been extremely cold (winters only, I wouldn’t think of going out without at turtle neck) which I attributed to old age since my hands weren’t cold, and I was fine in the summers. The day after I took the Armour Thyroid, I felt a wave of warmth as if a warm liquid was flowing in just beneath my skin. While I don’t notice the warm layer under my skin after that first day, I no longer have to wear turtlenecks all winter. The AT is pricier, but it is worth it not to be cold.
Crystal R
Hashimoto’s here. Hyperthyroid from birth to age 23 and putting away about 6K calories a day. 5’9″ and 130 lbs.; came off BCP and dropped to Euthroid and did well until about 25 yrs ago. Became hypothyroid. Doc used levothyroxine. Did pretty well until I didn’t. Saw Endocrinologist 5 yrs ago. She said I could be one of those people who doesn’t convert T4 to T3 and put me on Armour. What a difference! I am losing weight simply by avoiding carbs. Eating plenty of protein and good fats.
BTW, brother and my oldest daughter both have Hashimoto’s. Evidence supports the idea that our Dad passed it to us, and I gave it to the one daughter. Stable now.
Ariel
I would like to ask: some over the counter meds contain algae. Since Algae affects thyroid am wondering if it would affect the Armour thyroid med I take. I do not want over-take or under-take = thyroid levels?
Ariel
I read, as I understood it, that Armour Thyroid would be discontinued. I think it said in 2029. I could not find out the reason.
Am wondering what will replace it or what is a safe thyroid med to take .. no Synthroid.
Julie
I was diagnosed with hypothyroidism in 1972. I have been on Armour Thyroid 60mg ever since. A doctor new to me prescribed Synthroid; within 2 days I could not get out of bed–I was exhausted. Switching back to Armour had an immediate positive effect. I also have a sensitivity to generics: most won’t work for me. I found another doctor who listened to me about my quirky biochemistry. I told my sister-in-law she should pursue a better diagnosis for her symptoms–turns out she has Hashimoto’s and now has the right medication.
Naomi
When I first started having thyroid problems, my doctor began the regular regimen of Synthroid. I did not respond well. In fact, the symptoms got worse. He then changed me to Armour Thyroid. Over night the problem was solved. I have been taking Armour Thyroid for 45 years now, and at 81, I am no longer constantly tired and cold, and I feel great.
Joan
I tried to get two endocrinologists to give me Armour when I was experiencing exhaustion. Both suggested I consider other reasons for my tiredness, but one finally agreed. Before changing my medication to Armour, I googled and read all about it. I then understood what their concern was about changing my thyroid medication to Armour. Right after that, I was tested for sleep apnea, and it turned out they were right: My sleep apnea was causing my tiredness. I wonder, too, if some people don’t do as well on the generic versus the name brand of Synthroid, although an endocrinologist told me that the generic is the same.
Cindy
Synthetic or the natural drug, the proof is one’s own experience. If your dr won’t listen to you about this, they are probably not listening with a lot of issues. Find someone new. I started out on Amour Thyroid, but switched when it became so expensive and hard to get. Didn’t notice any difference and never switched back.
It always bothered me though, given the treatment of most animals’ living conditions, feed, and standard drug regimens, just how great the “natural” stuff is. Still. If that’s what one needs, not a lot one can do. Maybe overhaul one’s life with sleep, quality food, exercise, joy, and purpose, and hope the body responds.
Tom
I was first diagnosed with Hashimoto’s in 2004, and luckily it was by a doctor who recognized that, due to my elevated thyroid antibodies, I would need T3. Since then, some doctors have tried to put me on T4, but it does nothing for me at all. In fact, since it usually contains lactose, it screws with my digestion. Even taking T3 didn’t do much because it just increased my antibody levels. Getting off of dairy and gluten has helped, but I still have some symptoms.
Lynne
It took 4 doctors before I found one who would listen to me. Switching from synthroid to armour was like night to day. All my side effects disappeared, and I lost 10# the 1st month without changing my diet. Now if we could just get Medicare to cover this medicine. Does anyone know how to do that?
Alice
My doctor when testing my blood for Thyroid problems does not include the T3 factor. When I question him about it. He tells me it is not necessary and that it is expensive?
Karen
I am curious why there are no recent comments. I had to switch from the Armor product (to levothyroxine) years ago because it became difficult to get – some manufacturing issue. Has this changed or are there any more up-to-date treatments for hypothyroidism?
Barb
Flower Mound, TX
To Beverly,
I didn’t feel there was any alternative for myself because I had taken just about everything until I found a wellness endocrinologist about 4 months ago who put me on Thyroid WP. I think it has helped me quite a bit. The bloated look under my eyes has disappeared. Regular primary doctors don’t seen to know about this yet.
Lucy
Houston,
I have been on thyroid supplementation for 20+ years (since 1993). At that time, I asked my doctor what caused the hypothyroidism and his reply was a shrug and said “it just wore out”. Sometime during the 2000’s, I learned about chronic inflammation in the body and how it could be the cause of cancer, Alzheimer’s, etc. I had the C-Reactive Protein (ie, C-RP) blood test run and the results are always “off the charts”. My current doctor does not even want to run this test “because there is nothing that can be done about the inflammation” – that is how much the TYPICAL doctor knows. [I have found that 95% of the doctors want to prescribe drugs that can cause liver and/or kidney problems, then they make you come back every 2-3 months so they can bill insurance, especially Medicare.]
Recently, I have started learning about reducing inflammation in the body, and it turns out that hypothyroidism, inflammation in the body, gluten intolerance, and “leaky gut syndrome” are all INTER-related problems. So, if you solve one problem, you solve the other problems. I first learned about this on The Peoples Pharmacy website when you interviewed Dr. David Perlmutter. Giving up gluten, and including more prebiotic and probiotic foods into you diet, will heal the gut, and promote healthy gut bacteria. This in turn, helps your thyroid to heal and produce it’s own hormones – which are much better for your body than anything Big Pharma manufactures to sell to you.
Improving the health of your gut, also reduces the chronic inflammation and lowers the C-RP blood test results. And, yes, I too switched from Synthroid to Armour (pig’s) thyroid in the early 2000’s; and after about 6 months, my body eventually developed antibodies to the Armour pig’s thyroid, so it was back to Synthroid. Now, I have just started a gluten free diet, and am drinking fermented Kombucha tea which has billions of LIVE probiotics (for the healthy gut bacteria), and I am learning how to ferment/culture my vegetables to heal my gut, and hopefully heal my thyroid. I don’t know if I can heal my thyroid completely after being on Synthroid for 20-plus years, but I know I can assist it with this program, and hopefully reduce (if not totally eliminate) the dose of Synthroid I have to take.
I wish this information had been known 20 years ago, I would never have needed the prescription thyroid medication. Any prescription drug is NEVER as good as giving your body what it needs so that your body can heal itself. Look up Dr. Perlmutter on this website, or on the internet – that is a good starting place.
dzrlib
Pasadena, CA
I was on Synthroid from the time when Armour Thyroid was not available … when it became available again I switched back and I have felt more energetic, more regular, and hope Armour continues to be available.
Teresa
Portland OR
Twenty years ago I had half my thyroid removed because of a non cancerous tumor. I began Levothroid and for about three years felt good. Then I began to experience weight gain, painful muscle pain and frequent viral infections. I was significantly reducing my activity level and didn’t know the reason for my poor health. After reading a People’s Pharmacy column I realized that it could be inadequate thyroid replacement. I researched found a great Naturopathic Doctor and began desiccated thyroid. My health is so much improved. No more muscle and joint pain, my activity level has rebounded and a decrease in viral infections. Thank you Joe and Terry for your column. It saved my life.
Sarah
mid-west
I have taken Levothyroxin for a long time and still have symptoms. My doc sees no need for a full panel lab on my thyroid. He also will not prescribe Armour. I will seek another doctor as I feel it’s important to see what is going on with my t3.
My question is this: what is the link between the thyroid and bone health as I have an osteoporosis dx? Thank you.
Janice
NC
This is an excellent article. When you attempt to get treatment for hypothyroidism doctors want to give you synthroid only. I have been on thyroid medicine for a long time. It got to where I wasn’t getting relief. I read on line about being treated with Armour Thyroid. I asked for it and got it. I felt so much better but GP doctors and their PAs didn’t know how to use it. They wanted to treat me like I was still on Synthroid. A lot of the Endocrinologist didn’t believe in using Armour Thyroid either.
It is a frustrating experience to get treatment of this kind because since the standard treatment is T4 only. I have suffered with depression for so long and I felt better almost immediately after taking Armour. I highly recommend it to anyone who is not getting the benefit from just Synthroid or Levothyroid.
Dottie
NC
When my husband was hospitalized with a twisted colon at age 83, and had to have 14″ of his colon removed, I asked the surgeon what would cause such a problem. One of his suggestions was: regular use of a stool softener, particularly in the elderly. This came as a surprise to our family, and I thought your readers would like to know of this possibility.
M
Is it possible to need more T3 even though the TSH test indicates you are getting enough thyroid?
K. Christensen
Dear M~ The TSH test only tests to see if the feedback loop between pituitary and thyroid is working. It has nothing to do with actual thyroid levels.
For that you must test Free T3 and Free T4 levels–actual free and circulating storage (T4) and energy (T3) levels. MDs since the 1970s when Synthroid was born were taught just to test TSH (thyroid stimulating hormone) and then prescribe Synthroid, which is synthetic T4, betting that the body will convert it to T3.
This doesn’t occur smoothly for so many which is why hypothyroid symptoms continue. Many also find that the T3 goes into a sort of limbo called Reverse T3, which is why Reverse T3 should also be tested. Most hypothyroid patients are suffering from Hashimoto’s Disease which is an auto-immune disease whereby the thyroid is attacked. This can be confirmed by testing for the two types of anti-bodies: Anti-TPO and TgAb.
A reputable doctor will do a thorough thyroid panel consisting of TSH, Free T3, Free T4, Reverse T3 and Anti-TPO, TgAb.
So, you can see why doctors are ignorant in getting to the bottom of thyroid issues which affect mostly women. Much easier to just test the TSH and push Synthroid. Many women have complained that their thyroid symptoms continued and had the doctor suggest an anti-depressant!!
If you want more details, I suggest the site: stopthethyroidmadness.com.
Barbara
Orlando
I also thought I could benefit from Armour Thyroid and my doctor was more than willing to let me try it. Unfortunately, after being on it for 6 weeks not only did I not feel any different, I started gaining weight at an alarming rate! I switched back to Synthroid and everything returned to normal. The best way for me, at least, to feel better and improve my thryoid function is to avoid gluten as much as possible.
Mom
NC
My daughter had her thyroid removed 10 years ago. Ever since she has not felt well. It has been difficult getting the correct dose of Synthroid. She had asked about Armour but the doctor refused to prescribe it. Finally, this year she found someone to prescribe it, and she feels much better. She sleeps better, feels less sluggish, and has lost 15 pounds without trying. It is definitely a better thyroid replacement for her.
CJ
Indiana
I am very fortunate to have en endocrinologist willing to listen to me. After reading horror stories about Synthroid, he let me try the pig thyroid products, for which I am grateful. I was on Synthroid for two months just on a whim and I hated it. There ARE alternatives to Synthroid. Why don’t more doctors listen to their patients?
Beverly
Richardson, TX
It is my understanding that the Armour product is actually derived from desiccated pig organs. I am a vegetarian and if this is true, which I believe it is, I would therefore not be able to take the Armour. Although I would like to get off of Synthroid, which I have taken for decades, there does not seem to be an alternative.