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Choosing the Right Hypothyroid Medication

I wanted to shed a little bit of light onto the common medications for hypothyroidism because I see a lot of people who are medicated but still not feeling their best.

Let's start off with clearing something up: Hypothyroidism is an umbrella term that covers different types of underfunctioning thyroid states. It describes what is happening, but not the 'why'. Once we look more into the 'why' we can start supporting your body with what it needs to thrive. The different ways that your body can have hypothyroidism include:

  • Autoimmune condition, such as Hashimoto's Thyroiditis, when the immune system attacks the thyroid so it can't function as well

  • All other labs except TSH are fine, which I call frank hypothyroidism

  • Conversion issues when the body cannot convert inactive T4 into active T3 thyroid hormone

  • Resistance issues, which started as conversion problems when instead of making active T3 the body makes reverse T3 (basically a junk molecule) - this is an important one to remember because if you don't check for it your T4 and T3 could look just a little off on a lab report

  • Dysfunction somewhere else, most commonly stress, impacting how well the thyroid functions. Other causes include problems with nutrient absorption and cirrhosis of the liver. These issues need to be addressed to take the strain off of your thyroid

  • Normal cases when your thyroid levels can be thrown off, like in the first trimester of pregnancy, some medications, or illness

Main medication for treating hypothyroidism:

  • Levothyroxine (most commonly the trade name Synthroid)

  • Liothyronine (most commonly the trade name Cytomel)

  • Natural dessicated thyroid (NDT)

Levothyroxine is a synthetic version of T4, the most abundant hormone your thyroid produces and the most common medication for hypothyroidism. This is a great option for autoimmune thyroiditis, frank hypothyroidism, and basically a starting point to see how you do with thyroid support. This is not a great option if you have conversion or resistance issues.

Liothyronine is a synthetic version of T3 and I rarely see this prescribed in practice. This is a great option if you have had your thyroid removed, have a lot of thyroid resistance or a conversion issue. This is not a great option if you have frank hypothyroidism as it's strong stuff.

Natural Dessicated Thyroid is made from thyroid tissue and specified to have a combination of T4 and T3. This is the one that naturopaths can prescribe so there is a slight bias on this one. This being said, it does have it's pros and cons. This is a great option for someone who has conversion issues or resistance. That little extra T3 in NDT over levothyroxine is enough to have people feel like they've gotten their life back. This can also be helpful in individuals who have had part of their thyroid gland removed. This is not a great option for someone who has autoimmune thyroiditis, or at least would not be my first line therapy as it can further aggravate. It also may not be needed in frank hypothyroidism.

Now as a naturopathic doctor you would expect me to also post some info on supplements! I will save that for another post but know that I always start with herbs and nutrients before going into pharmaceutical options (even if they are natural).

Yours in Health & Happiness,

Dr. Erika

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