Most doctors will prescribe T4 (Synthroid or generic levothyroxine) to address an underactive thyroid. T4 as we now know is fairly inactive until the body converts it into T3, or activated thyroid hormone. If the problem is only with the thyroid gland itself, prescribing Synthroid or Levothyroxine will work just fine. However, during periods when the body wants to conserve energy (for example, during times of stress, illness or infection), the body slows down its metabolism. It does this by decreasing the production of active T3 from T4, which is turned into inactive "reverse T3" instead. In some cases, the body may get "stuck," and becomes unable to make adequate T3. Because of this problem, many physicians prefer to use a combination of thyroid medications which contain a mix of both T4 and T3.
We prefer to start new patients on combination medication that contains both T3 and T4 in it. Some well known brands are Nature-throid, Armor and NP Thyroid. If patients choose to transfer their care to us we can also continue to use whatever thyroid medication they currently take. New patients are started on a reasonable dose to get started and then with additional lab testing and follow-ups we determine whether the dose is working or needs to be adjusted. If we can’t get the lab values just right or you aren’t feeling much of a difference, we may decide to try a compounded T3 plus T4. This is formulated at a compounding pharmacy and we can be very specific with the dosage of both thyroid hormones if needed. In a couple of months, the patient usually finds a dose that feels best for them. If this therapy does not bring about relief, a trial of Synthroid or levothyroxine, which only contains T4 may work. Often, one hormone therapy works when the other does not. You will know if the therapy is working within three to six weeks on a given dose.
If you are shaky, hyper, or have a racing heart (for example, a pulse over 90 beats per minute), we need to lower the dose. In addition, try taking the full dose of thyroid in the morning on an empty stomach or half the dose twice a day to see which feels best. Do not take thyroid hormone within several hours of taking iron or calcium supplements, or you won't absorb the thyroid medication properly.
Once you have found a dose that feels best, your doctor should check the free T3 and T4 blood levels. The first blood test should be administered about one month after you've started on the medication and then repeated every 3-4 weeks until the dose is just right. After the optimal dose is reached then the blood test is repeated once every 6-12 months. Do not allow your doctor to just check the TSH levels. It may be low (because of the hypothalamic dysfunction) and your doctor will incorrectly think you're on too much thyroid—even if your blood T3 and T4 hormone levels are low normal. This will make most doctors crazy! Just remember, you can stay on Nature-thyroid or Synthroid for as long as it is needed.
Synthetic T4 (Synthroid or Levothyroxine), Nature-Throid and pure T3 (Cytomel) are available at any pharmacy. Sustained-release T3 or custom combinations of T3 and T4 can be obtained from compounding pharmacies. When we have found an optimal dose, the compounding pharmacy can then make a single capsule of that dosage to be taken one or two times a day.
If you suffer from things like weight gain, achy muscles, and joints, heavy periods, constipation, cold intolerance, dry skin, thin hair, chronic fatigue or a body temperature that tends to be on the low side of normal, you should consider getting a blood test to see how your thyroid is functioning. This is the first step in determining if you would benefit from thyroid hormone optimization.
Thyroid Optimization Therapy Consultation
For a consultation about Thyroid Hormone Optimization Therapy, call 480-839-4131 or fill out a consultation request form located throughout the site. We look forward to speaking with you and seeing if Thyroid Optimization Therapy is a good option for you and your health concerns.
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